In psychiatry, the delusion of nonexistence. The patient believes he no longer exists, that his mind or a part of his body is missing, or that the world itself has ceased to be.This delusion takes a variety of forms: “My brain has rotted away,” “I died twenty-five years ago, and now only my spirit remains,” “I lost my left eye in a car accident,” “My whole family is dead and gone and I haven’ta friend left alive,” “This is a dream world, all shadow and no substance,” “I am only an empty shell. I have no stomach, no liver, no genital organs.”
Nihilistic delusions occur primarily in schizophrenic reactions and depressive states, particularly in acute depression. They are also observed in occasional cases of general paresis, psychosis with cerebral arteriosclerosis, and the depressed and agitated type of senile dementia.
There are several interpretations of these delusions, none of them final. In schizophrenia they appear to be due to the autistic feelings and fantasies that develop as the patient divorces himself from the world. He may feel that reality no longer exists because he is not in contact with it.
It seems quite understandable, too, that a person who dwells in fantasy will begin to feel that all things, including himself, are shadowy and tenuous. And if he feels that he is a changed personality, as many schizophrenics do, it is not a long step to believing that he no linger exists.Another theory holds that nihilism arises out of fear and anxiety. The patient is so afraid that others will run off and abandon him, or die and leave him alone, that he comes to believe that this has already happened.
It is possible that the patient rejects reality because he feels, or fears, that it has rejected him. He may also develop such a fear of disease (hypochondriacal delusion) that he becomes convinced that his body has actually rotted away. This particular type of delusion is more common in depressed states than in schizophrenia.
It is frequently tied up with delusions of sin, since the patient thinks of his fancied disease as punishment for some horrible misdeed he has committed.Illustrative Case: “The beauty of the earth and the glory of the sky do not now exist; the seasons are not the seasons of yesteryear; the flowers, the trees and the birds are not raised in the glory of old time; people display only repulsiveness, deceit and all forms of wickedness.
All, all is gone; those days are bygone splendor, and things can never be changed; body, soul and spirit have been altered until I have become a weariness to myself. . . . The beautiful furniture; the beautiful needlework—clean and beautiful people—think of them all, all buried: these things are literally under the earth. That is all over; all is gone, absolutely, and here am I. I wish I had never seen the world, and now I have ruined it.” (Henderson and Gillespie, 1940)
