Note: This article has introduced newcomers to
Depersonalization for more than a decade. Because of the huge response it has
garnered through the years, it has been kept on this website and, in part, been
included as an introductory chapter in the new book Stranger to My Self
(2011). Much has been learned since this piece first appeared. But
it remains a solid introduction to a condition that still warrants serious
Strangers to Our Selves
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
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 overconsciousness 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.
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
In addition, a book touching on the subject, though in the
context of Dissociative Disorders in general, was published late last year.
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:
Its 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
Still, there are the pure cases, where DP comes about
for no particular reason, like it did for Karen, young Englishwoman in her
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
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.
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
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
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
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
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 being done by the clinics at Mount Sinai and in the UK, spawned the
beginnings of the comprehensive book about the disorder. Feeling
Unreal: Depersonalization and the Loss of the Self, by Daphne Simeon MD, and
Jeff Abugel, creator of this website, can be by clicking here--
the publisher, Oxford University Press
And, as shown on our opening page, the
follow up book by Jeffrey Abugel, Stranger To My Self, now available
through Amazon, Barnes and Noble, and many other venues and elsewhere.
Please feel free to
email your comments about this story.
2004 - jeffrey abugel and Depersonalization.info