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Cotard Syndrome (Walking Corpse Syndrome)

Summary:

Part 1 of "The Many Illnesses of Bucky Barnes" series.

“It’s a mental illness in which the affected person holds the delusional belief that they’re already dead, don’t exist, are putrefying, or have lost their blood or internal organs. Over half of Cotard patients indicate the denial of self-existence.”

Bucky thinks he's dead. This is worrying enough for Steve. But because he thinks he's dead, Bucky won't eat. He doesn't think he needs to.

That's what's scaring Steve the most.

Chapter 1: Acquittal and Diagnosis

Chapter Text

Bucky couldn't stay on the run forever. When Steve found him, he looked barely alive.

Steve practically begged Bucky to come back with him and, after Steve convinced Bucky to turn himself in with the promise that he would be okay, Bucky had been kept in a small cell, alone, for the months leading up to the trial and throughout it.

Steve hadn’t even been allowed to visit him, and that had pissed him off so much more than anyone had expected. Anyone else except Sam, of course. Sam could see how much it was eating Steve up knowing that Bucky was alone, locked up. Everyone else had assumed that Steve would respect the court’s decision to isolate Bucky for ‘everyone’s safety’. But no, Steve had argued until he was blue in the face. It had shocked everyone present, besides Sam, but it had made no difference to the decision made.

It also hadn’t helped that the inside informant Sam had managed to get on their side had told them that Bucky had been force-fed several times during his stay in the maximum security prison to stop him from starving to death. Bucky’s serum helped him survive a lot, but there’s only so much malnourishment even a super soldier’s body can take before it gives out and dies. The prison staff had kept Bucky alive, but only barely. They had only put in as much effort as they needed to in order to ensure a prisoner didn’t die in their care. As long as Bucky was still breathing, they didn’t really care. And that pissed Steve off so much, he had already gotten the lawyer to agree to represent Bucky again so that once all this was over, Steve could sue the prison for neglecting Bucky.

The day they had seen Bucky take the stand was engraved in everybody present’s mind. He had been kept out of the court for so long, left in his cell, with his lawyer (courtesy of Stark) representing him. That had been the plan. The lawyer, Matt Murdock, would represent him and Bucky didn’t have to be anywhere near the court at any time. He wouldn’t have to talk about everything that had happened to him during his time with the Soviets and HYDRA in front of a large group of people. The only people he would have to tell was Murdock. It had taken a while for Bucky to say more than two words with the lawyer, so his case had been mostly built on what was in the file Natasha had managed to get from Kiev up until then.

But the opposing lawyer kept arguing that Bucky should take the stand and tell the court himself why he had committed these atrocious crimes against humanity instead of doing so through Murdock. He said that if Barnes was really sorry for what he did, and he really didn't want to do any of it, he could at least have the decency to say it to them in person. Steve was so close to launching across the court and ripping the guy's throat out. Matt had reluctantly agreed to allow Bucky to take the stand.

He was so pale and there were dark circled under his eyes. His hair had been washed and his face shaved, but Murdock had told Steve that he had requested Bucky being cleaned and groomed before court, so he hadn’t been like that before. Matt’s associate, Foggy, told them that Bucky had looked awful before they had demanded he was cleaned up. He had a full beard, his hair looked like it hadn't been washed in months and he smelled like he hadn’t bathed in the same amount of time. But despite their best efforts, Bucky didn’t look healthy by the time he got to the stand. Steve had to force himself to stay in his seat, digging his nails into his palm to ground himself. If he didn’t, he would have bolted across the room to drag Bucky into him for a hug. He would have hissed at anyone who came near Bucky, and he would have pulled him out of the courthouse and to his bed to wrap Bucky in a blanket and keep him safe.

He was thin too, that was the thing that concerned Steve the most. The suit Matt had bought for him hung off his frame, and he reminded Steve of starving villagers they had come across in the war, ones that looked like they wouldn’t survive the week. On his way up to the stand, Bucky had stumbled slightly and squeezed his eyes shut, his face pinched in pain. Foggy had hurried over to him then and helped Bucky walk the last few feet to the stand, whispering words of encouragement to him the whole way there. Steve really liked Foggy and Matt, and he already planned to pay them at least double their agreed fee, and send them some fruit baskets.

As soon as the verdict was announced, Steve had ran up to hug Bucky, then immediately took him home. They had to leave the courthouse through the back exit to avoid the crowds of reporters, protestors and supporters alike. Foggy and Matt left through the front to give the verdict and make sure all the attention was on them, and the crowds wouldn’t spot Steve and Bucky leaving out of the back and into a – surprisingly inconspicuous- car sent by Stark.

So much of the public had already heard so much of the trial through someone leaking information, and many people had condemned Bucky as a traitor of the country, a terrorist, some even going as far as he say he was the devil. But others were more understanding, they remembered Bucky Barnes as an American hero, and they believed that what happened to him and what he was forced to do didn’t change that. Bucky was a prisoner of war, the longest-suffering prisoner of war in history. They were very vocal about their support, and that’s one of the only things that stopped Steve from wanting to tear this country apart in a blind rage.


The first week of having Bucky home, he hadn’t spoken. He didn’t seem particularly happy about his newfound freedom, but he didn’t seem upset either. It had been a real struggle to get Bucky to eat, but because he hadn’t been eating properly for so long, Bucky couldn’t eat much without throwing up. And he only ever ate when Steve reminded him consistently, pestering him almost constantly until Bucky forced himself to at least take a few bites of a sandwich.

He still didn’t speak, and he barely moved unless Steve prompted him. Steve had to bathe him, shave him, change his clothes and prompt him to lie down in bed. On the plus side, Bucky actually did sleep, even if it was only for an hour or so a night and it was always interrupted by a blood-chilling scream tearing free from Bucky’s throat. Steve didn’t mind that he himself couldn’t sleep much, it was worth it to get to take care of Bucky and just have him beside him in his—no, their—bed.

After just a few weeks, Steve knew something was very wrong with Bucky. He muttered a lot, barely ever spoke above a whisper, but Steve managed to catch a few words and from what he could gather… Bucky thought he was dead...

He would say things like “Why eat? Already dead.” Or “Dead people don’t eat.”  Or "Pills don't work on dead brains". Steve had tried to tell him several times that he wasn’t dead, but Bucky just shook his head and went silent. After speaking to Sam about it, completely at a loss for what else to do, Steve found himself in front of a therapist's office that Sam had referred him to.

The therapist agreed to meet with Bucky and see what he could do, and Steve managed to convince Bucky that this would be good for him. He started to get the impression that Bucky was getting annoyed with him always pestering him, but Steve couldn’t find it within himself to be sorry. Bucky would thank him for this one day, when he was healthy again and in his right mind. He would thank Steve for keeping him alive and getting him to a place where he could be happy again. Sam had warned Steve several times that there was no guarantee that Bucky would ever be the same person he was all those years ago. Steve was okay with that. He was still Bucky, no matter how different he may be. He was still his best friend, and Steve still loved him. Sam also warned him that Bucky may never function like a person again. That he might never know how to act or think for himself again. All the electricity Bucky had suffered being shocked through his brain may have caused irreversible brain damage. There was no way of knowing yet, though, since Bucky refused to let anyone who looked even remotely medical near him. He would scream and struggle and attack the professional.

The therapist agreed to make a home visit, so that Bucky could be in a familiar and comfortable place for their first meeting. For that first meeting, Steve had been present, and he was a little concerned Bucky had broken some bones in Steve's hand, he had gripped it so tight. It was a false alarm, though, and eventually Bucky became comfortable enough with the doctor to have his meetings with him without Steve having to be there. That was when the doctor really started trying to get to the bottom of Bucky’s aversion to eating and other forms of self-care.


“Cotard Syndrome.” Steve said with a sigh, then took a sip of his coffee. He was sat with Sam in a cheap little café, somewhere no one recognised them and therefore everyone left them alone.

“I’ve dealt with traumas for several years now, and I’ve heard a lot of different syndromes and conditions caused by brain damage and/or psychological trauma… But I’ve never heard of Cotard Syndrome. Care to elaborate?” Sam’s voice was low and calm, staying steady despite the slight tremble in Steve’s. He was great that way. No matter what was going on around them, Sam was always the calm one. People assumed Steve was the most level-headed, but they couldn’t be more wrong.

“It’s a mental illness in which the affected person holds the delusional belief that they’re already dead, don’t exist, are putrefying, or have lost their blood or internal organs. Over half of Cotard patients indicate the denial of self-existence.” Even as he spoke, Steve could hear that his voice sounded flat. His words were rehearsed. He had read them several times since the doctor had first explained it to him, had memorised the definition so that he could recite it to Bucky whenever he needed to, and so that he could explain it quickly and easily to others.

Sam clearly noticed the tone, and he nodded a little in understanding. “So that’s why he isn’t eating? He thinks there’s no point because he’s already dead? But for some reason still able to move, walk and talk?”

After a brief nod, Steve continued. “The doctor tried asking him about that, as a way to confront faulty cognition. But Bucky just shrugged and said something about being a zombie or a ghost…”

Steve had asked for advice, but all Sam could offer him was to keep getting Bucky to see the therapist, follow the therapist's suggestions, and just be there for Bucky ready to remind him that he was alive whenever he could.


“I’m alive…” Bucky muttered, staring up at the ceiling with Steve laid beside him in their bed.

It hadn’t really occurred to Steve that it could be seen as weird for him and Bucky to share a bed until Stark had questioned it a month ago, but Steve still couldn’t bring himself to break that habit. He wanted to be as close to Bucky as possible. He told himself it was so that he could help Bucky with his nightmares as soon as they happened, but Steve knew he was lying to himself. It was because after so many years of being apart from Bucky, he couldn’t stand the idea of being away from him again.

“Yeah, Buck. You’re alive.” Steve assured him, then turned on his side so he could watch Bucky’s face.

The main light in the room had been off for several hours now, but neither of them could sleep. Steve had asked about how Bucky’s meeting with his therapist went today, and they had been talking on and off since then, and a few hours ago they had turned the bedside lamps beside each of them on.

The low light caused shadows to cast over Bucky’s face. He was still too pale and thin, and the dark circles seemed even more prominent in this lighting. The sight made Steve feel useless. He had promised to take care of Bucky and get him healthy again, but it had been months and Bucky looked just has sick as he had when he took the stand in a few months ago. Nothing he did seemed to make a difference, and now Bucky was experiencing dizzy spells too, probably because of the malnourishment. Bucky suffered them in prison, but not as regularly as he did now.

Sam had said that that was probably because in the prison when they force-fed him, they put an IV in his hand and sent pure nutrients into his bloodstream. Steve couldn’t do that to Bucky. He hated needles, and regardless, Steve wouldn’t even know how to go about getting the equipment and know-how to feed Bucky through an IV. He had tried getting the most nutrient filled food possible, but it hadn’t made a difference. He had tried to make him feel more relaxed here, but Bucky was still skittish. He had tried to help him sleep, make him feel safe, but Bucky still woke up screaming not long after his eyes closed.

“I’m alive…”

One of the things the therapist had suggested was repeating that statement over and over, until Bucky started to believe it. Bucky had rolled his eyes at that, but the therapist assured him that there was a lot of good in repeating something until it changed your mindset. And the therapist had asked Steve to assure Bucky that he was right, he was alive, whenever he heard Bucky say that phrase or something else to the same affect.

“Yes you are…” Steve wanted to touch Bucky, to reassure himself of the same thing. That Bucky was alive and really here. But touching Bucky was risky. If Bucky didn’t know it was coming, it could go one of two ways.

Number one. Bucky’s mind would automatically tell him he was in danger, and he would lash out. Bucky’s mind would black out and he wouldn’t recognise that it was Steve, that he wasn’t going to hurt Bucky, and Bucky was safe. He would attack Steve until he realised who Steve was. Steve would never fight back, he would only defend himself as much as he could without hurting Bucky, and the whole time he would be talking to him, trying to get Bucky to recognise him. Bucky would then burst into tears and apologise over and over again, usually while he was still on top of Steve, and Steve would wrap his arms tight around him and hold him close. He would assure Bucky was it was okay, he knew Bucky didn’t mean to, it’s not Bucky’s fault.

Number two. Bucky’s mind would automatically tell him he was in danger, but from a superior. He would assume he did something wrong and he was about to be punished. Either he would flinch, his muscles would tense, and he would wait for the blows he thought were coming, or he would panic. He would start crying and curl in on himself, apologising over and over for whatever he thought he had done wrong. He would promise to be better, promise he would always follow orders better from now on. He would wrap his arms around his head to protect his face and head, and he would curl his knees up to his chest to make himself look as small as possible.

Steve could handle Bucky attacking him. He just saw that as Bucky’s will to survive shining through, and that was a good thing. It meant, despite everything, Bucky wanted to live. Steve could handle a black eye and a few cracked ribs in exchange for knowing that Bucky’s will to live was still in there.

Number two was the most painful, because there was nothing Steve could do. At least while he was being attacked he could call out his name and try to get Bucky to recognise him. He could be active, block the punches, backstep, duck, block the punches, spin, dive. He could grab Bucky’s arm, try and stop him from throwing another punch.

But when Bucky was so terrified that Steve was going to hurt him, Steve was powerless to help. If he tried to touch Bucky, pull him into a hug, reassure him that he was safe, all it got him was more sobbing and more terrified screaming. Steve was pretty sure his neighbours thought he was torturing Bucky, because he often got strange looks when he left his apartment. But he didn’t care about that. He knew he was trying to help Bucky, and the only person he cared about thinking the same way was Bucky. He wanted nothing more than to know that Bucky knew Steve was trying to help him.

So Steve didn’t touch Bucky unless he asked first, or unless he moved slowly and Bucky was looking right at him when he did it, and Bucky was tracking the movement of Steve’s hand. Because if his eyes weren’t following the movement, Bucky may have dissociated. So even if Bucky was looking right at him, that doesn’t mean he’s seeing him.

“Can you prove it?” Bucky whispered.

He was back to whispering. That meant he was uncomfortable or scared. He muttered most of the time now, but Steve will admit the whispering is down to a rarity now. That meant that Bucky was making some progress, even if this moment was a slight step back. But that was okay, whispering sometimes was okay. As long as it didn’t go back to all the time.

But, back to the subject at hand. “Prove it? How?”

Bucky’s brow furrowed, and his pouted as though he was putting a lot of effort into figuring out how to answer that. He had the same expression back in school when they started doing algebra, and Steve couldn’t help but smile at the sudden uncanny resemblance.

After a few moments of silence, Bucky shook his head as though he had given up on trying to figure out how Steve could prove to him that Bucky was alive. The silence stretched further until Steve spoke, feeling the need to fill the quiet with conversation. Maybe if he just kept speaking to him, Bucky would realise he wouldn’t be able to have these conversations if he were dead. The doctor had warned Steve it wouldn’t be that easy, but he could still hope.

“Have you been taking your medication?” It had been a real struggle to get Bucky to take the medication at first. He had had negative experiences with pills during those seventy years, but Steve didn’t know what they were. Bucky never told him, and there was nothing about pills in any of the files they had managed to get a hold of about him. Bucky was also convinced that the pills wouldn't work because the therapist had explained that they help his brain get better, and Bucky thought his brain was as dead as he thought the rest of his body was.

But he was getting better with that, Steve didn’t even have to pester him anymore. Bucky’s phone - courtesy of Stark - would chirp out an alarm to remind him when to take which medication, and Bucky would get up and go take the little pills. He was on antidepressants, antipsychotics, and some mood stabilisers. They were originally for his depression and hallucinations, but the therapist changed the dosage to make it combat those as well as his Cotard’s Syndrome. The only other treatment for what Steve had discovered is also known as Walking Corpse Syndrome was electroconvulsive therapy. Steve didn’t have to bring this up to Bucky to know that it would definitely be on Bucky’s No Way list. There were a lot of things on that list, and electric shocks to the head was definitely going to be one of them.

“Yeah… I’m almost out of the mood stabilizers, by the way…”

That was Bucky’s subtle way of asking Steve to go to the pharmacy and get his repeat prescription filled out for more, and he was muttering again, not whispering. Bucky was getting better at asking for things from Steve too, which was good. Just a few months ago, Bucky wouldn’t have dared ask Steve for something.

“I’ll get you some more tomorrow. Is there anything else we need?” Steve asked, making his tone as casually conversational as possible.

Bucky hated talking about his medications and his health conditions, so Steve tried to make them sound as normal as possible in conversations in the hopes that Bucky will relax about it a little more. It was working, kind of.

“You need more of those health shakes you drink.” Bucky reminded him, and Steve couldn’t help but smile. Even after all these years and everything that had happened, Bucky was still keeping track of what Steve needed.

“Yeah, okay. I’ll pick some of those up...” Then, Steve got an idea. “Hey, have you ever tried those things?"

If he could get Bucky to try them, he knew he would like them. Steve always got the fruity health shakes, the ones that tasted of forest fruits or mixed berries. Bucky would love the cherry one, he just knew it. And they were specifically designed to get as much good stuff into the body as possible without the person having to have too much. It was perfect for Bucky. He could only need one or two a day, he wouldn’t feel too full and throw up, and it would help him get healthy again. Steve was almost mad at himself for not thinking of it sooner.

But he was even madder at himself when he saw the flash of panic on Bucky’s face.

“I didn’t drink them, I promise. You only bought enough last time for a week’s worth, and that was eight days ago—“

“Bucky, Bucky. Relax. I’m not accusing you of anything, I knew I would be out by around this time, it’s okay. I was just thinking you might like them, so when I get some more you could try one? They're really good...”

Bucky seemed to relax a little, but there was still a little tension in his muscles, and Steve could see the shadow on Bucky’s jaw jump as he tensed and relaxed his jaw. “But… I don’t need it.”

Anyone who didn't love Bucky may have been frustrated at this point, that he had to repeat the same facts over and over, with little to no progress being made as a result. But not Steve. He would repeat it as much as he needed to. Because Bucky was sick, and he needed help to get better again. It was just like when Steve got a bad case of the flu and was bedridden for days, Bucky would always take care of him until he was healthy again.

Sure, brain damage, psychological trauma, forced faulty condition, and seventy years of dehumanisation wasn’t exactly the same as a few weeks in bed with a fever… But the principle was the same.

“You need to eat something, Bucky. And those things are really nice. I think you’ll love them.” Steve kept putting more emphasis on how good they were and that Bucky might enjoy them in the hopes that Bucky might see eating as more of an enjoyable hobby rather than something he had to do to survive. If he didn’t think he needed it, maybe he could still enjoy it. Steve didn’t really need to exercise, but he still did it.

Bucky grunted a little in acknowledgement, then turned on his side to face Steve so their faces were a few inches apart. “You still didn’t prove that I’m alive.”

“You’re breathing… You have a pulse…” Steve explained, then reached out slowly to place a hand on Bucky’s chest over his heart, where he could feel his pulse and his breathing.

“It’s a force of habit.” Bucky muttered, and Steve sort of understood what he meant. People don’t breathe on purpose, it’s just automatic. Bucky thought he was dead but his body didn’t know it yet.

“I’m alive, and we’re talking. We wouldn't be able to talk if you were dead...” Steve tried, but Bucky just shrugged. They had had that particular debate plenty of times, it was always a dead end. No pun intended.

“I’m stuck here…” Bucky muttered, and Steve frowned.

“No, Buck… This is your home. You're free, remember? You were acquitted, we can go wherever you want... You’re not stuck here…”

“No, not this apartment.” Bucky shook his head, then frowned in confusion, as if he was trying to figure out how to articulate what he was thinking in a way that Steve would understand. “This… World. I shouldn’t be here, but I missed the… the way out.”

Steve frowned as he watched Bucky. He didn’t understand what he meant, but Steve knew that he didn’t have to tell him that. If anything, that would just frustrate Bucky more. Steve just stayed quiet when he didn’t understand, then Bucky could decide to elaborate or reword it until Steve could understand and reply. If he told him he didn’t understand, it would bring Bucky’s problems with communication to the forefront of his mind and it would upset him.

“I missed… Heaven. Or Hell… When I fell, I was supposed to die but I kept missing the ledges and stuff, so I kept… Surviving…”

Steve could hear the frustration in Bucky’s voice as he tried to put his thoughts into words, so he stayed silent to let Bucky keep going. Bucky would keep going until his finally cracked what he was trying to say, and when he did, his eyes would light up like he had cracked a code. It was adorable.

“Heaven tried to catch me… But I was falling too fast and… then I hit the floor and I should have found my own way to Heaven but I… couldn’t move… So I missed it.”

That sort of made sense, and Steve could see that they were really getting to the point where Bucky was articulating his thoughts with little trouble, but this time there was no eureka moment where Bucky was so proud of himself for figuring this out. He still looked miserable.

“Then they dragged me away and they wouldn’t let me go look for Heaven so I missed the window so now I have to stay here and no one believes me when I say I’m dead but I am!” Bucky explained in one quick rush before bursting into tears, like his words were racing with his emotions to get out first.

Steve moved the hand from Bucky’s chest to wrap around him, maintaining contact at all times so that Bucky could feel that Steve’s arm was moving around him and so he wouldn’t be startled, then pulled him close to hold him against Steve’s chest. He wanted to reassure Bucky, but there wasn’t anything he could say...

And right then... Steve had one of his few epiphanies, where he truly did understand how Bucky felt and what he was going through, and why it was so upsetting to him when people try to convince him that what he's thinking is wrong. Bucky truly believed that he missed his limited window to get into Heaven, and he was so frustrated that everyone kept saying that he’s not dead when he was so sure that he is. It was like if everyone Steve introduced himself to looked at him funny, then said "You're not called Steve Rogers" and no matter how many times he told people that that was his name, everyone would look at him like he was insane and tell him he was wrong about something he wholeheartedly believed was true. Something he could feel and see as true.

No wonder Bucky was so frustrated.

“We’ll figure this out, Buck… I promise. One day, everything will make sense… But first, can you answer one thing for me, pal?”

Bucky mumbled something, then nodded against Steve’s chest.

“When you were…” Steve had to force himself to say the next part after swallowing thickly. “Falling… Could you see Heaven trying to get you, or is this in hindsight?”

“Hindsight… Until I hit the floor, then I knew I was dead and I could feel that I needed to find my way to Heaven… Didn’t see anything… Just felt…”

‘Until I hit the floor’. Steve had done his research of Cotard (of course he had, he wanted to know everything in the hopes that if he understood what was happening in Bucky’s head, he could help him with it). Doctors don’t know exactly what causes it, but it had said something about damage to the temporal lobe or the frontal lobe of the brain. That’s what might have happened when Bucky fell. The impact damaged one of those parts of his brain, and that triggered the Cotard's Syndrome.

Maybe seeing a medical doctor would help. They could scan Bucky’s brain, then prescribe some better medication for him than just a higher dose of what he had been on before his diagnosis. It would be a challenge getting Bucky to see the doctor and stay calm long enough for a brain scan, but it would be worth it if it meant there was more of a chance of Bucky being able to get better. And Steve would be with him the entire time to assure him that he was safe and he wasn’t going to let anyone hurt Bucky.

“Buck… I’m going to talk to your therapist tomorrow about making you a different kind of appointment… One that might help a lot more than what we’ve been doing so far.”

Bucky just nodded against Steve’s chest, his breathing now slower and his body more lax. He was about to fall asleep, and Steve smiled a little as he leant over to turn the lamps off, plunging the room into darkness.

“I love you…” He whispered, like he did every night.

“I love you too.” Bucky replied, as he usually did if he were still awake when Steve said it.

Steve pressed a kiss to Bucky’s hair and closed his eyes, wishing that he could just keep kissing Bucky’s head and fix all of the problems inside it with his love alone. But that wasn’t possible. So Steve started making a mental plan of action.

      1) Get Bucky’s therapist to book him in for a scan of his brain

      2) Convince Bucky that the machine wouldn’t hurt him, then convince him to allow the scan to happen

     3) Persuade Bucky to try some tasty food, then convince him that he could just eat as ‘something to do’ even if he didn’t need to eat to survive

    4)  Get him medication tailor made for his disorder that only a medical doctor can prescribe

Either

    5) Admit to Bucky that he loved him as more than just a friend and kiss him on the lips

Or

    6) Stop kissing and cuddling up to Bucky.

Steve really hoped he could pluck up the courage to pick five, and he was dreading the possibility of six.

But, one step at a time.

First, he needed to get Bucky an appointment for a brain scan.