Making Sense of the Cotard Syndrome Insights from the Study of Depersonalisation

Patients suffering from the Cotard syndrome can deny being alive, having guts, thinking or even existing. They can also complain that the world or time have ceased to exist. In this paper, I argue that even though the leading neurocognitive accounts have difficulties meeting that task, we should, and we can, make sense of these bizarre delusions. To that effect, I draw on the close connection between the Cotard syndrome and a more common (and better studied) condition known as depersonalisation. Even though they are not delusional, depersonalised patients seem to have experiences that are quite similar to those of Cotard patients. I argue that these experiences are essentially characterised by a (more or less important) lack of subjective character and of two other structural features of experience, which I call ‘the present character’ and ‘the actual character.’ Cotard’s nihilistic delusions simply consist in taking these anomalous experiences at face value. In the 1880’s the French psychiatrist and neurologist Jules Cotard (1891, 314) extensively described an intriguing psychiatric condition, which had first been observed by Esquirol, Leuret and others. This condition, which has been dubbed ‘Cotard syndrome’ (délire de Cotard) by Régis (Séglas and Meige, 1895, 463), essentially involves a variety of negating or ‘nihilistic’ delusions. Cotard patients can for example deny being alive or having guts. Even more strangely, those patients can deny thinking or existing! In the last twenty years, I thank Marie Guillot and Frédérique de Vignemont for helpful discussions on the relationship between affectivity and the subjective character, as well two anonlymous referees of this journal for their hepful comments. Address for correspondance: Email: [email protected]