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A patient with Cotard's Syndrome (also called "Cotard delusion" and "Walking Corpse Syndrome") has the delusion that he or she is dead (and sometimes immortal), either figuratively or literally, yet continues interacting with their environment and communicating with others. This seems like a contradiction in it's fundamental diagnosis. Even in this delusional state, how do they rationalize such interactions? To converse with people, they would need to believe such people are alive or at least in a state similar to themselves. Prior knowledge of environmental interactions and social behavior should cause some patients to reflect over their perceived delusional reality at the vary least.

How do patients with Cotard's Syndrome rationalize interactions in active environments and in social settings?

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    $\begingroup$ One example from the book "On being certain" (I'm quoting from memory here): A patient with this syndrome was asked "Are you breathing?" "Yes, I am". "So, what conclusions can you make from that?" "That it is possible that death people breathe" "Have you heard of this happening before?" "No, I haven't. But here I am, dead, and I breathe. So it must be possible". The point: they don't necessarily rationalize it. They accept the presence of environmental interactions as illogical and unexplainable. $\endgroup$
    – rumtscho
    Jan 15 '15 at 14:28
  • $\begingroup$ That actually seems perfectly rational if you start with the assumption that you are dead. $\endgroup$ Jan 15 '15 at 15:35
  • $\begingroup$ Josh: The clinically dead lack circulation, breathing, consciousness, and otherwise cease mobility in their environment. Accepting that one can be dead without such qualities requires redefining/negating the meaning of "clinically dead," which serves no constructive purpose. $\endgroup$ Jan 15 '15 at 16:00
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    $\begingroup$ @GrumpyCrawley they don't lose the ability to rationalize. But nobody rationalizes away everything they see, neither Cotard patients not healthy people. I don't know how curious they are about the controversy's explanation. But the whole point of their illness is that they know for sure that they themselves are dead, so if they look for explanations why they are dead and breathing at once, they just don't find them. If you have a tootache, can you convince yourself "I see no reason to have a tootache, so I'm not feeling pain", or do you think "I have no idea why, but it's painful"? $\endgroup$
    – rumtscho
    Jan 15 '15 at 18:34
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    $\begingroup$ rumtscho: Feeling pain around a tooth can make people jump prematurely to the conclusion it's a toothache when in fact the cause is from something else (excited nerve(s) from gum damage, blister, etc.). However, upon further research and analysis, they can better deal with it. In the case of Cotard's Syndrome, they could be coached into a more rational state-of-mind to better cope with their situation. $\endgroup$ Jan 15 '15 at 20:29

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