Fractured Reality: Distortions of Perception pt. 1

Fringe Beyond Limits - Fringe Beyond Limits, Bleav

This episode explores rare psychiatric conditions that distort perception of self and reality, including Cotard's Syndrome, prosopometamorphopsia, and depersonalization disorder. Through clinical cases and neuroscientifi

Key takeaways

• Cotard's Syndrome causes belief in being dead despite physical life

Transcript preview

You're Welcome to another episode of Fringe. Beyond the birds. You sounded extra recipe there, Mr. Frank. I did. Welcome. Welcome. Welcome. Welcome. Welcome. Welcome. Welcome. Welcome to the Thunderdome. Welcome to the Thunderdome. Welcome to the. Welcome to the Journal. I wasn't paying attention next. I made sure I had my mute off this time. Okay. That's good. Yes, very nice. Very nice. So. And I'm ready to eat my chips again. Okay, yeah. Yeah. So I don't make munchy noises on the mic. Go ahead. Go ahead. The listeners will love that. Yeah. Yeah, that's. They're crew ranch by the way if anyone was wondering. Yeah, no, they're not. But you know, that's. I can smell it all the way down here. I know one person that probably would wonder. Who's that? Who's that? Who's that? Does Wilson wants to be you? He agreed. I know. That was my next question. Does Wilson want to meet me? Every once while I'll say something he goes, I don't know if I'm ready for that. I'm like, what does he think? You're going to meet him. What do you think? What does he think I'm going to do? I don't know. You know, like, I'm not like, I'm not like a psychopath. What does he? I am a hugger that is true Wilson I am a hugger so you should be also has some dark humor like you do but he's more quiet where you're more verbal mmm so I need to bring him out of the shell so it'd be definitely an interesting conversation between you two I can't Wilson come on drinks you me and a couple stools you me and a couple stools no sure I don't he doesn't really drink but sure listen are going to have a man. It could be a mocktail. I'll say his string of choice is Coke. All right. Well, him and I are going to have a man-panion date. You heard that right, folks. Wilson, you got that? You're going to be my man-panion for the evening. That sounds terrible. I know. It sounds so terrible. It sounds so terrible. It does. But, you know, I'm a terrible human being, so. You're not selling it for Wilson. I didn't think I was to start off with. I mean from episode one till now I don't think I've sold anything to Wilson. So but yet he still listens to it. Hey you know what God bless. I think you for your loyalty Wilson so it's so funny so like we tend to always like record a bunch of episodes sometimes and then play him. I don't remember what order they are in so I randomly go get a text from him. on an episode I'm like what is he talking about? Yeah. What are you doing? What's going on? He's like and he tells me what is I'm like oh yeah forgot about that one. Yeah you know it's so weird because like I'll talk about the podcast to everybody and if I ever get asked well what what topics have you covered I'm like I have no idea I got to go to to the apple and go through our catalog and I'm like I don't remember I'm like I don't remember I get at my spotify So let me refer to my annals. Yeah, right. I believe I believe you mispronounced annals. So all right. Well. I hope you guys are doing great. Yeah. Yeah. Yeah. All right. Good. All right. So. Yeah. Let's just jump right into our tonight's story. So the mind is supposed to be the one place where reality feels anchored. a steady inner voice assuring us that we are here, that the people around us are who they seem to be, and that our bodies belong to us. Yet scattered throughout psychiatry are rare conditions that shatter those assumptions, so completely that they make ordinary life feel uncanny, dreamlike, or even horrifying. In the following episode, we'll step into some of these strange mental worlds, places where a person can believe they are dead. see familiar faces twisted into grotesque masks, feel their body turning into an animal, or become convinced that their own limbs don't belong to them at all. These are not stories from folklore or horror fiction, but documented clinical realities that reveal just how fragile our sense of self in reality truly is. So our first is going to be Kotard's Syndrome. often referred to as Walking Corps Syndrome is one of the rarest and most unsettling conditions in psychiatry. It is defined by a person's firm, unshakable belief that they are dead, do not exist, or have lost essential parts of their body or soul. This isn't metaphorical or poetic thinking. The individuals experiencing it genuinely believe that they have already died. Even why they continue to speak, move and interact. with the world. Some insist their organs are gone, that their blood has dried up, or that the entire world has ceased to exist along with them. It's not just a distortion of mood, it's a complete collapse of one's sense of existence. The condition was first described in 1880 by French neurologist Jules Kautard, who introduced it under the name L'Dilaire de Negation, or the Delirium of Negation. known as Mademoiselle X believed she had no brain, no nerves, no chest, and no internal organs. Only skin and bones. She insisted she was already dead and therefore did not require food or care. Tragically this belief led her to stop eating altogether and she eventually died of starvation. Kotard's work initially remained obscure but over time similar cases began to surface across Europe. linked to severe depression and psychotic disorders. What he identified wasn't just a strange dilution, it was a pattern, a recognizable collapse of the mind's ability to affirm its own existence. There is no single cause of Kotard's syndrome, but it is most often associated with severe psychiatric and neurological conditions. It frequently appears in individuals suffering from major depressive disorder with psychotic features, though it has also been observed in cases of schizophrenia, bipolar disorder, and certain forms of dementia. In some instances it emerges after brain injuries, strokes, or tumors that affect regions responsible for self-awareness and emotional processing. Neuroologically, researchers believe the condition may stem from a disconnect between the parts of the brain that recognize the self and the parts that attach emotional meaning to that recognition. In other words, a person may still intellectually understand that they exist. but they no longer feel it and the brain attempts to resolve that contradiction by concluding that they must not exist at all. Diagnosing Kotard's syndrome can be complex as it is not classified as a standard standalone disorder in a major diagnostic manual is like the DSM-5. Aren't they on that like the DSM-10 now? Mm-mm. No, I don't know. I'm trying to remember what I had when I went to school. Yeah. I think it was four. I don't know. Okay. Instead it is treated as a symptom or subtype of delusional thinking within broader conditions. Clinicians typically identify it through psychiatric evaluation focusing on persistent nullistic delusions such as I am dead or I don't exist paired with a lack of insight into the irrational nature of those beliefs. Doctors will often run neurological scans such as MRIs or CT scans throughout structural brain damage or disease. signs also play a significant role. Patients may withdraw socially, neglect their physical needs, or refuse to eat because they believe their body no longer requires nourishment. There's often a haunting calmness to their demeanor, as if they have already accepted a reality that others cannot see. One of the most compelling modern cases is that of a man named, or I'm sorry, man known as Graham, studied by neurologist Adam Zeman. After a suicide attempt, Graham regained consciousness with the found in chilling conviction. He believed he was dead. He told doctors that his brain no longer existed and that he was essentially a walking corpse. Unlike many psychiatric patients, Graham didn't express this belief with agitation or fear. Instead he spoke about it with a quiet certainty. He lost interest in everything he once enjoyed, music, social interaction, even smoking, and began spending time in graveyards because he felt more connected to the dead than the living. He still. He still. Dr. E. E. regularly explaining that food no longer served any purpose. What made Graham's case particularly extraordinary was what doctors discovered when they examined his brain. A pet scan revealed extremely low metabolic activity in regions associated with self-awareness, particularly the frontal and parietal lobes. His brain activity resembled that of someone under deep anesthesia or even in a vegetative state. Yet he was fully awake, able to speak. and aware enough to describe his condition. It was as if the parts of his brain responsible for generating the feeling of being alive had gone offline, leaving him in a strange limbo between biological life and psychological non-existence. Despite the severity of his condition, Graham eventually began to recover. Through a combination of antidepressants, antipsychotic medication, and therapeutic intervention, sometimes including electroconvulsive therapy in similar cases, his sense of self-self, gradually returned. The certainty that he was dead began to loosen and with time he regained a connection to the world around him. His case remains one of the clearest modern demonstrations of how fragile and constructed our sense of existence truly is. Kotard's syndrome forces us to confront a deeply unsettling idea. The feeling of being alive is not guaranteed simply because our bodies are functioning. It is something the brain actively maintains. When that system breaks down, the mind doesn't just become confused, it creates a new reality to explain the absence. In that reality, the person isn't sick or lost or disconnected. In their mind, they are simply no longer here. Question. Yeah. Do you think this is where zombies kind of were created? Like this syndrome? Like it kind of helped inspire in a way. No, there actually is a, I believe it's in Haiti, a Haitian, and I believe it derives from Voodoo. where they give the patient or the person they want to turn into a zombie a medicine that basically makes them put them in like a coma but they're they're aware and stuff aware and then they go through the rituals of burying them and then they dig them up and with this medicine and it's a psychotic break they have they truly think they're a zombie and under control of a witch doctor. I like that story. Oh, okay. That's like one of those like tales story, not tale, but like, it's interesting, interesting history. Yeah, sometimes they'll even bury them up to their neck and just leave their head out, which is... Yeah, heshin voodoo is always interesting though. Yeah, interesting, sure. Yeah, interesting, sure. I had... No, I mean it is, it is, you know, it is fun to read about and think about, but like, I mean, these people... It's definitely interesting because it's difference. Yes. Yeah. Lynette? I'm just making my beaker face of thinking about being buried up to my neck. Yeah. And I'm also excited for frankly read this next word. Oh, yeah. Oh, well, don't sound, don't sound quote-tarted when you say it. Oh, I, I, I, I, I, everyone knows I am. So. Better you than me. I'm going to totally. sure. If you if it makes me feel better I could try first. Okay yeah go ahead. Go ahead. Pro soap. Piate. Tantame. Prophosia. Close. That was real close. Well not you should try to. Yeah. I'll say it after Frank Toth. Because I'm pretty sure I got it. Prosoppo metamorphosis. M-O-O-Sof-Sof-H-O-H- Hold on. I had it. Pro-Sopo Metamorphosia. Yeah, the alliteration of trying to say that word is impossible. PRO-S-O-P-O-M-E-T-A, M-R-P-H-O-P-S-I-A. Morpho, op-sea. All right, I'm just gonna... Did you get it? I don't know, but I read something later on, I think it kind of... Okay, so I'm just gonna call it... So I'm just gonna call it... Proposaurus. Proposporus? Proposporus. Metaphoph, Metaphoph, okay, so I'm just gonna call ProSopo. So Proposopo is one of those conditions that feels almost surreal when you first hear about it. than just affect vision in a simple way. It specifically distorts how people perceive faces. Individuals with this condition see faces as warped. I think he paused. What's that? Yeah, I was like, you, you're frozen. Am I so? You froze for like five seconds. So here's the thing. So I've gone back and listened to our episodes of where that's happened. Your face is frozen. Is it still frozen? That's blotchy. Okay. So, so I look like 19. 1990s internet yeah so I've gone back and listened to other episodes where you guys say I froze The thing is is that since I'm recording on my end it the recording Picks me up the whole time and it does so all on all you hear is it makes it funny then yeah it does it's like I'm talking and you guys you're you're froze You know so That's awesome. I mean it might not be different than any other day but that's true. Yeah. Who else is going to listen besides Wilson? Not much not many people. All right we are in 190. Yeah that's true. So all right I'm going to just start this over so ProSopo is one of those conditions that feels almost surreal when you first hear about it because it doesn't just affect the vision in a simple way. It's specifically distorts how people perceive faces. Individuals with this condition as warped, stretched, twisted, or altered in ways that can be deeply unsettling. Eyes may appear too large or shifted out of place. Mounds may droop or stretch unnaturally. And the overall structure of a face can seem almost monstrous or inhuman. What makes it especially disorienting is that this distortion is often limited strictly two faces. Objects, environments, and even bodies can appear completely normal, while only the human face becomes something unfamiliar and disturbing. The condition falls under a broader category of visual distortions known as metamorphopsia. But prosoppo is unique in its specifici, it's specificity, the name itself comes from a Greek roots prosopo meaning face, metamorpho meaning transformation, and opseia relating to vision. Though it is extremely rare, it has been documented in neurological. Oop! Oopah! It has been documented in neurological and psychiatric literature for decades, often appearing in connection with disruptions in the brain's facial recognition systems. Unlike face blindness where a person cannot recognize faces at all, this condition allows recognition to remain intact, but the image itself is grotesquely altered. The underlying cause is typically linked to abnormalities or damage in areas of the brain. responsible for processing faces, particularly regions like the fusiform face area, which plays a crucial role in facial recognition. This can result from a variety of triggers, including head trauma, migraines, epilepsy, strokes, tumors, or infections. In some cases, it has also been associated with psychiatric conditions, though the neurological basis is more commonly emphasized. Essentially, the brain's ability to accurately map and interpret. to facial features becomes disrupted, causing it to reconstruct faces incorrectly while leaving the rest of visual processing untouched. Diagnosing ProSobo can be challenging, partly because patients often hesitate to describe what they're seeing out of fear that sounds unbelievable. When they do come forward, diagnosis typically involves a combination of neurological imaging, visual assessments, and detailed patient descriptions. Doctors work to rule out other conditions. Doctors work to rule out other conditions. Doctors work to rule out other conditions. Doctors work to rule out other conditions. such as hallucinations or broader visual impairments and focus on the very specific pattern of distortion affecting faces. Because the condition can be intermittent, sometimes triggered by migraines or seizures, it may not always be present during examination, which adds another layer of difficulty in confirming it. One of the most compelling modern cases involves a man who began experiencing these distortions suddenly without warning. He reported that when he looked at people, their faces appeared. grotesque altered as though they had been digitally manipulated into something almost demonic. Their features were stretched and shifted with deep grooves and unnatural proportions. Yet everything else in his environment remained completely normal. Importantly, he knew that what he was seeing wasn't real, that the people in front of him hadn't actually changed, but the visual distortion was vivid and persistent. This distinction helped doctors separate his condition from a psychiatric hallucination. and instead identified as a neurological issue. Researchers studying his case were able to document the phenomenon in a remarkable way. By working closely with him, they created visual representations of what he was seeing, effectively translating his distorted perception into images that others could understand. Brain imaging revealed irregularities in the regions associated with facial processing, supporting the idea that the conditions stemmed from a disruption brain interpreted faces rather than a break from reality itself. Over time and depending on the underlying cause, some individuals like him may experience improvement, especially the condition is tied to something treatable such as migraines or inflammation. What makes ProSopo so fascinating and deeply unsettling is how it targets something so fundamental to human connection. Faces are central to how we recognize, trust, and relate to one another. When that system is It doesn't