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Note: Much has been learned since this piece first appeared. But it remains a solid introduction to a condition that still warrants serious investigation
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When your world seems strange and you’ve lost your sense of self, you’ll be hard pressed finding a name for your affliction. But there is one “Depersonalization Disorder”, and it’s nothing new.
It may happen when you first wake up, or while flying on an airplane or driving in your car. Suddenly, inexplicably, something changes. Common objects and familiar situations seem strange, foreign. Like you’ve just arrived on the planet, but don’t know from where. It may pass quickly, or it may linger. You close your eyes and turn inward, but the very thoughts running through your head seem different. The act of thinking itself, the stream of invisible words running through the hollow chamber of your mind, seems strange and unreal. It’s as if you have no self, no ego, no remnant of that inner strength which quietly and automatically enabled you to deal with the world around you, and the world inside you. It may settle over time, into a feeling of “nothingness”, as if you were without emotions, dead. Or the fear of it may blossom into a full-blown panic attack. But when it hits for the first time, you’re convinced that you’re going insane, and wait in a cold sweat to see when and if you finally do go over the edge.
What you don’t know at the moment is that this troubling experience is distinctly human, experienced briefly at some time or another by as much as 70 percent of the population. In its chronic form, popular culture once saw it as part of a nervous breakdown. Some have called it “Alice in Wonderland” disease. Jean Paul Sartre called it “the filth” , William James dubbed it “the sick soul”. It’s been linked philosophically to existentialism, even Buddhism. Yet to its victims, it’s anything but an enlightened state of mind. Welcome to the world of Depersonalization Disorder.
The term itself has been around for a long time. A psychologist named Dugas coined it as a unique medical condition back in 1898. While the word “depersonalization” is often linked to “dehumanizing” situations such as prison life or brainwashing, chronic depersonalization is an insidious mental condition that can begin on its own. The individual’s perceptions of the self and the self’s place in the world somehow shifts into a mindset that is altered from the norm, becoming hellish for most.
Depersonalization, as a symptom, is what the majority of us experience at some time in our lives. It occurs briefly, and has no lasting effect. Depersonalization Disorder, however, is a chronic illness that can take a dreadful and long-lasting course.
Unlike relatively new disease phenomenon such as chronic fatigue syndrome and fibromyalgia, Depersonalization Disorder has been clearly defined for years, (though somewhat buried under the Dissociative Disorders heading) in the Psychiatric Diagnostic and Statistical Manual (DSM), the bible of psychiatric diagnoses.
According to DSM-IV, Depersonalization Disorder, in part, constitutes the following:
... a feeling of detachment or estrangement from one’s self . The individual may feel like an automaton or as if he or she is living in a dream or a movie. There may be a sensation of being an outside observer of one’s metal processes, one’s body, or parts of one’s body.
… Various types of sensory anesthesia, lack of affective response, and a sensation of lacking control of one’s actions, including speech, are often present. The individual with Depersonalization Disorder maintains intact reality testing (e.g., awareness that it is only a feeling and that he or she is not really an automaton) . Depersonalization is a common experience, and this diagnosis should be made only if the symptoms are sufficiently severe to cause marked distress or impairment in functioning).
In addition to DSM-IV, another vital diagnostic tool, Merck’s Manual, describes depersonalization clearly:
Persistent or recurrent feelings of being detached from one’s body or mental processes and usually a feeling of being an outside observer of one’s life.
Depersonalization is the third most common psychiatric symptom and frequently occurs in life-threatening danger, such as accidents, assaults, and serious illnesses and injuries; it can occur as a symptom in many other psychiatric disorders and in seizure disorders. As a separate disorder, depersonalization has not been studied widely, and its incidence and cause are unknown.2
The criteria for Depersonalization as a unique disorder has been clearly spelled out says Los Angeles psychiatrist Oscar Janiger. Janiger, formerly an associate clinical professor at the University of California, Irvine, has treated many patients with Depersonalization Disorder (DP) during his 40-plus year practice, and in fact has endured the condition himself.
But in addition to their common symptoms, DP sufferers have another shared experience, Janiger adds. Most have a pattern of going to doctor after doctor with little or no relief other than the standard trial and error treatments for depression and anxiety.
One key phrase in the disorder’s DSM-IV definition is: reality testing remains intact, Janiger adds. While a degree of depersonalization may be present in other illnesses, like schizophrenia, this is not a psychotic condition. The person knows that something is terribly wrong, and grapples with trying to figure out what it is. If anything, it’s the opposite of insanity. It’s like being too sane. You become hypervigilant of your existence and things around you.
Indeed, chronic depersonalization often includes a sensation of over-consciousness wherein each thought seems too apparent, or too loud, like the volume of a low-playing radio suddenly turned up to its maximum according to one sufferer
Signs of depersonalization can occur with many illnesses, however isn’t clear why the condition persists in some people. Chronically depersonalized persons (or D-People as they’re often called) are usually highly intelligent, and prone to intellectual ruminating. Onset is most often seen at an early age, from around puberty to the late twenties. There has been evidence of links in some cases to early childhood trauma, Temporal Lobe Epilepsy, stress resulting from life threatening situations, and Migraine. Evidence has also suggested that it afflicts females to a greater degree than males.
In time, depersonalized people can make some accommodations to the condition, Janiger says. They know it won’t kill them or make them insane. It isn’t a progressive illness. It may constitute a subtle alteration of perception. It’s more like adjusting to a pair of glasses that makes everything appear upside down. Eventually one may find ways of adapting.
Accordingly, people with DP disorder become masters at maintaining a front, appearing quite normal to friends, family and co-workers. The sense of being an automaton as described in DSM-IV is consistent with going through the familiar routines of a lifetime. You do what you’re expected to, and say what others expect you too, all the while feeling as if you’re acting out of habit, says John, a 32-year-old filmmaker who has had the condition for six years. Your mind is always a million miles away. All natural spontaneity and joy of living is gone. You know something’s wrong, and you’re constantly battling with what it might be, and evaluating how you feel.
While DSM-IV defines what clinicians consider to be pure cases, those not brought about by the introduction of an outside agent like drugs, the condition seems to be the same, no matter what precipitates its onset. Psychoactive drugs, however, may be one of the primary causal agents among DP sufferers today.
Many people develop the condition through the use of marijuana, notes Janiger. And ecstasy (MDMA), the drug of choice among the young rave crowd has been noted in particular as a catalyst for DP. LSD can cause it as well, it seems, but to a lesser degree than THC (Delta-9-Tetrahydrocannabinol) the active ingredient in pot.
This one young person’s account is typical of the feelings of unreality laced with intermittent panic that often besets sufferers in the earliest stages whether drug-induced or not:
… three times after I’ve smoked pot I’ve had a disabling depersonalization from it. Again, it’s the same numbness, then far away, unable to control my body, time feels like it’s flashing like movie stills, cannot tell what is happening, even what I am thinking, sound is far away, cannot speak. Think it is near death as one could get. Also one time it happened to me after half a beer (didn’t feel at all intoxicated) and the ambulance came and got me. Some lady was sitting over me saying something about Jesus, which only made the fear stronger.
The terror is inexplicable. In between attacks I experience feelings of unreality, sometimes lasting days. I deal with agoraphobia and panic, dread of dying. Sometimes just feel it is hard to move around. Like I will become disoriented and fall over (which really happens during my serious attacks). I avoid people, since they make me feel strange, especially if they are too close. Being in a store can make me feel strange too.
Why Now?
All of this begs the question: Why delve into Depersonalization Disorder at length when it has been clearly defined as an illness, or an offshoot of other illnesses in medical literature? There are several answers. First, there is evidence that more people are experiencing Depersonalization Disorder, and making it known, than ever before. Many of these people suffered in silence until the basics of brain chemistry, and words like neurotransmitter, panic disorder, and obsessive compulsive disorder (OCD) worked their way into the mainstream consciousness. The condition is widespread enough to have prompted the founding of the Britain-based Depersonalization Discussion Board website on the internet. Since 1997, hundreds of people with strikingly similar experiences and/or symptoms have congregated regularly with a hunger for information through this new virtual venue.
Second, the prevalence of DP has also impressed several seats of medical learning enough to establish clinics singly devoted to its study. These include the Depersonalization Research Unit at the London Institute of Psychiatry, and the Depersonalization and Dissociation Research Program at the Mt. Sinai School of Medicine in New York. These clinics are devoted to studying Depersonalization Disorder in depth and experimenting with new methods of treatment to offer relief to those who find it an unbearable mental condition.
In addition, a book touching on the subject, though in the context of Dissociative Disorders in general, was published in 2000.. The Stranger in the Mirror by Marlene Steinberg. M.D. and Maxine Schnall, (Harper Collins, 2000), explores the far-reaching extent of dissociation in today’s society. The book concentrates on the traditional sources of the condition, specifically child abuse, and makes extensive use of the author’s recognized scales for determining if one has the condition. But little discussion is given to the purely physiological causes of dissociative illnesses in general, or depersonalization syndrome specifically.
This is a review of the same, fairly well-known theories in a new package, Janiger says.
The epidemic, it seems, is being experienced by many persons with no history of abuse nor any of the traditional causes. In fact, young people using ecstasy often complain of the symptoms of depersonalization whether they had any predisposition to psychological problems or not.
Dr. Daphne Simeon is the primary investigator at Mt. Sinai’s Research unit and monitors the progress of volunteer patients who are screened by a questionnaire which first determines that they can be diagnosed as truly depersonalized. To date, a moderate degree of success has been achieved by many patients through the use of Selective Serotonin Reuptake Inhibitors (SSRIs) like Prozac, Zoloft and Paxil, as well as cognitive and psychodynamic psychotherapy. It is believed that there may be similarities between the brain chemistry of Depersonalization and that of Obsessive-Compulsive Disorders (OCDs) against which some antidepressants have been effective. But simply establishing Depersonalization Disorder as its own unique and separate illness has not been easy within the medical community, Simeon says.
For a long time, depersonalization has been thrown in with a group of other dissociative disorders, like out-of-body experiences, and dissociative fugues, but I’ve always been convinced that it’s an entity unto itself, Simeon says. Even now, the medical establishment doesn’t always agree. Papers on DP alone are still being rejected by medical journals.
The condition is often linked with depression and anxiety states, adds Janiger. But there are many people who feel depersonalized but not depressed, and not anxious, unless the DP causes them to be.
I never felt what I would consider to be clinically depressed, says Ron, who now in his thirties, has suffered with Depersonalization Disorder for 15 years And the anxiety isn’t spontaneous for me. It’s always as a result of my thinking in circles over and over again about life, death, infinity, and what’s wrong with me.
Like many reporting into interactive websites dealing with the subject, Ron traces his DP’s origins to a single marijuana cigarette. His stream of consciousness is often marked by a pondering of things that are familiar to the rest of us, or the nature of existence itself:
It’s like I fall deep within myself. I look at my mind from within and feel both trapped and puzzled about the strangeness of my existence. My thoughts swirl round and round constantly probing the strangeness of selfhood – why do I exist? Why am I me and not someone else? At these times, feelings of sweaty panic develop, as if I am having a phobia about my own thoughts. At other times, I don’t feel grounded’ – I look at this body and can’t understand why I am within it. I hear myself having conversations and wonder where the voice is coming from. I imagine myself seeing life as if it were played like a film in a cinema. But in that case, where am I? Who is watching the film? What is the cinema? The worst part is that this seems as if it’s the truth, and the periods of my life in which I did not feel like this were the delusions.
Still, there are the pure cases, where DP comes about for no particular reason, like it did for Karen, young Englishwoman in her twenties.
I came from a normal family and have never been abused.. I’ve just always been this way. It has never been a choice for me. I have never been officially diagnosed for depersonalization… But all the things match up. I’ve never really known who I am. I wish I did. I envy others in their secure identities…
Things that are supposed to be “familiar” look bizarre and incomprehensible. There is a big hole in my understanding of human relations and communication, nothing makes much sense as a whole. Often when someone calls my name I don’t feel identified with it. Nothing seems real.
A Lost Generation?
Like most DP sufferers, Ron and Karen have been involuntarily thrown into bona fide existential angst a term that unfortunately today seems more relevant to a Woody Allen movie than an individual in crisis. Their poignant observations run deeper than simply thinking in circles about the nature of existence they feel the black emptiness of existence that post World War II philosophers struggled to portray. It’s what the French have come to call Le Coup de Vide the blow of the void.
Depersonalization is a very unpleasant feeling, despite the fact that is often manifests itself by a seeming lack of feeling, says German psychologist Ursula Oberst. Stories by depersonalized people have a true flavor of existentialism about them. Philosophers wrote about it and theorized about it. But D-people feel it, and the feeling can be too much to bear.
Apparently one who wrote about it and felt it was French philosopher Jean Paul Sartre. While he reputedly scorned the term existentialism, his first novel Le Nausee (Nausea), published in 1938, portrays true Depersonalization Disorder with bone-chilling accuracy. Existentialist or not, Sartre clearly knew depersonalization first hand.
From Nausea (1938)
I buy a newspaper along my way. Sensational news. Little Lucienne’s body has been found. Smell of ink, the paper crumples between my fingers. The criminal has fled. The child was raped. They found her body, the fingers clawing at the mud. I roll the paper into a ball, my fingers clutching at the paper; smell of ink; my God how strongly things exist today. Little Lucienne was raped. Strangled. Her body still exists, her flesh bleeding. SHE no longer exists. her hands. She no longer exists. The houses. I walk between the houses, I am between the houses, on the pavement; the pavement under my feet exists, the houses close around me, as the water closes over me, on the paper the shape of a swan. I am. I am,. I exist, I think, therefore I am; I am because I think, why do I think. I don’t want to think any more, I am because I think that I don’t want to be, I think that I….because….ugh! I flee.
Literary depictions of depersonalization, panic, depression, phobias, and other disorders have threaded their way through most cultures throughout history. Dostoyevsky’s Notes From Underground Camus’ The Stranger, Borges’ The Aleph and others come to mind.
The word “panic” itself has its source in ancient lore which attributed a fearful shift in consciousness, or panic, to anyone viewing the face of the Greek forest god Pan. Doing so offered an overwhelming glimpse of the universe that the human mind was not equipped to handle, resulting in insanity.
Cosmic knowledge, and the brain’s inability to handle it, appears again and again in popular culture from 50s science fiction stories and movies with mind-expanding machines, to Aldous Huxley’s Doors of Perception, which suggested that mescaline could open the brain’s channels to the higher knowledge sought by those very sci-fi contraptions.
An exploration of all that depersonalization involves will take you down many paths, says Janiger, who is currently adding to the DP literature by authoring a comprehensive book on the subject.
Paths of self-exploration, or explorations of the lack of self, may ultimately lead one towards the ancient teachings of Buddhism or other eastern philosophies, or western mystic literature and contemporary Christian writers known as contemplatives, Janiger points out.
Trancenet (www.trancenet org), a Delaware- based nonprofit group that monitors cult activity and exploitative psychological techniques, sees many similarities between depersonalization syndrome and psychological states found in Transcendental Meditation, specifically as taught by the renowned Maharishi Mahesh Yogi.
According to Trancenet, numerous quotes from the 1967 book Maharishi Mahesh Yogi on the Bhagavad-Gita: A New Translation and Commentary directly parallel the descriptions of depersonalization in DSM-IV.
One statement from the book, for example, could fall directly under the DSM-IV subcategory of detachment, according to Trancenet:
In Nitya-Samadhi, or cosmic consciousness a man realizes that his Self is different from the mind which is engaged in thoughts and desires. He experiences the desires of the mind as lying outside himself,
Still, I’m not convinced that Depersonalization Disorder and Samadhi or bliss, enlightenment, or what have you, are the same thing, Oscar Janiger explains. Many people enjoy the states brought about through TM. But Depersonalization is an illness, sent straight from hell. It’s a psycho-physiological problem that involves the integrity of the ego and body image.
Whether they’re treating DP, or just social phobias, psychologists often spend years trying to build up a patient’s ego, with little result. There are many people who are successful in their careers and who have received plenty of laurels, awards food for the Ego. And it doesn’t do a thing toward alleviating the pain of losing one’s self because of this strange and uncanny condition.
Finding Relief
As Drs. Janiger and Simeon can attest, the search for cures of more pressing illnesses, like alcoholism, has kept funding for DP research on a back burner. (Ironically, many D-People find that alcohol is the only thing that brings temporary relief to the symptoms).
The existing clinics are a beginning. But it may be that treatment needs to take a new direction, Janiger feels. While today’s treatments utilize SSRIs, indications are that greater success involves SSRIs in combination with other drugs, like benzodiazapines such as Valium or Clonazepam.
Janiger has found about a 50 percent success ratio using one of the older anti-depressants, a monoamineoxidase inhibitor (MAOI) called Marplan. The other MAOIs haven’t worked as well in my experience, but for some reason, Marplan features a component that in some cases seems to be particularly effective against depersonalization, he says. (While more recent research has not shown much success with any of the MAOIs, they may in fact work best in cases of a known subgroup of patients who suffer from the so-called anxiety-depersonalization syndrome. Anxiety, panic and overconsciousness are frequent symptoms in these people; others who still fall within the clinical definitions of DPD do not experience these at all).
As more sufferers of the condition converge on the internet, more common symptoms are also emerging with greater clarity. For instance, D-People seem to be particularly susceptible to the condition when they spend time in fluorescent lighting, like that found in most retail stores. In addition, for most persons, DP seems be strongest in the mornings and progressively better as the day progresses. If they take naps, it can re-emerge with a vengeance.
This tells us something about it’s relationship to sleep, Janiger says. DP has something to do with regulating sleep and wake patterns, but I haven’t seen any studies on this yet. It’s odd how so many people refer to it as being in a dream or a dreamlike state, but nobody seems to have looked at how it relates to REM (Rapid Eye Movement) sleep.
If you visualize the brain’s two distinct types of consciousness REM sleep and wakefulness as being in their own separate airtight compartments, depersonalization might represent some kind of intrusion from one into the other, Janiger suggests. The respective compartments may not be as contained as they should be.
But whether it’s linked to the sleep/wakefulness cycle, a natural part of the human condition, or part of an awakening to a heightened consciousness, Depersonalization Disorder isn’t going away; D-people will continue to seek relief, and researchers will continue to try to provide it.
It’s a remarkable condition, notes Janiger, with implications that are fascinating. But it’s like the ocean, wondrous and deep unless you’re drowning in it. Then all you want is a way out.
Update: Dr. Janiger passed away in 2001, and he is sorely missed. However, his interest in depersonalization and new research was followed by the establishment of DPD clinics in the U.S. and U.K. Since this article first appeared online in 2000, numerous books and articles have appeared about depersonalization. This article served as the springboard for the seminal work on the subject, “Feeling Unreal: Depersonalization Disorder and the Loss of the Self, by Daphne Simeon MD, and Jeffrey Abugel, Oxford University Press (2006).
Copyright © 2000 – jeffrey abugel and Depersonalization.info
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