1 00:00:01,200 --> 00:00:04,160 Speaker 1: Welcome to Stuff You Missed in History Class from how 2 00:00:04,200 --> 00:00:13,760 Speaker 1: Stuff Works dot com. Hello, and welcome to the podcast. 3 00:00:13,840 --> 00:00:18,880 Speaker 1: I'm Holly Frying and I'm Tracy B. Wilson, A Tracy. 4 00:00:19,440 --> 00:00:22,279 Speaker 1: We work on a podcast. We do. We also listen 5 00:00:22,320 --> 00:00:27,319 Speaker 1: to podcasts, sure do. And uh. One thing that's going 6 00:00:27,360 --> 00:00:31,400 Speaker 1: on this March is that podcasts in general are all 7 00:00:31,440 --> 00:00:34,800 Speaker 1: trying to get people interested in podcasting as a general thing. 8 00:00:35,040 --> 00:00:39,160 Speaker 1: So all this month we are asking you to tell 9 00:00:39,240 --> 00:00:42,040 Speaker 1: somebody that you love about a podcast you think they'll 10 00:00:42,040 --> 00:00:45,440 Speaker 1: love that doesn't have to be our podcast. Um, I 11 00:00:45,520 --> 00:00:47,879 Speaker 1: love my big podcast love right now is How to 12 00:00:47,920 --> 00:00:50,879 Speaker 1: Be Amazing with Michael ian Black. I have said it 13 00:00:50,920 --> 00:00:53,000 Speaker 1: amongst friends, I will say it here. I think he 14 00:00:53,120 --> 00:00:58,200 Speaker 1: has the best interviewer in any medium right now. Awesome, 15 00:00:58,400 --> 00:01:01,520 Speaker 1: He's amazing. And I'm sure that there is someone out 16 00:01:01,520 --> 00:01:03,800 Speaker 1: there that you know or love, like our your best friend, 17 00:01:03,880 --> 00:01:06,119 Speaker 1: or someone in your family that you think, oh, this 18 00:01:06,160 --> 00:01:08,959 Speaker 1: podcast would be perfect for them, something like how to 19 00:01:09,000 --> 00:01:12,880 Speaker 1: Be Amazing or some other podcast and recommend it. Uh 20 00:01:12,920 --> 00:01:16,080 Speaker 1: So go tell them about these things because everybody should 21 00:01:16,080 --> 00:01:18,959 Speaker 1: be listening to podcasts. It's a medium that has something 22 00:01:19,040 --> 00:01:22,119 Speaker 1: truly for everyone. And we want you to also share 23 00:01:22,560 --> 00:01:25,000 Speaker 1: with us in the world what you recommended to that 24 00:01:25,080 --> 00:01:28,399 Speaker 1: friend by posting on social media and using the hashtag 25 00:01:28,480 --> 00:01:31,320 Speaker 1: tripod which is t r y p o D. So 26 00:01:31,440 --> 00:01:34,080 Speaker 1: spread the word about some podcasts. Uh. It will only 27 00:01:34,120 --> 00:01:36,280 Speaker 1: make us all smarter and more interested in the world. 28 00:01:36,319 --> 00:01:38,880 Speaker 1: So thanks for that, and now we're gonna hop into 29 00:01:39,000 --> 00:01:42,360 Speaker 1: our topic for today, which is another question to Tracy. Tracy, 30 00:01:42,440 --> 00:01:45,280 Speaker 1: you have heard of Qatard's delusion or Guitard syndrome before, right, 31 00:01:46,480 --> 00:01:48,840 Speaker 1: and usually probably if you've seen it. It comes up 32 00:01:48,880 --> 00:01:52,640 Speaker 1: on frequently online on like lists of you know, world 33 00:01:52,880 --> 00:01:58,080 Speaker 1: strangest maladies or or you know, lists of of sort 34 00:01:58,080 --> 00:02:02,520 Speaker 1: of disturbing or un settling mental disorders. Because in those 35 00:02:02,600 --> 00:02:06,080 Speaker 1: lists it's usually just characterized as a patient believing themselves 36 00:02:06,160 --> 00:02:09,400 Speaker 1: to be deceased. It is sometimes called walking corpse syndrome 37 00:02:09,480 --> 00:02:11,880 Speaker 1: because of that, and while that can certainly be part 38 00:02:11,919 --> 00:02:14,200 Speaker 1: of it, it is a lot more complex than that, 39 00:02:14,280 --> 00:02:17,520 Speaker 1: so Catard syndrome is quite rare. It involves both a 40 00:02:17,560 --> 00:02:21,400 Speaker 1: negation delusion, so the individual feels a major change in 41 00:02:21,400 --> 00:02:24,880 Speaker 1: their body or they deny the existence of one or 42 00:02:24,960 --> 00:02:27,079 Speaker 1: several parts of their organs or bodies like they will 43 00:02:27,120 --> 00:02:30,040 Speaker 1: sometimes think that they no longer have this era, or 44 00:02:30,080 --> 00:02:33,960 Speaker 1: that their blood is gone, or some other variation on 45 00:02:34,000 --> 00:02:37,440 Speaker 1: that theme. And it also has a nehalistic delusion element, 46 00:02:37,600 --> 00:02:39,880 Speaker 1: so in that in that part of it, the individual 47 00:02:39,919 --> 00:02:42,400 Speaker 1: also believes that they are are all people are dead, 48 00:02:42,440 --> 00:02:45,360 Speaker 1: that they are somehow comporting themselves around the earth in 49 00:02:45,400 --> 00:02:49,640 Speaker 1: a state of non living nous. Uh. So it is 50 00:02:49,639 --> 00:02:53,359 Speaker 1: it's very complex. And additionally, the work of Jules Quatard 51 00:02:53,600 --> 00:02:56,040 Speaker 1: is much debated even today, and part of that is 52 00:02:56,080 --> 00:02:58,959 Speaker 1: because it was unfinished, which we're going to talk about. 53 00:02:59,440 --> 00:03:02,320 Speaker 1: So really, the story of this syndrome that's named for him, 54 00:03:02,360 --> 00:03:05,160 Speaker 1: in many ways is the story of psychiatry and how 55 00:03:05,240 --> 00:03:09,400 Speaker 1: ideas are challenged and then shift and change through interpretation 56 00:03:09,560 --> 00:03:13,040 Speaker 1: as well as accumulation of data through the passage of time. 57 00:03:13,080 --> 00:03:15,960 Speaker 1: So we're gonna talk about Jules Guitard his work in 58 00:03:15,960 --> 00:03:18,600 Speaker 1: this area, and then sort of how things played out 59 00:03:19,440 --> 00:03:23,519 Speaker 1: later on in terms of using his work to address 60 00:03:23,600 --> 00:03:29,480 Speaker 1: issues patients for having Jules Quatard was born on June one, 61 00:03:29,680 --> 00:03:33,800 Speaker 1: eight forty, in East Tudan in central France. As a 62 00:03:33,840 --> 00:03:36,920 Speaker 1: young man, he became a medical student in Paris, where 63 00:03:36,920 --> 00:03:41,240 Speaker 1: he studied under several prominent and trailblazing physicians of the day. 64 00:03:41,800 --> 00:03:45,280 Speaker 1: These included Pierre Paul Broca, who has a portion of 65 00:03:45,280 --> 00:03:48,280 Speaker 1: the frontal lobe in the brain named after him because 66 00:03:48,320 --> 00:03:52,120 Speaker 1: of his work studying that area and then also establishing 67 00:03:52,160 --> 00:03:55,720 Speaker 1: the concept of brain function being associated with specific areas. 68 00:03:56,720 --> 00:04:00,320 Speaker 1: There's also Alfred Vulpian who is credited with the dicovery 69 00:04:00,400 --> 00:04:04,280 Speaker 1: of adrenaline being made by the adrenal gland, and Jean 70 00:04:04,280 --> 00:04:08,440 Speaker 1: Martin Charkoal who's considered the father of modern neurology and 71 00:04:08,520 --> 00:04:12,160 Speaker 1: has more than a dozen medical conditions or discoveries named 72 00:04:12,200 --> 00:04:15,160 Speaker 1: for him and short as kind of an incredible time 73 00:04:15,240 --> 00:04:19,520 Speaker 1: to be studying medicine in Paris, it really was. There 74 00:04:19,600 --> 00:04:21,880 Speaker 1: was also a lot going on, of course in Vienna 75 00:04:21,920 --> 00:04:24,440 Speaker 1: and Germany at the time that Paris had some really 76 00:04:24,480 --> 00:04:29,120 Speaker 1: interesting neurological and psychiatric culture growing up around it, so 77 00:04:29,200 --> 00:04:32,800 Speaker 1: initially Qatard was on the same path as the neurologist 78 00:04:32,839 --> 00:04:36,360 Speaker 1: that he had been studying under. His first significant paper 79 00:04:36,800 --> 00:04:41,920 Speaker 1: was titled Physiological and Pathological Studies on Cerebral Softening, exploring 80 00:04:41,920 --> 00:04:45,960 Speaker 1: how inflammation and hemorrhaging damage his brain tissue, and then 81 00:04:46,000 --> 00:04:49,120 Speaker 1: his doctorate paper in eighteen sixty eight, was titled Study 82 00:04:49,160 --> 00:04:53,320 Speaker 1: on Partial Atrophy of the Brain. One event though, would 83 00:04:53,320 --> 00:04:57,680 Speaker 1: really significantly change the course of Cotard's career. He witnessed 84 00:04:57,720 --> 00:05:01,920 Speaker 1: the psychiatrist Charles Les Sig interviewing a patient and he 85 00:05:02,000 --> 00:05:06,400 Speaker 1: was enthralled. Based on watching this man at work, Uh 86 00:05:06,480 --> 00:05:10,359 Speaker 1: Coutard began to shift his focus away from neurology and 87 00:05:10,480 --> 00:05:15,080 Speaker 1: into psychiatry. The two men would eventually become colleagues, and 88 00:05:15,279 --> 00:05:18,479 Speaker 1: I feel like we should say that this was It 89 00:05:18,560 --> 00:05:21,359 Speaker 1: was not uncommon for people going into psychiatry at this 90 00:05:21,440 --> 00:05:23,680 Speaker 1: time to have started out in neurology. A lot of 91 00:05:23,680 --> 00:05:28,200 Speaker 1: people did. In eighteen seventy four, l Sega introduced Jews 92 00:05:28,279 --> 00:05:31,800 Speaker 1: Coutar to Jews Falcli, and the two jewels Is would 93 00:05:31,839 --> 00:05:34,760 Speaker 1: go on to become research partners, working side by side 94 00:05:34,760 --> 00:05:37,920 Speaker 1: in the Mazon de Sante that's the asylum at von 95 00:05:38,040 --> 00:05:42,640 Speaker 1: Zes in Paris, UH in the southwestern suburbs. And incidentally, 96 00:05:42,920 --> 00:05:47,680 Speaker 1: Fare's father actually owned that asylum. What Tired gave a 97 00:05:47,760 --> 00:05:54,240 Speaker 1: presentation to Paris's Medical Psychological Society on June eighty. He 98 00:05:54,279 --> 00:05:57,479 Speaker 1: read a case report he and fall I had assembled 99 00:05:57,560 --> 00:06:01,560 Speaker 1: titled of the Hypochondriact arium in a severe form of 100 00:06:01,600 --> 00:06:05,719 Speaker 1: anxious melancholy. In this case, the patient was a woman 101 00:06:05,760 --> 00:06:09,880 Speaker 1: who was forty three. She had a unique set of symptoms. 102 00:06:09,920 --> 00:06:11,880 Speaker 1: So this woman, who is referred to in the paper 103 00:06:11,920 --> 00:06:14,839 Speaker 1: as Madame X, thought that she was made of nothing 104 00:06:14,880 --> 00:06:18,160 Speaker 1: but skin and bone, and that she had no brain, nerves, 105 00:06:18,279 --> 00:06:22,080 Speaker 1: chest or entrols. Additionally, she had come to the conclusion 106 00:06:22,200 --> 00:06:24,840 Speaker 1: that God did not exist, nor did the devil, and 107 00:06:24,880 --> 00:06:28,360 Speaker 1: that she would live forever. She had made several attempts 108 00:06:28,360 --> 00:06:31,600 Speaker 1: on her own life and requested of her doctors and 109 00:06:31,680 --> 00:06:36,560 Speaker 1: others that she be burned alive. As Coutard presented, he 110 00:06:36,680 --> 00:06:39,279 Speaker 1: referenced similar cases that had been on the record going 111 00:06:39,320 --> 00:06:43,480 Speaker 1: as far back as twenty years. He specifically mentioned similar 112 00:06:43,520 --> 00:06:46,920 Speaker 1: cases handled by doctor Juel by Rs as some of 113 00:06:46,960 --> 00:06:50,200 Speaker 1: the oldest. These were considered part of a diagnosis of 114 00:06:50,279 --> 00:06:54,320 Speaker 1: general paralysis, and in this context the paralysis referred to 115 00:06:54,480 --> 00:06:57,920 Speaker 1: as a failure of the brain characterized by a loss 116 00:06:57,920 --> 00:07:01,880 Speaker 1: of inhibitions and the exhibition of delusional thinking. So not 117 00:07:02,000 --> 00:07:04,920 Speaker 1: a lack of physical movement or an inability to move 118 00:07:04,960 --> 00:07:07,520 Speaker 1: your body right. When we think of paralysis, that's usually 119 00:07:07,560 --> 00:07:09,479 Speaker 1: what comes to mind, but that's not the application of 120 00:07:09,480 --> 00:07:14,000 Speaker 1: the word here. So yeah, this these similar um cases 121 00:07:14,080 --> 00:07:17,280 Speaker 1: that had been studied two decades earlier had kind of 122 00:07:17,280 --> 00:07:20,520 Speaker 1: gotten lumped in as general paralysis, but Qatard felt like 123 00:07:20,560 --> 00:07:23,640 Speaker 1: there was something a little more specific about them, and 124 00:07:23,680 --> 00:07:26,320 Speaker 1: he thought that what his patient was exhibiting was actually 125 00:07:26,320 --> 00:07:29,520 Speaker 1: a form of what was at the time called lipomania 126 00:07:29,640 --> 00:07:34,800 Speaker 1: or lipomania, and that term eventually was supplanted by melancholy. Basically, 127 00:07:34,840 --> 00:07:39,160 Speaker 1: he thought he had identified a specific form of melancholia, 128 00:07:39,240 --> 00:07:42,800 Speaker 1: and this was, in his opinion, and anxious melancholia, with 129 00:07:42,880 --> 00:07:47,920 Speaker 1: delusions that could include religious misbeliefs of damnation or demon possession, 130 00:07:48,480 --> 00:07:50,800 Speaker 1: the perception that some or all of the body had 131 00:07:50,800 --> 00:07:56,880 Speaker 1: ceased to exist, inability to perceive physical pain, immortality delusions, 132 00:07:56,920 --> 00:08:02,880 Speaker 1: and suicidal behavior. Jules Cotard also drew possible connections and 133 00:08:02,920 --> 00:08:05,920 Speaker 1: this presentation from the symptoms he had observed in the 134 00:08:05,960 --> 00:08:11,000 Speaker 1: patient two similar historical events, including various cases of reported 135 00:08:11,160 --> 00:08:15,760 Speaker 1: demon obsession. He suggested that the idea of the wandering 136 00:08:15,880 --> 00:08:18,920 Speaker 1: Jew legend, which was a man who had taunted Christ 137 00:08:19,000 --> 00:08:21,679 Speaker 1: on the cross and then was doomed to wander earth 138 00:08:21,840 --> 00:08:24,840 Speaker 1: until the world ended, He thought that may have had 139 00:08:24,920 --> 00:08:28,280 Speaker 1: roots in the observation of a person with a similarly 140 00:08:28,400 --> 00:08:32,240 Speaker 1: delusional state. Yeah, he was kind of making this case 141 00:08:32,320 --> 00:08:34,520 Speaker 1: that it could be that that whole legend grew out 142 00:08:34,559 --> 00:08:37,800 Speaker 1: of someone speaking with a person who actually had this 143 00:08:37,920 --> 00:08:42,360 Speaker 1: delusion that he was trying to identify. And Guitar continued 144 00:08:42,400 --> 00:08:46,200 Speaker 1: to develop his research on this topic. In two he 145 00:08:46,280 --> 00:08:51,360 Speaker 1: expanded on it by introducing the term deligions and that's 146 00:08:51,480 --> 00:08:54,800 Speaker 1: neolistic delusions in an article that he published in the 147 00:08:54,880 --> 00:08:59,360 Speaker 1: Archives den Patients with such delusions, he said, had a 148 00:08:59,400 --> 00:09:03,920 Speaker 1: tendency to deny everything, leading in extreme cases to denial 149 00:09:04,000 --> 00:09:08,160 Speaker 1: of the self. He separated the delusions of negation clinically 150 00:09:08,320 --> 00:09:13,160 Speaker 1: from delusions of persecution. In that article, he characterized persecution 151 00:09:13,200 --> 00:09:18,880 Speaker 1: delusions as exhibiting mistrust, paranoia of poisoning, delusions of grandeur, 152 00:09:19,160 --> 00:09:25,040 Speaker 1: and acoustic verbal hallucinations that would sometimes be homicidal. In contrast, 153 00:09:25,080 --> 00:09:30,440 Speaker 1: he listed anxious monologue, deep melancholic depression, refusal to eat, 154 00:09:30,960 --> 00:09:35,920 Speaker 1: visual hallucinations, and suicidal behavior as characteristics of the delusion 155 00:09:36,040 --> 00:09:41,920 Speaker 1: of negation. Four years after Qatar's initial presentation on the 156 00:09:41,960 --> 00:09:45,280 Speaker 1: symptoms of madam X, he wrote about another patient, this 157 00:09:45,320 --> 00:09:47,440 Speaker 1: one an adult man who said that he could no 158 00:09:47,520 --> 00:09:52,240 Speaker 1: longer see his children's features. In eighty four, Qatar, still 159 00:09:52,240 --> 00:09:54,680 Speaker 1: trying to build up a unified theory of what he 160 00:09:54,760 --> 00:09:58,360 Speaker 1: believed to be related symptoms, came to the conclusion that 161 00:09:58,400 --> 00:10:01,000 Speaker 1: this was a loss of mental vision, and that this 162 00:10:01,080 --> 00:10:04,120 Speaker 1: was actually the root of the problem. When patients exhibited 163 00:10:04,200 --> 00:10:09,040 Speaker 1: nehalistic delusions, the mind, in his estimation, was simply unable 164 00:10:09,120 --> 00:10:13,559 Speaker 1: to process visual representation of objects. He would later refine 165 00:10:13,600 --> 00:10:16,240 Speaker 1: this concept by describing the problem as a loss of 166 00:10:16,320 --> 00:10:21,160 Speaker 1: quote psychomotor energy, causing the patient to lose visual representation 167 00:10:21,440 --> 00:10:26,720 Speaker 1: and to experience psychomotor impairment. It's entirely likely that Cotard 168 00:10:26,760 --> 00:10:29,760 Speaker 1: would have continued to refine his work on the topic 169 00:10:29,840 --> 00:10:33,719 Speaker 1: had he not met an untimely end. In eighteen eighty nine, 170 00:10:33,800 --> 00:10:37,400 Speaker 1: at just forty nine years old, he contracted He contracted diphtheria, 171 00:10:37,520 --> 00:10:40,280 Speaker 1: which he caught from his daughter. He never recovered, and 172 00:10:40,320 --> 00:10:43,760 Speaker 1: he died on our August nineteen of that year. At 173 00:10:43,800 --> 00:10:47,520 Speaker 1: his funeral, his partner for I spoke calling him quote 174 00:10:47,520 --> 00:10:51,600 Speaker 1: a profound and original thinker, given to paradox but guided 175 00:10:51,600 --> 00:10:55,880 Speaker 1: by a robust sense of reality. And next up, we're 176 00:10:55,920 --> 00:10:59,880 Speaker 1: gonna talk about what the rest of Paris's psychiatric community 177 00:11:00,040 --> 00:11:02,640 Speaker 1: did with Qatard's work after his death. But first we're 178 00:11:02,640 --> 00:11:04,360 Speaker 1: going to pause and have a word from one of 179 00:11:04,360 --> 00:11:15,480 Speaker 1: our sponsors. Almost immediately after Jules Quatard's death, debate began 180 00:11:15,520 --> 00:11:17,720 Speaker 1: about his work and where he had been headed with 181 00:11:17,760 --> 00:11:21,240 Speaker 1: it and what his intentions actually were. One of the 182 00:11:21,280 --> 00:11:24,480 Speaker 1: ongoing themes of Qatard's work was this struggle to develop 183 00:11:24,559 --> 00:11:28,480 Speaker 1: terminology for psychiatric ailments, and he had also championed this 184 00:11:28,559 --> 00:11:33,200 Speaker 1: idea of using symptomatic classification for psychiatry. So, of course, 185 00:11:33,320 --> 00:11:36,280 Speaker 1: with his work in this state of arrested development, I 186 00:11:36,280 --> 00:11:38,679 Speaker 1: mean he had been writing updates to his ideas just 187 00:11:38,840 --> 00:11:41,680 Speaker 1: days before his death, there was a lot of room 188 00:11:41,800 --> 00:11:46,080 Speaker 1: for interpretation. While some of his contemporaries thought he had 189 00:11:46,080 --> 00:11:50,160 Speaker 1: been cataloging an entirely new disease, others thought his work 190 00:11:50,200 --> 00:11:54,079 Speaker 1: had always been focused on exploring a severe and specific 191 00:11:54,160 --> 00:11:58,920 Speaker 1: form of melancholia. Others thought that he merely sought to 192 00:11:59,040 --> 00:12:02,920 Speaker 1: catalog and described a symptom cluster that could be found 193 00:12:02,920 --> 00:12:07,480 Speaker 1: in other diseases in addition to melancholia. In August of 194 00:12:07,520 --> 00:12:11,280 Speaker 1: eight two, the issue was hotly debated at the Mental 195 00:12:11,320 --> 00:12:16,600 Speaker 1: Medicine Congress in Bois France, Coutard's partner Falclay, advocated for 196 00:12:16,640 --> 00:12:19,600 Speaker 1: the idea that his friend had identified a new disease, 197 00:12:20,200 --> 00:12:22,160 Speaker 1: and to argue his case, he claimed that there was 198 00:12:22,200 --> 00:12:26,400 Speaker 1: an essential form of Qutard's delio de negusion which stood 199 00:12:26,400 --> 00:12:29,320 Speaker 1: on its own and also in a secondary form of 200 00:12:29,360 --> 00:12:32,920 Speaker 1: it that could be part of other melancholia and even 201 00:12:32,960 --> 00:12:38,360 Speaker 1: non melancolia disorders. Others and attendants argued that the specific 202 00:12:38,480 --> 00:12:42,200 Speaker 1: cluster that Fare was advocating as part of Coltard's newly 203 00:12:42,400 --> 00:12:47,600 Speaker 1: identified disorder included elements that were so rare, specifically those 204 00:12:47,640 --> 00:12:51,920 Speaker 1: relating to religion based concepts of demonic possession, damnation, and 205 00:12:51,960 --> 00:12:55,560 Speaker 1: eternal life, but there was no validity to calling it 206 00:12:55,559 --> 00:12:59,520 Speaker 1: its own singular syndrome. To support this view, was pointed 207 00:12:59,520 --> 00:13:02,760 Speaker 1: out the verse really, all patients with melancholia had a 208 00:13:02,760 --> 00:13:06,760 Speaker 1: tendency toward negation and guilt, so the cases in Cotard's 209 00:13:06,800 --> 00:13:13,480 Speaker 1: writings were just extreme examples of this. Additional arguments against 210 00:13:13,520 --> 00:13:17,840 Speaker 1: this being a standalone disorder or disease identification included claims 211 00:13:17,840 --> 00:13:21,640 Speaker 1: that Qatard was merely listing a random assortment of symptoms 212 00:13:21,640 --> 00:13:24,600 Speaker 1: that could be found in any number of mental disorders, 213 00:13:24,640 --> 00:13:28,679 Speaker 1: so grouping them together was essentially meaningless aside from anyone's 214 00:13:28,679 --> 00:13:32,320 Speaker 1: specific patient having them. Cases were also brought into the 215 00:13:32,320 --> 00:13:36,199 Speaker 1: discussion to illustrate the rather common occurrence of nehalistic delusions 216 00:13:36,280 --> 00:13:40,760 Speaker 1: in cases of chronic melancholia. While the Mental Health Congress 217 00:13:40,840 --> 00:13:44,480 Speaker 1: came to no clear conclusion as to whether Cotard's work 218 00:13:44,600 --> 00:13:49,120 Speaker 1: was describing a specific syndrome or common elements of multiple 219 00:13:49,160 --> 00:13:52,640 Speaker 1: mental disorders, there was some agreement on how to define 220 00:13:53,120 --> 00:13:56,800 Speaker 1: realistic delusion syndrome, and that was that it included two 221 00:13:57,040 --> 00:14:04,040 Speaker 1: specific elements, anxious melancholia and systematized ideas of negation. So 222 00:14:04,200 --> 00:14:08,120 Speaker 1: as an assign to clarify what that means, uh systematized 223 00:14:08,160 --> 00:14:12,640 Speaker 1: delusion indicates that a patient has developed a consistent, complex 224 00:14:12,679 --> 00:14:16,600 Speaker 1: system of beliefs associated with their condition, which often fit 225 00:14:16,679 --> 00:14:20,160 Speaker 1: together perfectly in a really elaborate narrative. So, for example, 226 00:14:20,200 --> 00:14:22,160 Speaker 1: if you think that you died in an accident where 227 00:14:22,200 --> 00:14:26,080 Speaker 1: you did not die, all of the strange things that 228 00:14:26,160 --> 00:14:28,600 Speaker 1: may happen to you you will put together into a 229 00:14:28,600 --> 00:14:32,320 Speaker 1: puzzle to support that conclusion, like I'm clearly dead. That 230 00:14:32,400 --> 00:14:34,760 Speaker 1: is why that person never calls me back. It's because 231 00:14:34,760 --> 00:14:36,800 Speaker 1: I'm dead and they're not getting my call. That's a 232 00:14:36,880 --> 00:14:40,080 Speaker 1: very simplified and and basic way, and I'm sure any 233 00:14:40,160 --> 00:14:43,600 Speaker 1: doctor would be like hallad no. But that's just to 234 00:14:43,640 --> 00:14:45,880 Speaker 1: kind of give you an idea of what this systematized 235 00:14:46,280 --> 00:14:51,080 Speaker 1: aspect of it means. One year after that Congress and 236 00:14:51,240 --> 00:14:55,560 Speaker 1: four years after Cotard's death, the term Cotard syndrome was 237 00:14:55,600 --> 00:15:00,680 Speaker 1: first introduced. That was a by Emil Resis name the 238 00:15:00,800 --> 00:15:05,360 Speaker 1: depressive disorder that Coutard had studied and described that then 239 00:15:05,440 --> 00:15:09,360 Speaker 1: became cemented in the lexicon through its use by another 240 00:15:09,560 --> 00:15:15,280 Speaker 1: of Coutard's contemporaries, who was psychiatrist Jules Sigla. Although there 241 00:15:15,280 --> 00:15:19,560 Speaker 1: were some differences in how Sigla and Coutard viewed this condition. 242 00:15:20,120 --> 00:15:23,320 Speaker 1: While many believed that Cotard's work had led him to 243 00:15:23,360 --> 00:15:28,000 Speaker 1: the conclusion that neilistic delusion was a separate and unique condition, 244 00:15:28,880 --> 00:15:32,120 Speaker 1: Segla felt that it was an expression of an extreme 245 00:15:32,320 --> 00:15:37,440 Speaker 1: state of anxious melancholia. So the case in which Sigla 246 00:15:37,640 --> 00:15:40,600 Speaker 1: first used the term Qatar's syndrome to describe a patient 247 00:15:41,080 --> 00:15:44,320 Speaker 1: featured a man who, much like Coutard's patient, Madam X, 248 00:15:44,480 --> 00:15:48,920 Speaker 1: believed himself to be immortal, damned, and without his internal Organs, 249 00:15:50,040 --> 00:15:53,440 Speaker 1: and despite his different view of whether the syndrome was 250 00:15:53,840 --> 00:15:56,960 Speaker 1: a unique disorder or a way to identify extreme cases, 251 00:15:57,480 --> 00:16:01,640 Speaker 1: Sigla's diagnosis of a patient as having Gutarge syndrome really 252 00:16:01,680 --> 00:16:06,120 Speaker 1: popularized the terms usage. With the dawn of the twentieth 253 00:16:06,200 --> 00:16:09,400 Speaker 1: century came many changes in the way mental health was 254 00:16:09,480 --> 00:16:13,400 Speaker 1: discussed and treated, and Coutard's work had to be examined 255 00:16:13,480 --> 00:16:16,480 Speaker 1: in new ways as a consequence. So first you probably 256 00:16:16,520 --> 00:16:19,360 Speaker 1: noted that leading up to this point we exclusively used 257 00:16:19,360 --> 00:16:24,400 Speaker 1: the term melancholia. That's because depression and manic depressive illness 258 00:16:24,600 --> 00:16:28,040 Speaker 1: as diagnostic terms didn't exist until the twentieth century, and 259 00:16:28,040 --> 00:16:31,640 Speaker 1: those have continued to be refined. Now people generally say 260 00:16:31,680 --> 00:16:37,120 Speaker 1: bipolar disorder and not manic depressive illness. Once they were introduced, though, 261 00:16:37,160 --> 00:16:40,760 Speaker 1: these terms really impacted a lot of disorders and illnesses, 262 00:16:40,800 --> 00:16:45,520 Speaker 1: including Coutard syndrome. So in the early nineteen hundreds, Cotard 263 00:16:45,600 --> 00:16:48,840 Speaker 1: syndrome was invoked as a symptomatic analysis of patients who 264 00:16:48,880 --> 00:16:53,520 Speaker 1: were being treated for general paralysis and senile dementia, as 265 00:16:53,960 --> 00:16:56,000 Speaker 1: it had been towards the end of the nineteenth century 266 00:16:56,120 --> 00:16:58,240 Speaker 1: been used in both of those, but now it was 267 00:16:58,320 --> 00:17:01,720 Speaker 1: also associated with the newer terms depression and at that 268 00:17:01,760 --> 00:17:06,199 Speaker 1: point manic depressive illness. And so this wider range of 269 00:17:06,320 --> 00:17:09,639 Speaker 1: use also came with the development of a subdivision of 270 00:17:09,680 --> 00:17:13,480 Speaker 1: the syndrome by some doctors into two types, the melancholic 271 00:17:13,560 --> 00:17:17,680 Speaker 1: type of Catard syndrome and the hypochondriacal type of Catard syndrome. 272 00:17:18,720 --> 00:17:21,960 Speaker 1: The melancholic type was considered secondary and a patient with 273 00:17:22,040 --> 00:17:25,679 Speaker 1: effective disorder. It's a mood disorder such as depression by 274 00:17:25,720 --> 00:17:30,720 Speaker 1: polar disorder or anxiety disorder, characterized by nihilistic delusions and 275 00:17:30,760 --> 00:17:36,240 Speaker 1: the patient's subjectivity. The hypochondriacal type was considered a primary 276 00:17:36,280 --> 00:17:40,240 Speaker 1: manifestation of the syndrome, where the patient's symptoms were focused 277 00:17:40,280 --> 00:17:44,040 Speaker 1: around incorrect and paranoid feelings about that body, like that 278 00:17:44,080 --> 00:17:47,080 Speaker 1: it was missing viscera or that it was no longer alive. 279 00:17:48,280 --> 00:17:51,000 Speaker 1: And again we should make clear that this was not 280 00:17:51,040 --> 00:17:55,480 Speaker 1: a universally accepted approach to to dividing this UH. In 281 00:17:55,600 --> 00:17:59,600 Speaker 1: nineteen oh four, Leonardo Bianchi and James hog McDonald wrote 282 00:17:59,640 --> 00:18:03,600 Speaker 1: a tech Book of Psychiatry for physicians and students, and 283 00:18:03,640 --> 00:18:06,960 Speaker 1: in it they wrote, quote Qatard and others have assigned 284 00:18:07,040 --> 00:18:10,800 Speaker 1: undue importance to the delirium of negation, attributing to its 285 00:18:10,800 --> 00:18:14,320 Speaker 1: certain clinical characters, many of which, as a matter of fact, 286 00:18:14,359 --> 00:18:17,679 Speaker 1: are common to the majority of cases of depressive delirium, 287 00:18:18,080 --> 00:18:21,919 Speaker 1: such as self accusation and hypochondria, of which it represents 288 00:18:21,960 --> 00:18:25,880 Speaker 1: a more advanced stage of evolution. It was just as 289 00:18:25,880 --> 00:18:28,200 Speaker 1: a decade earlier, a time when some of the medical 290 00:18:28,240 --> 00:18:31,920 Speaker 1: mental health community believed that Qatard had wrongly associated a 291 00:18:31,920 --> 00:18:36,680 Speaker 1: series of fairly common symptoms into one unique cluster. Another 292 00:18:36,840 --> 00:18:40,480 Speaker 1: idea developed during this period was a way to identify 293 00:18:40,920 --> 00:18:46,480 Speaker 1: analyistic delusions as true Guitard syndrome. This particular approach required 294 00:18:46,480 --> 00:18:50,240 Speaker 1: that a patient exhibit a combination of an effective or 295 00:18:50,320 --> 00:18:55,280 Speaker 1: mood component like anxiety, and an intellectual component, which is 296 00:18:55,320 --> 00:18:59,960 Speaker 1: the idea of negation. This approach meant that these delusions 297 00:19:00,080 --> 00:19:03,640 Speaker 1: could be recognized and acknowledged in a variety of scenarios 298 00:19:03,680 --> 00:19:07,359 Speaker 1: without the identification of Qatard syndrome, And to make things 299 00:19:07,400 --> 00:19:11,520 Speaker 1: even more nebulous, some positions also suggested breaking down the 300 00:19:11,560 --> 00:19:16,080 Speaker 1: syndrome into complete and incomplete versions based on variations in 301 00:19:16,160 --> 00:19:20,840 Speaker 1: the patient's symptoms. This is one of those things where 302 00:19:20,880 --> 00:19:22,840 Speaker 1: the more I read, the more I was like how 303 00:19:23,040 --> 00:19:29,120 Speaker 1: do any doctors or clinicians ever agree on anything, because 304 00:19:29,400 --> 00:19:31,919 Speaker 1: because it is so hotly debated, and I know this 305 00:19:31,960 --> 00:19:35,920 Speaker 1: isn't just unique to Catard syndrome. Yet others suggested that 306 00:19:35,960 --> 00:19:40,320 Speaker 1: Catard syndrome is really a result of institutionalization, and in fact, 307 00:19:40,359 --> 00:19:43,480 Speaker 1: that first patient that Qatard described back in eighty was 308 00:19:43,560 --> 00:19:46,280 Speaker 1: a woman who had been confined at the Van Vis 309 00:19:46,320 --> 00:19:49,840 Speaker 1: Asylum for a number of years. So to wrap things up, 310 00:19:49,880 --> 00:19:52,560 Speaker 1: we're going to talk a bit about the discussion and 311 00:19:52,720 --> 00:19:56,160 Speaker 1: handling of Quatard syndrome after World War Two. But first 312 00:19:56,200 --> 00:19:58,680 Speaker 1: we're gonna take one last quick break for a word 313 00:19:58,760 --> 00:20:07,760 Speaker 1: from a sponsor. During World War two, Paris was of 314 00:20:07,760 --> 00:20:11,000 Speaker 1: course occupied by the Nazis, and so work on psychiatry 315 00:20:11,080 --> 00:20:14,800 Speaker 1: they're certainly slowed. But after the war, Catard's work was 316 00:20:14,880 --> 00:20:18,480 Speaker 1: once again examined, and in some ways history repeated itself, 317 00:20:18,520 --> 00:20:22,400 Speaker 1: as various clinicians offered their interpretations based on their work 318 00:20:22,440 --> 00:20:26,359 Speaker 1: with patients that had similar or related symptoms. In the 319 00:20:26,400 --> 00:20:31,919 Speaker 1: book Uncommon Psychiatric Syndromes, writers Morgan Enoch and William Trethowen wrote, 320 00:20:32,119 --> 00:20:36,520 Speaker 1: it is quote justifiable to regard Cotard's syndrome as a 321 00:20:36,600 --> 00:20:40,000 Speaker 1: specific clinical entity, because it may exist in a pure 322 00:20:40,040 --> 00:20:44,240 Speaker 1: and complete form even when symptomatic of another mental illness. 323 00:20:44,680 --> 00:20:50,240 Speaker 1: Analyistic delusions dominate the clinical picture and today, of course, 324 00:20:50,600 --> 00:20:54,359 Speaker 1: classification of mental disorders continues to be debated, and in 325 00:20:54,400 --> 00:20:57,360 Speaker 1: the eighties many of the concepts that were being introduced 326 00:20:57,400 --> 00:20:59,960 Speaker 1: were in their infancy, so things were constantly in flux. 327 00:21:00,680 --> 00:21:04,159 Speaker 1: There was ongoing debate about what various disorders should be called, 328 00:21:04,240 --> 00:21:06,800 Speaker 1: and even how to arrange the known disorders into a 329 00:21:06,880 --> 00:21:11,800 Speaker 1: larger classification system. Because the very juvenile stage of many 330 00:21:11,800 --> 00:21:14,679 Speaker 1: of the concepts that Gatard was writing about, and the 331 00:21:14,720 --> 00:21:17,239 Speaker 1: fact that he was writing in French, there have been 332 00:21:17,280 --> 00:21:20,480 Speaker 1: additional debates through the years about the interpretations of his 333 00:21:20,560 --> 00:21:24,439 Speaker 1: work and how translation has affected it. For example, in 334 00:21:24,480 --> 00:21:28,880 Speaker 1: a paper written in by G. E. Barrios and R. Luke, 335 00:21:29,240 --> 00:21:31,600 Speaker 1: there is some discussion about the use of the French 336 00:21:31,640 --> 00:21:36,080 Speaker 1: word dellier, which has more complex and nuanced meaning than 337 00:21:36,119 --> 00:21:40,760 Speaker 1: it's usual translation to delirium or delusion. The two writers 338 00:21:40,760 --> 00:21:43,400 Speaker 1: of that paper explain that the word is more inclusive 339 00:21:43,440 --> 00:21:45,440 Speaker 1: than that and can be used to describe a syndrome 340 00:21:45,480 --> 00:21:50,159 Speaker 1: with lots of different symptoms, not just delusions, and this 341 00:21:50,240 --> 00:21:54,359 Speaker 1: syndrome now has three distinct developmental stages recognized within it 342 00:21:54,800 --> 00:21:58,240 Speaker 1: UH In the work of some doctors, the German Nation 343 00:21:58,359 --> 00:22:01,520 Speaker 1: stage is characterized by depression and often a fear or 344 00:22:01,560 --> 00:22:04,679 Speaker 1: worry about illness. And in the second stage, called the 345 00:22:04,680 --> 00:22:09,520 Speaker 1: Blooming stage, patients exhibit anxiety and negativism and the delusions 346 00:22:09,560 --> 00:22:12,760 Speaker 1: of death and immortality appear. This is what most people 347 00:22:12,800 --> 00:22:15,000 Speaker 1: are describing if you ever read like a very quick 348 00:22:15,040 --> 00:22:18,280 Speaker 1: blurb about what Gutard's is UH, and then the third 349 00:22:18,359 --> 00:22:23,720 Speaker 1: chronic stage of Quatard syndrome manifests in severe depression. Gutard's 350 00:22:23,760 --> 00:22:27,720 Speaker 1: syndrome is not listed in the Diagnostic and Statistical Manual 351 00:22:27,760 --> 00:22:31,560 Speaker 1: of Mental Disorders or in the International Classification of Diseases 352 00:22:31,680 --> 00:22:35,840 Speaker 1: as an independent disorder. Instead, it is listed as a 353 00:22:35,920 --> 00:22:40,080 Speaker 1: nihilistic delusion, which is an effective delusion within an oppressive 354 00:22:40,080 --> 00:22:45,080 Speaker 1: episode with psychotic features and Guitards. Syndrome can be treated 355 00:22:45,520 --> 00:22:50,800 Speaker 1: with antidepressants, antipsychotics, and mood stabilizers, either by themselves or 356 00:22:50,840 --> 00:22:53,119 Speaker 1: in some combination, depending on the tests that have been 357 00:22:53,200 --> 00:22:57,080 Speaker 1: run and what the doctor and and patient determined to 358 00:22:57,119 --> 00:23:00,240 Speaker 1: be the best course of action. Sometimes UH these still 359 00:23:00,240 --> 00:23:03,959 Speaker 1: controversial electro convulsive therapy is also used. That is very 360 00:23:03,960 --> 00:23:06,200 Speaker 1: different than it used to be. F y. I. Uh. 361 00:23:06,280 --> 00:23:09,640 Speaker 1: The greatest risks in terms of the syndrome today when 362 00:23:09,680 --> 00:23:13,639 Speaker 1: speaking about potential mortality are starvation and patients that refuse 363 00:23:13,720 --> 00:23:17,280 Speaker 1: to eat or suicide. So patients undergoing treatment do you 364 00:23:17,280 --> 00:23:19,480 Speaker 1: have to be watched very carefully. But there is treatment 365 00:23:19,680 --> 00:23:22,080 Speaker 1: and there are many cases of people who come out 366 00:23:22,080 --> 00:23:25,679 Speaker 1: of this and uh treat it and no longer have it. 367 00:23:25,760 --> 00:23:30,840 Speaker 1: So that's guitar syndrome, which fascinates me. Yeah. Do you 368 00:23:30,840 --> 00:23:33,520 Speaker 1: also have some listener mail? I do, and it's not 369 00:23:33,600 --> 00:23:38,440 Speaker 1: about psychiatric weirdness at all. Um. This is from our 370 00:23:38,480 --> 00:23:42,080 Speaker 1: listener whose name is genevra I. Hope I am pronouncing 371 00:23:42,160 --> 00:23:44,760 Speaker 1: that correctly. She says, Hi, guys, I love your show. 372 00:23:44,840 --> 00:23:47,560 Speaker 1: I'm an illustrator and love listening to it when I'm working. 373 00:23:47,920 --> 00:23:51,520 Speaker 1: I made a hardcore Heroines of History Cards series last year, 374 00:23:51,800 --> 00:23:53,199 Speaker 1: and a few of the women I had heard of 375 00:23:53,240 --> 00:23:55,600 Speaker 1: because of your show and the others I found through research. 376 00:23:56,080 --> 00:23:58,840 Speaker 1: I recently saw that you did an episode on Edmonia Lewis, 377 00:23:58,880 --> 00:24:00,960 Speaker 1: and I was so excited since I found her last 378 00:24:01,000 --> 00:24:03,119 Speaker 1: year and was blown away by what she accomplished in 379 00:24:03,160 --> 00:24:07,040 Speaker 1: her lifetime. Also, here is the archaeology badger that came 380 00:24:07,080 --> 00:24:09,560 Speaker 1: to mind from the Unearthed episode. I laughed so hard 381 00:24:09,640 --> 00:24:12,520 Speaker 1: and loved your tagline. At any rate, here's a pack 382 00:24:12,560 --> 00:24:15,960 Speaker 1: of cards for fun. I've included my artist animal pun 383 00:24:16,040 --> 00:24:18,359 Speaker 1: series since I know cats and are are also a 384 00:24:18,440 --> 00:24:23,080 Speaker 1: love of uh one of yours. Thanks for being superstellar, Geneva. 385 00:24:23,240 --> 00:24:25,920 Speaker 1: And she also writes, PS, this is my first fan 386 00:24:26,000 --> 00:24:28,840 Speaker 1: mail I've ever sent. Of course, a history podcast moved 387 00:24:28,840 --> 00:24:31,400 Speaker 1: me to embarrass myself. I love it and I love 388 00:24:31,480 --> 00:24:34,680 Speaker 1: the shows. These are the cutest things. So now I 389 00:24:34,720 --> 00:24:37,720 Speaker 1: will describe these adorable cards which she has sent, and 390 00:24:37,720 --> 00:24:40,040 Speaker 1: I'll have to take pictures and share them. So one 391 00:24:40,320 --> 00:24:43,520 Speaker 1: is a hardcore history of heroines, no hardcore heroines of 392 00:24:43,600 --> 00:24:46,080 Speaker 1: history that you've probably never heard of. And basically she 393 00:24:46,160 --> 00:24:50,080 Speaker 1: has incorporated animals into these portraits. So for example, there 394 00:24:50,160 --> 00:24:53,359 Speaker 1: is um Caroline Herschel that we did an episode on 395 00:24:54,359 --> 00:24:57,879 Speaker 1: as a bird, and she's lovely. Uh sojourn her truth 396 00:24:59,040 --> 00:25:02,600 Speaker 1: uh is I think that is a ferret, but I'm 397 00:25:02,600 --> 00:25:05,680 Speaker 1: not a certain. They're all very, very adorable and this 398 00:25:05,720 --> 00:25:08,440 Speaker 1: new pack, which includes artists, has some of the best 399 00:25:08,520 --> 00:25:13,800 Speaker 1: things ever including Marcel du Chimp, Mark Chagal, Leonardo duck Vinci, 400 00:25:13,840 --> 00:25:17,680 Speaker 1: and Beatrix Otter. UH have to take picture of the 401 00:25:17,720 --> 00:25:20,439 Speaker 1: pictures of these and share them because they are so cute. 402 00:25:20,720 --> 00:25:23,320 Speaker 1: So thank you, thank you, thank you. Shanever, these are 403 00:25:23,440 --> 00:25:25,840 Speaker 1: just the most darling things I have maybe ever seen. 404 00:25:25,920 --> 00:25:28,480 Speaker 1: I love them. UH. If you would like to write 405 00:25:28,480 --> 00:25:31,320 Speaker 1: to us, you can do so at History Podcast at 406 00:25:31,320 --> 00:25:33,840 Speaker 1: house to works dot com. You can find us across 407 00:25:33,920 --> 00:25:37,040 Speaker 1: the spectrum of social media as missed in History. That 408 00:25:37,080 --> 00:25:39,480 Speaker 1: means we're on Twitter, is at missed in History at 409 00:25:39,480 --> 00:25:42,800 Speaker 1: Facebook dot com, slash missed in history, on Instagram, as 410 00:25:42,840 --> 00:25:46,240 Speaker 1: at misst in history, at mist in history dot tumbler 411 00:25:46,280 --> 00:25:49,320 Speaker 1: dot com, and at pinterest dot com slash mist in history. 412 00:25:49,560 --> 00:25:52,240 Speaker 1: If you would like to research a little bit on 413 00:25:52,280 --> 00:25:53,679 Speaker 1: your own, you can go to our parents site, how 414 00:25:53,720 --> 00:25:56,920 Speaker 1: stuff Works. You could type in uh psychiatry and find 415 00:25:56,960 --> 00:25:59,840 Speaker 1: a wealth of information an interesting articles to keep you occupied. 416 00:26:00,240 --> 00:26:02,359 Speaker 1: You can also visit me and Tracy at missed in 417 00:26:02,520 --> 00:26:04,600 Speaker 1: history dot com, where we have every episode of the 418 00:26:04,600 --> 00:26:07,240 Speaker 1: show that has ever existed, as well as show notes 419 00:26:07,280 --> 00:26:09,159 Speaker 1: for every episode that Tracy and I have worked on 420 00:26:09,240 --> 00:26:12,399 Speaker 1: together in the last four years. UH. So we encourage 421 00:26:12,480 --> 00:26:14,600 Speaker 1: you come and visit us at missed in history dot 422 00:26:14,640 --> 00:26:21,879 Speaker 1: com and houses dot com for more on this and 423 00:26:21,960 --> 00:26:24,439 Speaker 1: thousands of other topics. Is It How Stuff Works dot 424 00:26:24,520 --> 00:26:37,040 Speaker 1: com