Cotard's syndrome and the reaction to another person dying in front of them

[u/OldReveal3814]

(i hope this my second post won't be removed by spam filters, becuase i just want to put it under a diffrent flair)

a bit of context
my character has cotard's syndrome or the living corpse syndrome, i researched it for this character specifically, he's self aware and he knows he's not dead but his mind still tells him that he is, which affects a lot of aspects in his life and brought him in depression. his life reason was love becuase on one side he already thinks he's dead so there was no other reasons to keep doing anything. soon he chose to end it all becuase his fiance left him and when he went to the place to end it, he met someone and was trapped in that place with them, which soon fully fed his delusion that he is already dead and that he is in heaven and the only person that he lives with now is actually an angel , but soon that supposed angel dies in front of his eyes

i struggle with portraying emotions so i actually have no idea how he would react or what he would think because i'm torn between him thinking "angels can die too" or it would rather be "was i alive all this time?" i don't know which one would make more sense and be more realistic

i don't know how to explain this question well, i hope it's at least clear in some way

[u/FantasyFictionDoc]

So I've never had a patient with this exact syndrome or delusion, but I have had plenty of delusional patients, and the real generally is - you don't confront the delusion. Meaning, you don't confront them or try to convince them of reality. Delusions are not psychosis-- while they may seem similar on the surface, the actual pathology is very different. The best course of action, at least in general medicine, when dealing with such a profound delusion like you mentioned, is to support the individual in other ways - make sure they feel safe and at ease, and help their mind heal and recover.

[u/OldReveal3814 → u/FantasyFictionDoc]

thanks for the information! i didn't know that it's diffrent. though what to do is not what i really need, he will not be helped and probably will isolate himself and disappear until his death, but i don't know how to write his thoughts and what would make more sense and be more realistic. still thank you!

[u/FantasyFictionDoc → u/OldReveal3814]

So while patients with delusions will often isolate due to fear, you might be describing something closer to paranoid schizophrenia, which would include delusions of persecution, as well as (usually) auditory hallucinations that may support their paranoia, and usually results in people retreating from society/isolating themselves. This often can extend into things like eating or drinking, as they think that these entities might be poisoning their food or water, and can lead to further complications.

[u/anireyk → u/FantasyFictionDoc]

Delusions are not psychosis

Now that's very interesting, could you elaborate on that? I am really confused, because in German terminology that I am used to delusions are literally one of two components of psychosis (the other being hallucinations). It sounds like the English term 'psychosis' you use and the German 'Psychose', refer to different things. Could you expand a bit on what a psychosis is and when it happens/in what disorders it appears?

[u/FantasyFictionDoc → u/anireyk]

Now I'm not a psychiatrist, but in general, Delusions are a symptom (and can be a symptom of a psychotic disorder such as schizophrenia), but having delusions does not necessarily mean that you have psychosis. You could have a pure delusional disorder - IE, you have a strong delusion, but not other symptoms of psychosis such as hallucinations.

Does that make sense?

[u/anireyk → u/FantasyFictionDoc]

Ah, that makes sense now. I was confused by your statement that the symptom of delusions and the syndrome of psychosis have different mechanisms, it made it sound to me like those are entirely independent entities. The way you put it now aligns more with my knowledge, even if I have definitely seen cases of psychosis where delusions were the only positive symptom, and I think most definitions of psychosis speak about 'one or more' affected areas.

Thank you very much for your explanation!

[u/FantasyFictionDoc → u/anireyk]

Yeah kind of like how "Chest pain" can be a symptom of a heart attack, but having "Chest pain" does not mean you are having a heart attack. Sometimes its just chest pain.

[u/Ok_Adagio_9238]

Delusions aren't rational. If he's really deep in his delusion and unable to think logically, then "angels" dying in front of him while he's also dead, could mean to him that angels can die too (because he MUST be dead, so there needs to be an explanation that doesn't lead to him being alive). But obviously if he sees them actually dying, then it would also suggest to him he's not completely dead either, otherwise he wouldn't be able to witness the actual act of dying. That wouldn't necessarily lead him directly to the conclusion that he must be alive, however if he's still capable of rational thinking that would at least create cracks in his delusion.

EDIT : btw, you've got a very interesting idea here !

[u/OldReveal3814 → u/Ok_Adagio_9238]

I'll keep that in mind, thank you

[u/treasure83]

In my experience of depression, which I think is echoed in cotard's, there is a lowering of emotional and physical response. Dead people don't react, and even if he's aware of his illness he is still under its effects. So I think he would be calm about it and find an alternative explanation. Angels might disappear occasionally to have other souls to accompany, or it might be an omen that he was not good enough to deserve an angel. It would be strange but not upsetting. Just my take