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The Cotard delusion is often referred to as the belief that one is dead or does not exist (see Bayne & Pacherie, 2004; Coltheart, Menzies & Sutton, 2010; Gardner-Thorpe & Pearn, 2004; Hirstein, 2010; Pacherie, 2009). Such is the paradoxical nature of this belief that arguably, it, above all else, best captures what Jaspers (1946/1963) referred to as the un-understandability of delusions. Further, "the Cotard delusion is unique in that, in Cartesian logic or philosophy, it is the only self-certifiable delusion" (Gardner-Thorpe & Pearn, 2004, p. 563) insofar as to declare I am dead or do not exist is self-evidently a contradiction. So what does it mean to be dead in a Cotardian sense? Is the patient talking about physical death, or 'spiritual" or emotional death? Perhaps they are referring to total annihilation; after all, some patients claim not to exist at all. On the other hand — contra-death — others claim to be immortal. These differences have a clear underlying theme — that of existential change.

DOI: 10.1057/9781137329325_12

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