1 00:00:02,520 --> 00:00:07,920 Speaker 1: Happy Saturday. Neurologist Jules Kuttard was born on June first, 2 00:00:08,119 --> 00:00:12,039 Speaker 1: eighteen forty or one hundred and eighty four years ago today. 3 00:00:12,119 --> 00:00:15,400 Speaker 1: If you're listening on the day this episode drops, so 4 00:00:15,440 --> 00:00:18,480 Speaker 1: we have our episode on him and the syndrome named 5 00:00:18,520 --> 00:00:22,599 Speaker 1: for him as Today's Saturday Classic. This originally came out 6 00:00:22,680 --> 00:00:29,479 Speaker 1: on March thirtieth, twenty seventeen. Enjoy Welcome to Stuff You 7 00:00:29,520 --> 00:00:39,800 Speaker 1: Missed in History Class, a production of iHeartRadio. Hello, and 8 00:00:39,840 --> 00:00:44,040 Speaker 1: welcome to the podcast. I'm Holly Frye and I'm Tracy B. Wilson. 9 00:00:45,360 --> 00:00:48,680 Speaker 2: Tracy, you have heard of Qatard's delusion or Catard syndrome before, right, 10 00:00:48,880 --> 00:00:51,760 Speaker 2: mm hmm, And usually probably if you've seen it. It 11 00:00:51,800 --> 00:00:55,480 Speaker 2: comes up on frequently online on the lists of you know, 12 00:00:55,600 --> 00:01:01,600 Speaker 2: world's strangest maladies or you know list of sort of 13 00:01:01,640 --> 00:01:06,440 Speaker 2: disturbing or unsettling mental disorders. Because in those lists it's 14 00:01:06,520 --> 00:01:10,280 Speaker 2: usually just characterized as a patient believing themselves to be deceased. 15 00:01:10,720 --> 00:01:13,440 Speaker 2: It is sometimes called walking corpse syndrome because of that, 16 00:01:13,640 --> 00:01:15,960 Speaker 2: and while that can certainly be part of it, it 17 00:01:16,000 --> 00:01:18,640 Speaker 2: is a lot more complex than that. So Catard syndrome 18 00:01:18,800 --> 00:01:22,399 Speaker 2: is quite rare. It involves both a negation delusion, so 19 00:01:22,800 --> 00:01:25,600 Speaker 2: the individual feels a major change in their body, or 20 00:01:25,640 --> 00:01:29,080 Speaker 2: they deny the existence of one or several parts of 21 00:01:29,080 --> 00:01:31,200 Speaker 2: their organs or bodies, like they will sometimes think that 22 00:01:31,280 --> 00:01:35,040 Speaker 2: they no longer have viscera, or that their blood is gone, 23 00:01:35,800 --> 00:01:38,800 Speaker 2: or some other variation on that theme. And it also 24 00:01:39,000 --> 00:01:42,600 Speaker 2: has a nehilistic delusion element, so in that part of it, 25 00:01:42,640 --> 00:01:45,320 Speaker 2: the individual also believes that they or are all people 26 00:01:45,400 --> 00:01:48,400 Speaker 2: are dead, that they are somehow comporting themselves around the 27 00:01:48,440 --> 00:01:53,000 Speaker 2: earth in a state of non livingness. So it is 28 00:01:53,040 --> 00:01:56,800 Speaker 2: it's very complex. And additionally, the work of Jules Catard 29 00:01:56,960 --> 00:01:59,440 Speaker 2: is much debated even today, and part of that is 30 00:01:59,440 --> 00:02:02,400 Speaker 2: because it was unfinished, which we're going to talk about. 31 00:02:02,840 --> 00:02:05,720 Speaker 2: So really, the story of this syndrome that's named for him, 32 00:02:05,800 --> 00:02:08,560 Speaker 2: in many ways is the story of psychiatry and how 33 00:02:08,639 --> 00:02:12,720 Speaker 2: ideas are challenged and then shift and change through interpretation 34 00:02:12,960 --> 00:02:16,440 Speaker 2: as well as accumulation of data through the passage of time. 35 00:02:16,520 --> 00:02:19,240 Speaker 2: So we're going to talk about Jewels Cautard, his work 36 00:02:19,280 --> 00:02:21,760 Speaker 2: in this area, and then sort of how things played 37 00:02:21,760 --> 00:02:26,040 Speaker 2: out later on in terms of using his work to 38 00:02:26,480 --> 00:02:28,080 Speaker 2: address issues patients. 39 00:02:27,720 --> 00:02:33,440 Speaker 1: For having Jules Catard was born on June first, eighteen 40 00:02:33,520 --> 00:02:37,880 Speaker 1: forty in Istudon in central France. As a young man, 41 00:02:38,080 --> 00:02:40,800 Speaker 1: he became a medical student in Paris, where he studied 42 00:02:40,840 --> 00:02:45,520 Speaker 1: under several prominent and trailblazing physicians of the day. These 43 00:02:45,639 --> 00:02:48,800 Speaker 1: included Pierre Paul Broca, who has a portion of the 44 00:02:48,800 --> 00:02:51,800 Speaker 1: frontal lobe in the brain named after him because of 45 00:02:51,840 --> 00:02:55,640 Speaker 1: his work studying that area and then also establishing the 46 00:02:55,639 --> 00:03:00,320 Speaker 1: concept of brain function being associated with specific areas. There's 47 00:03:00,360 --> 00:03:03,840 Speaker 1: also Alfred Volpien, who is credited with the discovery of 48 00:03:03,880 --> 00:03:08,680 Speaker 1: adrenaline being made by the adrenal gland, and Jean Martin Charcot, 49 00:03:09,120 --> 00:03:12,320 Speaker 1: who's considered the father of modern neurology and has more 50 00:03:12,360 --> 00:03:16,040 Speaker 1: than a dozen medical conditions or discoveries named for him. 51 00:03:16,280 --> 00:03:18,760 Speaker 1: In short, that was kind of an incredible time to 52 00:03:18,800 --> 00:03:20,560 Speaker 1: be studying medicine in. 53 00:03:20,600 --> 00:03:24,000 Speaker 2: Paris, it really was. There was also a lot going on, 54 00:03:24,080 --> 00:03:26,640 Speaker 2: of course, in Vienna and Germany at the time. That 55 00:03:26,720 --> 00:03:31,520 Speaker 2: Paris had some really interesting neurological and psychiatric culture growing 56 00:03:31,600 --> 00:03:34,920 Speaker 2: up around it, So initially Katard was on the same 57 00:03:34,960 --> 00:03:37,440 Speaker 2: path as the neurologist that he had been studying under. 58 00:03:38,360 --> 00:03:42,960 Speaker 2: His first significant paper was titled physiological and pathological studies 59 00:03:43,000 --> 00:03:48,480 Speaker 2: on cerebral softening, exploring how inflammation and hemorrhaging damages brain tissue. 60 00:03:49,080 --> 00:03:51,640 Speaker 2: And then his doctorate paper in eighteen sixty eight was 61 00:03:51,680 --> 00:03:54,320 Speaker 2: titled Study on partial atrophy of the brain. 62 00:03:55,400 --> 00:03:58,840 Speaker 1: One event though, would really significantly change the course of 63 00:03:58,880 --> 00:04:04,360 Speaker 1: Cotard's career. He witnessed the psychiatrist Charles Le Sigue interviewing 64 00:04:04,400 --> 00:04:08,240 Speaker 1: a patient and he was enthralled. Based on watching this 65 00:04:08,360 --> 00:04:12,560 Speaker 1: man at work, Quotard began to shift his focus away 66 00:04:12,640 --> 00:04:16,680 Speaker 1: from neurology and into psychiatry. The two men would eventually 67 00:04:16,720 --> 00:04:20,560 Speaker 1: become colleagues, and I feel like we should say that 68 00:04:20,800 --> 00:04:23,839 Speaker 1: this was It was not uncommon for people going into 69 00:04:23,839 --> 00:04:26,680 Speaker 1: psychiatry at this time to have started out in neurology. 70 00:04:26,720 --> 00:04:29,720 Speaker 2: A lot of people did. In eighteen seventy four, Le 71 00:04:29,880 --> 00:04:34,240 Speaker 2: Segia introduced Jews Qutard to Jules Farrey, and the two 72 00:04:34,320 --> 00:04:37,640 Speaker 2: Juleses would go on to become research partners, working side 73 00:04:37,640 --> 00:04:40,560 Speaker 2: by side in the Maison de Sante that's the asylum 74 00:04:40,880 --> 00:04:46,080 Speaker 2: at von Vez in Paris in the southwestern suburbs, and incidentally, 75 00:04:46,320 --> 00:04:49,440 Speaker 2: Farre's father actually owned that asylum. 76 00:04:50,120 --> 00:04:54,880 Speaker 1: Quotard gave a presentation to Paris's Medical Psychological Society on 77 00:04:55,040 --> 00:04:58,840 Speaker 1: June twenty eighth, eighteen eighty, he reade a case report 78 00:04:58,920 --> 00:05:03,800 Speaker 1: he and Falay had assembled titled of the hypochondriac delirium 79 00:05:03,880 --> 00:05:07,839 Speaker 1: in a severe form of anxious melancholy. In this case, 80 00:05:07,920 --> 00:05:10,479 Speaker 1: the patient was a woman who was forty three. She 81 00:05:10,520 --> 00:05:14,160 Speaker 1: had a unique set of symptoms. So this woman, who 82 00:05:14,200 --> 00:05:17,000 Speaker 1: is referred to in the paper as Madame X, thought 83 00:05:17,040 --> 00:05:19,279 Speaker 1: that she was made of nothing but skin and bone, 84 00:05:19,480 --> 00:05:24,039 Speaker 1: and that she had no brain, nerves, chest, or entrails. Additionally, 85 00:05:24,160 --> 00:05:26,919 Speaker 1: she had come to the conclusion that God did not exist, 86 00:05:27,160 --> 00:05:29,720 Speaker 1: nor did the devil, and that she would live forever. 87 00:05:30,520 --> 00:05:33,120 Speaker 1: She had made several attempts on her own life and 88 00:05:33,200 --> 00:05:36,840 Speaker 1: requested of her doctors and others that she be burned alive. 89 00:05:37,760 --> 00:05:41,840 Speaker 1: As Cotard presented, he referenced similar cases that had been 90 00:05:41,880 --> 00:05:44,400 Speaker 1: on the record going as far back as twenty years. 91 00:05:45,160 --> 00:05:49,719 Speaker 1: He specifically mentioned similar cases handled by doctor Jule Bayarze 92 00:05:49,960 --> 00:05:52,600 Speaker 1: as some of the oldest. These were considered part of 93 00:05:52,640 --> 00:05:56,400 Speaker 1: a diagnosis of general paralysis, and in this context the 94 00:05:56,440 --> 00:06:00,760 Speaker 1: paralysis referred to as a failure of the brainized by 95 00:06:00,839 --> 00:06:04,640 Speaker 1: a loss of inhibitions and the exhibition of delusional thinking, 96 00:06:04,960 --> 00:06:08,000 Speaker 1: So not a lack of physical movement or an inability 97 00:06:08,000 --> 00:06:10,480 Speaker 1: to move your body. Right, when we think of paralysis, 98 00:06:10,480 --> 00:06:12,159 Speaker 1: that's usually what comes to mind, but that's not the 99 00:06:12,200 --> 00:06:17,400 Speaker 1: application of the word here. So yeah, these similar cases 100 00:06:17,480 --> 00:06:20,640 Speaker 1: that had been studied two decades earlier had kind of 101 00:06:20,680 --> 00:06:23,920 Speaker 1: gotten lumped in as general paralysis. But Katard felt like 102 00:06:23,960 --> 00:06:27,000 Speaker 1: there was something a little more specific about them, and 103 00:06:27,080 --> 00:06:29,680 Speaker 1: he thought that what his patient was exhibiting was actually 104 00:06:29,720 --> 00:06:32,920 Speaker 1: a form of what was at the time called lipomania 105 00:06:33,040 --> 00:06:38,200 Speaker 1: or lipomania, and that term eventually was supplanted by melancholy. Basically, 106 00:06:38,240 --> 00:06:42,000 Speaker 1: he thought he had identified a specific form of melancholia, 107 00:06:42,640 --> 00:06:46,159 Speaker 1: and this was, in his opinion, an anxious melancholia, with 108 00:06:46,279 --> 00:06:51,320 Speaker 1: delusions that could include religious misbeliefs of damnation or demon possession, 109 00:06:51,880 --> 00:06:54,200 Speaker 1: the perception that some or all of the body had 110 00:06:54,200 --> 00:06:59,919 Speaker 1: ceased to exist, inability to perceive physical pain, immortality, delusion, 111 00:07:00,320 --> 00:07:06,320 Speaker 1: and suicidal behavior. Jules Coutard also drew possible connections in 112 00:07:06,320 --> 00:07:09,359 Speaker 1: this presentation from the symptoms he had observed and the 113 00:07:09,400 --> 00:07:14,360 Speaker 1: patient to similar historical events, including various cases of reported 114 00:07:14,520 --> 00:07:19,160 Speaker 1: demon obsession. He suggested that the idea of the wandering 115 00:07:19,320 --> 00:07:22,360 Speaker 1: Jew legend, which was a man who had taunted Christ 116 00:07:22,400 --> 00:07:25,080 Speaker 1: on the cross and then was doomed to wander earth 117 00:07:25,240 --> 00:07:28,240 Speaker 1: until the world ended. He thought that may have had 118 00:07:28,320 --> 00:07:31,680 Speaker 1: roots in the observation of a person with a similarly 119 00:07:31,800 --> 00:07:35,640 Speaker 1: delusional state. Yeah, he was kind of making this case 120 00:07:35,720 --> 00:07:37,920 Speaker 1: that it could be that that whole legend grew out 121 00:07:37,960 --> 00:07:41,160 Speaker 1: of someone speaking with a person who actually had this 122 00:07:41,320 --> 00:07:45,760 Speaker 1: delusion that he was trying to identify, and Gutard continued 123 00:07:45,800 --> 00:07:49,320 Speaker 1: to develop his research on this topic. In eighteen eighty two, 124 00:07:49,480 --> 00:07:52,760 Speaker 1: he expanded on it by introducing the term de de 125 00:07:52,960 --> 00:07:57,480 Speaker 1: negascion and that's neilistic delusions in an article that he 126 00:07:57,520 --> 00:08:01,000 Speaker 1: published in the Archives de de re Regi. Patients with 127 00:08:01,040 --> 00:08:04,640 Speaker 1: such delusions, he said, had a tendency to deny everything, 128 00:08:04,840 --> 00:08:08,720 Speaker 1: leading in extreme cases to denial of the self. He 129 00:08:08,840 --> 00:08:13,320 Speaker 1: separated the delusions of negation clinically from delusions of persecution. 130 00:08:13,640 --> 00:08:18,760 Speaker 1: In that article, he characterized persecution delusions as exhibiting mistrust, 131 00:08:19,080 --> 00:08:24,640 Speaker 1: paranoia of poisoning, delusions of grandeur, and acoustic verbal hallucinations 132 00:08:24,640 --> 00:08:30,600 Speaker 1: that would sometimes be homicidal. In contrast, he listed anxious monologue, 133 00:08:30,880 --> 00:08:36,560 Speaker 1: deep melancholic depression, refusal to eat, visual hallucinations, and suicidal 134 00:08:36,600 --> 00:08:40,040 Speaker 1: behavior as characteristics of the delusion of negation. 135 00:08:41,880 --> 00:08:45,920 Speaker 2: Four years after Qatar's initial presentation on the symptoms of 136 00:08:45,960 --> 00:08:49,080 Speaker 2: madame X, he wrote about another patient, this one an 137 00:08:49,120 --> 00:08:51,560 Speaker 2: adult man who said that he could no longer see 138 00:08:51,600 --> 00:08:55,880 Speaker 2: his children's features. In eighteen eighty four, Qatars, still trying 139 00:08:55,920 --> 00:08:58,520 Speaker 2: to build up a unified theory of what he believed 140 00:08:58,520 --> 00:09:01,880 Speaker 2: to be related symptoms, came to the conclusion that this 141 00:09:02,080 --> 00:09:04,520 Speaker 2: was a loss of mental vision, and that this was 142 00:09:04,559 --> 00:09:08,880 Speaker 2: actually the root of the problem. When patients exhibited nehilistic delusions, 143 00:09:09,440 --> 00:09:13,080 Speaker 2: the mind, in his estimation, was simply unable to process 144 00:09:13,200 --> 00:09:17,680 Speaker 2: visual representation of objects. He would later refine this concept 145 00:09:17,720 --> 00:09:21,320 Speaker 2: by describing the problem as a loss of quote psychomotor energy, 146 00:09:21,720 --> 00:09:25,840 Speaker 2: causing the patient to lose visual representation and to experience 147 00:09:25,880 --> 00:09:31,439 Speaker 2: psychomotor impairment. It's entirely likely that Cotard would have continued 148 00:09:31,480 --> 00:09:33,640 Speaker 2: to refine his work on a topic had he not 149 00:09:33,760 --> 00:09:37,480 Speaker 2: met an untimely end. In eighteen eighty nine, at just 150 00:09:37,600 --> 00:09:41,440 Speaker 2: forty nine years old, he contracted diphtheria, which he caught 151 00:09:41,440 --> 00:09:44,200 Speaker 2: from his daughter. He never recovered, and he died on 152 00:09:44,520 --> 00:09:48,640 Speaker 2: August nineteenth of that year. At his funeral, his partner 153 00:09:48,720 --> 00:09:52,560 Speaker 2: Faleri spoke, calling him quote a profound and original thinker, 154 00:09:52,920 --> 00:09:57,199 Speaker 2: given to paradox but guided by a robust sense of reality. 155 00:09:58,520 --> 00:10:01,199 Speaker 2: And next up, we're gonna talk about what the rest 156 00:10:01,200 --> 00:10:05,480 Speaker 2: of Paris's psychiatric community did with Catard's work after his death. 157 00:10:05,559 --> 00:10:07,320 Speaker 2: But first we're going to pause and have a word 158 00:10:07,360 --> 00:10:18,640 Speaker 2: from one of our sponsors. Almost immediately after Jules Catard's death, 159 00:10:19,080 --> 00:10:21,600 Speaker 2: debate began about his work and where he had been 160 00:10:21,600 --> 00:10:25,360 Speaker 2: headed with it and what his intentions actually were. One 161 00:10:25,400 --> 00:10:28,280 Speaker 2: of the ongoing themes of Katard's work was this struggle 162 00:10:28,320 --> 00:10:32,120 Speaker 2: to develop terminology for psychiatric ailments, and he had also 163 00:10:32,240 --> 00:10:36,880 Speaker 2: championed this idea of using symptomatic classification for psychiatry. So, 164 00:10:37,040 --> 00:10:40,319 Speaker 2: of course, with his work in this state of arrested development, 165 00:10:40,520 --> 00:10:42,840 Speaker 2: I mean he had been writing updates to his ideas 166 00:10:42,960 --> 00:10:45,680 Speaker 2: just days before his death, there was a lot of 167 00:10:45,800 --> 00:10:46,959 Speaker 2: room for interpretation. 168 00:10:48,160 --> 00:10:51,280 Speaker 1: While some of his contemporaries thought he had been cataloging 169 00:10:51,320 --> 00:10:55,120 Speaker 1: an entirely new disease, others thought his work had always 170 00:10:55,160 --> 00:11:00,240 Speaker 1: been focused on exploring a severe and specific form of melancholia. 171 00:11:00,800 --> 00:11:04,800 Speaker 1: Others thought that he merely sought to catalog and describe 172 00:11:05,200 --> 00:11:08,359 Speaker 1: a symptom cluster that could be found in other diseases 173 00:11:08,400 --> 00:11:09,960 Speaker 1: in addition to melancholia. 174 00:11:11,160 --> 00:11:14,439 Speaker 2: In August of eighteen ninety two, the issue was hotly 175 00:11:14,480 --> 00:11:18,920 Speaker 2: debated at the Mental Medicine Congress in Blois, France. Catard's 176 00:11:18,960 --> 00:11:22,440 Speaker 2: partner Falcays advocated for the idea that his friend had 177 00:11:22,480 --> 00:11:25,720 Speaker 2: identified a new disease, and to argue his case, he 178 00:11:25,760 --> 00:11:28,640 Speaker 2: claimed that there was an essential form of Catard's de 179 00:11:28,760 --> 00:11:31,960 Speaker 2: lo de negacion which stood on its own, and also 180 00:11:32,480 --> 00:11:34,880 Speaker 2: a secondary form of it that could be part of 181 00:11:34,960 --> 00:11:38,959 Speaker 2: other melancholia and even non melancholia disorders. 182 00:11:39,880 --> 00:11:44,040 Speaker 1: Others and attendants argued that the specific cluster that Faler 183 00:11:44,200 --> 00:11:48,560 Speaker 1: was advocating as part of Coutard's newly identified disorder included 184 00:11:48,600 --> 00:11:53,240 Speaker 1: elements that were so rare, specifically those relating to religion 185 00:11:53,280 --> 00:11:57,520 Speaker 1: based concepts of demonic possession, damnation, and eternal life, that 186 00:11:57,559 --> 00:12:01,800 Speaker 1: there was no validity to calling it at own singular syndrome. 187 00:12:02,080 --> 00:12:05,040 Speaker 1: To support this view, was pointed out that virtually all 188 00:12:05,200 --> 00:12:09,160 Speaker 1: patients with melancholia had a tendency toward negation and guilt, 189 00:12:09,720 --> 00:12:13,920 Speaker 1: so the cases in Cotard's writings were just extreme examples 190 00:12:13,960 --> 00:12:19,640 Speaker 1: of this. Additional arguments against this being a standalone disorder 191 00:12:19,720 --> 00:12:24,360 Speaker 1: or disease identification included claims that Katard was merely listing 192 00:12:24,400 --> 00:12:26,800 Speaker 1: a random assortment of symptoms that could be found in 193 00:12:26,880 --> 00:12:30,560 Speaker 1: any number of mental disorders, so grouping them together was 194 00:12:30,640 --> 00:12:35,600 Speaker 1: essentially meaningless aside from anyone's specific patient having them. Cases 195 00:12:35,640 --> 00:12:38,280 Speaker 1: were also brought into the discussion to illustrate the rather 196 00:12:38,400 --> 00:12:42,560 Speaker 1: common occurrence of neihilistic delusions in cases of chronic melancholia. 197 00:12:43,559 --> 00:12:47,120 Speaker 1: While the Mental Health Congress came to no clear conclusion 198 00:12:47,400 --> 00:12:51,360 Speaker 1: as to whether Cotard's work was describing as specific syndrome 199 00:12:51,559 --> 00:12:54,960 Speaker 1: or common elements of multiple mental disorders, there was some 200 00:12:55,120 --> 00:13:00,240 Speaker 1: agreement on how to define nialistic delusion syndrome was that 201 00:13:00,280 --> 00:13:06,240 Speaker 1: it included two specific elements, anxious melancholia and systematized ideas 202 00:13:06,280 --> 00:13:07,040 Speaker 1: of negation. 203 00:13:08,240 --> 00:13:12,440 Speaker 2: So as an aside to clarify what that means, systematized 204 00:13:12,480 --> 00:13:16,960 Speaker 2: delusion indicates that a patient has developed a consistent, complex 205 00:13:17,000 --> 00:13:20,960 Speaker 2: system of beliefs associated with their condition, which often fit 206 00:13:21,040 --> 00:13:24,520 Speaker 2: together perfectly in a really elaborate narrative. So, for example, 207 00:13:24,520 --> 00:13:26,520 Speaker 2: if you think that you died in an accident where 208 00:13:26,520 --> 00:13:30,360 Speaker 2: you did not die, all of the strange things that 209 00:13:30,480 --> 00:13:32,920 Speaker 2: may happen to you, you will put together into a 210 00:13:32,960 --> 00:13:36,640 Speaker 2: puzzle to support that conclusion, like I'm clearly dead. That 211 00:13:36,720 --> 00:13:39,079 Speaker 2: is why that person never calls me back. It's because 212 00:13:39,080 --> 00:13:41,120 Speaker 2: I'm dead and they're not getting my call. That's a 213 00:13:41,240 --> 00:13:44,760 Speaker 2: very simplified and basic way, and I'm sure any doctor 214 00:13:44,800 --> 00:13:48,160 Speaker 2: would be like Holle no, But that's just to kind 215 00:13:48,160 --> 00:13:51,080 Speaker 2: of give you an idea of what this systematized aspect 216 00:13:51,080 --> 00:13:51,680 Speaker 2: of it means. 217 00:13:53,080 --> 00:13:57,439 Speaker 1: One year after that Congress and four years after Cotard's death, 218 00:13:57,840 --> 00:14:01,800 Speaker 1: the Termqutard syndrome was first introduced. That was in eighteen 219 00:14:01,840 --> 00:14:06,360 Speaker 1: ninety three by Emil Regis to name the depressive disorder 220 00:14:06,520 --> 00:14:10,920 Speaker 1: that Cotard had studied and described. It then became cemented 221 00:14:11,040 --> 00:14:15,640 Speaker 1: in the lexicon through its use by another of Cotard's contemporaries, 222 00:14:16,040 --> 00:14:20,960 Speaker 1: who was psychiatrist Juz Segla, although there were some differences 223 00:14:21,040 --> 00:14:25,080 Speaker 1: in how Siegla and Cotard viewed this condition. While many 224 00:14:25,240 --> 00:14:28,480 Speaker 1: believed that Cotard's work had led him to the conclusion 225 00:14:28,840 --> 00:14:33,680 Speaker 1: that nihilistic delusion was a separate and unique condition, Segla 226 00:14:33,920 --> 00:14:36,960 Speaker 1: felt that it was an expression of an extreme state 227 00:14:37,040 --> 00:14:42,240 Speaker 1: of anxious melancholia. So the case in which Segla first 228 00:14:42,320 --> 00:14:45,800 Speaker 1: used the term Qutard's syndrome to describe a patient, featured 229 00:14:45,800 --> 00:14:49,160 Speaker 1: a man who, much like Coutard's patient Madam X, believed 230 00:14:49,240 --> 00:14:53,280 Speaker 1: himself to be immortal, damned, and without his internal organs. 231 00:14:54,400 --> 00:14:57,800 Speaker 1: And despite his different view of whether the syndrome was 232 00:14:58,160 --> 00:15:01,360 Speaker 1: a unique disorder or a way to identi extreme cases, 233 00:15:01,840 --> 00:15:06,000 Speaker 1: Segla's diagnosis of a patient as having Cotard syndrome really 234 00:15:06,040 --> 00:15:11,000 Speaker 1: popularized the term's usage. With the dawn of the twentieth century, 235 00:15:11,080 --> 00:15:14,360 Speaker 1: came many changes in the way mental health was discussed 236 00:15:14,400 --> 00:15:17,960 Speaker 1: and treated, and Cotard's work had to be examined in 237 00:15:18,040 --> 00:15:21,200 Speaker 1: new ways as a consequence. So first you probably noted 238 00:15:21,200 --> 00:15:23,760 Speaker 1: that leading up to this point we exclusively use the 239 00:15:23,840 --> 00:15:29,080 Speaker 1: term melancholia. That's because depression and manic depressive illness as 240 00:15:29,160 --> 00:15:32,640 Speaker 1: diagnostic terms didn't exist until the twentieth century, and those 241 00:15:32,640 --> 00:15:36,560 Speaker 1: have continued to be refined. Now people generally say bipolar 242 00:15:36,600 --> 00:15:41,440 Speaker 1: disorder and not manic depressive illness. Once they were introduced, though, 243 00:15:41,520 --> 00:15:45,160 Speaker 1: these terms really impacted a lot of disorders and illnesses, 244 00:15:45,160 --> 00:15:46,680 Speaker 1: including Cotard syndrome. 245 00:15:47,560 --> 00:15:51,120 Speaker 2: So in the early nineteen hundreds, Cotard syndrome was invoked 246 00:15:51,160 --> 00:15:53,960 Speaker 2: as a symptomatic analysis of patients who were being treated 247 00:15:54,000 --> 00:15:58,840 Speaker 2: for general paralysis and senile dementia, as it had been 248 00:15:58,880 --> 00:16:00,920 Speaker 2: toward the end of the nineteenth cent been used in 249 00:16:00,960 --> 00:16:03,840 Speaker 2: both of those, but now it was also associated with 250 00:16:03,880 --> 00:16:07,600 Speaker 2: the newer terms depression and at that point manic depressive illness, 251 00:16:08,520 --> 00:16:11,680 Speaker 2: and so this wider range of use also came with 252 00:16:11,760 --> 00:16:14,880 Speaker 2: the development of a subdivision of the syndrome by some 253 00:16:15,040 --> 00:16:19,200 Speaker 2: doctors into two types, the melancholic type of catard syndrome 254 00:16:19,320 --> 00:16:24,120 Speaker 2: and the hypochondriacal type of catard syndrome. The melancholic type 255 00:16:24,160 --> 00:16:27,720 Speaker 2: was considered secondary and a patient with effective disorder. It's 256 00:16:27,760 --> 00:16:32,120 Speaker 2: a mood disorder such as depression, bipolar disorder, or anxiety disorder, 257 00:16:32,720 --> 00:16:38,640 Speaker 2: characterized by nihilistic delusions and the patient's subjectivity. The hypochondriacal 258 00:16:38,680 --> 00:16:42,480 Speaker 2: type was considered a primary manifestation of the syndrome, where 259 00:16:42,520 --> 00:16:47,120 Speaker 2: the patient's symptoms were focused around incorrect and paranoid feelings 260 00:16:47,120 --> 00:16:49,960 Speaker 2: about the body, like that it was missing viscera or 261 00:16:50,000 --> 00:16:53,800 Speaker 2: that it was no longer alive. And again we should 262 00:16:54,240 --> 00:16:57,040 Speaker 2: make clear that this was not a universally accepted approach 263 00:16:57,120 --> 00:17:03,640 Speaker 2: to dividing thisnineteen four Leonardo Bianci and James Hogg MacDonald 264 00:17:03,680 --> 00:17:07,919 Speaker 2: wrote a textbook of psychiatry for physicians and students, and 265 00:17:07,960 --> 00:17:11,280 Speaker 2: in it they wrote, quote Catard and others have assigned 266 00:17:11,400 --> 00:17:15,160 Speaker 2: undue importance to the delirium of negation, attributing to its 267 00:17:15,160 --> 00:17:18,639 Speaker 2: certain clinical characters, many of which, as a matter of fact, 268 00:17:18,720 --> 00:17:22,000 Speaker 2: are common to the majority of cases of depressive delirium, 269 00:17:22,440 --> 00:17:26,280 Speaker 2: such as self accusation and hypochondria, of which it represents 270 00:17:26,320 --> 00:17:30,199 Speaker 2: a more advanced stage of evolution. It was just as 271 00:17:30,240 --> 00:17:32,560 Speaker 2: a decade earlier, a time when some of the medical 272 00:17:32,600 --> 00:17:36,199 Speaker 2: mental health community believed that Catard had wrongly associated a 273 00:17:36,280 --> 00:17:39,720 Speaker 2: series of fairly common symptoms into one unique cluster. 274 00:17:40,600 --> 00:17:44,040 Speaker 1: Another idea developed during this period was a way to 275 00:17:44,240 --> 00:17:49,840 Speaker 1: identify nihilistic delusions as true cu Tard syndrome. This particular 276 00:17:49,920 --> 00:17:53,680 Speaker 1: approach required that a patient exhibit a combination of an 277 00:17:53,680 --> 00:17:59,240 Speaker 1: effective or mood component like anxiety, and an intellectual component, 278 00:17:59,280 --> 00:18:03,360 Speaker 1: which was the idea of negation. This approach meant that 279 00:18:03,400 --> 00:18:07,080 Speaker 1: these delusions could be recognized and acknowledged in a variety 280 00:18:07,119 --> 00:18:11,240 Speaker 1: of scenarios without the identification of Cotard syndrome. And to 281 00:18:11,280 --> 00:18:15,520 Speaker 1: make things even more nebulous, some physicians also suggested breaking 282 00:18:15,560 --> 00:18:19,480 Speaker 1: down the syndrome into complete and incomplete versions based on 283 00:18:19,640 --> 00:18:21,840 Speaker 1: variations in the patient's symptoms. 284 00:18:23,800 --> 00:18:26,000 Speaker 2: This is one of those things where the more I read, 285 00:18:26,040 --> 00:18:29,080 Speaker 2: the more I was like, how do any doctors or 286 00:18:29,119 --> 00:18:35,720 Speaker 2: clinicians ever agree on anything? Because it is so hotly debated, 287 00:18:35,720 --> 00:18:38,120 Speaker 2: and I know this isn't just unique to Catard syndrome. 288 00:18:39,040 --> 00:18:42,240 Speaker 2: Yet others suggested that Cathard syndrome is really a result 289 00:18:42,320 --> 00:18:46,199 Speaker 2: of institutionalization, and in fact, that first patient that Qatard 290 00:18:46,280 --> 00:18:49,120 Speaker 2: described back in eighteen eighty was a woman who had 291 00:18:49,160 --> 00:18:51,840 Speaker 2: been confined at the Van Vis Asylum for a number 292 00:18:51,880 --> 00:18:52,520 Speaker 2: of years. 293 00:18:53,320 --> 00:18:55,199 Speaker 1: So to wrap things up, we're going to talk a 294 00:18:55,200 --> 00:18:59,359 Speaker 1: bit about the discussion and handling Ofqutard syndrome after World 295 00:18:59,359 --> 00:19:01,840 Speaker 1: War II, But first we're going to take one last 296 00:19:01,920 --> 00:19:11,520 Speaker 1: quick break for a word from a sponsor. During World 297 00:19:11,560 --> 00:19:14,960 Speaker 1: War II, Paris was of course occupied by the Nazis, 298 00:19:15,000 --> 00:19:18,600 Speaker 1: and so work on psychiatry there certainly slowed. But after 299 00:19:18,640 --> 00:19:21,840 Speaker 1: the war, Catard's work was once again examined, and in 300 00:19:21,880 --> 00:19:25,600 Speaker 1: some ways history repeated itself as various clinicians offered their 301 00:19:25,600 --> 00:19:29,400 Speaker 1: interpretations based on their work with patients that had similar 302 00:19:29,520 --> 00:19:34,720 Speaker 1: or related symptoms. In the book Uncommon Psychiatric Syndromes, writers 303 00:19:34,800 --> 00:19:39,439 Speaker 1: Morgan Enoch and William Treuthowen wrote, it is quote justifiable 304 00:19:39,600 --> 00:19:44,040 Speaker 1: to regard Catard's syndrome as a specific clinical entity because 305 00:19:44,040 --> 00:19:47,120 Speaker 1: it may exist in a pure and complete form even 306 00:19:47,200 --> 00:19:52,359 Speaker 1: when symptomatic of another mental illness. Nallistic delusions dominate the 307 00:19:52,400 --> 00:19:53,680 Speaker 1: clinical picture. 308 00:19:54,480 --> 00:19:58,399 Speaker 2: And today, of course, classification of mental disorders continues to 309 00:19:58,440 --> 00:20:00,959 Speaker 2: be debated, and in the at eighties many of the 310 00:20:01,000 --> 00:20:03,760 Speaker 2: concepts that were being introduced were in their infancy, so 311 00:20:03,880 --> 00:20:07,560 Speaker 2: things were constantly in flux. There was ongoing debate about 312 00:20:07,560 --> 00:20:10,239 Speaker 2: what various disorders should be called, and even how to 313 00:20:10,359 --> 00:20:14,720 Speaker 2: arrange the known disorders into a larger classification system. Because 314 00:20:14,840 --> 00:20:18,000 Speaker 2: the very juvenile stage of many of the concepts that 315 00:20:18,040 --> 00:20:20,639 Speaker 2: Gutard was writing about, and the fact that he was 316 00:20:20,720 --> 00:20:23,879 Speaker 2: writing in French, there have been additional debates through the 317 00:20:23,960 --> 00:20:27,399 Speaker 2: years about the interpretations of his work and how translation 318 00:20:27,640 --> 00:20:30,600 Speaker 2: has affected it. For example, in a paper written in 319 00:20:30,640 --> 00:20:34,200 Speaker 2: nineteen ninety five by G. E. Barrios and R. Luke, 320 00:20:34,480 --> 00:20:36,879 Speaker 2: there is some discussion about the use of the French 321 00:20:36,920 --> 00:20:41,360 Speaker 2: word deliere, which has more complex and nuanced meaning than 322 00:20:41,359 --> 00:20:46,000 Speaker 2: its usual translation to delirium or delusion. The two writers 323 00:20:46,040 --> 00:20:48,640 Speaker 2: of that paper explain that the word is more inclusive 324 00:20:48,720 --> 00:20:50,720 Speaker 2: than that and can be used to describe a syndrome 325 00:20:50,760 --> 00:20:55,439 Speaker 2: with lots of different symptoms, not just delusions, and this 326 00:20:55,520 --> 00:20:59,639 Speaker 2: syndrome now has three distinct developmental stages recognized within it 327 00:21:00,680 --> 00:21:04,159 Speaker 2: in the work of some doctors. The germination stage is 328 00:21:04,280 --> 00:21:07,920 Speaker 2: characterized by depression and often a fear or worry about illness, 329 00:21:08,440 --> 00:21:11,520 Speaker 2: and in the second stage, called the blooming stage, patients 330 00:21:11,600 --> 00:21:15,320 Speaker 2: exhibit anxiety and negativism, and the delusions of death and 331 00:21:15,359 --> 00:21:18,959 Speaker 2: immortality appear. This is what most people are describing if 332 00:21:19,000 --> 00:21:21,040 Speaker 2: you ever read like a very quick blurb about what 333 00:21:21,119 --> 00:21:24,840 Speaker 2: Catard's is, and then the third chronic stage of catard 334 00:21:24,880 --> 00:21:30,680 Speaker 2: syndrome manifests in severe depression. Gotard's syndrome is not listed 335 00:21:30,800 --> 00:21:34,400 Speaker 2: in the Diagnostic and Statistical Manual of Mental Disorders or 336 00:21:34,480 --> 00:21:39,760 Speaker 2: in the International Classification of Diseases as an independent disorder. Instead, 337 00:21:39,840 --> 00:21:43,199 Speaker 2: it is listed as a nihilistic delusion, which is an 338 00:21:43,200 --> 00:21:48,520 Speaker 2: effective delusion within a depressive episode with psychotic features, and 339 00:21:48,560 --> 00:21:54,320 Speaker 2: Catard's syndrome can be treated with antidepressants, antipsychotics, and mood stabilizers, 340 00:21:55,000 --> 00:21:57,720 Speaker 2: either by themselves or in some combination, depending on the 341 00:21:57,760 --> 00:22:01,280 Speaker 2: tests that have been run in what the doctor and 342 00:22:01,480 --> 00:22:04,480 Speaker 2: patient determined to be the best course of action. Sometimes 343 00:22:04,960 --> 00:22:09,000 Speaker 2: the still controversial electroconvulsive therapy is also used. That is 344 00:22:09,080 --> 00:22:12,120 Speaker 2: very different than it used to be FYI. The greatest 345 00:22:12,240 --> 00:22:15,520 Speaker 2: risks in terms of the syndrome today when speaking about 346 00:22:15,560 --> 00:22:19,480 Speaker 2: potential mortality are starvation and patients that refuse to eat 347 00:22:19,800 --> 00:22:22,800 Speaker 2: or suicide. So patients undergoing treatment do you have to 348 00:22:22,800 --> 00:22:25,200 Speaker 2: be watched very carefully. But there is treatment and there 349 00:22:25,240 --> 00:22:27,600 Speaker 2: are many cases of people who come out of this 350 00:22:27,720 --> 00:22:32,520 Speaker 2: and treat it and no longer have it. So that's 351 00:22:32,520 --> 00:22:42,439 Speaker 2: Catard syndrome, which fascinates me. Yes, thanks so much for 352 00:22:42,560 --> 00:22:45,600 Speaker 2: joining us on this Saturday. Since this episode is out 353 00:22:45,600 --> 00:22:47,560 Speaker 2: of the archive, if you heard an email address or 354 00:22:47,600 --> 00:22:50,159 Speaker 2: a Facebook RL or something similar over the course of 355 00:22:50,160 --> 00:22:53,800 Speaker 2: the show, that could be obsolete now. Our current email 356 00:22:53,840 --> 00:22:59,200 Speaker 2: address is History Podcast at iHeartRadio dot com. You can 357 00:22:59,200 --> 00:23:01,639 Speaker 2: find us all over social media at missed in. 358 00:23:01,880 --> 00:23:05,600 Speaker 1: History, and you can subscribe to our show on Apple podcasts, 359 00:23:05,640 --> 00:23:09,200 Speaker 1: Google podcasts, the iHeartRadio app, and wherever else you listen 360 00:23:09,280 --> 00:23:14,399 Speaker 1: to podcasts. Stuff you missed in History Class is a 361 00:23:14,400 --> 00:23:18,800 Speaker 1: production of iHeartRadio. 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