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Discussion Starter · #1 ·
Perhaps We Should Count Our Blessings?

Cotard's Syndrome in a Homeless Man
Richard C. Christensen, M.D., M.A.

"To the Editor: In 1880 the French psychiatrist Jules Cotard described several patients who suffered from a syndrome referred to as d?lire de n?gation (1). This relatively rare syndrome is characterized by the presence of nihilistic delusions that one is dead or the world no longer exists (2). I report a case of a man who developed Cotard's syndrome while living in an urban shelter for the homeless. What makes this case noteworthy, apart from the rarity of the clinical syndrome, is the protracted morbidity and suffering endured by an impoverished individual because he was unable to pay for psychiatric services.

Mr. K, a 44-year-old Caucasian man, had recently relocated from New York to Florida. He was unable to find employment and became homeless. While he was in jail on a trespassing charge, he developed signs of depression that was not identified or treated. After he returned to the homeless center where he was residing, his depressive symptoms worsened over a six-week period. He reported to his case manager feelings of hopelessness, poor sleep, decreased appetite, and anergia. Because he had not yet applied for public health insurance and had no means of paying, he was not seen by a psychiatrist until he was taken to the public crisis unit several weeks later after stating that he had "melted away" and was "dead."

At the crisis unit Mr. K was diagnosed as having schizophrenia, treated with a combination of oral and depot haloperidol, and discharged back to the homeless center. Because he lacked insurance, the community mental health center referred him to the homeless center's primary care clinic for follow-up. Over the course of several weeks his symptoms and daily functioning worsened. He continued to voice delusional beliefs, such as "my brain's rotted away," "parts of my insides are gone," and "I'm dead." He denied perceptual abnormalities and suicidal ideation. He was readmitted to the crisis unit, where valproic acid and fluoxetine were added to his regimen of haloperidol. He was discharged several days later with little improvement in his symptoms.

Mr. K was then referred to a university-affiliated free psychiatric clinic that had recently been established at the homeless center. A diagnosis of major depression with psychotic features consistent with Cotard's syndrome was made. Because of the duration of his illness?four months?and its associated morbidity, the clinic staff decided to hospitalize him and to administer electroconvulsive therapy (ECT), which has been shown to be efficacious in the treatment of Cotard's syndrome (3,4). The university-affiliated hospital did not offer ECT, and the clinic staff personally requested that administrators and treating physicians at the few area hospitals providing ECT accept Mr. K for treatment. In all cases he was denied admission because of his lack of insurance and inability to pay for services.

The university-affiliated hospital agreed to admit Mr. K on a "compassionate" basis. Over the course of several days his dosages of haloperidol and valproic acid were tapered. Fluoxetine was increased to 40 mg a day, and risperidone was initiated and titrated to 3 mg a day. Mr. K made slow progress over the next two weeks. His nihilistic delusions diminished, and he experienced partial resolution of major depressive symptoms. In the several months since he was discharged, he has continued to improve and has had no recurrence of the nihilistic delusions or of major depression.

I present this case not only to illustrate the unique constellation of symptoms associated with Cotard's syndrome but also to underscore the persistent obstacles to care often encountered by the poorest and most ill members of our communities. It remains a human and social tragedy in our country that the ability to pay rather than medical need is what determines whether a person receives timely and appropriate psychiatric services."


Dr. Christensen is assistant clinical professor and director of the community psychiatry program at the University of Florida College of Medicine in Jacksonville. ... 6#R5291272

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Why are they calling this cotards syndrome? It sounds to me like the guy simply had depression(low serotonin) that went untreated till he became depersonalized. He didnt need any drugs except for the ssri which is what probably brought him out of it.

Discussion Starter · #3 ·
Actually, I sort of agree with DakotaJoe on this one.

See, this is precisely how "disorders" or conditions get identified. In the 19th Century, Cotard noticed several people who suffered from identity/reality issues. Some were probably schizophrenic, others were probably like us.

In DESCRIBING these patients, he coined a term - and those type of symptoms were then called "Cotard's Syndrome." If dp wasn't know at ALL, we could decide to call it "Baker's Syndrome" (so named after the woman who described it well and had many patients who felt she understood)

THAT is "diagnosis" my friends. ANd that's precisely why I keep trying to tell you it just doesn't MATTER what you "have" - you HAVE whatever the listenting doctor hears when you describe your set of symptoms.

The origin of the symptoms will differ depending on who you're talking to. DakotaJoe sees it as stemming from anxiety or depression and serotonin deficiency (as do many professionals). I see it as likely stemming from psychological isses (as do many professionals).

But the DISEASE or DISORDER is not a "THING" that doctors look inside you and verify. All they can do is listen to how you describe yourself and observe how you behave (to observe more hidden symptoms). What matters are the SYMPTOMS - those are yours, and they are real. THe NAME for whatever disorder is a kind of shorthand, created by professionals to more efficiently describe a particular set of recurring symptoms.


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No eyepoking 8)

Though I repeatedly note that individuals should be treated as UNIQUE ... no one diagnosis can fit all of us exactly, there is a reason for identifying certains groups/constellation of symptoms. V.S. Ramachandran, M.D. talked about Capgras and Cotard's as having similarities with DP/DR, but we know that we don't feel like the individual with Cotard's or Capgras and as a result the treatment is more specific and hopefully more directed at the specific problem. You can't know how to treat something if you don't know what you're dealing with.

In "physical medicine" I can note re: this amyloidosis (you'll have to look it up) which is extremely difficult to diagnose, Alzheimer's (which my mother had and took 2 weeks to diagnose as her symptoms could have been indicative of about 10 other illnesses), and AIDS. AIDS manifests itself initially in a variety of ways.

I am vaguely familiar with these syndromes as they are discussed by my two favorite neurologists Ramachandran and Sacks.

"Definition of Capgras and Cotard's:"

"Capgras' Syndrome is a delusional disorder in which the victim believes that all of his close friends and family members have been replaced with nearly-exact replicas, often perceived as robots or actors.

Cotard's Syndrome involves believing yourself to be dead, that you no longer exist, and (sometimes) that your limbs and body belong to another. These two disorders do not deserve separate writeups because they are caused by damage to the same part of the right hemisphere of the cerebral cortex, and are thus just different cognitive interpretations of the same perception. Cotard's is always accompanied by severe depression, while Capgras' is not, in most cases.

These diseases are caused by a breakdown -- which can be caused by accident, stroke, etc. -- in the pathway between perception and affect.

That is to say, while the victim can tell who someone is, they receive no emotional response from the recognition. For instance, you might visit your mother and recognize her completely, but it wouldn't feel like what being with mother was actually like. A Capgras sufferer would interpret this as being because his mother was an imposter, while a Cotard sufferer would assume that he had no response because he was dead inside.

A theory suggested for the differences of these interpretations is that the depression accompanying Cotard's caused the victim to view the perception change as being his fault for being dead, while the non-depressed Capgras sufferer sees the difference in actions that others suddenly started doing wrong.

These syndromes are the exact opposite of prosopagnosia, where the visual/recognition pathway is broken but the emotional one is not, making it impossible to recognize the face of a loved one while still allowing emotional response to their name.

Treatment with the bicyclic and tricyclic antidepressives has no effect on the delusions, although it may break the Cotard's sufferer's depression. Electroconvulsive therapy, however, has been shown to improve blood flow to the damaged areas, in many cases ending the delusions after only a few treatments. If the brain area has been completely destroyed, severed by an automobile accident or what have you, recovery is impossible and the delusions will probably last for the victim's entire life."

EDIT: end of definition

If one hasn't studied the complexity of neurology, one doesn't see the subtle difference in a neurological perceptual distortion. And note that the treatment one might ASSUME to be correct (for depression) is not the correct line of choice.

Also Cotard's can be caused by LITERAL BRAIN DAMAGE (as suffered in head trauma) -- that is out of the realm of psychiatry completely.

Psychiatry and Neurology overlap, and this is why Psychiatrists must study neurology as well as psychology and abnormal psychology. Neurologists study psychiatry.

I know folks see me hear as the biological reductionist, but we are often talking about VERY specific failures in particular areas of the brain, that yes, do affect our perception of the world.

Lord, re: this horrible story ... yes, "But for the Grace of God go I!"

Note one would NOT give anti-depressants to someone with Cotard's. They are ineffective re: the delusion. A doctor needs to be taught this, understand this, and not put the patient through unnecessary Hell as a result. This poor man!

Holy Moses!
D :shock:

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Sorry, that definition was from a medical database I now lost the link too. Shucks. Ah well.

By noting the SPECIFIC differences in someone's symptoms, a doctor, in this case really a neurologist, needs to be aware of this type of damage.

The brain is infinitely complex, we are infinitely complex, it is our nature (and certainly mine :shock: ) to "have a handle" on definitions of things.

Now, if I could only remember things...............

Suffice it to say, I would not like to be an emergency room doctor faced with a head trauma.

God, that is a horrifying story, which again reminds us that we don't have ANY transitional care facilities, good Board and Care facilities ... so many of the homeless are mentally ill. This is a crime.


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Ah, these illnesses are also not "AS IF". The patient does not say I feel "AS IF" I'm dead, they say "I AM DEAD", etc.

With DP/DR, those of us here retain insight (unless our symptoms are a part of a psychotic disorder, etc.). We say, "I feel 'AS IF' the world is dim, two dimensional. AS IF I can't feel my body." But we know this ISN'T TRUE. We don't believe it, or have a delusion about it.

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We should be glad that Cotard and Capgras and the man ... Ludovig Dugas (GOD MY MEMORY, I THINK THAT'S CORRECT) have named their syndromes and ours. "Depersonalization" was first "coined" by Dugas ... hope that's correct ... back in the 1800s. If he hadn't defined it, given it specific parameters, well I wouldn't have said, at age 15, "THANK GOD, now I know what is wrong with me, and my mother will believe me! -- even though she knew what was wrong, years before."

Psychiatrists are such lovely folks :evil:
Well, no, there are some great folks in mental health, and I include my current shrink who is only a 3rd year resident. The "new blood" is more informed about DP/DR etc.

My shrink, he is young enough to be my son, LOL!

Discussion Starter · #8 ·
Eyes are safe. 8)

I do agree with your points re: Cotard's and Capgras. But...those are neurological injury disorders. There is a physical something in a brain scan...there is physical injury that produces a highly specific (and SINGLE) delusion.

When I talk, I'm always referring to psychologically-induced mental states/symptoms. And that's where Dreamer and I differ, in our approach to the symptoms described on this board. It's VERY interesting and VERY GOOD in many ways for folks who read these posts to get a sound taste of two divergent opinions/schools of thought.

Naturally, everyone assumes they are right, lol...but my point here is that it's USEFUL to readers to get a taste of both our approaches as they both reflect a HUGE proportion of the treatment options out there. In fact, I would go so far as to say, if you find a "therapy" that doens't fit with either my or Dreamer's intereprations of dp symptoms, run away! LOL.....

My point in this thread is that for PSYCHOLOGICAL symptoms (which Dp can certainly be for some of us) it really is not the same process at all as diagnosing a physically-based disorder. In physical disorders, symptoms POINT TO certain "conditions" that are verifiable by some physical means.

In psychological disorders, the symptoms ARE the disorder. Does someone "have" dp? Well, the only way to answer that is to answer: do you experience dp to massive degrees and/or chronicallY? THAT is the determination of the "diagnosis" - it can be much more realistic to view them as symptoms you experience, rather than something you "have"


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my initial and worst episode of dp was exactly that. i was aware that i was dead (hence couldn't top myself as knew that i would stay in that state of horror indefinitely).

as this was brought on through fairly heavy drug use i suppose i must have damaged my brain. in the last few weeks of using i often had balance problems. the dp started 3 weeks after i finished using through a severe panic/anxiety attack. interesting post :?

Discussion Starter · #10 ·
Thank you all for your interesting replies.

As far as why he came to be diagnosed with Cotards Syndrome I imagine that he had symptoms that are common to the disorder that were not mentioned in the letter and that was their "working hypotheses." Also perhaps for these various agencies, in order to be financially reimbursed by the State, they had to give him some sort of diagnosis of a medical condition in addition to the Depression.

The central theme of the letter, at least as I read it, was that this man, because he had no money, was denied quality psychological/medical help from the society in which he lived.

I think that many of us here have experienced how that works.

Janine I agree with you that is a fine idea that you and Dreamer express different perspectives in regards to possible causes for DP/DR.

There are times when I feel that my DP is strictly psychological in origin, and then there are times when it really feels physical like I have some sort of tissue or nerve damage.

Recently from my readings of C.G. Jung and Ken Wilber, and from my own personal experience, I am begining to suspect that DP for me at least , is a sort of "spiritual" wake up call. I have had DP experiences off and on all of my adult life. Odds are that I will probably have it during all the years I have left. Perhaps it is just my "fate."

Learning the Grace to accept that in this life I have been given, DP is likely to continue to be a part of it, therefore, how should I proceed in order to give my life a sense of purpose and meaning, and to experience some sense of emotional fulfillment, as well as some kind of philosophical/religious feeling of being correctly situated in the face of it all?

So in that sense in a certain way it doesn't even matter whether DP/DR is "simply physical" or fundamentally a "psychological condition" it might be both.

Nevertheless, the challenge of "having a life" still remains.

That is sort of where I am at these days.


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Dear John,
You unleashed my research monster :shock: and I found one point to debate Joe and Janine with 8)

I agree, in one sense the story emphasized the mess of a mental healthcare system we have. And this guy went through Hell to not only get a diagnosis, but the proper treatment. This is again my argument.

And in my research, no one shoot me, I found that Cotard's by and large (is that an expression) IS considered a psychiatric syndrome which accompanies a number of psychiatric disorders. NOT TO SCARE ANYONE ON THIS BOARD - I don't think in the years I've been on this board or the previous one have I EVER heard of a Cotard's type case.

My relentless research on Pubmed yielded the following.... and the case of the unfortunate gentleman you noted, John, is in there I think.


1: Nejad AG, Toofani K.
Co-existence of lycanthropy and Cotard's syndrome in a single

Acta Psychiatr Scand. 2005 Mar;111(3):250-2.
PMID: 15701110 [PubMed - in process]

2: Mahgoub NA, Hossain A.
Cotard's syndrome and electroconvulsive therapy.
Psychiatr Serv. 2004 Nov;55(11):1319. No abstract available.
PMID: 15534033 [PubMed - indexed for MEDLINE]

3: Kucia K, Delkowski RS.
[ECT treatment of Cotard's syndrome in a patient with combined
valvular heart disease and persistent atrial fibrillation]

Wiad Lek. 2004;57(5-6):290-2. Polish.
PMID: 15518080 [PubMed - indexed for MEDLINE]

4: Shiraishi H, Ito M, Hayashi H, Otani K.
Sulpiride treatment of Cotard's syndrome in schizophrenia.
Prog Neuropsychopharmacol Biol Psychiatry. 2004 May;28(3):607-9.
PMID: 15093970 [PubMed - indexed for MEDLINE]

5: Caliyurt O, Vardar E, Tuglu C.
Cotard's syndrome with schizophreniform disorder can be
successfully treated with electroconvulsive therapy: case

J Psychiatry Neurosci. 2004 Mar;29(2):138-41.
PMID: 15069468 [PubMed - indexed for MEDLINE]

6: Reif A, Murach WM, Pfuhlmann B.
Delusional paralysis: an unusual variant of Cotard's

Psychopathology. 2003 Jul-Aug;36(4):218-20.
PMID: 14504457 [PubMed - indexed for MEDLINE]

7: Kondo S, Hayashi H, Eguchi T, Oyama T, Wada T, Otani K.
Bromocriptine augmentation therapy in a patient with Cotard's
Prog Neuropsychopharmacol Biol Psychiatry. 2003 Jun;27(4):719-21.
PMID: 12787862 [PubMed - indexed for MEDLINE]

8: Nejad AG.
Hydrophobia as a rare presentation of Cotard's syndrome: a case

Acta Psychiatr Scand. 2002 Aug;106(2):156-8; discussion 158.
PMID: 12121215 [PubMed - indexed for MEDLINE]

9: Hagen S, Voss SH.
[Cotard's syndrome in depression and maintenance
electroconvulsive therapy]

Ugeskr Laeger. 2002 Jun 24;164(26):3452-3. Danish.
PMID: 12119758 [PubMed - indexed for MEDLINE]

10: Pearn J, Gardner-Thorpe C.
Jules Cotard (1840-1889): his life and the unique syndrome
which bears his name.

Neurology. 2002 May 14;58(9):1400-3.
PMID: 12011289 [PubMed - indexed for MEDLINE]

11: Duggal HS, Jagadheesan K, Haque Nizamie S.
Biological basis and staging of Cotard's syndrome.
Eur Psychiatry. 2002 Apr;17(2):108-9. No abstract available.
PMID: 11973121 [PubMed - indexed for MEDLINE]

12: Christensen RC.
Cotard's syndrome in a homeless man.
Psychiatr Serv. 2001 Sep;52(9):1256-7. No abstract available.
PMID: 11533410 [PubMed - indexed for MEDLINE]

13: Allen JR, Pfefferbaum B, Hammond D, Speed L.
A disturbed child's use of a public event: Cotard's syndrome in
a ten-year-old.

Psychiatry. 2000 Summer;63(2):208-13.
PMID: 10965550 [PubMed - indexed for MEDLINE]

14: Butler PV.
Diurnal variation in Cotard's syndrome (copresent with Capgras
delusion) following traumatic brain injury.

Aust N Z J Psychiatry. 2000 Aug;34(4):684-7.
PMID: 10954402 [PubMed - indexed for MEDLINE]

15: Baeza I, Salva J, Bernardo M.
Cotard's syndrome in a young male bipolar patient.
J Neuropsychiatry Clin Neurosci. 2000 Winter;12(1):119-20. No
abstract available.
PMID: 10678525 [PubMed - indexed for MEDLINE]

16: Silva JA, Leong GB, Weinstock R, Gonzales CL.
A case of Cotard's syndrome associated with self-starvation.
J Forensic Sci. 2000 Jan;45(1):188-90.
PMID: 10641937 [PubMed - indexed for MEDLINE]

17: Yamada K, Katsuragi S, Fujii I.
A case study of Cotard's syndrome: stages and diagnosis.
Acta Psychiatr Scand. 1999 Nov;100(5):396-8; discussion 398-9.
PMID: 10563458 [PubMed - indexed for MEDLINE]

18: Cohen D, Cottias C, Basquin M.
Cotard's syndrome in a 15-year-old girl.
Acta Psychiatr Scand. 1997 Feb;95(2):164-5.
PMID: 9065683 [PubMed - indexed for MEDLINE]

19: Sabbatini F, Actis-Giorgio M, Madaro A, Ravizza L.
[Description of a case of Cotard's syndrome]
Minerva Psichiatr. 1996 Mar;37(1):35-7. Italian.
PMID: 8926855 [PubMed - indexed for MEDLINE]

20: Silva JA, Leong GB. Related Articles, Links
The relation of Cotard's syndrome to delusional

Isr J Psychiatry Relat Sci. 1996;33(3):188-93.
PMID: 9009518 [PubMed - indexed for MEDLINE]
Items 1 - 20 of 52


Bottom line. I insist that in psychiatric disorders it is as important to have a correct diagnosis as in any other illness. And, Janine 8) here's where we differ is in my belief that there are biological underpinnings in at least the major mental illnesses.

And again, John, I agree now, finally, that I'm less interested in my past and how I "got" DP/DR than in trying to get on with my life.

Nature/Nurture ... they are both there. But at this point, I can't beat myself senseless trying to figure which and why.


Done with my reserach, maybe?
I know :roll:
But again -- "Without the Grace of God........"

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Forgive, all that and I forget to say. Those are the first 20 of a huge list of journal articles on Cotard's at

I simply plugged in Cotard's+syndrome for those geeky enough to want to torture themselves with this stuff as I do. :?


And actually my post was directed more to Dakota Joe. I believe in diagnoses, in "labels" to help with treatment. But no psychiatric diagnosis be stigmatizing, and it should be worthy of health insurance parity. John, that article is a tragedy.

Joe you said:
Why are they calling this cotards syndrome? It sounds to me like the guy simply had depression(low serotonin) that went untreated till he became depersonalized. He didnt need any drugs except for the ssri which is what probably brought him out of it.
It notes repeatedly in the literature that Cotard's does not respond well to antidepressants, and the individual isn't "just depressed." There is a SPECIFIC syndrome here that presents in various psychiatric situations and in neurological trauma. ECT appears to be the treatment of choice, and can be effective.

EDIT: And Cotard's and Capgras ARE NOT depersonalization or derealization. And this isn't just a matter of semantics.

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OK, this is really fascinating, and tonight I am a Border Terrier of research ... any response? Janine?
This is spooky stuff, and fascinating.... :shock:

Psychiatry. 2000 Summer;63(2):208-13.

A disturbed child's use of a public event: Cotard's syndrome in a ten-year-old.
Allen JR, Pfefferbaum B, Hammond D, Speed L.

University of Oklahoma Health Sciences Center, College of Medicine, Department of Psychiatry and Behavioral Sciences, Oklahoma City 73190-3048, USA.

"Public events can be incorporated into the mental life and life narratives of children with psychiatric illnesses. A 10-year-old boy who was not in Oklahoma City at the time of the 1995 bombing of the Murrah Federal Building and who knew no one directly impacted, claimed that he himself was dead, then that his grandfather, and finally that a peer and the peer's family had been killed in the blast.

This is the first known reported case of Cotard's syndrome, the delusion of being dead, in a prepubescent child. The article also explores the relationships between this boy's symptoms, transference phenomena, real life events, themes of loss, abandonment, neglect, and death, and his fabricated stories."

Publication Types:
Case Reports

PMID: 10965550 [PubMed - indexed for MEDLINE]

Discussion Starter · #14 ·
Now remember, you ASKED, lol

That is most fascinating - and I'd love to read more about it - what type of treatment, etc. See, again this addresses the Great Divide between our mindsets on mental illness and theory. I have no trouble at all embracing that a) someone can have a LESION that creates a delusion such as Cotard's, and that b) someone else can have a NON-physical cause for the same delusion.

For ex: There are triggers within the brain that invoke massive anxiety states. Give Person A this drug, and they will likely flip out into major temporary terror. Or open up Person A's brain and tinker in there, touching selected nerve endings, and you can absolutely INVOKE an immediate and temporary terror. Those two would be physical and/or neurobiochemical-caused massive anxiety states.

Same thing for depression.

Same thing for dp.

Same thing for paranoid delusions (angel dust, heavy tabs of acid).

Same thing for psychosis and/or mania (large doses of amphatemines).

All those symptoms (and disorders) can be caused by physical sources.

But....they can ALSO be caused by psychological sources. So while this young boy may have a very Cotard's-LIKE delusion, to my way of thinking, if it's not caused by a brain lesion, it's much more likely that he is having a "standard" anxiety-based delusion that is just like the Cotard's fantasy.

Same thing re: paranoid schizophrenics - they can have ideas of reference and paranoid thoughts of being the center of attention and/or the subject of some Matrix or "Truman Show" sinister game. But...NON-psychotic people (such as myself) can also have such delusions.

For whatever reason, there are just "stock" delusions - and people, worldwide, have very very similar versions of them. If someone lives in a place that has no C.I.A. or television, they can't conjure up the fear that they are being "controlled" by the government spies through television waves, but they sure do create something very close - such as thoughts that they are being controlled from beyond the grave by ancestors who have chosen them for some special experiment. (that's the primitive black magic version of the C.I.A. delusion, and psychotics from around the world create similar tales to fall victim to).

And for ME, the chances of someone's mental symptom being caused by something physical is SO much smaller (astoundingly smaller) than being caused by a psychological mechanism that TRIGGERED the neurochemical shift - yes, it's not our IMAGINATIONS that we have symptoms, but that's not the same thing as saying our symptoms are chemically-INDUCED.

Studies on Hysterical Conversion, for example, show profound changes in the body's limbs, sensitivity to muscle contraction, blood flow, etc...all in the 'numb' limb - EVEN if there is NO physical reason for the limb not to work. Purely psychologically-induced paralysis will produce massive physical changes - detectable changes in fMRI's - and once the person is recovered from their Psychological Paralysis, their actual LIMB shows a pronounced difference in follow-up scans.

Mind (defenses, ego structure, underlying fears, memories, conflicts, hidden motives, hidden agendas, etc...) ALONE can trigger things within the Central Nervous System. And we can "fix" those things sometimes with medication (or at least help them!) but that is still not addressing the source of the problem.

IF there was a way to "locate" the precise neural pathway that is damaged in Cortard's and to rejuvenate the cells that the lesion has severed, Cotard's patients would be just fine and dandy again.

Not so with the "Cotard's" boy in Oaklahoma - even if there was a way to "undo" the triggered brain spot that "produced" his particular delusion of being dead, we wouldn't expect the kid to suddenly be all okay for the rest of his life. SOMEthing from that incident triggered something in his psyche - and likely that is what caused his delusional state.

As always, that is ONLY my two cents, lol...

:oops: :lol:

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WOW, reply appreciated, and yes I asked for it :shock: 8)
And I would like to get a copy of that article definitely. It did indicate the child was already mentally ill I believe... it was implied in the title, but I may be wrong....

Janine you said:

a) someone can have a LESION that creates a delusion such as Cotard's, and that b) someone else can have a NON-physical cause for the same delusion.
Where we differ is I believe that the psychological is physical. And that the pathway to DP/DR and or Cotard's is physical. I can't separate the psychological from the physical.

Here's a stupid example, and this is SO difficult to write about.

A sneeze, LOL.

A sneeze is a particular automatic reaction we have to getting some offending foreign substance out of our sinuses.

But there are many causes for sneezing:

1. A cold
2. Allergies
3. The scent of excessive perfume

All three of these factors cause a sneeze. But the sneeze is always a sneeze, nothing more, nothing less. And I suppose someone could poke at someone's brain and make them sneeze if they know where the "sneeze center" is, LOL.

My sense is regardless of how one "gets" to DP/DR (or even Cotard's -- and that seems to be a serious psychotic symptom, and if I'm not mistaken all delusions are psychotic. These are not "AS IF" experiences, these are "I am dead." NOT, "It feels AS IF I am dead.") it all follows the same path.

It would make no sense that a perceptual distortion such as DP/DR could come from more than one place in the brain. And we know that normal people experience DP/DR and it is the same experience as our pathological DP/DR, and interestingly can be caused by lack of sleep, stress, etc. (Similar to some of our triggers.)

Also, as noted, many of us here have more than just the symptoms of DP/DR (and many of the case studies of Cotard's note that this symptom comes WITH other psychiatric illnesses ... in the Case of Cotard's -- serious depression, bipolar, schizophrenia, etc.)

I don't see DP/DR existing in a vacuum, and I guess I believe all roads lead to Rome. I can't separate the psychological from the physical I guess.

Man this is hard to express.

But this does not mean that DP/DR cannot be treated. And it doesn't mean that a variety of treatments can't lead to the same end.

We see so many varieties of onset, but the end result is the same.

As noted in Cotard's, Capgras, and DP/DR (per my dear Ramachandran, and with this article re: Cotard's) there is disruption in the brain's perception of SELF.

Re: the common experiences of FBI or in the past (before the FBI demons) invading someone's head (in psychosis) all of these themes are common. THey have to do with a disruption of the sense of SELF. For humans, this makes perfect sense, as it is a quality we humans seem to have developed (beyond other animals).

Understanding of Self/existence/solidity of a core SELF, the fear of death, the meaning of life are common to all, no matter what century. And yes, there are cultural differences, but again they are variations on a theme.

Yes I see the difference in our interpretation, and I am pretty condifent about it.

And one day, more sensitive imaging (and there has been some success with PET scans at Mt. Sinai and the IoP) I believe that the psychological and physical origins of DP will show up in the same areas of the brain.

I find it impossible that one perceptual distortion could come from more than one area of the brain. I belive all roads lead to Rome. And also, do not subscribe to the concept of Unconscious drives.

On the other hand, I could be full of hogwash! 8)

I hope some of this makes sense.
In the spirit of healthy debate
D The Ramachandrian, of the evolutionary neuropsychiatric school :wink:

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Okay....these are some very interesting POVs on this thread. I'm going to add a little bit from my personal experience, or at least what I can given confidentiality agreements. I've known about Cotard's for quite a long time. Some of the literature speaks of it as a definitively neurologic, some of it as definitively psychiatric. True Cotard's is so rare, and rarely comorbid with any other delusion, that I would see it as a neurologic phenomenon, since it responds to mostly physical treatments such as ECT. To my knowledge, there has never been a case of Cotard's at Western Psychiatric Institute and Clinic in Pittsburgh. I have known of several cases of Capgras here, and they are extremely interesting. I think we can all stretch our DPed imaginations and say that we could see trauma causing us to beleive ourselves dead. I mean, everybody says things like "I feel dead on my feet", "I wish I were dead", and "I'm dead tired". But true Cotard's patients really FEEL worms crawling through their bodies in the literature. Some go as far as sleeping in coffins. In cases where it isnt precipitated by a neurologic insult ( and many, many neurologic insults do not cause imageable lesions) I think that it is probably organically psychotic people. One of the Capgras patients I knew was schizophrenic, and I've known ones who thought they were Jesus. I can totally see some of them taking naps in coffins. But their disease is purely organic - schizophrenics slowly lose brain tissue. And Freud at one point felt that psychotics and schizophrenics were having delusions because of over-protective mothers. This was the mainstream view until about 1960.

We've shown that talk-therapy CAN change brain scans. The brain is a very malleable organ which makes new dendrite connections every second. But many people, due to the genetic makeup of their brain ie, disorganized cell firings, epileptic and quasi-epileptic states, lack of key neurotransmitter connections in certain lobes of the brain, are controlled more by their brains than vice-versa. This is why objective case by case brain scanning would be helpful. You would know the areas to work on, and could even gauge the success of talk therapy with a patient. Oh, and this is kind of interesting, on the adolescent floor of Western Psych, I have actually seen patients with conversion disorders. They are mostly adolescents who "cant" walk well enough to go to school. They arent quite faking it, and they arent quite telling the truth. Usually the staff helps them walk to the tutor every day, and eventually one day they can do it on their own. The cases I've seen arent quite as dramatic as you'd think, honestly. Usually , they seem to be highly suggestible, very depressed kids. I'm enclosing a link to a psychiatrist at Western Psych who has treated Capgras patients. He's a really nice, intelligent professor/doctor at the university, and is pretty good with dissociative disorders. Although he's not quite as good a doctor as I'll be.....I know, I know, I shouldnt be so humble.

I'll be keeping an eye on this thread.


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Dear Home,
"You are da' BOMB!" as Randy Jackson of American Idol says, LOL.
(Yes, I do catch that now and again, cough).

This quotation from that article is amazing, and I think may be
right on point re: the battle WE have here (w/DP/DR).

"Although we tend to think of ourselves as having fixed
structures -- we know where our body begins and ends and we have a
sense of who we are in the world -- in actuality," he said, "our
identity is in a constant state of transformation and is always
That is incredible stuff. I wanted to highlight it all. Printed
the thing out. And my Ramachandran is mentioned.
Nature/Nurture in this sense is again inextricably linked, and SELF
is one of the most complicated parts of the human brain, and we
HUMANS are the only critters on this planet who have a sense of
SELF, an observing SELF, and a sense of mortality.

Brilliant stuff that is MORE food for thought.

Also, I wanted to clarify something re: psychological problems and
physical symptoms. I've tried to explain this before.

OK, I have BOTH.

1. I have psychological problems that ANYONE could have with no
physical symptoms necessarily
. Like, I have low self-esteem.
I feel it very difficult to express my opinion directly to someone.
I see things in "black and white" -- generally I see things in a
more negative light.

I can attribute these things very easily to how I was raised. But
these are "feelings" and could also be attributed to my generally
"oversensitive nature." So indeed these are the givens of who I
am, made more dramatic and conditioned by my abusive upbringing.

2. Then I have symptoms. DP/DR being the most obvious and
debilitating for me. I still see them as a reflection then of the
above quotation. We all have somewhat (on a spectrum) tenuous grasp
on "our SELVES" (the SELF) and damage/trauma (physical or in the
form of a "negative" "confusing" "stressful" enviornment) can cause
the SELF to become more precarious.

And what I also find interesting in the article. The "themes" of
our illnesses can be formed around life events. So for me, DP/DR
is more a sense/embodiment of abandonment/loss that I actually
experienced in life.

I just thought, I don't fear insanity. Never really feared that, (more a fear of complete disability and no let up of the torture of the symptoms)
but I fear eternal loneliness. And I felt that loneliness (in a
psychological way) as a child. From as far back as I can recall.

Wow, have to ponder this more.

Fascinatng stuff from everyone!!!!!


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2,383 Posts
I asked my husband to have a look at this thread ... and he wrote something interesting. He's a better writer than I am by far.

"...... the relationship between the biological and the behavioral causes of mental illness goes
both ways. A physical trauma to the brain will result in a
phenomenological state which we label as a "psychological,"
perceptional, or cognitive experience. The trauma caused by genetics,
disease, or whatever manifests itself in behavior and the subjective
experience of self and others which we call psychology. But our
behavioral conditioning from our experience in the world is transformed
into the psychological via the changes made in the
neuro-chemical-electrical machine called the brain. Consciousness, both
emotional and cognitive, is a manifestation of the intersection between
the genetically given and the environmentally altered, just as lung
cancer, for example, is the set of symptoms caused by a specific
combination of genetic predisposition and environmental exposure.

I have read about some recent experiments in which electro-magnetic
stimulation is used to alleviate depression. I believe that in the near
future mental illnesses will be diagnosed with criteria that include
subjective reports from the patient, observations of the patients
behavior, radiological and MRI scans, blood tests, and genetic analysis.
Just as doctors no longer use a broad diagnosis such as leukemia, but
substitute a more specific diagnosis, such as hairy cell leukemia,
psychiatrists will identify mental illness in the future with a great
deal more specificity, which would result in a more successful treatment
-- my husband's two cents, LOL :shock: --

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2,383 Posts
PS, again to clarify (Dreamer shut up, LOL)

I am still highly aware of the need for talk therapy. "People, people who need people....." 8)

People need human contact, validation to survive. If one is going through a crisis of one for or another, one needs an objective 3rd party... the therapist. I have NO question about that.

Though I see psychiatry as becoming subsumed under neurology (as my husband says in a sense) there will always be a need for human beings to understand who they are, deal with fears, concerns.

We are social critters. We need to interact with other human beings. Children without love don't thrive... and again we knows this in re: Harry Harlow's famous neglected monkeys. They didn't thrive when taken from their mothers.

Ooooo, I'm eating this up.


Discussion Starter · #20 ·
See, this is like the old board, lol....good healthy debate!! Very intriguing stuff here, both Dreamer and Homeskee, :wink:

No eye poking at all (and again, this stuff really helps ME to formulate my particular position - to be able to communicate it stronger).

The only thing I'd add, Dreamer, is while many delusions are psychotic, not all. Truth is, most of us have delusions (they're just "ordinary" delusions, lol....and not what psychiatry calls "bizarre").

The differences lie in two places: 1) delusions may include realistic possibilities (but still be delusional) i.e., certain jealousies people have, "I am CONVINCED you're sleeping with your secretary!" when in fact, it's untrue. But it's Possible. There is a secretary and she is potentially someone he could have sex with. Bizarre Delusions include things outside the realm of reality - aliens, etc.

(2) the delusion itself may be psychotic, but the PERSON may not operate 24/7 in a psychotic state of ego organization. Those bizarre delusions have a psychotic quality for sure - but do NOT presume schizophrenia. Many paranoid psychotics have "state dependent" delusions - they function within normal reality - may hold a job, etc. but harbor a Particular delusion, in ONE area, that is bizarre enough to be called "psychotic" But one could work next to this person, and not in a million years would you call them psychotic.

Confusing enough?

Love you guys,
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