“Life Can’t Come From Death”
My Descent Into the Delirium of Negation
I am dead inside.
I don’t remember the first stirrings of my realization. As a child, I was relatively happy, in the way all children are happy, despite a home life that turned into a nightmare at five o’clock every day.
Did it set in during my teen years? I don’t recall any nihilistic ideas coming to me full-blown, but I do remember that by my early to mid-twenties, I knew with absolute certainty that my insides were dead.
I was aware other people didn’t see me this way. But I also believed they sensed it, and knew something was different about me. I was a shy person, probably difficult to get to know. But I attributed that distance from others not to shyness but to our fundamental, ontological difference: they were alive. I was not.
To be clear, it wasn’t that I believed I was dying, though other Cotard’s sufferers sometimes do. In my case, as I grew up, a creeping understanding that I’d been born dead slowly seeped into my consciousness. My insides were rotting. I was here, but not fully. I knew that I would never be able to grow a garden or get pregnant because life can’t come from death. I did not question how or why this could have happened to me except that Death had marked me. Others were born with illnesses or deformities; I was born dead.
Cotard’s Delusion was first recognized as a syndrome by Dr. Jules Cotard in 1880 when treating a young woman he called Mademoiselle X. Mademoiselle X believed that parts of her body were missing; that, being dead, she didn’t need to eat; and that she was cursed to suffer eternal hellfire.
When Cotard published this case study, other doctors began to add their stories of patients suffering from the delusion, the commonalities being: nihilistic delusions about the self and, often, existence, feelings of guilt, anxiety, denial of the need to eat, denial of pregnancy, and delusions of immortality. Informally, the symptom cluster became crudely known as Walking Corpse Syndrome. Cotard himself referred to it as ‘The Delirium of Negation.’
The etiology of Cotard’s isn’t fully known. It is not considered a psychiatric disorder in its own right; it is not included in the DSMV (Diagnostic and Statistical Manual Five). Cotard’s does not come alone, but presents as a symptom of a host of other disorders: schizophrenia, depression, prolonged substance abuse, encephalopathy, and several other neuropsychiatric illnesses.
This accorded with my own history; I’ve been diagnosed with several psychiatric disorders (which sounds extreme, but in psychiatric patients, comorbidity is more often the rule for patients than the exception.) I also suffer from migraines, one of the neurological conditions related to Cotard’s.
Brain scans of Cotard’s patients often reveal parietal lobe abnormalities, including lesions and decreased blood flow in the region. Treatment protocol often involves talk therapy (such as CBT) and psychiatric medication. Bilateral modified ECT is a more extreme method of treatment, but it has been proven effective in cases of concomitant depression and Cotard’s syndrome.
*****
I always went to a lot of trouble with my appearance and hygiene, horrified by the prospect of anyone realizing I wasn’t really alive. I felt I had to try a hundred times harder than the average person, to hide my basic otherness. I could never follow the oft-bestowed advice: Be yourself. Myself was the last person I wanted to be.
In my case, as in most others, Cotard’s delusions did not come alone, but as the culmination of a relentless assault on my mind that started in early childhood.
At six, I began dwelling on the oddities of my appearance. I remember sitting on a swing outside the apartment we were renting, and brooding that my head was shaped like a potato (to be fair, my head is disproportionally large. I have what Conan O’Brian calls the Irish Pumpkin Head Curse, and I have trouble finding hats to fit me!) But I also thought my fingers and fingernails grew strangely, crookedly, like witch hands. My ears were different from other peoples’ ears, not in a good way, weirdly shaped, too large, too flat.
I would fixate on one body part at a time. When my obsession about a particular feature grew unbearable, I tried to tell my parents about it, hoping for some wisdom or comfort. My father’s reaction was to hit me. Not just because he didn’t want to be bothered with my bullshit, but because he harbored a twisted belief, probably a remnant of his own rough Texas childhood, that hitting a child had some actual curative power. Weirdly, this proved true in the short run. The blow would knock out my erstwhile fixation on that one body part, but then the obsession would just jump to another feature of my head or body.
By age eight, I developed a particularly virulent strain of OCD called scrupulosity. This was at a time when my life became a nightly torture. The minute five o’clock rolled around (or earlier, if one of my parents declared that the sun is down over the yardarm somewhere in the world!), the evening libations would be poured, and my glamorous parents would disappear into repulsive, stumbling, slurring imposters. My fear of the oncoming night, and my loathing of the creatures my parents metamorphosed into, somehow became the crucible for a new obsession. I believed myself guilty of some unnamed and unknowable crime, and felt a need to “confess” that would not be denied. This time around, I wasn’t hit for relating my sins. My mother listened sometimes, and tried to understand and reassure me; at other times she berated or ignored me.
I think now that the belief in my own physical monstrosity and sin-tarnished soul were precursors to the Cotard’s. Around this same time, my natural fear of death devolved into an obsession with it; I started longing to be dead (not in the Cotard’s Delusion way, but fully dead, gone from this world.) That wish would linger for decades.
By my twenties, I was convinced my insides were dead, that my organs were rotting and my soul was similarly corrupt. My body was here, in this world, putting on a show of being alive; only I saw the truth. This belief didn’t require evidence; it was something I knew, implicitly. Occasionally some scant biological strangeness popped up that confirmed it for me. For instance, I used Q-tips inside my ears, but what came off on the Q-tip was black, not yellow-gold as it was supposed to be, its texture more fluid than sticky. I saw this as evidence of internal putrefaction, the rot leaking out of me. The one time I searched for an alternate explanation I was advised that black ear wax was a sign of impaction. I didn’t think was true for me, because I cleaned my ears daily, and made sure not to stick the Q-tip in too far. The default explanation was, of course, my unalive state.
*****
I was 28 when, I realized, with a shock, that my period was late. Friends told me it could be stress, or excitement, or a host of other possibilities. But my period’s schedule was ironclad, one absolute in a largely chaotic life. My body also felt different, and had for about a week. That day I knew beyond all doubt that I was pregnant.
This fulfillment of my deepest, lifelong wish — to become a mother — was a paradigm-shattering event. It was absolutely impossible for me to be pregnant. Death could not produce life.
Yet, here it was. A bona-fide miracle.
The nine months of this pregnancy were my happiest in memory since early childhood. But as my due date loomed, I felt the demon of my delusion reasserting itself. When I was seven or eight months along, my partner and I, along with numerous other very pregnant couples, attended Lamaze classes. I don’t remember much about what we learned, but what I do recall is the sudden sadness and envy I felt, comparing myself to the other moms-to-be. I suddenly knew as a certainty that, while they were all likely to have “normal,” healthy children, mine would be born dead, or horribly deformed, or would have some condition incompatible with prolonged life. That my OB-GYN and midwives hadn’t picked up anything on their scans or exams did not decrease my certainty. Cotard’s is not a rational disorder.
When my son was finally born, all 7 lbs and 11 oz of a regular, breathing, living baby, I couldn’t believe it. I must have looked comic, picking him up and turning him all which ways, searching for the fatal flaw that I was sure had to be there, but somehow couldn’t find. My amazement at producing what I finally had to admit was a healthy, living child almost equaled the shock at my pregnancy in the first place.
Was my delusion smashed with the birth of a living child? No. It had been weakened, certainly, but it hid out somewhere in my psyche. Addicts in 12-Step programs are told the whole time you’re sober, your addiction is doing pushups. Cotard’s was the same. It was off licking its wounds, but it hadn’t yet admitted defeat.
A few years later my partner, my two children, and I were living in a small, rural village in Pennsylvania. Our neighbors were mostly Mennonites, and all the women had vast vegetable gardens in back of their houses These gardens were in a sense communal; children were always running to their neighbors’ back doors with grocery bags, offering whatever veggies their moms had just harvested.
I wanted to be part of that communal world. Wistfully I told my partner that I wished I could start a garden; he encouraged me to go ahead and try. So I did, I planted vegetables and weeded and watered, but with the absolute certainty that nothing would ever grow for me. Having my kids had been an anomaly, I’d decided, a gift from the universe; but that didn’t change my fundamentally nihilistic belief system. It had made a dent, but that was all.
When the first green sprout appeared in my garden, a tiny shoot nestled in the rich black soil, the word astonished is beyond inadequate for what I felt. My children were a miracle, but how many miracles did a person get in their life? This was an impossibility.
A dead thing had breathed life into this garden.
Later, in grad school for psych, I would learn about cognitive distortions. By the time I began working with clients, I’d been trained to guide them in what we called a Socratic dialogue, designed to root out and identify thinking errors. At the time of my garden, I knew nothing of this, but reason started to reassert itself. Three times now, I’d seen empirical evidence that my lifelong conviction was wrong. That third time proved to be, to a considerable extent, the charm. Life itself was smashing up against my false beliefs, and finally it refused to be denied.
A few years later I sought out therapy and medication for depression and anxiety. I was fortunate; the first antidepressant that was tried on me actually worked. The Cotard’s delusions, which continued to find their way into my mind during dark times, were in retreat, although I was left with PTSD from my upbringing, and other issues that required different modes of trauma therapy, such as EMDR.
I still have never met another Cotard’s sufferer. The syndrome is extremely rare, afflicting an approximated 200 people worldwide. Of course, this statistic doesn’t capture the milder cases, those who, like me, manage to keep it to themselves, who don’t recognize their thoughts as bizarre, and who have no idea that it is something that can even be treated.
I’ve achieved enough distance from Death to fear it now, though I confess it still fascinates me. What matters most, though, is that I no longer believe Death is my intimate companion. I’ll meet it soon enough (as will we all), but I am now able to let it to reside in my future, and my imagination.
And at this point, I’m at least relatively sure that I’m no more deceased than the next person.
Sources:
Esme Weijun Wang, The Collected Schizophrenias, Graywolf Press, 2019
Anil Ananthaswamy, The Man Who Wasn’t There, Prenguin Random House Canada/Dutton, 2015
Anne Ruminjo, MD and Boris Mekinulov, MD, https://www.ncbi.nim.gov/pmc , PMC PubMed Central, A Case Report of Cotard’s Syndrome, 2008
