Refining the Explanation of Cotard’s Delusion

Recent work in cognitive neuropsychiatry explains the Capgras and Cotard delusions as alternative explanations of unusual qualitative states caused by dam‐age to an affective component of the face recognition system. The difference between the delusions results from differences in attributional style. Cotard patients typically exhibit a style of internal attribution associated with depression, while Capgras patients exhibit the external attribution style more typical of paranoia. Thus the Cotard patient attributes her condition to drastic changes in herself and the Capgras patient attributes the same changes to alterations in the environment. I suggest three modifications to this explanation. Firstly, the nature of the affective deficit in Cotard cases may be more global than in Capgras cases, resulting from the diffuse effects of the neurochemical substrate of depression. Secondly, this explanation gives us additional insight into the content of the delusion. It is unsurprising that persons whose global affective responses were suppressed would explain their lack of response by saying that they had no bodily existence. Finally I suggest that in Cotard cases the delusion is produced by a reasoning deficit, rather than attributional style.