What is walking corpse syndrome?

The King of France - thinking he was made of glass - was terrified he might shatter... and he wasn't alone in that belief. After the Emperor met his Waterloo, a steady stream of Napoleons turned up at France's asylums claiming that they themselves were the Emperor of France and demanding their orders be obeyed. In Paris, in 1918, a housewife walked into a police station demanding a divorce on the grounds that her husband had been murdered and swapped for a double.

For centuries, we've dismissed delusions as something for doctors to sort out behind closed doors. But delusions are more than just bizarre quirks of the mind - they hold the key to our collective anxieties and traumas. They may even offer us vital protection from difficult realities.

My first book, A History Of Delusions: the Glass King, a Substitute Husband and a Walking Corpse is published by OneWorld.

What is walking corpse syndrome?

In 1874 at Vanves asylum outside Paris, a 43-year-old woman informs her physician that she has just had a strange and revelatory physical experience. The doctor listens as she describes an extraordinary feeling, something electrical, like lightning, which ran all the way up her back to her head, accompanied by a noise that she thought would split her in two along the spine. The event has set off a chain of thoughts and revelations about herself, her body and spirit, which has led inexorably to the conviction that she is dead.

This macabre scenario brings to mind the opening of a Victorian gothic story or a mid-fifties Hammer Horror film. The image of a living-dead person looms large in the popular imagination. This woman’s story became one of the case studies featured in my book, A History Of Delusions: the Glass King, a Substitute Husband and a Walking Corpse.

The woman’s physician is the prominent Paris neurologist and psychologist Jules Cotard and in 1880, following many interviews with the woman he calls ‘Madame X’, he presents a new illness to the medical community. He believes it to be a type of ‘melancholia’ (broadly speaking what we might now think of as depression).

Madame X, he writes, complained that she "did not have a brain, nerves, chest, stomach or guts; all she had left was the skin and bones of her disorganised body." God and the Devil didn’t exist, she said. She didn’t need to eat, and could no longer die a natural death. The only means to put an end to her life was to burn her alive. Her doctor describes her as "like a lost soul". Beneath the ghoulish melodrama is a real person who is withdrawing herself from the world, both physically and mentally. Cotard calls it a ‘délire de negation’.

As is so often the case with delusions, the story feels as though it has a communiqué smuggled inside it, the meaning encrypted, demanding an audience and interpretation.

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Historical explanation

The generally accepted definition of a delusion is a fixed false idea which is unshakeable despite plenty of evidence to the contrary. For centuries, delusions were thought to be the result of an imbalance of ‘humours’ (too much black bile, to be precise), then they were evidence of demonic possession, and then of brain disease, and were by definition un-understandable. Historically, they were presented as curios and marvels of the mind.

My project as a historian has been to find traces of real lives and struggles, to try to catch glimpse of the flesh-and-blood people behind the pseudonyms, the poster girls and boys for clinical newly coined disorders, like that suffered by Madame X, to see if we can understand better.

‘Varney the Vampire’ was the first popular image of the living-dead, the star of a gothic horror serial within the Penny Dreadful magazines of the 1840s, and the warm-up act for Bram Stoker’s iconic creation Dracula in the 1897 novel. But walking corpses presented themselves to physicians in real life long before these iconic characters were put to paper, and centuries before Cotard formally described the phenomenon.

The dead don't eat...

Petrus Forestus, a 16th-Century physician in the Dutch Republic, tells the story of a melancholy patient who believed that he was dead and refused to eat anything. A ‘ruse’ followed - a trick intended to snap a person out of their false belief. The doctor apparently asked an associate to pretend to be another corpse and put this stooge "... in a chest like a dead man, by his bedside, and made him rear himself a little, and eat: the melancholy man asked the counterfeit whether dead men used to eat meat. He told them yay, and did eat likewise and was cured."

The farce of a ‘dead body’ sitting up in a coffin to shock another person out of a delusion has a ghoulish entertainment value. We should take the success story with a pinch of salt. Physicians had a habit of talking up their success for their own reputational ends. People with the belief they are dead won’t be easily revived, by any means, and they continue to rear up again and again over the centuries.

During his career, Cotard encountered many patients with this belief and a "strange logic" that they are "neither alive nor dead, or that they are alive-dead". The conviction is unsettling and pre-empts Sigmund Freud’s 1919 essay, The Uncanny. For Freud, delusions, like dreams, are stories from the unconscious.

Psychoanalysis would soon view trauma as the generator of madness, and uncovering the trauma, bringing murdered memories back into consciousness, as the road to a cure. With her delusion, we might imagine Madame X disconnecting from her traumas. She pulls out the connections to these experiences one by one, disassembling her body, absenting herself, or performing a disappearing trick. The belief that she is dead makes her immune from blame for her actions or her character.

Is it depression?

In a psychiatric context, what became known as ‘Cotard's syndrome’ can be read as severe depression; a person’s explanation to themselves and others of their experiences of disassociation and alienation.

In 1960, R.D. Laing produced his landmark The Divided Self, and was exploring how to treat his catatonic patients. Like Madame X, they had completely withdrawn from the world. Some behaved as though they were already dead. Laing attributes the catatonia in his patients to claustrophobic families and their demands.

In Sanity, Madness And The Family, Laing talks about withdrawal as "a strategy which a person invented in order to live in an unliveable situation". It made a lot of sense psychologically, and if a person was listened to, natural healing was possible without drugs or restraint.

There is a profound sense of alienation in Madame X’s delusion. So where did her belief come from? She was admitted to the asylum at Vanves just three years after the Siege of Paris which ended the Franco-Prussian War by starving the population of Paris into submission. She mentioned a more personal trauma, too, and feelings of guilt and shame, confessing to her doctor that she had "done wrong during her first communion."

It’s an unclear picture.

Zombies in popular culture

In popular culture, the living dead have found their most shocking expression on film as zombies.

As with vampires, there was a spin on the conceit here. The alienation was not from the point of view of the person who believes they are dead but from the minds of those who fear it as an external threat.

In the 1968 film Night Of The Living Dead, director George Romero uses a cast of zombies to critique American society and the blind conformity of the population. Americans were in the middle of a war they couldn’t win in Vietnam and audiences packed into movie theatres to watch the ‘Living Dead’ destroy civilisation as we know it.

The archetype of the zombie originated in Haiti where a ‘zombia’ was a figure stuck between life and death. These were not simply the living dead, they were substitutes for loved ones. You recognised them, but they were not the real person, provoking a particularly disturbing cocktail of familiarity and strangeness.

What's going on in the brain?

In real life, neurologists have continued to investigate organic causes of delusions, through ever more sophisticated diagnostic technologies like the Magnetic Resonance Imaging (MRI) scanner and traced them in many cases to right temporal lesions in the brain. Also seen was a disconnection between the sensory areas of the brain and the limbic system, which is responsible for emotions and memory. This breaks a person’s emotional relationship with the outside world and leads to feelings of unreality and delusions of death and negation.

In 2007, a variety of receptor encephalitis caused by an ovarian tumour and linked to delusions was identified by Josep Dalmau at the University of Pennsylvania. The growth instigates an autoimmune attack, and there are particular brain cells that resemble the embryonic cells in the ovary that are mistakenly treated as though they present a similar threat and attacked also. The resulting encephalitis inflames the right hemisphere of the brain and delusions result. Characteristic symptoms with this particular encephalitis include grunting and growling with convulsions, and may even help to explain historic cases of ‘demonic possession’.

For many of the people in my book who were alive before the advent of new technology, undiagnosed organic brain disease may well have been part of the story alongside any psychological dimension. Cotard recalls that on examination Madame X "showed reduced sensitivity to pain in most areas of her body: for example, she would not show any reaction when pricked by a pin."

Could this be brain injury or disease?

Jules Cotard tried to cure Madame X, but he ran out of time, dying from diphtheria aged 49. His patient is reported to have starved to death. It’s a desperately sad outcome but the notes which record her conversations with Cotard remain as evidence that beneath her outlandish belief was a real and complex woman worthy of attention and interpretation.