The Walking Undead

A rare psychiatric condition leaves people believing that they’ve died. Can readily available treatments bring them back to life?

When William Burroughs was teaching creative writing one semester at the City College of New York, a student asked: “Mr. Burroughs, do you believe in life after death?” “What makes you think you’re not dead already,” Burroughs replied.

For Warren McKinlay, an Army veteran living in the south of England, the answer was obvious. He was dead. He’d died in a motorcycle accident several years earlier. He was sure of it. The doctors said he’d recovered from his injuries, but they were wrong.

“I genuinely believed I’d died in the crash, but for some reason my spirit hadn’t moved on,” McKinlay told the British tabloid The Mirror in 2016. “I was convinced that I didn’t have to eat, because I was dead. I was a ghost.”

McKinlay was suffering from Cotard delusion, a condition in which a person believes they’re dead or rotting or have missing body parts. They may stop bathing and caring for themselves or, like McKinlay, stop eating because the dead no longer need food.

The bizarre syndrome was first described in 1880 by the French neurologist and psychiatrist Jules Cotard as le délire des négations (”the delusion of negation”), in a report about “Mademoiselle X,” a 43-year-old patient who claimed to need no food because she’d died and was now immortal—she ultimately died of starvation.

Sometimes called “walking corpse syndrome,” Cotard delusion is extremely rare. The most authoritative recent investigation, a 2018 study by researchers at the Mayo Clinic found only 12 cases in the institution’s vast database of over 30 million hospital records from 1996 to 2016.

The Mayo team reported: “Eight of the 12 patients described feeling that they had died, and four patients claimed that they were dying. Three of the eight patients described being killed by healthcare workers. Three of the four patients who claimed to be dying described the destruction of their internal organs and body parts by either ‘worms,’ ‘viruses,’ or ‘bugs.’”

The patients were adamant that their perceptions were true in the face of incontrovertible evidence otherwise. A 65-year-old patient, who insisted he’d died on the operating table during surgery, offered as proof to his doctors that the television screen light “keeps fading,” affirming that he’d entered the afterlife. A 50-year-old man continued to believe his arm had been cut off even after being shown that it was clearly still attached to his body, and a 35-year-old woman said her brain was rotting and infested with worms, despite being shown that her brain scans revealed neither rot nor worms.

Cotard delusion isn’t included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the standard reference doctors use to diagnose and treat psychiatric illnesses. Instead, the disorder is seen as a manifestation of severe depression, bipolar disease, or schizophrenia, although a direct link between Cotard delusion and any of these conditions remains circumstantial.

Other possible causes cited in medical literature include syphilis, typhoid fever, migraine, epilepsy, Parkinson’s disease, and brain injury. The last is the most intriguing.

Neuroimaging studies showed evidence of brain injury in seven of the patients in the Mayo Clinic report. Lesions in the nondominant hemisphere of the brain—the same side of the brain as a person’s dominant hand—have been linked to facial recognition disorders and “hypofamiliarity delusions,” in which a person is unable to connect what they’re seeing or experiencing with autobiographical memories. Familiar people and situations seem unreal. Thus, someone with Cotard delusion might leap to the conclusion that they’re dead because they no longer recognize the face in the mirror as their own.

Such brain injuries have also been associated with a related syndrome Capgras delusion, in which people believe family members and loved ones are imposters. In the Mayo Clinic study, a patient with a dual Cotard and Capras diagnosis believed he’d been stabbed to death in his nursing home and that his wife was a space alien.

The English walking corpse Warren McKinlay recovered after his doctors discovered that the cause of his syndrome was a nondominant-hemisphere brain injury, causing a disconnect between facial recognition and his emotional response to faces, including his own. Almost all the Mayo Clinic patients also recovered. Electroconvulsive therapy (ECT) was often effective, as was a cocktail of antipsychotic, antidepressant, anxiolytic, and anticonvulsant drugs.

My inner adman can see the TV spot now. “Feeling dead? Does everything seem rotten inside? Do you miss your body parts? You may be suffering from CD. Ask your doctor about Lazarusaphen for fast, effective relief from symptoms of expiration, purification, and amputation. Live again with Lazarusaphen!”

It’s funny but not as funny as the actual advice offered in Medical News Today to readers if Cotard delusion is suspected: “A person should seek medical care if they believe they are dead, dying, or that a part of their body is missing. If a loved one displays [these] signs, do not try to argue or persuade them they are wrong, as this will not change their mind. Instead, suggest they seek medical care and offer to go with them”

In addition, the wellness site Healthline recommends keeping a journal of symptoms to anyone who might have Cotard delusion.

Maybe something like this:

Tuesday: Dead.

Wednesday: Still dead.

Thursday: Positively, absolutely dead.

Friday: Undeniably and reliably dead.

Saturday: Not merely dead.

Sunday: Most sincerely dead.