One of the strangest cases I have encountered involves a man named Michael. Despite nearly three years of therapy and a rigorous regiment of drugs, he remains adamant that he is no longer alive. This thought is based in an affliction known as Cotard's delusion, in which a person believes they are dead. This causes him to retreat from others, and the impact on his life is pronounced. Even the act of eating is something that requires convincing, often requiring an IV, and causing him to be very underweight. Much of the time, the very essentials that are required to take care of him are things that are left up to other people, and despite the intensive treatment it only seems to be getting worse, leading to a belief that his body is gradually putrefying.
Cotard's syndrome starts with a very intense depression, along with hypochondria. As the disorder progresses, the individual begins to deny that parts of their bodies exist, or can even claim that do not exist at all. Michael's symptoms have been progressing for a while, starting after a traumatic experience in his mid twenties.
I had an opportunity to speak with Michael recently, and he seemed willing to speak on the incident that occurred years before. His family and doctors have encouraged this, in the hope that discussion will help to allow a confrontation with his delusion.
“I was traveling in Romania years ago. I had been sad, and was having trouble even getting out of bed, let alone going to work. I had vacation time, and I figured that maybe a trip to Europe would help break me out of it.
Like most of Europe, there are some incredible churches to visit. I have never been a religious person, but I could not pass up a chance to see such old buildings. I was in a small town, and though it was pleasant enough, it was the ornate chapel that caught my attention. I walked inside, only to realize I had walked in on a service. I found a seat off to the side and waited for it to finish, meanwhile taking in the unique interior. The stained glass was a predominated by greens, and lining the edges of the church were graves of what I assumed were some of the previous priest that presided there. The service was in Romanian, yet the mood was clear and still, the parishioners lingering on every word.
I did not have to wait long for the service to end, and after a short time I heard bells begin to ring, as people stood up and began to leave, giving me an opportunity to walk around freely. Meanwhile, the priest moved up and down the pews, placing the books back into place and tidying up.
I was walking around for a couple of minutes when I heard the priest ask me if I needed assistance. I was surprised, not suspecting that I was going to find a priest in this small community who knew English. Seeing an opportunity, I began to ask him questions about the church and its history, and he began to ask me about myself, wondering about my family and my reasons for being there. He seemed nice enough, and after a short while I began to tell him about my depression, and my feelings of helplessness.
I told him how recently I had become paralyzed with fear of death. I figured I could likely source it to the loss of a friend of mine two months before. She had been sick her entire life, but when she suddenly died one day without warning, I began for the first time in my life to seriously consider the idea that I could die too. This thought became an obsession, and I had begun to become terrified of leaving the house out of fear that something would happen to me. It was only the desire to travel that had managed to get me out of the house, and only with medicine on hand.
The priest listened intently, never speaking a word until I had finished.
“My son,” he said. “Death is something we must all face. But in the end, we can find solace in the fact that we can one day face our maker, and find joy in eternity.”
I admitted to him that I was not a religious person, and had no belief in heaven.
“Heaven is not immediately at hand. Only in the end times shall we become collected to be judged. Those deemed unworthy shall not rise, but walk in a state of undeath. You,” he said solemnly, “you must die in order to view eternity.”
I began to feel uncomfortable, and began to get up and leave. The room became cold, and I watched as the man's face depressed and sunk, his eyes...black...recessed into his skull. His skin paled, and the flesh around his mouth disappeared.
“Many of my congregation have already known death. In order to find eternity, you must first face your death. I can free you...from your fear.”
Michael claims that he does not remember what happened after that point, but his therapist feels that he is lying. He was meant to be head back home the following day, but after three days he was picked up by a local man, wandering the nearby hills. He was brought to the American embassy and was gotten home, but it was clear that he had been damaged. His depression had worsened, and as the weeks passed he began to show the initial signs of the illness. His fear of his death had gone away, but a host of other symptoms appeared. In the nearly four years since his return, it seems that his beliefs have only deepened.
Since then, a barrage of mood stabilizing drugs and antidepressants have helped to slow the progress of his . However, during recent years the delusion has begun to deepen. There are sometimes months at a time where he seems to recover, but invariably he falls back into his old beliefs, seemingly get worse after every sign of recovery.
I have tried to locate the church he went to, but have so far been unable to find anything. It is hard to know just how much of what he says about his experiences is true. Though rare, Cotard's syndrome can sometimes find its source in a wide variety of illnesses, including schizophrenia, making his claims. Whatever he witnessed in the church, it is uncertain how it could have caused such a severe change in his personality.
The greatest concern is the deepening of his delusions, and discussions into moving him to a hospital have began to claim that he was unable to feel pain.