杏吧原创

Name: Graham
Condition: Cotard鈥檚 syndrome

鈥淲hen I was in hospital I kept on telling them that the tablets weren鈥檛 going to do me any good 鈥檆ause my brain was dead. I lost my sense of smell and taste. I didn鈥檛 need to eat, or speak, or do anything. I ended up spending time in the graveyard because that was the closest I could get to death.鈥�

Nine years ago, Graham woke up and discovered he was dead.

He was in the grip of Cotard鈥檚 syndrome. People with this rare condition believe that they, or parts of their body, no longer exist.

For Graham, it was his brain that was dead, and he believed that he had killed it. Suffering from severe depression, he had tried to commit suicide by taking an electrical appliance with him into the bath.

Eight months later, he told his doctor his brain had died or was, at best, missing. 鈥淚t鈥檚 really hard to explain,鈥� he says. 鈥淚 just felt like my brain didn鈥檛 exist any more. I kept on telling the doctors that the tablets weren鈥檛 going to do me any good because I didn鈥檛 have a brain. I鈥檇 fried it in the bath.鈥�

Doctors found trying to rationalise with Graham was impossible. Even as he sat there talking, breathing 鈥� living 鈥� he could not accept that his brain was alive. 鈥淚 just got annoyed. I didn鈥檛 know how I could speak or do anything with no brain, but as far as I was concerned I hadn鈥檛 got one.鈥�

Baffled, they eventually put him in touch with neurologists at the University of Exeter, UK, and at the University of Li猫ge in Belgium.

鈥淚t鈥檚 the first and only time my secretary has said to me: 鈥業t鈥檚 really important for you to come and speak to this patient because he鈥檚 telling me he鈥檚 dead,'鈥� says Laureys.

Limbo state

鈥淗e was a really unusual patient,鈥� says Zeman. Graham鈥檚 belief 鈥渨as a metaphor for how he felt about the world 鈥� his experiences no longer moved him. He felt he was in a limbo state caught between life and death鈥�.

No one knows how common Cotard鈥檚 syndrome may be. A study published in 1995 of 349 elderly psychiatric patients in Hong Kong found two with symptoms resembling Cotard鈥檚 (, DOI: 10.1016/0163-8343(94)00066-M). But with successful and quick treatments for mental states such as depression 鈥� the condition from which Cotard鈥檚 appears to arise most often 鈥� readily available, researchers suspect the syndrome is exceptionally rare today. Most academic work on the syndrome is limited to single case studies like Graham.

Some people with Cotard鈥檚 have reportedly died of starvation, believing they no longer needed to eat. Others have attempted to get rid of their body using acid, which they saw as the only way they could free themselves of being the 鈥渨alking dead鈥�.

Graham鈥檚 brother and carers made sure he ate, and looked after him. But it was a joyless existence. 鈥淚 didn鈥檛 want to face people. There was no point,鈥� he says, 鈥淚 didn鈥檛 feel pleasure in anything. I used to idolise my car, but I didn鈥檛 go near it. All the things I was interested in went away.鈥�

Even the cigarettes he used to relish no longer gave him a hit. 鈥淚 lost my sense of smell and my sense of taste. There was no point in eating because I was dead. It was a waste of time speaking as I never had anything to say. I didn鈥檛 even really have any thoughts. Everything was meaningless.鈥�

Low metabolism

A peek inside Graham鈥檚 brain provided Zeman and Laureys with some explanation. They used positron emission tomography to monitor metabolism across his brain. It was the first PET scan ever taken of a person with Cotard鈥檚 (, DOI: 10.1016/j.cortex.2013.03.003). What they found was shocking: metabolic activity across large areas of the frontal and parietal brain regions was so low that it resembled that of someone in a vegetative state.

Some of these areas form part of what is known as the 鈥渄efault mode network鈥� 鈥� a complex system of activity thought to be vital to core consciousness, and our theory of mind. This network is responsible for our ability to recollect the past, to think about ourselves, to create a sense of self and it allows us to realise that we are the agent responsible for an action.

鈥淚鈥檝e been analysing PET scans for 15 years and I鈥檝e never seen anyone who was on his feet, who was interacting with people, with such an abnormal scan result,鈥� says Laureys. 鈥淕raham鈥檚 brain function resembles that of someone during anaesthesia or sleep. Seeing this pattern in someone who is awake is quite unique to my knowledge.鈥�

Graham鈥檚 scans could have been affected by the antidepressants he was taking and, as Zeman points out, it is unwise to draw too many conclusions from scans from a single person. But, Zeman says, 鈥淚t seems plausible that the reduced metabolism was giving him this altered experience of the world, and affecting his ability to reason about it.鈥�

鈥淭here鈥檚 many things we don鈥檛 know about how to define consciousness,鈥� says Laureys. At the very least, unusual cases such as Graham鈥檚 add to our understanding of how the brain creates the perception of self and how it can be impaired.

For Graham, the brain scans didn鈥檛 mean a lot. 鈥淚 just felt really damn low,鈥� he says. By this time, his teeth had turned black because he could no longer be bothered to brush them, compounding his belief that he was dead.

Graham says he didn鈥檛 really have any thoughts about his future during that time. 鈥淚 had no other option other than to accept the fact that I had no way to actually die. It was a nightmare.鈥�

Graveyard haunt

This feeling prompted him on occasion to visit the local graveyard. 鈥淚 just felt I might as well stay there. It was the closest I could get to death. The police would come and get me, though, and take me back home.鈥�

There were some unexplained consequences of the disorder. Graham says he used to have 鈥渘ice hairy legs鈥�. But after he got Cotard鈥檚, all the hairs fell out. 鈥淚 looked like a plucked chicken! Saves shaving them I suppose鈥︹��

It鈥檚 nice to hear him joke. Over time, and with a lot of psychotherapy and drug treatment, Graham has gradually improved and is no longer in the grip of the disorder. He is now able to live independently. 鈥淗is Cotard鈥檚 has ebbed away and his capacity to take pleasure in life has returned,鈥� says Zeman.

鈥淚 couldn鈥檛 say I鈥檓 really back to normal, but I feel a lot better now and go out and do things around the house,鈥� says Graham. 鈥淚 don鈥檛 feel that brain-dead any more. Things just feel a bit bizarre sometimes.鈥� And has the experience changed his feeling about death? 鈥淚鈥檓 not afraid of death,鈥� he says. 鈥淏ut that鈥檚 not to do with what happened 鈥� we鈥檙e all going to die sometime. I鈥檓 just lucky to be alive now.鈥�