Cotard’s delusion & fiction.

mental health & illness


To say, “I am living with Cotard’s delusion,” is a sort of oxymoron; to say, “I am living as a dead person,” makes little sense. And yet the idea of being dead, and of believing that I am dead as firmly as I once believed that I was alive, has burrowed into my mind like a parasite.

I have only seen one pop culture reference to Cotard’s delusion, named as such because of the doctor who first documented it in detail. A young woman turns out to be the killer in Episode 10, titled “Buffet Froid,” of Hannibal. It’s Dr. Hannibal who introduces Cotard’s to the protagonist of the show, and therefore the audience: “Have you considered Cotard’s syndrome? It’s a rare delusional disorder in which a person believes that he or she is dead… Even those closest to them seem like impostors.” The woman, named Georgia, has suffered from Cotard’s syndrome for years, and tore the face off of one of her victims to presumably see what was beneath. At some point, when Will encounters her, he shouts, probably unhelpfully, “You’re alive!”

Cotard’s delusion is closely related to Capgras delusion, which I have experienced multiple times over the last seven years. Both are rare. Both affect the same region of the brain. The person afflicted with the delusion is unable to process faces in an emotional manner; it is thought that this lack of ability to process therefore leads to a conclusion — with Capgras, that the person’s loved ones have been replaced by doubles (“invasion of the body-snatchers” and “reverse zombie syndrome” are two pop-journalism, unsubtle references to low-grade horror that have little to do with the actual horror of either of these delusions), and in Cotard’s, that the person is herself dead.


I love books. I have ever since I can remember being conscious. I have especially loved fiction.

In the depths of psychosis, my ability to discern what is real and what is not wavers. This makes fiction tricky.

My therapist had, in the past, suggested that I avoid it. This, after reading a novel about boarding school and horse riding had me confused. I thought my parents were wealthy and lived in upstate New York. I thought that I was a prodigy with horses.

But to exist without books is a terrible way for me to exist. At times I read nonfiction, which is hard on even my more functional days. I end up raging at the author who exhorts me to look past my past or work hard or pursue my deepest dream. This, I feel, is much easier to do when one’s mind has not become a scramble of delusion, a mind that even in better circumstances can shatter into catatonic psychosis under the weight of, say, viewing a single art exhibition at the Legion of Honor, or having a thirty-minute conversation. This is especially galling when I have always worked hard. I have always pursued my deepest dreams, in one way or another. My nature is to be ambitious, to be industrious. It has only been recently that the factory chose to stall.

So nonfiction, especially of the personal development, writerly, or business variety, can pull me under. So can books about overcoming grief, or living through loss, or stories of triumph. The problem that I have can’t be talked through or thought through or meditated through. The problem exists in my own terrible master — in my Self.

Recently I have been listening to the Gilead audiobook. I decided that if I had to choose a reality to be confused in, the reality of John Ames would be a pretty beautiful substitute.

I do find myself lost in the book. Another issue of language: “lost in a book.” This is not a pretty metaphor. I become lost in the book. The world of Gilead is no more or less real than my own world. The world of a film, any film, is simply a full world that I don’t know how to get to. Either I don’t have the directions, or it’s too out of the way — but I would not be any more surprised to exit my studio and find myself in a church, being preached at by Marilynne Robinson’s John Ames, than in the hallway, which is no more or less real to me than my dreams.

This process of discerning what is, or is not, safe to watch or read is an endless one. Science fiction, as it turns out, or anything that challenges reality beyond its understood boundaries, such as Marisha Pessl’s Night Film, is to be avoided.


Language is my backbone. I have said this over and over, but it’s more than a pretty turn of phrase. I use language, and in particular, writing, in order to reconstruct the world that I once understood so easily, and so well; I write about my experience of Cotard’s, and of illness in general, in order to help others who may experience similar things, and similarly feel confused or despairing; I do advocacy work because I want to help others who have never experienced similar things to understand that I am a person — a kind, generally cheerful, and funny person — who has an illness that causes even the most open-minded people to think of me as a foreign object, and generally one to be feared.

I do this for myself. I do this for others who can’t do it for themselves. I do it for you — with great tenderness, and with love.





P.S. Hannah of Becoming Who You Are interviewed me for Episode 51 of her podcast. We talked about Radical Sincerity, among other delicious things. Check out Becoming Who You Are, and my interview, here.  If you haven’t managed to get your hands on your own copy of Radical Sincerity yet, I highly recommend that you hop on over here. (I hear that it’s “beautifully written, soulfully articulated, and refreshingly honest.”) Hurrah.

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The Care & Keeping of Esmé (& of You)

compassion & care, mental health & illness

For whatever reason, it was this most recent episode of illness that prompted me to create a book. The book is written in a notebook (from invite.L, my favorite seller of stationery, if you’re a stationery geek like me), and has been informally dubbed The Care and Keeping of Esmé. Should you, too, have a chronic mental illness, I invite you to create one for yourself. Here are some of the things that are being recorded in The Care and Keeping. If you should have any suggestions, feel free to leave them in the comments.

  1. A grocery shopping list. This might sound bizarre, but my acupuncturist has recommended certain foods for me, both for my schizoaffective disorder and for my fibromyalgia. But in general, it is easy to slide into a not-eating state of mind, or an eating-too-much-crap state of mind. Creating a grocery shopping list when well encourages me to remember what is actually good for me to eat. (And that I need to eat.)
  2. Basic, basic recipes. Brown rice plus tuna fish plus lemon juice. Okay.
  3. Nourishment activities. I have a page that details for me how to get to the ocean. I have a terrible sense of direction and don’t drive, so I made extensive instructions about taking public transit to the shore. You might not love the ocean; maybe you love the zoo, or have a forest that you like to go to.
  4. Nourishment activities, continued. These are the things that help alleviate the anguish/psychosis/mania/etc. You might need different lists for different types of episodes, as I do. I have included things like “using Headspace” (a simple, but lovely meditation app), “drinking ginger tea,” and “Skyping with Mum.” Having a tangible list of activities helps to at least remind me that I can attempt to not go straight for alcohol or self-injurious behavior, or any of my other long-standing, but unpleasant, coping mechanisms.
  5. Lists of signs of oncoming episodes. I didn’t realize until I stopped craving the taste of alcohol after my yearlong episode of depression ended that “craving alcohol daily” was a symptom, or that making a million lists and obsessively tidying was a sign of oncoming psychosis. Yours may or may not vary.
  6. A list of resources. This may include your best friends, your family, your doctors, a crisis line, your local clinic, etc.

I hope that was helpful. Again, if you have any more suggestions, leave them in the comments. And if you think this might be helpful for someone you know, feel free to send them the link; tweet the link if you feel like it might be nice. ( Be well, all of you. I wish you all the very, very best.

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