10 Case Reports of Cotard’s Delusion

SIphotography/iStock via Getty Images
SIphotography/iStock via Getty Images

Cotard’s Delusion is a mental disorder where people suffer the nihilistic delusion that they are dead or no longer exist. First reported in the 1700s, the disorder is still largely a mystery today. The underlying cause isn’t understood; it’s been linked to bipolar disorder, depression and/or schizophrenia depending on the patient’s age. Here, ten people who went to their doctors and complained that they were dead.

1. In 1788, Charles Bonnet reported one of the earliest recorded cases of Cotard’s Delusion. An elderly woman was preparing a meal when she felt a draft and then became paralyzed on one side of her body. When feeling, movement, and the ability to speak came back to her, she told her daughters to dress her in a shroud and place her in a coffin. For days she continued to demand that her daughters, friends, and maid treat her like she was dead. They finally gave in, putting her in a shroud and laying her out so they could “mourn” her. Even at the “wake,” the lady continued to fuss with her shroud and complain about its color. When she finally fell asleep, her family undressed her and put her to bed. After she was treated with a “powder of precious stones and opium,” her delusions went away, only to return every few months.

2. Some 100 years after Bonnet met the old lady, French neurologist Jules Cotard saw a patient with an unusual complaint. Mademoiselle X, as Cotard called her in his notes, claimed to have “no brain, no nerves, no chest, no stomach and no intestines.” Despite this predicament, she also believed that she “was eternal and would live for ever.” Since she was immortal, and didn’t have any innards anyway, she didn’t see a need to eat, and soon died of starvation. Cotard’s description of the woman’s condition spread widely and was very influential, and the disorder was eventually named after him.

3. In 2008, New York psychiatrists reported on a 53-year-old patient, Ms. Lee, who complained that she was dead and smelled like rotting flesh. She asked her family to take her to a morgue so that she could be with other dead people. They dialed 911 instead. Ms. Lee was admitted to the psychiatric unit, where she accused paramedics of trying to burn her house down. After a month or so of a drug regimen, she was released with great improvement in her symptoms.

4. In 1996, a Scottish man who suffered head injury in a motorcycling accident began to believe he had died from complications during his recovery. Not long after he completed recovery, he and his mother moved from Edinburgh to South Africa. The heat, he explained to his doctors, confirmed his belief because only Hell could be so hot.

5. In 2012, Japanese doctors described a 69-year-old patient who declared to one of the doctors, “I guess I am dead. I’d like to ask for your opinion.” When the doctor asked him whether a dead man could speak, the patient recognized that his condition defied logic, but could not shake his conviction that he was deceased. After a year, his delusion passed, but he insisted on the truth of what happened during it. “Now I am alive. But I was once dead at that time,” he said. He also believed that Kim Jong-il was also a patient at the same hospital.

6. In 2009, Belgian psychiatrists reported the case of an 88-year-old man who came to their hospital with symptoms of depression. The man explained that he was dead, and was concerned and anxious that no one had buried him yet. His delusions subsided with treatment.

7. The same doctors also treated a 46-year-old woman who claimed to have not eaten nor gone to the bathroom in months, nor slept in years. She explained that all her organs had rotted, that she had no blood and that doctors who monitored her heart or took her blood pressure were deceiving her because her heart didn’t beat. After multiple admissions to the hospital and a lapse in taking her medication over the next 10 months, her condition gradually improved.

8. Greek psychiatrists received a patient in 2003 who believed he was literally empty-headed. He had attempted suicide years earlier because he thought it wasn’t worth living since he didn’t have a brain. He was not treated after the incident and simply returned to work. Once at the hospital he “claimed that he was born ‘without a mind,’ meaning that his head is empty without a brain and for this reason he is retarded.” He left against medical advice after several days, and was re-admitted the next year. This time he completed treatment and showed sustained improvement in a follow-up interview months later.

9. The Greek doctors also treated a 72-year-old woman who went to the ER claiming “all of her organs had melted; only skin had remained and that she was practically dead.” She was admitted to the hospital and her outcome not reported.

10. In 2005, Iranian doctors described what may be the most unusual case recorded. A 32-year-old man arrived at their hospital saying that not only was he dead, but that he had been turned into a dog. He said that his wife had suffered the same fate. His three daughters, he believed, had also died and had turned into sheep. He said that his relatives had tried to poison him, but that nothing could hurt him because God protected him even in death. He was diagnosed with Cotard’s and clinical lycanthropy, treated with electro-convulsive therapy and relieved of his major symptoms. (You can read more about this case at my website.)

When Pokémon Sent Hundreds of Viewers to the Hospital

Warner Bros. Pictures/Getty Images
Warner Bros. Pictures/Getty Images

By the time the 38th episode of the animated children’s series Pokémon, or Pocket Monsters, aired in Japan, it was a bona fide sensation, drawing roughly 4 million viewers weekly. One survey estimated that 55 percent of schoolchildren in Tokyo's Kawasaki school district followed the series. The show—which began airing April 1, 1997, and focused on the adventures of Ash and affable monsters like Pikachu in their attempt to collect one creature from each species to train for combat—was also a comic, a Nintendo video game, a trading card series, and more. The devoted fandom would soon spread to the United States.

But then something peculiar happened—so peculiar that it become the subject of medical journal research. The Pokémon episode that aired at 6:30 p.m. on Tuesday, December 16, 1997 depicted a cataclysmic explosion between thunderbolts thrown by Pikachu and a “vaccine bomb.” Red and blue flashing lights began to pulse onscreen. Though the sequence lasted only a few seconds, hundreds of children were stricken by an immediate and visceral response that ranged from headaches and dizziness to full-blown seizures. Japanese hospitals found themselves treating viewers for epileptic symptoms.

This wave of deleterious effects became international news. Never before had a television program had such a direct and immediate health consequence on its audience. Some people initially dismissed the whole thing as a hoax or possibly some kind of mass hysteria, but the physical reactions were genuine. What had made this episode of Pokémon so dangerous—even among those viewers not diagnosed with epilepsy? And could it happen again?

 

The potential for a television program to trigger seizures is rooted in how it displays light. Light displayed at frequencies between 10 and 30 hertz, or the number of cycles per second, is known to induce symptoms for a percentage of the population susceptible to them. The color red is also stimulating. When light is shifting from color to black and back again, nerve cells in the brain can fire electrical impulses rapidly, leading to convulsions. This is often referred to as photosensitive epilepsy, where certain visual stimuli can cause a seizure.

As a result, there have been a handful of programs that have prompted medical concern for viewers. In 1993, the UK had three reported seizures as a result of a commercial for pot noodles that used flickering light, prompting the advertiser to pull it from the air. A 2012 animation for the Olympics also triggered adverse effects for a reported 18 viewers. People don’t necessarily need to have epilepsy in order to be affected; they might have an undiagnosed condition, remaining symptom-free until viewing such footage. Others might react even in the absence of epilepsy, suffering headaches or other symptoms as a result of being overly sensitive to flickering light.

Mew and Mewtwo are pictured in a scene from 1998's 'Pokémon: The First Movie'
Getty Images

In Japanese animation, the strobe effect was obviously not intended to cause distress. Animators considered it a technique, which they dubbed paka paka, and which was intended to communicate to the viewer a sequence of high intensity. In “Denno Shenshi Porigon” (“Electric Soldier Porygon”), the Pokémon episode that became infamous, Pikachu’s attempt to free a monster named Porygon from a digital prison results in his being attacked by computer virus missiles. Throwing his thunderbolt attack, he intercepts the missiles and creates a paka paka explosion augmented by another technique known as flash, which accentuates bright and flashing lights. The frames in the sequence were alternating at 12 hertz—well within the window to cause problems.

The scene, which occurred roughly 21 minutes into the episode, is what prompted individuals with photosensitive epilepsy to react. Statistically, it made sense. It’s believed that one in every 4000 people are vulnerable to the condition. With 4 million people watching, 1000 of them could conceivably have been struck with symptoms. A reported 618 people were hospitalized for treatment. Some even wound up in intensive care with breathing problems.

That such a sizable number were in need of attention did not go unnoticed, particularly since it was the result of a children’s show. The story was covered by the late-evening newscasts in Japan, some of which inexplicably decided to air footage of the episode, which provoked more photosensitive reactions. By Wednesday morning, the Pokémon incident was the talk of Japanese schoolyards, with kids being asked if they had been struck down by the cartoon.

 

It took science some time to figure out why this sequence had been so particularly consequential, even among those who weren’t epileptic. As it turned out, the typical living environment in some areas of Japan was partly to blame. In small living rooms often dominated by large television screens, kids were confronted with a towering and flickering image. Some even sat close to the screens, compounding the potentially negative effects of the sequence. Children are also more susceptible to epileptic seizures, and kids were Pokémon's target audience. The length of the sequence, which was roughly six seconds, and its heavy emphasis on the color red may have also played a part.

Hospitals who were sent questionnaires by researchers reported that many of the children treated were not diagnosed with epilepsy, though the incident seemed to precede a diagnosis. One letter to the editor published in The New England Journal of Medicine in 2004 stated that of 91 patients evaluated for Pokémon-induced symptoms, 25 had another convulsion within five years. Of 13 patients who were treated and had no history of epilepsy, 10 wound up being diagnosed eventually.

Pikachu (L) and Ash (R) appear in a scene from 1998's 'Pokémon: The First Movie'
Getty Images

Animators were flummoxed. The paka paka and flash sequences had been used before, though likely not in a program approaching the viewership of Pokémon. Police launched an investigation to make sure Television Tokyo, the broadcast network, was not somehow negligent in airing the program. They weren’t, though the consequence would be the same either way: No one would ever take the risk of airing “Denno Shenshi Porigon” again.

 

The episode was pulled from the series and was never rebroadcast, save for the news clips. The show itself was taken off the air in Japan entirely, not returning until April 1998 and carrying cautionary warnings. (When Pokémon was imported to America in 1999, the episode was predictably left out.) New broadcast standards in Japan were implemented that mandated the color red could not flash more than three times per second, with no more than five flashes per second of any color, and no flash more than two seconds in length.

That wasn’t quite the end of seizure concerns in popular culture. In 2018, some theaters put up signs cautioning viewers that flashing lights in The Incredibles 2 could be a problem for those with photosensitive epilepsy. Disney later reedited the film in the UK so it complied with the Harding Box test, which sets standards on flash and flicker rates for light and can reduce—though never eliminate—the potential for problems. The company is also issuing a warning for the upcoming December 20 release of Star Wars Episode IX: The Rise of Skywalker, stating the film has “several sequences” utilizing flashing lights.

Owing to the relative rarity of these events, it’s likely productions will continue to use flashing images, though producers of Pokémon would probably prefer to forget the 1997 incident ever happened. The episode has never again been cited and the character of Porygon disappeared, save for one fleeting mention in Japan when Hulu kept a preview for the episode at the conclusion of the previous installment. While it doesn’t contain any of the incendiary sequence, it might be the only surviving footage of the day television really was bad for kids.

These Microwavable Plush Animals Are a Charming Way to Keep Warm and Help Reduce Stress

Intelex / Amazon
Intelex / Amazon

There are plenty of ways to stay warm as winter bears down, but one of the easiest solutions is to simply cuddle with one of these microwavable plush animals from Intelex. Aptly called Warmies, there's a whole line to choose from, including bears, bunnies, sloths, pink hippos, and more. Each Warmie is available on Amazon for $17–$20.

Unlike similar products, Warmies don't have a removable heat pack inside; instead, they are filled with natural grains that heat up when you put them in the microwave. What really separates Warmies from the rest, though, is that they contain dried French lavender, which is not only soothing to smell, but can potentially act as a natural sleep aid, according to research.

Microwavable animals from Intelex.
Intelex/Amazon

While Warmies are safe for all ages (make sure kids are doing so under proper adult supervision), they can help adults looking to soothe minor aches, stress, and other ailments. Each time they're warmed up to specifications, expect the heat to last for around 40 to 45 minutes.

And if needed, you can put your Warmie in the freezer for two to three hours (in a sealed freezer bag) and use it as an ice pack.

Humans aren’t the only ones who need some added warmth and stress reduction every now and then. Check out these heated plush toys for dogs.

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