The walking dead go to the hospital.
He didn’t believe in the undead. Not, at least, until that cold, rainy winter afternoon. The young resident psychiatric physician was stunned to hear what the latest patient was telling him. He was on a grueling watch and was looking forward to getting home, showering, and resting. A patient had just been brought to the University Medical Center for assaulting several people.
The detainee’s name was Mr H. and he was a paranoid schizophrenic patient with a long history of abuse of psychoactive substances. An assault has little in particular, but the most interesting thing was the explanation that he gave to the young doctor who was taking the anamnesis.
Mr H. confessed that:
“He was a zombie, a ‘walking dead’ who had drowned twelve months ago in a nearby swamp. While underwater, he was revived by other “zombies” who used mobile phones to bring him back to life. “
According to him, all humanity had already perished and all had gone through an experience similar to his and therefore all were “zombies or undead.”
That had been the cause of the aggression, since Mr. H considered himself a peaceful man incapable of hitting a living being, but not a “living dead” who could hardly care if they hit him.
After being admitted to the hospital, Mr. H. was diagnosed with Cotard’s syndrome.
In August 2012, Doctors Agorastos Agorastos and Christiam G. Hubber from the Department of Psychiatry and Psychology of the University of Hamburg in Germany, published the clinical case of Mr. H. in a letter that was addressed to the Journal of Neuropsychiatry. and Clinical Neuroscience.
Are there the undead?
The vast majority of people are firmly convinced that the undead do not exist. They can accept the opposite, while they watch their favorite series like “Walking Dead” on television, but deep down they know perfectly well that “zombies” or “the walking dead” are a fictional product of novelistic, cinematographic or television fiction.
Along with this majority there is a small group of people, some would call them “geeks”, who are convinced of the existence of “zombies”. That is, they believe that under certain conditions a deceased human being can revive again in the form of the undead.
Finally, we could admit the existence of a third group of people, very small indeed, who not only believe in “zombies”, but are also convinced that they are “the undead” themselves. It is certainly a very small minority of people.
These people accept that they died and are now roaming an afterlife that will never end.
The ideas of this last group of subjects are not homogeneous, as some believe that their bodies have died. Others that his body is rotten and in a state of decomposition. Others think that what has died is their soul or their spirit.
All these people have something in common: they are ill and suffer from a rare syndrome that was described in the late 19th century by the French neurologist Jean Cotard.
The “walking dead” in fiction.
Cinema, television and narrative are full of strange beings who have in common being “dead while alive.” Thus we can find beings as varied as liches, mummies, shadows, vampires and zombies.
Each group has its peculiarities and its classifications and only with each of these types could a complete article be written. In literature, books on zombies are proliferating lately:
- David Wellington’s Zombie Trilogy.
- Trilogy “Diary of a zombie invasion” by JL Bourne.
- Trilogy “Apocalypse Z” by Manel Loureiro.
- Zombie: Max Brooks Survival Guide.
- Trilogy: The walkers of Carlos Sisí.
- Max Brooks World War Z.
- The book series: “The Walking Dead” by Robert Kirkman.
In television and cinema there are countless films about the undead, vampires, mummies and other specimens. Special mention should be made of the first Dracula characters, played by famous actors such as Peter Cushing or Cristopher Lee.
At present they have been replaced by the pale and haggard protagonists of the Twilight series.
In 1880, the French neurologist Jules Cotard presented the clinical case of one of his patients at the Medical Psychological Society of Paris, whom he called Mademoiselle X.
This 43-year-old woman was firmly convinced that her body only had skin and bones. She claimed that she was hollow inside, she had no brain or nerves or viscera in her thorax.
The patient claimed that she was eternal and that she would live forever. She did not believe in the existence of God or the Devil, despite which she was convinced that she was eternally damned, never being able to achieve a natural death. Jules Cotard named the painting a “delusion of denial.”
Even before Cotard described this painting, in 1788 another French doctor described the case of an old woman who believed she was dead and begged her relatives to put her dressed in her best clothes in a coffin.
Eleven years after the presentation in the Parisian society of Mademoiselle X, Jules Cotard expands the description of the painting in his book “Brain and mental diseases . ” In 1983 the name Cotard syndrome began to be used to refer to this unusual condition.
From 1880 to the present, not much progress has been made in the knowledge, origin and etiopathogenesis of Cotard syndrome. This may be due both to the rarity of the disease and to the diversity of symptoms reported by these patients.
We could group Cotard syndrome patients into two large groups according to the nature of the delirium they present.
The first group would refer to those patients who claim that they have died, that their body is rotten, that they lack viscera, that is, those whose delirium is about their body .
The second group would be those who complain that they have lost their soul, are eternally condemned, and other types of spiritual complaints .
Frequency and presentation.
As we have already said previously, Cotard syndrome is a fairly rare disease, of which there are only a few hundred cases described in the last century. It usually affects both men and women. It usually appears from mature age, its appearance in adolescence being very rare.
It is usually linked to severe depression and schizophrenia. The fundamental symptom of the picture is the delusion of denial. However, the way in which this delusion of denial manifests itself can have enormous variability and thus we can find mild cases, in which the patient reports loss of affective or intellectual qualities.
Very severe cases can appear next to it where the patient denies the existence of his body, the outside world and the entire universe.
Approximately eight out of ten patients have severe depressive symptoms. One in ten usually suffers from some form of schizophrenia and the rest may have delusions of diverse etiology: neurosyphilis, alcohol poisoning, drug abuse or various encephalitis.
Tests and diagnosis.
The diagnosis of Cotard syndrome is usually reached by exclusion. The blood test does not contribute anything, although it can rule out many infectious or immunological encephalitis.
Modern imaging techniques such as CT, MRI or PET are used to rule out underlying organic pathologies, which makes the clinician finally able to apply the diagnosis in the presence of a delusion of denial in patients with depressive, delusional or schizophrenic pictures .
A case of Cotard syndrome in Colombia.
The Colombian psychiatrist Eduardo Castrillón Muñoz and the resident psychiatry physician published in 2009 in the Colombian Journal of Psychiatry a clinical picture of a patient with Cotard’s Syndrome whom we will call Laura.
Laura is 48 years old. At the age of 24, she became a widow. Two years later he traveled to the United States where he lived for twenty-one years. During the time that he lived in the USA, he presented several depressive episodes that were treated with antidepressant drugs of the SSRI type (Selective Serotonin Reuptake Inhibitors), as well as anxiolytics such as Trankimazin.
In 2006 she was fired from her job and lost the few material possessions she had in the USA, which led her to return to Colombia. His hometown arrives in Buenaventura with a depressive picture characterized by sadness, anhedonia (“I don’t feel anything”, “I’m empty”), anxiety and ideas of guilt and ruin. He barely eats anything.
Dead in life.
She makes a suicide attempt by cutting her veins and in 2007 she is treated with antidepressants. Given the lack of improvement, he went to live in Medellín with a sister.
In the city of Medellín, Laura presents the first delusional ideas that can make us think of a Cotard syndrome.
He says that he blew smoke out of his mouth and that when he looked in the mirror his eyes were dead and expressionless. She associates the smoke with the soul that leaves her body and thinks that everything is a divine punishment for having wished for death.
It is considered “a living dead, a zombie for all eternity . ” He had olfactory and sensory hallucinations:
“I smell rotten.”
“I feel the worms moving under my skin that will soon pass through to get out of my body.”
Laura refused to eat and lost a lot of weight. He went to several churches where they performed rites of healing and exorcism without any result.
The patient was admitted to Cali due to her deteriorated appearance with the initial diagnosis of schizophrenia.
Treatment with antipsychotics and antidepressants was started. After a month of treatment, his physical condition improved but his delusions did not.
Laura claimed that she had no organs, that her case was unique on earth and that no doctor could cure her.
In 2008, due to the lack of improvement, treatment with ECT (Electro-convulsive Therapy) was started. He received six sessions that were unsuccessful.
Subsequently, a progressive remission of delusional symptoms is achieved after receiving treatment with valproic acid (Depakine).
Given the improvement, she was discharged after more than a month without presenting hallucinations.
Cotard’s syndrome in Spain.
The journalist Regina Navarro published in the newspaper “El Mundo” the confessions of the daughter of a patient with Cotard Syndrome, who preferred not to be known. These are some of the statements of the patient that her daughter tells us:
“I can’t walk because half of my body has stayed in bed.”
“I can’t eat because my stomach has disappeared.”
“I’m dead. We are all dead ”.
The Spanish psychiatrist Manuel Sánchez Pérez treated this patient with Cotard Syndrome, whose manifestations his daughter told us.
The disease progressed through outbreaks. In the first, the patient said that she was totally disoriented and did not know how to do anything.
The second outbreak was in May 2016 and delusions already appeared in it. The patient claimed to be dead, both she and everyone around her.
One of the main dangers that can appear in delusional phases is that of aggressiveness. This can be directed towards oneself or towards those around them.
By thinking that they are dead, they believe that nothing bad can happen to them. This belief can lead them to self-harm or threaten their life or that of those around them.
For Dr. Sánchez Pérez, electroconvulsive therapy (ECT) is the treatment of choice in patients with Cotard syndrome. At least eighty percent of patients respond satisfactorily to ECT.
Alexa Clark specializes in Cognitive Behavioral Therapy. She has experience in listening and welcoming in Individual Therapy and Couples Therapy. It meets demands such as generalized anxiety, professional, love and family conflicts, stress, depression, sexual dysfunction, grief, and adolescents from 15 years of age. Over the years, She felt the need to conduct the psychotherapy sessions with subtlety since She understands that the psychologist acts as a facilitator of self-understanding and self-acceptance, valuing each person's respect, uniqueness, and acceptance.