Dead certainty in the Cotard delusion

Some people insist that they are dead. Rather than starting with the usual assumption that delusions are ‘false beliefs about external reality’ I want to consider how interpreting their claim as a report of a certain kind of anomalous experience assists us in understanding why they are certain, why their claim is immune from evidence to the contrary, and why they do not act in ways we would expect were they to believe their claim to be true of the world. While this helps us understand cases where people do not act on their delusions, more must be said about the people who do act on their delusions. I shall attempt to describe a process where an intense anomalous experience leads to a context-specific narrowing of attention. The ultimate result of this is that the appearance / reality distinction becomes lost in the context of the anomalous experience. The sense of conviction that would be appropriately associated with a report of experience thus becomes inappropriately associated with a claim about external reality. While there have been efforts to provide cognitive therapy for delusional subjects such therapy seems to be based on the notion that confronting them with their contradictions will assist in weakening their sense of certainty about the delusional utterance. I consider whether more progress could be made via empathetic validation of the sense of certainty which is appropriate when associated with the person’s anomalous experience.