I am working with a retired corrections supervisor who has known PTSD that is quite poorly controlled. He was diagnosed only 2 years ago even though he has not been in the inside for 9 years. He has dozens of traumatic experiences most of which have gone untreated. In most cases, law enforcement and corrections officers alike would undergo debriefing when officers are required to retrieve human remains or to cut down an inmate hanging from his bed rail or someplace else.

CO is cooperative and likable. I had heard about walking corpse syndrome once or twice. I have even had one or two cases of this specific delusional disorder and may have missed its significance. I was trained to think that walking corpse was usually associated with borderline personality disorder, hypochondriasis, or somatization disorder. It goes beyond the cookie cutter explanation and does not incorporate an organic cause. In a case I worked with in the summer of 2022, the 57-year-old male has a history of unstable PTSD because of his 21 years of service at a maximum-security prison here in Massachusetts. During this time, he experienced physical attacks over five times – one of which kept him out of work for 10 months. He witnessed over 100 prisoner hangings – deaths by suicide that required a special team response. He was a supervisor and was called upon to organize “teams” of men to deal with offenders who were violent and admitted with pride that he was always the first man at the scene. By doing so, he witnessed men who had cut their own throats and died before the entry team could assemble and make the save. He witnessed vicious fights among competing prison factions. And was himself attacked and lost time at work.

These experiences followed him into retirement and invade his sleep regularly even now. He sleeps only 2 hours at a time, awakened by images of his death own and embalming. He walks the house checking doors – just as he did on the block during his time on the job. For his part, he feels conflicted because he is a Christian and believes in his heart that he could help many inmates – some of whom may have taken their own lives. Instead, he could not turn the other cheek at times when inmate brutality broke the normal clamor behind bars. Correction’s officers are often seen as the last first-responders and are rarely debriefed following inmate deaths, personal attacks, or violence toward officers.

I had heard about walking corpse syndrome once or twice. I have even had one or two cases of this extremely specific delusional disorder and may have missed its significance. I was trained to think that walking corpse was usually associated with borderline personality disorder, hypochondriasis, or somatization disorder. It goes beyond the cookie cutter explanation of diagnoses and fails to include an organic neuropsychological underpinning that we now understand is important.

MIchael Sefton, Ph.D.

Cotard’s syndrome is characterized by nihilistic delusions focused on the individual’s body including loss of body parts, being dead, or not existing at all. Cotard’s is neither mentioned in DSM-V nor in ICD-10 – both diagnostic tools made for identifying nervous and mental disorders. There is growing unanimity that Cotard’s syndrome with its typical nihilistic delusions externalizes an underlying disorder. Even though Cotard’s syndrome is not a diagnostic entity in our current classification systems, recognition of the syndrome and a specific clinical understanding is essential for definitive treatment options and classification. Organic causes should be ruled out as an etiology before attribution of Cotard’s syndrome as a fully functional problem. Some papers are cited in the literature that indicate that separate typologies should be considered. The most common is a syndrome more strongly associated with major depression and its symptomatology including melancholia, nihilism, and psychotic features. A slightly different nosology abnegates depression and aligns it more closely with delusional thinking and not primarily associated with affective disorder.

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Cotard delusion is a rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist. It usually occurs with severe depression and some psychotic disorders. It can accompany other mental illnesses and neurological conditions. You might also hear it referred to as walking corpse syndrome, Cotard’s syndrome, or nihilistic delusion.

Debruyen, H, et al. (2011) Cotard Syndrome.

Debruyne, Hans & Portzky, Michael & Peremans, Kathelijne & Audenaert, Kurt. (2011). Cotard’s syndrome. Mind & Brain, The Journal of Psychiatry. 2. 67-72.