Taphophobia and resurrection mania following left parietal stroke

Abstract

ABSTRACT The paper describes a patient with psychotic depression following left inferior parietal stroke. He had a dominant delusion: a belief that he was buried alive and had died thereafter. This delusion was an amalgamation of taphophobia (fear of being buried alive) and Cotard’s nihilistic delusion. This taphophobia-Cotard complex was accompanied by a resurrection delusional belief that his son would resuscitate him by pressing his chest through the gravestone, during which the son’s hands would be detached from his body. This uncanny presentation is analyzed on various levels: Psychiatric level with an attempt to understand this presentation as reactivation of post-traumatic stress disorder; classical neurological level based on the function of the left parietal cortex and its role in body representations as in Gerstmann’s syndrome; Coltheart’s neuropsychological “Two-Factors Model” of delusional beliefs suggesting that the nihilistic-like delusion stems from false interpretation secondary to impaired mental activity that follows similar brain lesions and that this interpretation is not rejected due to lack of censorship activity; psychodynamic level – looking at the switch to primary thinking processes and at the accompanying uncanniness, anxiety and manic defenses. The paper suggests that what seems like diverse and haphazard presentation can be a multifaceted expression of the crucial function of the left inferior parietal cortex as a heteromodal cortex sited in an intersection between concrete perceptions and symbolic constructs and between primary and secondary thinking processes.