Rare neurological disorder (about 100 cases reported in the literature) that owes its name to the French neurologist Jules Cotard (1840-1889). He was the first to describe it in a lecture in Paris in 1800 calling it "le délire de négation" or Delirium of Denial, accompanied by feelings of guilt, denial of body parts and also, paradoxically, by suicidal intentions and ideas.
In his lecture Cotard described a patient: Mademoiselle X. She denied the existence of God and the devil, parts of her body, such as her stomach, and denied the need to eat. After a phase characterized by anxiety and depression, more centered on her body, she developed the conviction that she was damaged for eternity and that she could no longer die of a natural death. At this stage suicidal ideas could emerge because immortality was conceived in its negative meaning of punishment and condemnation for one's faults.
Also called Nihilistic Delirious Disorder, it can be accompanied by anxiety, hypochondriac themes of somatic depersonalization and derealization. This syndrome can lead the patient to believe that his body has been transformed, petrified; that he has no name, no soul; that he has never been born, that he has never had a mother, father, children; that he has lost all his vital organs (heart, intestine, head) or all his blood; that he is "dead" to the point of even perceiving the smell of his own rotting flesh. He can also believe that he is immortal and condemned to eternal damnation for his sins. Often this denial can extend to external reality, the world around him is reduced to nothing. He complains that he has lost his possessions, his social status and his strength; he even goes so far as to believe that loved ones are dead.
The only way to explain rationally this total absence of emotions remains to be convinced of one's own statements and therefore of one's own death. It is a condition observed in patients with schizophrenia, depression, dementia syndromes such as Alzheimer's but also after brain damage. At first, intense anguish is followed by a phase of impoverishment and chronicity, where patients seem to detach themselves from their delusions, which are then told without emotional involvement.
Liz, a young 24-year-old patient, was admitted to the National Hospital for Neurology and Neurosurgery in London, with episodes of epilepsy following a cerebral infection with the Herpes Simplex virus. She was confused, terrified by the idea that the place she was in might not be paradise but hell. She had no doubt that she was dead: "I am dead two weeks ago. Can you please tell me if I'm in heaven?".
Dr. R. McKay, in addition to the treatment of the case, also asked Liz a series of questions to try to understand if the "style of attribution" was "internal": tendency to confer the causes of events that happen to themselves; or "external": conferring them to external circumstances, noting that this patient actually had an unusual tendency to internal attribution. According to Young and McKay, patients correctly recognize the physical characteristics of a face they are familiar with, but are no longer able to experience the emotional response associated with that visual stimulus. The pathological interruption of the connections between the recognition system, which is in itself intact, and the emotional activation system, would lead patients to recognize faces without feeling emotions. Scientists believe that patients with Cotard's syndrome have experienced the same "interruption" between face recognition and familiar emotion that occurs in patients with Capgras' syndrome (characterized by the belief that a familiar person has been replaced by a double, by strangers. What differentiates them is the style of attribution; the latter would attribute the problem to the outside (the patient "feels" that it is no longer his family members) while the former would attribute it to themselves ("I no longer feel anything for people familiar to me, so I must be dead").
The delirium, then, according to Young and McKay would represent an attempt at a rational explanation of the absence of emotions towards one's family members.