“I speak, breathe and eat but I am dead,” said the patient.
The symptoms had started two years earlier, and his family finally brought the patient, a 32-year-old high school dropout, laborer and family man, to the Kerman Psychiatric Hospital in southern Iran after he refused to go to work for two straight weeks. At first, he just felt restless and sensed a subtle, strange feeling in his body, like a faint electric shock. Soon he felt as if his whole body had changed and, finally, he concluded that he was dead and that his death was caused by his sins during life. He said that after his death, sometimes his jaw moved automatically and concluded that he had been transformed into a dog. His wife had suffered the same fate. His three daughters had also died and were transformed into sheep and the scent of their urine made him restless. He could smell their it even then, in the hospital, far away from his family.
He started having trouble sleeping and then felt no need for it. At night, he laid far away from his family, afraid of sexually assaulting his daughters while they slept. He had, after all, had a sexual relationship with a sheep during his life as a human and still could not get over the guilt from it. He also refused sexual contact with his wife, as he believed his sins were so grave that he should never look at any woman again.
He began to accuse his friends of harming him. When they asked why he thought that and how they had supposedly harmed him, he gave no explanation, but did not worry either. He believed that God protected him, even in death, and that no poisons could hurt him. He explained that his relatives and friends repeatedly poisoned his tea with cyanide but that he had not been harmed.
The man and the beast were dead, but would live forever. Having suffered for their sins, they were now protected by the hand of God.
The man met DSM-IV criteria for mixed-type bipolar mood disorder with psychotic features. In addition, he displayed delusions that DSM-IV criteria could not explain. Lycanthropy in folklore and horror movies is applied to humans who change into wolves. In the psychiatric literature, though, it is a rare belief or delusion that one has transformed into an animal, or the exhibition of behavior suggesting that belief. Cotard’s syndrome is another rare condition in which the afflicted has nihilistic delusions that lead them to deny their own existence or that of the external world. The syndrome also involves the paradoxical ideation of immortality. He presented a typical case of Cotard’s syndrome, having both delusions of being dead and of immortality. His lycanthropy was a rare variant in which both the patient and others were transformed into animals, a delusion reported only once before.
How could these two conditions co-exist in one patient? The man’s caretakers found several ties that bound them to each other. Immortality is a common symptom of both lycanthropy and Cotard’s syndrome. His sins in life, one of them being sexual contact with a sheep, were explained as the cause of his death, and zoophilia and bizarre and chaotic sexuality in general are often expressed in a primitive way by lycanthropes (the prevalence rate of zoophilia – both actual sexual contact and sexual fantasies – is significantly higher among psychiatric patients, 55%, than control groups, 10 and 15%). In addition to the paradoxical pairing of the delusions of being dead and immortal in Cotard’s syndrome, the man’s lycanthropy presented its own paradox. In Persian folklore, the dog is both a symbol of loyalty and a symbol of impureness. The man’s sexual history with sheep, coupled with his desire to protect his sheep-daughters and many dogs’ roles as herders and protectors of flocks, adds another layer of paradox. It was concluded that zoophilic orientation associated with a sense of guilt was a driving factor in causing his delusions.
The man was given medication and six sessions of electro-convulsive therapy and after two weeks, the main symptoms were relieved. The sheep, though…the sheep would never be the same.
(Note: This post has been edited from it’s original version in an effort to make the information in the first two paragraphs flow more easily. Info was moved around and rewritten slightly, but no information was removed, nor additional information added).
Reference: Nejad AG, & Toofani K (2005). Co-existence of lycanthropy and Cotard’s syndrome in a single case. Acta psychiatrica Scandinavica, 111 (3) PMID: 15701110
Image: German woodcut of werewolf, 1722.