The People Who Believe They Are Dead

 The People Who Believe They Are Dead

There’s a psychiatric condition so strange it almost sounds like a ghost story. People who have it insist that they are dead. Not metaphorically. Not depressed and saying “I feel dead inside.” They mean it literally.

This is “Cotard’s delusion”, sometimes called walking corpse syndrome.

Imagine looking in the mirror and being convinced that what you see is just an empty shell. Some patients believe their organs have rotted away, or that their blood is gone, or that their body is nothing but a corpse they happen to be carrying around. Others say they have already died, and the world they’re living in is some kind of afterlife.

The first time I read about it, I couldn’t stop thinking about how terrifying it must feel… To wake up and believe you don’t even exist anymore.





Like most delusions, Cotard’s syndrome doesn’t have one simple cause. It often appears in people with severe depression, psychotic disorders, or neurological conditions. Some cases are linked to strokes or damage in the brain regions that help us map our body and sense of self (the parietal lobe, frontal lobe, temporal lobe, and parts of the default mode network such as the posterior cingulate cortex and precuneus). When these circuits misfire, the brain struggles to reconcile the mismatch between sensation and identity. One of the most extreme stories it can write is: “I must already be dead.”

That is the part that fascinates me. The brain never likes a gap in the story. When reality feels fractured, it fills in the missing pieces with something, even if that something is bizarre. Cotard’s delusion is one of the most chilling examples of this storytelling instinct.

———————-

It also makes me wonder about how fragile our sense of self really is. Most of us walk around assuming “I am me, and I am alive” is the most basic, unquestionable fact there is. But in Cotard’s, that foundation crumbles. A person can be breathing, eating, walking, and yet their brain insists: “I no longer exist.”

In a way, it echoes the freezer-container story we talked about before. Back then, the belief “I am freezing to death” was so strong that the body went along with it. In Cotard’s, the belief “I am already dead” becomes the lens through which every sensation is filtered. Hunger doesn’t mean you need food, it means your body is rotting. Pain doesn’t mean you’re alive, it means your corpse is decaying.


What unsettles me most is how convincingly the brain can overwrite reality. You can try to reason with someone who has Cotard’s, but logic rarely works. Their lived experience feels too real.

And maybe that’s the haunting lesson of Cotard’s delusion. Life, death, selfhood, these things feel fundamental, but they are also perceptions the brain maintains moment by moment. If the brain shifts the script, even “being alive” can vanish.

✨ It leaves me with a strange thought: maybe being alive is less about the beating of a heart and more about the story your brain is willing to believe…







References

Davies, M. & Coltheart, M., 2022. Cotard delusion, emotional experience and depersonalisation. Cognitive Neuropsychiatry, 27(6), pp.430–446. doi: 10.1080/13546805.2022.2119839.

Fonseca, A.C., Pinho e Melo, T. & Ferro, J.M., 2013. Cotard delusion after stroke. European Journal of Neurology, 20(7), pp.e98–e99. doi: 10.1111/ene.12171.

Sahoo, A. & Josephs, K.A., 2018. A neuropsychiatric analysis of the Cotard delusion. Journal of Neuropsychiatry and Clinical Neurosciences, 30(1), pp.58–65. doi: 10.1176/appi.neuropsych.17010018.



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