Speaker 1: Welcome to Stuff to Blow your Mind from housetop work
Speaker 1: dot com. What seems to be the problem. Well, so
Speaker 1: the thing is, dr I am dead? Mm hmm, you're dead?
Speaker 1: Well can you explain I'm I'm dead. My organs have
Speaker 1: stopped working, They've ceased to function, my heart, my intestines,
Speaker 1: my brain. That you're speaking to me right now, well,
Speaker 1: I agree, I don't know how to explain that. I
Speaker 1: guess I should be quiet, but I need to be
Speaker 1: put in a grave. I'm registering a heartbeat, a pulse.
Speaker 1: You're certainly breathing now. I think you're just getting the
Speaker 1: sound of air moving through the empty skin, empty, I guess,
Speaker 1: except for the bones. Everything else feels like it's gone.
Speaker 1: It's rotten, melted away. Well, if this were the case,
Speaker 1: you wouldn't be able to think, or reason or or
Speaker 1: even travel to my office and tell me these things.
Speaker 1: Something isn't letting me die. Something not God, I mean,
Speaker 1: not not God, but something. Anyway, doctor, I need you
Speaker 1: to destroy my body, if that's possible. Hey, welcome to
Speaker 1: stuff to blow your mind. My name is Robert Lamb
Speaker 1: and my name is Joe McCormick. And that is an
Speaker 1: odd scenario that most doctors probably would never find themselves in.
Speaker 1: But it is actually not not just a fictional contrivance.
Speaker 1: There have been scenarios where a doctor has had someone
Speaker 1: show up at their office claiming not that they're dying,
Speaker 1: but that they are dead. Yes, yeah, and it would
Speaker 1: I mean, it would be comedic if the examples of it,
Speaker 1: the actual case studies, weren't so depressing and heartbreaking. And
Speaker 1: then the condition itself we're not so real. Yeah. Um,
Speaker 1: so this is going to be the subject of today's episode.
Speaker 1: What it looks, What it's like to experience being dead
Speaker 1: while still being alive. Yes, it is sometimes referred to
Speaker 1: as Quatard's syndrome, also Qutard's delusion, and I think delusion
Speaker 1: is more accurate based on the commentaries we've been reading
Speaker 1: the idea that this is not a a specific affliction
Speaker 1: so much as kind of an array of symptoms that
Speaker 1: emerges from a few different conditions that can occur neurologically.
Speaker 1: So let's go back into history where do we first
Speaker 1: see this emerging? That the concept of someone who presents
Speaker 1: to a doctor claiming to be dead yet from the
Speaker 1: outside there obviously alive. Well, it's an interesting question, and
Speaker 1: and some of the individuals who have tackled it have
Speaker 1: certainly pointed to examples in myth and legend and saying, well,
Speaker 1: this could possibly explain these scenarios. Um. However, it seems
Speaker 1: to be that the earliest case of Qatar's delusion, even
Speaker 1: though it was not known as Guitar's delusion yet, possibly
Speaker 1: goes back to seventy sev UM. And this is when
Speaker 1: Geneva naturalist and philosophical writer Charles Bonnet encountered what might
Speaker 1: be the early example, earliest example the condition. Uh. And
Speaker 1: this was a seventy year old, otherwise healthy woman who
Speaker 1: upon experiencing something like a stroke. And this was after
Speaker 1: a draft of air hit hit her in the neck,
Speaker 1: according to the the studies. I read the same thing
Speaker 1: there and she reported a draft of air hit her
Speaker 1: in the neck and then she felt like a paralysis
Speaker 1: across half her body and uh. And then she was
Speaker 1: silent as a corpse for four days. And then when
Speaker 1: she opened her mouth finally she demanded burial. That is
Speaker 1: a strange thing to demand. Yeah. Yeah, Like I said,
Speaker 1: it would be comedic if it weren't so serious. Um.
Speaker 1: But yeah, so she seemed to be under the real
Speaker 1: persistent idea that she was no longer alive even while
Speaker 1: she was alive to tell people this. Yeah, yeah, she so,
Speaker 1: she she apparently, it's just very insistent of it, Like
Speaker 1: it was very much like a delusion, like something again
Speaker 1: that the individual that's believing it is it in completely
Speaker 1: invested in it, completely convinced of its of this reality,
Speaker 1: no matter how ridiculous it might seem to anyone on
Speaker 1: the outside. It's like she became agitated, and she was
Speaker 1: scolding her friends for for not for not doing it.
Speaker 1: She she asked, she said, I'm not alive anymore. I
Speaker 1: need to be buried. Um, you know. They they ended
Speaker 1: up calling a doctor, and eventually everybody thought it was
Speaker 1: necessary to dress her like a co warps and layer
Speaker 1: layer out to calm her down, and they actually had
Speaker 1: a sort of funeral for her, like they essentially had
Speaker 1: to indulge in her delusion a bit just to to
Speaker 1: calm her down, and and she eventually fell asleep and
Speaker 1: was undressed and put to bed. But but yeah, how
Speaker 1: do you even treat something like this? Certainly well, uh,
Speaker 1: Bennet arrived on the scene and he treated her with quote,
Speaker 1: a powder of precious stones mixed with opium. And I
Speaker 1: guess it worked because he reported that she emerged from
Speaker 1: her death delusion. But while she she gave up the
Speaker 1: notion that she was dead. She then became became convinced
Speaker 1: that she was in Norway with her daughter while she
Speaker 1: was actually in Copenhagen the whole time, and insisted that
Speaker 1: she needed to return to Copenhagen from Norway. Um And
Speaker 1: during this time she was otherwise normal, but she could
Speaker 1: not sweep without the opium, So sadly, she ended up
Speaker 1: suffering the same condition every three months thereafter. So mean
Speaker 1: a reprisal of the idea that she had already died, right,
Speaker 1: the idea that she she had died would return, she'd
Speaker 1: have to be talked out of it, and then she
Speaker 1: would register surprise when she finally learned that she was
Speaker 1: in fact alive. Now, I wonder what it's like, um, Like,
Speaker 1: what what is the behavior of a person who truly
Speaker 1: believes themselves to be dead? Like? What does that entail
Speaker 1: for how they act? Well? It seems to vary from
Speaker 1: case to case as we look at it, I mean
Speaker 1: a lot of it seems to boil down to just
Speaker 1: an essential breakdown in conception of self and identity. Instead
Speaker 1: of like the like, we all walk around through our
Speaker 1: lives with a de facto statement, I am alive. And
Speaker 1: you know, maybe being alive is fantastic, maybe it's not,
Speaker 1: but we at least begin the sentence with I am alive.
Speaker 1: It's sort of an axiom. Yeah, like you, you don't
Speaker 1: need to debate this point. But for them, the accident
Speaker 1: axiom is vacant. It's it's absent, and in its place
Speaker 1: I am dead. I'm clearly not alive. I must be dead,
Speaker 1: and then therefore x sometimes that excess clearly I must
Speaker 1: be buried, or my body must be destroyed. Or in
Speaker 1: some cases it's uh, I'm not alive and yet I exist.
Speaker 1: Perhaps I have entered some deathless state, perhaps some afterlife,
Speaker 1: some afterlife, etcetera. So it kind of varies depending on
Speaker 1: what's going. The underlying conditions that are causing these symptoms
Speaker 1: come into play as well, is presumably the the exact,
Speaker 1: you know, worldview of the individual afflicted. Yeah. Another thing
Speaker 1: that I've read about in many of the cases here
Speaker 1: is a sort of denial of life sustaining activities like
Speaker 1: the person seems to in many cases lose interest in
Speaker 1: eating and going about their business as one normally would
Speaker 1: and doing any of the things that would constitute a
Speaker 1: life going on. Yeah, sleeping, it's etcetera. Um. Authors Hands
Speaker 1: Forstal and Barbara Beats wrote about the the Benet case
Speaker 1: for the British Journal of Psychiatry, and they theorized that
Speaker 1: the idea of imminent death played a role in this too. Uh,
Speaker 1: the the idea of imminent death during the old woman's
Speaker 1: stroke overpowered her thoughts at least, and so she regained
Speaker 1: full consciousness. Um So, so like while she was having
Speaker 1: a stroke, she had the idea that she was dying,
Speaker 1: and then in some sort of liminal state following the stroke,
Speaker 1: she had not yet overcome the conclusion of that assumption. Yeah,
Speaker 1: I mean, because like if the last, if the last
Speaker 1: experience you have with like a full consciousness and a
Speaker 1: full conception of self is that of oh crap, I'm
Speaker 1: about to die. Oh crap, something horrible is happening to
Speaker 1: my body. And then when the then then the next
Speaker 1: phase you exist in is this altered phase in which
Speaker 1: some of your normal neural processes are adjusted. That maybe
Speaker 1: the explanation you've all back on that at least is
Speaker 1: one one theory. Here's a quote from what they had
Speaker 1: to say. The most exceptional and strange ideas can gain
Speaker 1: such acceptance if the mind is suddenly thrown from its
Speaker 1: ordinary reasoning and forced into a new main idea. A
Speaker 1: sudden physical disorder in the brain or a sudden violent
Speaker 1: excitement can cause such a change there that we are
Speaker 1: pushed beyond insight into its unreasonable nature, because we assume
Speaker 1: to notice a correct functioning of our imagination, even in delusion,
Speaker 1: which I love that because it I think one of
Speaker 1: the things that's fascinating about delusions such as this with
Speaker 1: other neurological conditions is that it not It not only
Speaker 1: illustrates what is possible in terms of human perception of reality,
Speaker 1: but also how ultimately ephemeral the quote unquote normal perception
Speaker 1: of reality actually is. Well. Yeah, and it also I
Speaker 1: think underlies our our inherent predisposition for a completely a
Speaker 1: rational thinking um like Obviously, I don't mean this as
Speaker 1: an indictment of people suffering from Catard's delusion. I'm not.
Speaker 1: I'm not trying to impugne their rationality, but this seems
Speaker 1: to be a thing that's it's latent in the human brain. Uh,
Speaker 1: the ability to hold thoughts that are impossible, because in
Speaker 1: a strange way, this this is perhaps the most delusional
Speaker 1: possible thought, like from a Cartesian point of view. And
Speaker 1: what I mean by that is, you know, so Renee
Speaker 1: Decartes was trying to come up with an axiom that
Speaker 1: he could start his deductive philosophy with, right, um, And
Speaker 1: so he could start with like, well, I observe that
Speaker 1: I'm in a room. But then you can't actually start
Speaker 1: with observations, according to him, because there's no way you
Speaker 1: can be certain you're not hallucinating every aspect of your surroundings.
Speaker 1: But Decarter eventually said, you know what, I can start
Speaker 1: with cogito ergo some I think, therefore I exist, because
Speaker 1: I mean, it's pretty much that is true by definition,
Speaker 1: it cannot be false. So this syndrome is kind of
Speaker 1: some form of the denial of the Cartesian axiom. It's
Speaker 1: denying the thing that could not by definition be false.
Speaker 1: I think, but I do not exist. Yeah, in this
Speaker 1: it would be the ultimate denial, the ultimate nihilism, right yeah.
Speaker 1: And indeed this is uh, this is some of the
Speaker 1: thinking that the namesake of French neurologist Jewels Qatard had
Speaker 1: as well. So again this is this is where we
Speaker 1: get the name. Obviously. Uh, the year was eighteen eighty,
Speaker 1: so it's about a hundred years after the original KI. Yeah,
Speaker 1: and it wasn't ye until later people piece that together. Um.
Speaker 1: He received a most curious patient, okay, a forty three
Speaker 1: year old woman who believed she had no brain, nerves, chest,
Speaker 1: or entrails. She believed she was merely skin and bones
Speaker 1: and it quote neither God nor the devil existed, and
Speaker 1: that she no longer required food as she was quote
Speaker 1: eternal and would live forever. So she requested to be
Speaker 1: burned alive and attempted suicide several times thereafter, and then
Speaker 1: eventually died of starvation. So this is a pretty pretty
Speaker 1: severe and grim case. Well, so what did Quatard make
Speaker 1: of this? Well, he initially saw it as an extreme
Speaker 1: form of hypochondriasis, you know, hypochondriacts, and he he thought
Speaker 1: that this is a this would occur during a severe
Speaker 1: psychotic depression. And in many cases this delusion has been
Speaker 1: linked strongly to depression, not not in every case, because
Speaker 1: there are a lot of different scenarios that seem to
Speaker 1: produce similar effects and delusions, but we do see that
Speaker 1: as a recurring factor along with like near death or
Speaker 1: some traumatic experience. But it has been often linked to
Speaker 1: severe types of depression. And he He indeed is a
Speaker 1: one that mentioned that tales of the wandering Jew might
Speaker 1: be related to bits of myth that extend from such abouts.
Speaker 1: So so he's thinking that cultural ideas like not not
Speaker 1: just the hardware of the brain malfunctioning, but that software
Speaker 1: running on the brain, you know, received ideas or informing
Speaker 1: this syndrome or sorry, you shouldn't say syndrome the delusion. Well,
Speaker 1: or at least that like these ideas of saying that
Speaker 1: they're being an immortal, depressed wanderer out there in the
Speaker 1: world might have some ties to this condition, that this
Speaker 1: might be the nugget of truth behind such a concept, right,
Speaker 1: if you're not familiar, the concept of the wandering Jew
Speaker 1: is the idea that, of course uh in in the
Speaker 1: New Testament, the Christ predicts that he will return to
Speaker 1: Earth before everyone standing before him has passed away. Obviously
Speaker 1: a lot of time has passed, and so one solution
Speaker 1: to this textual problem is that people assumed that at
Speaker 1: least one person standing there listening to Jesus was actually
Speaker 1: essentially immortal and had continued to wander the earth since then. Yeah,
Speaker 1: essentially cursed because some tellings the wandering Jew laughed at
Speaker 1: Christ on the cross. Oh, I don't think i'd heard that.
Speaker 1: That's that's the version I ran across recently. So it's
Speaker 1: kind of like Highlander, except more anti Semitic. So Inquitard's
Speaker 1: later writings on the condition, he he described it as
Speaker 1: a nihilistic delusion, a negation of everything, God, food, life
Speaker 1: itself quote, a marked tendency to deny everything. Well, then
Speaker 1: in this case, it would seem that the way that
Speaker 1: we originally characterized it as the belief that one is
Speaker 1: dead is actually not the not the overarching nature of this,
Speaker 1: but it's sort of like one expression of it. Ultimately,
Speaker 1: as Qutard conceived it, it's just a denial of everything,
Speaker 1: and the denial of one's own continuing life is one
Speaker 1: facet of that. Right. Yeah, if if this absolute denial
Speaker 1: enters your consciousness, then even if it's an altered consciousness,
Speaker 1: then how do you make sense of it? Um? So
Speaker 1: I assume he didn't name this this delusion after himself. No, No,
Speaker 1: that wasn't until three uh Emil Regius coined the term
Speaker 1: Qatard's syndrome, and it was made famous by Jules Sieglass,
Speaker 1: who himself thought that it was all a severe anxious
Speaker 1: melancholia rather than a distinct clinical condition. Now, of course,
Speaker 1: if it were just two cases, that wouldn't be much
Speaker 1: to go on. But of course there have been other
Speaker 1: cases of Cotard's delusion, which we'll get to right after
Speaker 1: this break. All right, we're back, alright, So, uh, there
Speaker 1: have been more than just these two historical cases we
Speaker 1: talked about. But it also is not an extremely common condition. Yeah,
Speaker 1: it's exceedingly rare um and perhaps even more so in
Speaker 1: the modern age, since swift treatment of the underlying psychotic
Speaker 1: disorder uh typically occurs. And most studies related to Qatar's
Speaker 1: delusion are, of course about a single patient. This is
Speaker 1: not the kind of thing where a doctor is going
Speaker 1: to encounter multiple Qatard's delusion patients, say with him, you know,
Speaker 1: within the core of an entire lifetime, right Like here,
Speaker 1: here's this one clinical encounter, Not like I recruited a
Speaker 1: group of a hundred people suffering from Qatard's delusion, right, Yeah,
Speaker 1: it's that this is, you know, one of those conditions.
Speaker 1: It's super rare, probably, but it gets more attention because
Speaker 1: it is so alarming. Um. In fact, some of you,
Speaker 1: I know we have some Hannibal fans out there. There
Speaker 1: was actually an episode of Hannibal where we had the
Speaker 1: the sort of killer or character of the week with
Speaker 1: somebody with quitards syndrome. Um. But I don't have a
Speaker 1: clear enough memory of the episode two to do any
Speaker 1: kind of critiquing of it of how they presented it. Well, so,
Speaker 1: now that we've seen more cases showing up throughout history,
Speaker 1: what are the most common symptoms, Like, how does this
Speaker 1: delusion present itself most frequently? Claims of being dead obviously,
Speaker 1: of organs missing or having rotten or melted away. Claims
Speaker 1: of a missing brain. Oh yeah, I saw that one
Speaker 1: with the guy who said I don't have a brain.
Speaker 1: I don't know how to explain this, but I just
Speaker 1: don't have one. Claims of course of being I didn't
Speaker 1: see any encounter where someone actually said hey, I'm a
Speaker 1: zombie or I am a litch or something. But that
Speaker 1: is they basically explained undeadness. Yeah, they basically are like
Speaker 1: I'm not alive, I'm dead. But I'm also in some
Speaker 1: sort of protected state, as if in some cases it's
Speaker 1: there are a few cases will look at where that
Speaker 1: where the individual is saying like, God won't let me die.
Speaker 1: But then other times they're just they're just totally negating
Speaker 1: God or the devil as well. So, yeah, there's this
Speaker 1: sense of what, you know, what what a a Dungeons
Speaker 1: and dragons um A fan might term litch um, the
Speaker 1: idea that you're not dead, you're not alive, but somehow
Speaker 1: death is given you a either a cursed or elevated status. Well,
Speaker 1: let's look at some more modern examples of what this
Speaker 1: actually looks like in people who present with it. Okay, well,
Speaker 1: one interesting case, and we're not going to touch on
Speaker 1: all of them, because even though it is rare, there
Speaker 1: have been multiple cases. Some of them just aren't particularly
Speaker 1: noteworthy or or provide much illumination for our purposes here.
Speaker 1: But in two thousand four, there was a case of
Speaker 1: an individual by the name of Graham Harrison, and he
Speaker 1: attempted suicide by empty entering a bathtub with an electrical appliance.
Speaker 1: And the next thing he knew is he awoke in
Speaker 1: the hospital and he thought he was dead. So in
Speaker 1: this we see we definitely see elements of the traumatic
Speaker 1: like occurrence, the near death event, and then waking up
Speaker 1: with this condition. And he was indeed diagnosed with Guitard's delusion.
Speaker 1: But most interestingly, given the time in which this took
Speaker 1: place in the hostile environment, it allowed doctors an unprecedented
Speaker 1: uh PET scan peek into the brain of the deathly
Speaker 1: deluded here. Oh, so they could get some imaging results
Speaker 1: see how the brain of a person experiencing this delusion
Speaker 1: looks compared to someone who's not. Yeah, at least in
Speaker 1: this particular patient. Yeah, And they found that his brain
Speaker 1: wave patterns were were vegetative despite his being awake, so
Speaker 1: he had very low metabolic activity across large areas of
Speaker 1: the frontal and parietal brain regions. Some of his this
Speaker 1: expanse related to the default mode network, which we've covered before.
Speaker 1: This is the you know, the constant chatter in your
Speaker 1: your head that's uh, you know, questions about the and
Speaker 1: worries about the past in future, that sort of thing.
Speaker 1: But also the regions afflicted here uh were involved in
Speaker 1: formulating theory of mind. Now, one of the researchers who
Speaker 1: worked on this case, who was interviewed in an article
Speaker 1: and New Scientists about it. Stephen Lori's of the University
Speaker 1: of Louisian, Belgium said that the pet scan results were
Speaker 1: essentially what you'd expect to see in someone who is
Speaker 1: asleep or under general anesthesia. Like you know, so you
Speaker 1: mentioned the low metabolism. It was as if the brain
Speaker 1: had sort of been shut down. And however, the researchers
Speaker 1: also cautioned that this scan could be affected by the
Speaker 1: antidepressants he was taking, So you know, we shouldn't draw
Speaker 1: too many conclusions from one case, right, but apparently something
Speaker 1: had happened to his sense of self. Yes, inde, that's
Speaker 1: what's really interesting here, and that's that's what we're going
Speaker 1: to see reflected in some of the other cases. We're
Speaker 1: gonna look at this idea that that the brain's ability
Speaker 1: to conceive self, uh, and and and and indeed to
Speaker 1: conceive the identity of others is what is afflicted here. Um. Now, Luckily,
Speaker 1: in the case of Harrison here, thanks to psychotherapy and
Speaker 1: drug treatment, he was eventually able to overcome these symptoms
Speaker 1: and return to something of a normal life. And there's
Speaker 1: actually an interview with him in New scientists from a
Speaker 1: few years back. You can find it Mindscapes First Interview
Speaker 1: with a dead Man. Yeah, and I was just gonna
Speaker 1: say that it's an interesting read worth checking out. Now.
Speaker 1: In some of these papers, I found reference to an
Speaker 1: individual who wanted to erase their body with acid, but
Speaker 1: I wasn't able to track down a particular study on
Speaker 1: that one. But there were some other interesting cases that
Speaker 1: came up, But one of which was a two thousand
Speaker 1: five I ran i in case covered in the article.
Speaker 1: This is a telling title covered in the study coexistence
Speaker 1: of lacanthropy and Qtard syndrome in a single case. Wait, lacanthropy,
Speaker 1: that's werewolf syndrome andn't indeed, Yeah, something you don't really
Speaker 1: expect to pop up in a in a serious psychological paper. Now,
Speaker 1: in the clinical definition, I think like canthropy is what
Speaker 1: the belief that one has been transformed into an animal
Speaker 1: or behaviors indicating such a belief, right, Yeah, so we're
Speaker 1: not talking about actual transformation into a wolf for a
Speaker 1: dog or what have you. Uh. This individual is a
Speaker 1: thirty two thirty two year old man who arrived at
Speaker 1: the hospital and complained a that he was dead and
Speaker 1: be that he had turned into a dog both yea,
Speaker 1: and that the same was true of his wife and daughters.
Speaker 1: Well that I think. He claimed that his wife had
Speaker 1: been turned into a dog and that his daughters had
Speaker 1: been turned into sheep. That's right, So his delusion of
Speaker 1: zoological transformation extended to his family, but not necessary really
Speaker 1: the same animal. Now. I claimed that his relatives had
Speaker 1: tried to poison him as well. Yeah, I think by
Speaker 1: putting cyanide in his tea. Well, that's one tactic to employ.
Speaker 1: And he also claimed that God protected him even in
Speaker 1: this undead form, which which is interesting. It ties back
Speaker 1: into this this theme we see again and again that
Speaker 1: they're they're dead, but somehow undying. So what did the
Speaker 1: study conclude about this patient? Well, here's the here's the quote.
Speaker 1: A patient meeting a d s M for criteria for
Speaker 1: bipolar mood disorder mixed type with psychotic feature had the
Speaker 1: delusion of being transformed into a dog. He was also
Speaker 1: deluded that he was dead. He was restless, and had
Speaker 1: a serious sense of guilt about a previous sexual contact
Speaker 1: with a sheep. Coexistence of lecanthropy and Cotard syndrome has
Speaker 1: not been reported before and this patient, zoophilic orientation assorted
Speaker 1: associated with a sense of guilt were concluded to be
Speaker 1: important factors causing his delusions. So he had also like
Speaker 1: some guilt going on about a zoophilic encounter. Essentially, yes,
Speaker 1: that's that's what the paper is getting at. So a
Speaker 1: rather disturbing case all around. I think everyone will agree.
Speaker 1: But it's interesting because we're seeing this delusion here. In
Speaker 1: this case, perhaps have causes that are less tied to
Speaker 1: physical trauma and more to just like severe guilts of
Speaker 1: your psychological trauma over over a past incident. Uh. Matt
Speaker 1: Soniac has a great blog post about this at Matt
Speaker 1: Sonia soni Act. That's m A T T s O
Speaker 1: in I A k dot com uh, and he adds
Speaker 1: that quote in Persian folklore, the dog is both the
Speaker 1: symbol of loyalty and a symbol of impureeness. The man's
Speaker 1: sexual history was sheep, coupled with his desire to protect
Speaker 1: his sheep daughters and many dogs roles as herders and
Speaker 1: protectors of flocks, adds another layer of paradox. So this
Speaker 1: is another thing perhaps comparable to whether this is sumption
Speaker 1: was correct or not. The The original assumption of Qatar that,
Speaker 1: like the Wandering Jew, mythology could figure into the presentation
Speaker 1: of this delusion. Here, it's saying like cultural ideas or
Speaker 1: beliefs or sort of received associations can also play a
Speaker 1: role in how this delusion is manifest because you have
Speaker 1: a condition that is causing these symptoms, and then the
Speaker 1: mind has to somehow make sense of the symptoms that
Speaker 1: it's working with, and for that you often need to
Speaker 1: be able to you have to call on cultural motifs
Speaker 1: or some some bit of mythology, or some some at
Speaker 1: least vague concept of what it means to not be yourself,
Speaker 1: what it means to not be alive. Yeah, So a
Speaker 1: lot of the the cases we've talked about so far,
Speaker 1: cases where the information we have comes from uh well
Speaker 1: and in one case at least an interview, but mostly
Speaker 1: from sort of clinical observation. So researchers are looking at
Speaker 1: these patients and at the symptoms they're presenting and trying
Speaker 1: to describe them for for the scientific literat sure, but
Speaker 1: I think it's also important to try to get a
Speaker 1: picture from people's own first person perspective. So, first of all,
Speaker 1: there's an article in the Washington Post in November about
Speaker 1: card guitard syndrome and one of the people that tells
Speaker 1: the story of in the article is is this this
Speaker 1: woman as Mayway Jun Wang and Uh and in thirteen
Speaker 1: she came to the conclusion that she was dead. According
Speaker 1: to the article, Wang lost consciousness during a long flight
Speaker 1: from London to San Francisco, and her doctor has never
Speaker 1: found any explanation for the incident. But afterward she began
Speaker 1: to experience increasingly strange symptoms of of distress and disorientation psychosis,
Speaker 1: losing her sense of reality, and about a month later,
Speaker 1: she woke up one morning with a new consciousness of
Speaker 1: her situation. And I'm going to quote from the article
Speaker 1: uh quote she gives to them quote. I was convinced
Speaker 1: that I had died on that flight, that I was
Speaker 1: in the afterlife, and hadn't realized it until that moment,
Speaker 1: said Wang, now thirty two, who has convinced her husband
Speaker 1: and their dog Daphne, were dead as well. And then
Speaker 1: her quote continues, that was the beginning of when I
Speaker 1: was convinced that I was dead, But I wasn't upset
Speaker 1: about it because I thought I could do things in
Speaker 1: my life over and do them better. But her condition
Speaker 1: did worsen from there. So Whang wrote an essay called
Speaker 1: Perdition Days that she posted online about her experience. And
Speaker 1: I read this and I really recommend reading it because
Speaker 1: it's a really interesting um and I would say, very
Speaker 1: well written description of of what it's like first person
Speaker 1: to have this kind of experience. So in the essay,
Speaker 1: she describes how when she first discovered she was dead
Speaker 1: and living in some sort of afterlife, she felt happy,
Speaker 1: but this soon decayed into a state of misery where
Speaker 1: she began to believe that she was living in a
Speaker 1: form of perdition, which is a state of punishment or hell.
Speaker 1: And she writes quote, during the perdition days, which had
Speaker 1: no rhythm to them, I could not summon the motivation
Speaker 1: to do anything. I would not eat, I often would
Speaker 1: not move. I would not attempt to read or answer
Speaker 1: an email or have a conversation because there is no
Speaker 1: point in doing anything when in perdition. Instead, there is
Speaker 1: only horror and a physical agitation that refuses to manifest
Speaker 1: physically for a lack of motivation. But it does line
Speaker 1: up with these other examples. We've looked at this sense
Speaker 1: that it's it's not nearly waking up and saying, oh,
Speaker 1: I think I'm dead. It's this you feel it odds
Speaker 1: with everything in your world, like again, kind of getting
Speaker 1: into that negation of everything, that ultimate nihilism though that
Speaker 1: almost puts to defined, uh a definition on it, you know,
Speaker 1: like it seems like it's it's basically again, it comes
Speaker 1: down to your left with this just in human feeling
Speaker 1: and you have to make something human out of it
Speaker 1: or attempt to with with what you had to work with. Yeah,
Speaker 1: so it's obvious that these these cases. And by the way,
Speaker 1: I do recommend that the listeners read this essay Perdition Days,
Speaker 1: because I think it's really good. Will include a link
Speaker 1: to that as well as the other interview on the
Speaker 1: landing page for this uh this episode is stuff to
Speaker 1: buy your mind dot com. But also I think we
Speaker 1: should be asking the question of, well, wait a minute, if,
Speaker 1: if what you're just saying is true, Robert, you know
Speaker 1: there's this problem with UM, this collection of symptoms being
Speaker 1: kind of only very vague and loosely associated while certainly
Speaker 1: very real. Um, are are we talking about one coherent
Speaker 1: thing when we talk about Guitard's delusion, or instead, are
Speaker 1: we sort of are are we fabricating the connective tissue
Speaker 1: that's holding all these cases together? Yeah? So this is
Speaker 1: this is something that really throughout the history of Guitard's
Speaker 1: delusion or Guitard syndrome, you see time and time again.
Speaker 1: Is it a true syndrome or is it just a
Speaker 1: delutional state that emerges from various other conditions. Now we're
Speaker 1: certainly not questioning the reality of the experiences of the
Speaker 1: individual people how having this, uh these experiences, But what
Speaker 1: are we saying is essentially is it one thing or
Speaker 1: are these different things that we're trying to group together
Speaker 1: under the same heading. Right, So it's kind of like,
Speaker 1: in a broad sense, you have hallucinations, but there are
Speaker 1: various forms of hallucinations, and there are myriad reasons for
Speaker 1: why one would experience a hallucination. So is this the
Speaker 1: case where Guitard's delusion is simply something that emerges due
Speaker 1: to various causes? Well, one thing, and I think there's
Speaker 1: a strong case to be made for them. Okay, Yeah, Well,
Speaker 1: one thing we could do to sort of sort of
Speaker 1: help unify or understanding of it is to look at
Speaker 1: the cause and effect situation. It has there been a
Speaker 1: cause isolated by the researchers who work on this. Uh,
Speaker 1: is there something they can point to to say, yeah,
Speaker 1: we think when we see coutar this is the most
Speaker 1: likely cause. Well, based on the resources I was looking
Speaker 1: at there a number of researchers seemed to think that
Speaker 1: it boils down to to misfiring in the fusiform face
Speaker 1: areas of the brain. Now what is that? So these
Speaker 1: are areas involved in facial recognition as well, and also
Speaker 1: misfirings in the amigola, which matches emotional response to all
Speaker 1: those faces. So again we're getting back to that idea
Speaker 1: of the brain's ability to deal with self, to deal
Speaker 1: with identities, and to then attribute appropriate emotional responses to
Speaker 1: those identifications. Um so how how would this be man
Speaker 1: So if you're if you're having trouble recognizing faces and
Speaker 1: feeling the correct emotional reactions to them. Um, how would
Speaker 1: this manifest as a belief that one was dead or
Speaker 1: had lost your existence or identity? Well, you can think
Speaker 1: of like one way to think of it is to
Speaker 1: think of use of a mirror. And again, this is
Speaker 1: not saying that that Cotard's delusion depends on an individual
Speaker 1: visual looking in a mirror. But if you have if
Speaker 1: you're having, if you're experiencing a lack of emotion and
Speaker 1: viewing faces UH and a resulting attachment, and then you
Speaker 1: view your own face in a mirror, well then that
Speaker 1: could lead to this startling detachment between your sense of
Speaker 1: self and the project itself in the mirror. So, in short,
Speaker 1: you cease to see yourself as you you end up
Speaker 1: you do not exist. It's kind of like the Medusa
Speaker 1: staring into the being confronted with a mirror. Do you
Speaker 1: just feel that you have turned to stone? Yeah? Yeah, exactly. So.
Speaker 1: One thing I came across when reading about this is
Speaker 1: that there seemed to be a wide range of different
Speaker 1: treatment options that have been tried. The Washington Post article
Speaker 1: I mentioned earlier spoke with a psychiatrist named Jesus Ramirez
Speaker 1: Bermudez at the National Institute of Neurology and Neurosurgery in Mexico,
Speaker 1: and he says he's treated at least fourteen patients with
Speaker 1: UH with the Coutard's delusion using a combination of medication
Speaker 1: and psychotherapy. Yeah, and that that seems to be UM
Speaker 1: the situation you run across that UM, it's coming back
Speaker 1: around to the to the the idea that Cotard syndrome
Speaker 1: again has not it's it's a it's a battery of
Speaker 1: symptoms that emerge from a from different causes, and so
Speaker 1: you know, you can't really treat the symptoms. You can
Speaker 1: try and control the symptoms, but it's going to vary,
Speaker 1: you know, depending on what is actually causing them and
Speaker 1: and whether that's being addressed or not. So you see
Speaker 1: anti depressants, anty psychotics, and even electro convulsive therapy uh
Speaker 1: resulting in some benefits from time to time. Now, when
Speaker 1: we mentioned disorders of the recognition of faces, this does
Speaker 1: seem related to another type of delusion I've read about before,
Speaker 1: the cap Graw delusion. Yeah, yeah, and this is one
Speaker 1: that I've at least written about in the past. I
Speaker 1: can't remember if I've done any podcast content on it.
Speaker 1: I think maybe Josh and Chuck have. But it's it's
Speaker 1: a delusional identification syndrome, which generally involves right brain anomalies
Speaker 1: linked to a number of illnesses and neurological disorders, ranging
Speaker 1: from schizo effective disorder and Alzheimer's disease to severe head injuries,
Speaker 1: pituitary tumors, and migraines. Even alcoholism can play a role,
Speaker 1: but it basically entails the experience of doppelgangers, thinking that basically,
Speaker 1: you encounter individuals in your life, maybe they're even family members,
Speaker 1: but suddenly you see them, but there's this mix up
Speaker 1: in identity. So you see them, but you think they
Speaker 1: are not themselves. You think that, and then if you
Speaker 1: try and make sense of that, while they have been replaced,
Speaker 1: these are replis. That's how I've heard it explain, is
Speaker 1: that you you recognize the person, but you don't think
Speaker 1: they're really them. Yeah, you know, my family has been
Speaker 1: replaced by impostors. Yeah, so they're there. Definitely seems to
Speaker 1: be some strong connective tissue between these two scenarios, again
Speaker 1: getting back to that idea that it's a disruption of
Speaker 1: the ability to process self and identity. Now, in researchers
Speaker 1: ge Barrios and are A Luke presented three different possible
Speaker 1: categorizations for Cadard's solusion uh and this was following their
Speaker 1: analysis of two d public cations um uh you know,
Speaker 1: concerning Guitard's syndrome or delusion. So they they said one
Speaker 1: their psychotic depression and this includes patients where uh where
Speaker 1: where there's this overhanging sense of melancholy and in this
Speaker 1: uh in these nihilistic delusions emerge. And then there's Guitard
Speaker 1: type one, they said, which includes patients that represent a
Speaker 1: clear case of Guitard syndrome, but more specifically, the delusion
Speaker 1: is is prominent in comparison to the depressive picture um
Speaker 1: that we already mentioned. And then there's a Gutard type two,
Speaker 1: a mixed group, and this is where they patients of
Speaker 1: demonstrate anxiety, depression, and even auditory allusions as well. So
Speaker 1: even so, basically the take home here is that if
Speaker 1: you if you start breaking it down, it's it's not
Speaker 1: even that that Qutard's delusion of Quatard syndrome is like
Speaker 1: one set of thing, you know, it maybe three different things.
Speaker 1: It's a it's kind of depending on it's a battery
Speaker 1: of symptoms, and that exact battery of symptoms will differ
Speaker 1: from one page into another. Seems like it might be
Speaker 1: kind of a what what a working theory, like a
Speaker 1: working categorization technique. Yeah, yeah, I think so, because overall
Speaker 1: the delusion has been reported as a symptom or or again,
Speaker 1: a battery of symptoms, in a number of different underlying conditions,
Speaker 1: including migraine, uh neoplasms of the parietal cortex uh serbovascular disease,
Speaker 1: and epilepsy, trauma, acute toxic phase of typhoid fever, multiple sclerosis. Wow. Yeah,
Speaker 1: again with with such a range of causes and such
Speaker 1: a range of different specific presentations, it makes me wonder,
Speaker 1: yet again, is this really one thing? Yeah? And and
Speaker 1: I think I think that the case is very strong
Speaker 1: that it is not that it is that this is
Speaker 1: this is something emerges from various conditions. One thing that
Speaker 1: makes me think about, and I mentioned it a couple
Speaker 1: of times so far, is the role of beliefs in
Speaker 1: the four Nation of delusions. We mentioned it with the
Speaker 1: Wandering Jew and with the the idea of permit perdition. Um.
Speaker 1: So there's sort of like the hardware versus software formulations
Speaker 1: of brain function. Right, So if you imagine hardware is
Speaker 1: the physical and chemical activity of the brain and the
Speaker 1: software or your thoughts and beliefs. Um. When I read
Speaker 1: literature about um mental conditions or any disorder of the brain,
Speaker 1: it often seems theorized in terms of hardware malfunction, and
Speaker 1: there is some kind of malfunctioning of the hardware of
Speaker 1: the brain that is producing negative effects in the software.
Speaker 1: But I keep thinking about the way the software feeds
Speaker 1: back into how the hardware works. Like again, um that
Speaker 1: the things we mentioned so far. One thing I thought
Speaker 1: was interesting in Wine's essay, she mentions that she came
Speaker 1: to believe that she was living in perdition even though
Speaker 1: she had never been a Christian, but that was still apparently,
Speaker 1: I mean, that was still obviously a script that was
Speaker 1: available to her. It's kind of like individuals who who
Speaker 1: experience some sort of supernatural occurrence um, paranormal event, and
Speaker 1: then there they have to make sense of it. So
Speaker 1: they have a few different scripts they can go to
Speaker 1: if if they if they want. Yeah. Another experience that
Speaker 1: I think is interesting here in terms of how this
Speaker 1: reads on beliefs is the reports of people sort of
Speaker 1: recognizing the illogical nature of what they're being told and
Speaker 1: yet being unable to stop believing it. Like when people
Speaker 1: say I'm dead and someone says to them, but you're
Speaker 1: walking around and you're talking dead. People can't do that. Uh.
Speaker 1: It seems that some of these people who who experience
Speaker 1: Guitard's delusion, they recognize that they're like, oh, yeah, you know,
Speaker 1: I that's true that dead people can't walk around and stuff,
Speaker 1: But yet it is a fact that I'm dead, Like
Speaker 1: that is a primary, uh you know, prima facie conclusion. Yeah,
Speaker 1: I mean, it's not just a situation where you can
Speaker 1: talk somebody out of it and therefore it Yeah, it's
Speaker 1: it is interesting to think of it in terms of
Speaker 1: the hardware software, because there are these these clear cases
Speaker 1: where it's like, all right, clearly there's there's damage to
Speaker 1: the brains, some sort of trauma occurred, stroke like scenario, etcetera,
Speaker 1: and then that messed up the software. But in other
Speaker 1: cases it seems like it might be pure software, such
Speaker 1: as the case of the the the Iranian um um
Speaker 1: man who thought he was both you know, I mean
Speaker 1: not to say there's not some potential physical trauma going
Speaker 1: on there as well, that was either uh, you know,
Speaker 1: underreported or not reported. But still, you know, one of
Speaker 1: the scariest and most troubling things about this delusion is
Speaker 1: that in some forms of it, it seems like medical
Speaker 1: science is having difficulty helping people. In other cases, people
Speaker 1: do seem to have been able to get treatment that
Speaker 1: achieved a positive conclusion. In Wayne's essay again, she she
Speaker 1: talks about meeting with her doctors and feeling to spare
Speaker 1: at the idea that they really didn't have any way
Speaker 1: that they could cure this. They were just talking about, like, well,
Speaker 1: how much of her life would she have to live, Uh,
Speaker 1: feeling these heightened states of psychosis as opposed to relatively
Speaker 1: milder periods, And uh, that's just such a horrible thing
Speaker 1: to have to be told. I mean, not like it's
Speaker 1: the doctor's fault, um, but I would hope that this
Speaker 1: is something that we can make progress on. You know,
Speaker 1: when people talk about about curing diseases, about medical progressing
Speaker 1: curing diseases, they're almost always talking about somatic illnesses, people
Speaker 1: having you know, cancer or other problems, And of course
Speaker 1: those are worth addressing too, But I but I think
Speaker 1: it's really important to help keep up hope for the
Speaker 1: for the alleviation and curing of mental illnesses. I agree,
Speaker 1: I agree. So, hey, that's it for this episode. But
Speaker 1: we know that this probably stirred a number of thoughts
Speaker 1: from our listeners, and hey, it's not it's not impossible
Speaker 1: that somebody out there listening to this has second or
Speaker 1: even firsthand experience with with the Qatar's delusions. So if
Speaker 1: you if you do, if you have, get in touch
Speaker 1: with us, we would love to hear from you. If
Speaker 1: you want to learn more about Stuff to Blow Your Mind,
Speaker 1: If you want to check out past episodes of the podcast,
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