Cotard's Delusion Among Addicts With Near-Death Experiences: Are We Already Dead?

How do we know that we aren't dead already? Incidence of the strange belief system known as Cotard's delusion among drug addicts who have had Near-Death Experiences (NDE).

It started with what, for too many people I have known, was the end: I took a bunch of drugs and passed out.

"You were in a coma," a matronly nurse told me when I regained consciousness in the hospital some 12 hours later. She looked vaguely familiar, like an actress who'd played a supporting character in a movie I'd seen long ago.

"It wasn't a very long one," she offered by way of consolation.

It was a few minutes before I realized that I couldn't feel or move my right hand. I had pinned it underneath myself while I was unconscious, the hospital staff later informed me.

"It's probably just taking that side of you a little longer to wake up," the same nurse assured me in a tone of voice that made my reptile brain scream lie-lie-lie.

My right arm didn't wake up. It lay at my side, numb and heedless, as I learned to write, eat, pleasure and clean myself with my left hand.

I was able to raise that arm at the shoulder and move the hinge of my elbow, but my hand - and the fingers on it - were useless. I felt a steel wheel dragged over my shoulder and onto my forearm, but when it reached my palm or the back of my hand, I felt nothing.

Damaged nerves regrow at the rate of a millimeter a day (or an inch a month), I learned. If the damage to the nerve is great enough, though, sensation and movement, which run in the same nerve fiber, might never return.

In such cases, I was told, amputation is sometimes necessary. It turns out that limbs that have lost sensation are a serious liability - not just because you can't feel acute, severe injuries, like breaks and burns, but also because your body loses the ability to more subtly regulate blood flow and position based on changes in temperature and pressure.

It is a strange feeling, which I hope you will never experience, to look down at your right hand, to recognize that it is a part of you, and then to reach out and touch it with your left hand and to feel nothing - as though you are making contact with some foreign object.

It is a bad-brain feeling; your mind assumes that your fingers are wrong, somehow, and there is an internal script error as it tries to reconcile the discrepant streams of feedback from eyes and fingers.

What if my entire body felt that way? I mused one day. What if I reached out to touch it and none of it felt like "me" anymore?

A dark-humor-tinged thought arrived one day midway through my 14-week recovery: Drugs really are killing me - one limb and organ at a time. My right hand is dead, and now I've just got to kill off the rest of me.

That macabre thought, that part of me hadn't come back from my last OD, seeded itself in the dark soils within me; it grew sticky filaments to connect with my regenerated nerve and all of the other damaged and lost parts of myself.

***

"I lived in Death Valley. I died seven times, seven times."

An old hippie named Saul sat next to me on the flight to Shenzhen. He was as wild and wizened as any fairytale grandfather, and he'd kept me entertained for the better part of a 16-hour flight from New York.

"Seven times, seven times I died while I was living out there in Death Valley."

When we got into Shenzhen, I discovered that Saul didn't have data on his Chinese phone. I let him borrow mine to call his Chinese wife, whose name, I learned, was Enya.

"Bye, Saul," I said to him. "I hope number eight is a long way away."

Two months later, it happened to me again after what I assumed was a seizure.

I had woken up in my hotel room in Guangzhou, too disoriented to recognize where I was - too discombobulated, even, to load the four walls around me into the category "room." I glanced at my cell phone on the bed next to me, and it took a full 10 or 15 seconds for me to recognize the sleek black box and remember what it was for.

I knew that I had been out for a while, but I can't explain how I knew this. I didn't feel like I had been asleep, during which some deep monitoring faculty remains online (you'd wake up to the sound of your name or to the smell of smoke, for example).

This time, I had simply gone.

I wanted water. I walked out into the CBD of Guangzhou, a trade center that in ancient times we called Canton, where apartments worth 30 million USD exist a hundred meters above hovels whose residents think that 20 RMB (3 USD) is a sum worth fighting over.

The air is filled with the smog and grit of industry. There are no stars in Guangzhou, and you rarely see the sun, which confines itself to a diffuse brightening behind the uniform beige curtain of the sky.

The dry, polluted air gives the people a sort of mummified appearance. Many bear the burns and scars and missing digits of people who have done early-supply-chain work their entire lives.

There is a popular fashion among the young people of Guangzhou, a sort of Asian-goth aesthetic that involves dark clothing, light makeup, and a pagan concatenation of skulls, crosses, and other symbols.

Tonight was a Friday night, my phone had assured me. As I walked past the young, riotous crowds in their punk gear, interspersed with the old, wearied factory workers, a seed germinated within me:

I am dead, and this is Hell.

I entered a 7-11 to buy a drink. When I reached into my pocket for my wallet, my good-luck rosary - blessed by Pope John Paul II, a gift from my cousin Megan upon my Confirmation - fell out of my pocket.

The lady behind the counter stooped to pick it up, and I swear on everything - when she saw what it was, she recoiled.

"It wasn't a very long one, at least," she said a moment later.

I froze.

"What?"

"The typhoon - it wasn't a very long one," she repeated.

I am dead, and this is Hell.

Central Business District (CBD) of Guangzhou. Even at night, it's still very hazy.

Canton Tower. There is a distinct Mordor - where the shadows lie - vibe that I hope my pictures help you to appreciate.

Lobby of the Four Seasons Hotel, Guangzhou, one of the most luxe hotels I've ever stayed at.

K11: High-end retail, China style. Some of these malls have average ring-up prices to the tune of thousands of US dollars.

Think this is a public library, but don't quote me on that.

***

It wasn't just me, I learned. In treatment, I had heard accounts from other addicts who had had Near-Death Experiences (NDEs) and woken up convinced not just that they had died, but that they were still dead.

This was also a common occurrence among opioid addicts who were given buprenorphine or naloxone (Narcan) too quickly or too soon, I realized; precipitated withdrawal tended to set it off.

As an inverted variation on the same theme, some addicts I met believed that they couldn't die: They had tried to OD, again and again, but it was like death wouldn't accept them.

I was curious enough that I searched the psychiatric literature. There, I learned that there was a name for this phenomenon - although unfortunately very little understanding of it.

Cotard's delusion, first recognized as a delusion of negation by French psychiatrist Jules Cotard in 1880, describes a belief that part or all of oneself is dead, existing either in the "normal" world or the afterlife.

Mademoiselle X denied the existence of parts of her body. She refused to eat, claiming that she had been sentenced to eternal damnation, did not require physical sustenance, and could not die a natural death.

Mademoiselle X died from starvation, we are told.

There was another patient, a Scottish man who suffered brain damage in a motorcycle accident, after which he'd recovered in a hospital in Edinburgh. Upon his discharge from the hospital, his mother took him to South Africa for the remainder of his convalescence.

This man became convinced that he was dead and in Hell; the heat was an obvious indicator of where he'd ended up, he averred. He wasn't quite sure how he had died - perhaps from an OD from a yellow fever injection, whatever that means, or from sepsis.

But he was dead, and the spirit of his mother - who he believed was asleep in Scotland - had arrived to give him a tour of the infernal domain in which he found himself.*

*I've been meaning to steal this as the idea for a novel. Very Salman Rushdie.

It is not a particularly creative delusion, as delusions go. It is a kissing cousin of Descartes' Evil Demon hypothesis:

Question: What if an evil being were creating everything that I experience? How could I be sure of anything at all?

Answer: I think, therefore I am; this I can know

No one knows what causes Cotard's delusion or why people sometimes suddenly recover from it.

Wikipedia tells us that Cotard's delusion, also known as "walking corpse syndrome," is related to Capgras delusion, another delusion of misidentification in which people are replaced by imposters. The Capgras delusion is believed to result from dysfunction of the fusiform face area of the brain, which recognizes faces, and the amygdala, which associates emotions with a recognized face.

I never really believed that I was dead, but I did dwell on how much sense that explanation seemed to make.

There were times when I had been so very reckless with the quantities of drugs I had taken, a kind of thinly veiled suicide; doctors and nurses had repeatedly told me how lucky I was to be alive.

What if I had died in that first bad OD and ended up in an afterlife for people who weren't at their core awful, but who were self-destructive and hurt those around them because of it - people who just couldn't get it together?

What if every time I overdosed, I lost another level of the game, as it were, and advanced deeper into Hell?

Maybe if I recovered from addiction and spent the rest of any given life living as the best version of myself, I could pass away for real - an idea that isn't so far off from the concept of Nirvana as freedom from the cycle of reincarnation (samsara) in Buddhism.

Perhaps the people gone from my life have finished their games - they've either become the highest versions of themselves and been released or been trapped in the lower circles of Hell if they couldn't get it together.

***

"It wasn't a very long one, at least," my colleague remarked.

"Huh?"

"That meeting I forgot to tell you about."

It's an interesting mind-worm, isn't it?

***

I'm really curious about other addicts' experience with this sort of phenomenon; I've heard at least five or six addicts reference an experience or belief similar to Cotard's delusion, and I would love to hear such accounts in greater detail.

Safe to say, again, that I don't really believe in this delusion, but I will say that quantum physics is uncovering fascinating, troubling phenomena that hint at supposedly separate systems being inexplicably connected and that reveal the importance of the observer in generating the universes that each of us inhabit.