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Feeling Unreal
 Feeling Unreal
Depersonalization and the Loss of the Self
Second Edition

DA P H N E SI M E O N , M D A N D J E F F R EY A BU G E L
 Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Oxford University Press 2023

All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
rights organization. Inquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Names: Simeon, Daphne, 1958– author. | Abugel, Jeffrey, author.
Title: Feeling unreal : depersonalization and the loss of the self /
Daphne Simeon, MD and Jeffrey Abugel.
Description: Second edition. | New York, NY : Oxford University Press, [2023] |
Includes bibliographical references and index.
Identifiers: LCCN 2022053526 (print) | LCCN 2022053527 (ebook) |
ISBN 9780197622445 (paperback) | ISBN 9780197622469 (epub) |
ISBN 9780197622476
Subjects: LCSH: Depersonalization. | Identity (Psychology)
Classification: LCC RC553 .D4 S56 2023 (print) | LCC RC553 .D4 (ebook) |
DDC 155.2—dc23/eng/20221202
LC record available at https://lccn.loc.gov/2022053526
LC ebook record available at https://lccn.loc.gov/2022053527

DOI: 10.1093/​oso/​9780197622445.001.0001

1 3 5 7 9 8 6 4 2
Printed by Sheridan Books, Inc., United States of America
 To my children.
—​Daphne Simeon

To family and friends who have supported me through the years.

—​Jeffrey Abugel
 Contents

Preface  ix

1. Strangers to Ourselves  1
2. The Path to Understanding: A Historical Exploration  19
3. Symptoms and Scales  42
4. Making the Diagnosis  53
5. Differential Diagnosis  65
6. Refining the Diagnosis  81
7. Trauma, Attachment, Emotion, and Cognition  102
8. Neurobiology  121
9. The Blow of the Void and Spirituality  146
10. Biological Treatments  173
11. What to Expect When Starting Psychotherapy  189
12. Cognitive-​Behavioral and Mindfulness-​Based Psychotherapy  199
13. Psychodynamic Psychotherapy  213
14. Digital Depersonalization  240

References  255
Index  271
 Preface

When Feeling Unreal: Depersonalization and the Loss of the Self appeared in
2006, it was praised as a seminal work—​the first book providing a compre-
hensive overview of the baffling condition then known as depersonalization
disorder. The world has changed dramatically since. To some degree, what is
now known as depersonalization/​derealization disorder (DDD) is emerging
from the shadows of obscurity, through continuing and expanding scientific
inquiry as well as an explosion of social media. Major articles about DDD
have appeared in print in the Washington Post, Atlantic Monthly, Elle, and
The Guardian. The feature film Numb, starring Matthew Perry, brought the
disorder into mainstream culture. In some quarters, the social isolation
resulting from the COVID-​19 lockdown brought depersonalization to the
forefront of concern and discussion. And yet DDD’s obscurity is slow to fade,
and the condition remains relatively unknown or unacknowledged by many
in the medical and other mental health communities.
Whether documented yesterday or a century ago, the core symptoms of
DDD remain unchanged. Many people have felt “unreal” at some point in
life, albeit fleetingly. For people with DDD, the world within, or the world
around, is experienced as strange and unreal for prolonged periods of time.
They feel detached from the sense of self they once took for granted and they
struggle, sometimes for years, in search of answers, which can be difficult to
come by. Imagine thinking without feeling, devoid of emotional connection
to past or present. Imagine a heightened awareness of the thoughts parading
through your head, or always watching yourself a step removed, interrupted
periodically by a single emotion—​the real fear of losing your mind. Living
this way, vacuous, numb, and lost, wreaks havoc on individuals’ inner lives.
Outwardly they may appear rather normal, even well adjusted. But they
know something is wrong, though they may not know what it is, so their lives
often become façades of normalcy, masks to cover the unreality within.
The second edition of Feeling Unreal aims to present and discuss all that
we now know about DDD, nearly two decades after the first edition. Our in-
tention is to present a comprehensive and unbiased distillation of the broad-
ening range of scientific material that has addressed depersonalization/​
x Preface

derealization to date, as well as to examine the many philosophical, lit-

erary, religious, and spiritual reflections on depersonalized-​like states of
mind. Feeling Unreal is the culmination of decades of work seeking answers
to questions that have remained elusive or unsynthesized for too long. As
such, we hope that the book will be a valuable resource for sufferers and their
loved ones, clinicians, students of depersonalization across disciplines, and
all others intrigued by the state of mind that uniquely straddles psychopa-
thology and being.
 1
Strangers to Ourselves

We do not see things as they are, we see them as we are.

—​Anaïs Nin

The idea that reality is subjective, constructed from our own perceptions, is
an ancient concept. “We are what we think. All that we are arises with our
thoughts. With our thoughts, we make the world,” said the Buddha. In the
same vein, Anaïs Nin’s observation above originated in the Hebrew Talmud.
But what if our perceptions of our own thoughts, or the world around us,
change in an inexplicable way? What if the world suddenly seems strange,
and foreign? This is the story of a baffling but very real condition of the
mind that plagues millions of people worldwide. It isn’t depression, or anx-
iety, though it can sometimes appear as a symptom of these better-​known
conditions. Often, it emerges with cruel ferocity as a chronic disorder com-
pletely unto itself. Its destructive impact on an individual’s sense of self is im-
plied in its very name—​depersonalization.
Depersonalization/​derealization disorder (DDD) is a serious disruption
in a person’s experience of the self that alters their entire world. Take the case
of Ron, a 39-​year-​old magazine editor living in a coastal city. To his peers,
Ron’s life is practically heaven on earth. He’s bright, funny, and successful at
his job. With an apartment near the beach and plenty of friends, he is living
a life that is envied by many. But Ron has a problem. And each day when he
returns to his upscale neighborhood in time to see the sun setting, he won-
ders how long he can maintain what he has. He wonders if tonight will be the
night he finally slips into the isolated hell of insanity.
Ron’s problem is a mental one, and he knows it. Trapped within the
confines of his mind, he is too aware of every thought passing through it, as
if he were outside, looking in. At night he often lies awake ruminating end-
lessly about what’s wrong with him, about death, and about the meaning of
existence itself. At times his arms and legs feel like they don’t belong with his

Feeling Unreal. Second Edition. Daphne Simeon and Jeffrey Abugel, Oxford University Press. © Oxford University Press
2023. DOI: 10.1093/​oso/​9780197622445.003.0001
2 Feeling Unreal

body. But most of the time, his mind feels like it is operating apart from the
body that contains it.
While he can interact with others who have no idea that anything is wrong,
Ron lives without spontaneity, going through the motions, doing what he
thinks people expect him to, glad that he is able to at least appear normal
throughout the day and maintain a job. He studied drama briefly while in col-
lege and remained enamored of Shakespeare and literature, but an emerging
self-​consciousness eventually robbed him of his ability to act. Now he feels as
if all of his life is an act—​just an attempt to maintain the status quo.
Recalling literature he once loved, he sometimes pictures himself as
Camus’s Meursault, in The Stranger, an emotionless character who plods
through life in a meaningless universe with apathy and indifference. He’s
tired of living this way but terrified of death. So he’s settled into a predict-
able routine whereby work serves as a necessary diversion, and happiness is a
dearly departed illusion. Dead people can’t be happy, he thinks. To be happy,
one has to feel, and Ron has not felt anything but fear, confusion, and despair
for a long time.
In his autobiographical account of his battle with debilitating depression,
Darkness Visible, William Styron writes: “Depression is a disorder of mood,
so mysteriously painful and elusive in the way it becomes known to the self—​
to the mediating intellect—​as to verge close to being beyond description.”1
The writer’s skills are tested when writing about what Styron calls “a ship-
wreck of the mind.” The wreckage caused by depersonalization is equally in-
describable to anyone who has not experienced it. Phrases like “things feel
unreal to me,” “I feel detached from myself,” and “my voice sounds different
to me” are enigmatic to normal people yet often quite understandable to
depersonalized individuals.
Most of us can imagine our darkest fear, such as being buried alive, or
locked in a room full of rats or spiders. Most of us can remember moments of
intolerable grief or unbridled terror, whether they occurred in waking life or
in nightmares. We can remember being unable to “shake” some awful sensa-
tion in the conscious hours after a particularly bad dream, or feeling “unreal”
in the face of a sudden tragedy or loss. For the most part, depersonalized
people are actually living every day with the fear and unreality of a dream
state come true. Inner and outer worlds seem strange and foreign, resulting
in an altered sense of selfhood that dominates their mental lives.
Our sense of familiarity with ourselves, our sense of past, present, or fu-
ture, who we are, and how we fit into the world around us enables us to live
 Strangers to Ourselves 3

from day to day in relative stability, with purpose, sanity, and reason. But
people with chronic depersonalization are never quite sure who they are, in a
sense. As such, they can find themselves in a life of going through the motions
robotically, often attempting to appear “normal,” wondering if others can see
through their façade to the inexplicable disconnection that pervades their
existence.
Tom, a 44-​year-​old sales executive, feels that he gets through his job using
about 10% of his brain capacity:

I’ll sit in an important meeting and be asked crucial questions, and

somehow I come up with the answers. But I’m not really there. It’s as if
nothing is real, myself or the meeting I am in. I look out the window 40
stories up and wonder where the sky ends. Or I see myself sitting in this
meeting, discussing bottom lines and sales promotions as if they actually
had meaning to me. It’s more than daydreaming. It’s like I’m too aware of
certain larger aspects of reality. In the face of the infinite sky above me, or
infinite time before and after my short existence, how could such things
as my job have any meaning at all? Doesn’t anyone else ever wonder about
this stuff?

Tom’s sense of detachment from everything that is immediate and vivid in

the day-​to-​day world, and his over-​preoccupation with the nature of exist-
ence, is something often experienced by depersonalized people. Says Cheryl,
a 33-​year-​old fabric designer:

I sometimes feel like I’m from Mars. . . . Being human seems strange, bodily
functions seem bizarre . . . My thoughts seem separate from my body. At
times, the most common, familiar objects can seem foreign, as if I am
looking at them for the first time. An American flag, for instance. It’s in-
stantly recognizable, and immediately means something to everyone. But if
I look at it for more than a moment, I just see colors and shapes on a piece of
cloth. It’s as if I’ve forgotten ever seeing the flag before, even though I’m still
aware of what my “normal” reaction should be.

This sense of strangeness about familiar objects outside of one’s self is

known specifically as derealization, the flip side of the depersonalization ex-
perience. “What’s so troubling to me is that if I were seeing these things for
the first time, like a child, there should be some sense of wonderment, but
4 Feeling Unreal

there isn’t,” Cheryl adds. “I know that there’s something wrong with me, and
all it does is fill me with fear, especially the fear of being taken away screaming
in a straitjacket.”
Louise is a 29-​year-​old grade school teacher whose experiences of deper-
sonalization permeate all the ways in which she relates to her body and her
movements, as well as her whole visual experience of the world. Her deper-
sonalization started when she was around 10, at which time she felt that when-
ever she lifted up her legs or arms, her body felt weightless, and she began to
float. She says: “For me, it can be a very visual experience. It’s like I’m wearing
glasses that I can’t see through, like there is a zipper to unzip.” She no longer
feels much; she describes herself as numb, and it’s rare for her to cry even when
she feels like it. Her body does not feel like a part of her: “I sometimes smack
my hand or pinch my leg just to feel something, and to know it’s there.” Louise
often feels like one part of her is “acting.” At the same time, “there is another
part ‘inside’ that is not connecting with the me that is talking to you,” she says.
When the depersonalization is at its most intense, she feels like she just does
not exist. These experiences leave her confused about who she really is, and
quite often she feels like an “actress” or simply “a fake.”
Phil, 42, owns a successful business and is the father of two. He first experi-
enced depersonalization when he was 17, and in the beginning the episodes
would come and go. For the past 15 years or so, however, his depersonaliza-
tion has been constant, at times more intense than at others. Like Louise, he
eloquently describes the many facets of his self-​experience that have become
chronically distorted by depersonalization. He has thought about his condi-
tion a great deal and has researched it on his own, as fervently as any doctor
he has met to date. When he tries to explain his experiences to a professional,
or to someone close to him, he does so in terms of the distinct domains of his
selfhood that are affected:

Emotions: “I want to feel things like everyone else again, but I’m deadened
and numb. I can laugh or cry but it’s intellectual; my muscles move but
I feel nothing.”
Body: “I feel like I’m not here, I’m floating around. A separate part of me
is aware of all my movements; it’s like I’ve left my body. Even when I’m
talking I don’t feel like it is my words.”
Mind: “My mind and my body are somehow not connected; it’s like my
body is doing one thing and my mind is saying another. Like my mind
is somewhere off to the back, not inside my body.”
 Strangers to Ourselves 5

Vision: “It’s like glass over my eyes, a visual fog totally flat and
two-​dimensional.”
Agency: “I feel I’m not really here, I’m not in control of my actions. I’m just
going through the motions, like a robot.”

People like Phil may suffer from chronic DDD for many years, vis-
iting a variety of doctors, psychiatrists, and therapists. Typically, health
professionals are not only unable to offer much relief, but they rarely even
offer a reassuring label for the condition. Patients are commonly told that
they suffer from some kind of anxiety or depression and that what they feel is
secondary to their main problem.
The frightening absence of feeling often encountered in DDD also can
create a somewhat paradoxical state of mind. On one hand, selfhood, and
with it the individual’s relation to the outer world, seems to deteriorate,
leaving the sensation of “no-​self.” Conversely, a heightened awareness of
inner experiences, like the thoughts running through one’s head, or visceral
sensations that cannot be ignored, can result in a hyper-​monitoring of the
self, a self that no longer feels familiar, grounded, or unquestioned. Strongly
held desires and beliefs, vivid memories, strong emotions that were nat-
urally sparked by the senses now all seem like illusions, far away, without
real meaning, somehow false. Familiar mental images are reduced to movie-​
screen images devoid of the smells, sounds, and punch that once made them
click. Ideas and memories that once had emotional meaning are now experi-
enced with alien-​like awareness and little feeling, while the sufferer remains
intellectually aware that this altered perspective is anything but normal. This
lack of “embeddedness” that accompanies a normal sense of self can leave
one feeling lost, vulnerable, and fearful.
“When I try to explain this, it sounds like a complete contradiction,”
says Joanne, a 35-​year-​old mother of three. “Minutes can seem like hours
to me when every thought, no matter how insignificant, is weighed and
overly present. It’s like my thoughts are on a big movie screen in huge type,
or shouted at me in a loud unpleasant voice. Yet at the same time, my life-
time, and all the lifetimes before and after mine, seem to last just seconds in
the scheme of things. I try to recapture the feeling I had when I was young,
that life was rich with promise. I looked forward to building memories to
cherish in my old age. But now it all seems so short and empty, as if all the
experiences I did enjoy to this point have been erased and I’m just existing in
this very second . . . there is no past, no future. Instead of being rooted in this
6 Feeling Unreal

world, enjoying my children and my life, all I can think of is how transient it
all is.”
“I’d really rather have cancer than this,” Joanne concludes. And she’s not
alone in this sentiment: others who are chronically depersonalized have
made the exact same statement. “With a disease that people know, you get
some degree of empathy. But if you try to explain this, people either think
you’re crazy or completely self-​absorbed and neurotic. So you keep your
mouth shut and suffer silently.” Indeed, depersonalized individuals often say
they would give anything to live their lives again with less scrutiny of exist-
ence and more spontaneity. While Socrates may have concluded that “the
unexamined life is not worth living,” the overly examined life, as experienced
by the people we’ve met so far, is often too painful to endure.

Hardly a New Disorder

Depersonalization, as a human experience, is nothing new. It has tradition-

ally been viewed as the mind’s natural way of coping with overwhelming
shock or stress, or intolerably inhumane living conditions. In such
instances, the mind detaches itself from the surroundings for the purpose
of sheer survival. But strangely, depersonalization can also appear sponta-
neously, without any apparent trigger. Possible causes of onset have only
been researched in depth in the past couple of decades, though theories
have proliferated for over a century (we’ll cover these causes in more detail
later). Some people can recall exactly how and when the problem began and
whether or not it was tied to a specific event. For others, the condition may
have begun so early in life that it is simply all they have ever known. In such
cases, depersonalization becomes a safe void where nothing affects them,
but at high price: when they’d like to feel, they can’t. They become what some
have come to call “the living dead.”
The word depersonalization itself, in a diagnostic sense, refers to both
symptoms and to the full-​blown psychiatric disorder of DDD. Ludovic
Dugas, a psychologist and philosopher who often wrote on the topics of
memory and déjà vu, is most often credited with first using the term in its
present context, in the late 1890s.2 However, Dugas had first seen the word
in a popular literary work of the era, The Journal Intime, by Henri Frédéric
Amiel (1821–​1881). This journal, the voluminous diary of an introspective
and obscure professor, was published posthumously. One particular entry
 Strangers to Ourselves 7

helped to define the nature of depersonalization for all time: “And now I find
myself regarding existence as though beyond the tomb, from another world.
All is strange to me; I am, as it were, outside my own body and individuality;
I am depersonalized, detached, cut adrift. Is this madness?”3
Other more renowned individuals later recognized depersonalization/​de-
realization (dpdr) as very concrete human experiences. Sigmund Freud ex-
perienced a vivid encounter with derealization while visiting the Acropolis
during a trip to Athens in 1904.4 We’ll take a closer look at Freud’s experi-
ence, as well as dpdr’s presence in psychology, history, and philosophy, in
subsequent chapters.
In years that followed, renowned psychologists either touched on the
subject of dpdr in books or issued lengthy papers on it in nearly every
major language. In the 1930s, a medical textbook entitled Modern Clinical
Psychiatry first included depersonalization within the context of schizo-
phrenia. Revised years later in the 1960s, it provided a particularly insightful
description:

Depersonalization, a pervasive and distressing feeling of estrangement,

known sometimes as the depersonalization syndrome, may be defined as
an affective disorder in which feelings of unreality and a loss of conviction
of one’s own identity and of a sense of identification with and control over
one’s own body are the principal symptoms. The unreality symptoms are
of two kinds: a feeling of changed personality and a feeling that the out-
side world is unreal. The patient feels that he is no longer himself, but he
does not feel that he has become someone else. The condition is, therefore,
not one of so-​called transformation of personality. Experience loses emo-
tional meaning and may be colored by a frightening sense of strangeness
and unreality. The onset may be acute, following a severe emotional shock,
or it may be a gradual onset following prolonged physical or emotional
stress. It is more frequent in personalities of an intelligent, sensitive, affec-
tionate, introverted, and imaginative type. The patient may say his feelings
are “frozen,” that his thoughts are strange; his thoughts and acts seem to be
carried on mechanically as if he were a machine or automaton. People and
objects appear unreal, far away, and lacking in normal color and vividness.
The patient may say he feels as if he were going about in a trance or dream.
He appears perplexed and bewildered because of the strangeness of unre-
ality feelings. He has difficulty in concentrating and may complain that his
brain is “dead” or has “stopped working.”5
8 Feeling Unreal

To be accurate in terms of what’s known today, the description should

have ended there. But, in line with older theories about depersonalization,
the textbook postulated that depersonalization was not a specific condition
outside of other neurotic and psychotic states and that it occurred more com-
monly in women and in puberty, and recommended electroshock therapy
as the effective form of treatment. Times and attitudes have changed. It is
now thought that the condition occurs about equally across genders, at many
stages of life. Chronic dpdr is now recognized as a unique disorder of its own
standing, depersonalization/​derealization disorder (DDD), rather than a
condition secondary to other ailments.
Unlike the early days of studying the mind, today’s field of psychiatry
has developed a reference book, the Diagnostic and Statistical Manual of
Psychiatric Disorders (DSM), revised periodically to stay current. These
revisions list the latest criteria for making an accurate diagnosis of virtually
any known mental illness based on more recently gathered evidence. Early
versions of the DSM from the 1950s and 1960s mentioned depersonaliza-
tion as a dissociative reaction or syndrome, classified in the category of neu-
rotic disorders. From 1980 on, chronic depersonalization was placed within
the new category of dissociative disorders, yet the DSM offered few specifics
about the condition. But today that’s changed. According to the latest edition,
DSM-​5-​TR,6 DDD is described as follows.
An individual suffering from depersonalization may experience:

• Detachment from one’s whole self or from aspects of the self.

• Detachment from feelings.
• Detachment from thoughts.
• Detachment from the whole body or body parts.
• Detachment from sensations.
• Diminished sense of agency.
• A split self, one part observing and one participating.

Sufferers of derealization may experience:

• Detachment from the world (people, objects, or all surroundings).

• Feeling as if one is in a fog, dream, or bubble.
• The sensation of a veil or glass between the self and the world around.
• Surroundings that seem artificial, colorless, or lifeless.
 Strangers to Ourselves 9

• Visual distortions (blurriness, changes in visual field, dimensionality, or

size of objects).
• Auditory distortions (voices or sounds are muted or heightened).

Patients may experience symptoms of one or both elements for a diag-

nosis of DDD to be made. And symptoms may be episodic or recurring (see
Chapters 3 and 4 for more about symptoms and diagnosis). Unreality and
detachment are the essence of dpdr, despite the multitude of symptoms that
have been recorded over time. People may have difficulty describing their
symptoms and may fear that their experiences in fact signify that they are
losing their mind, going “crazy.”
At some point in their lives, many adults will experience a brief episode
of dpdr, usually precipitated by severe stress or trauma. Depersonalization
has been found to occur transiently in one-​third to one-​half of student
populations.7 Transient depersonalization, lasting seconds, minutes, or even
hours, can readily occur in otherwise “healthy” individuals under extreme
conditions of sleep deprivation, sensory deprivation, travel to unknown
places, or acute intoxication with marijuana or hallucinogens. It also occurs
in about one-​third of people who have been exposed to life-​threatening
danger, and about 10% of patients hospitalized for various mental disorders.8
Depersonalization has been found to occur, at least fleetingly, in 50% to 70%
of the general population.9 Most often, initial depersonalization goes away as
mysteriously as it came, but sometimes it becomes more chronic, with an en-
igmatic life of its own. Research shows that approximately 2% of the general
population suffers from chronic depersonalization that rises to the level of a
psychiatric disorder.9
Sudden depersonalization is likely to make a person think they’re going
insane. When it occurs after they’ve taken an illicit drug, they often think
they’ve suffered brain damage. No longer grounded by familiar sensations
or surroundings, they feel as if they’re losing their grip on reality. But un-
like people with psychotic conditions like schizophrenia, they are not going
insane at all. They are, if anything, suddenly overly aware of reality and ex-
istence and of the ways in which their own experience is a distortion of the
“normal” sense of a real self.
Depersonalization, in fact, resembles a sort of altered “conscious-
ness,” akin to the “awakening” that in some cultures is thought to be a
level of spiritual growth. This is touched upon in the DSM-​5-​TR, which
10 Feeling Unreal

distinguishes the condition from mental states that are actively sought
out, often through meditation. But for most “Westerners,” this abnormal
sense of having no self is a state they’d prefer to leave behind (in Chapter 9,
we’ll take a closer look at philosophical and spiritual interpretations of
this state of mind).

The Madness of the New Millennium?

Exploration of the nature of dpdr, as a transient symptom or as a full-​blown

chronic disorder, is now taking on a new importance for several reasons.
First, the use of illicit drugs, from the 1960s until now, has fostered an ex-
plosion of depersonalization cases in the last 50 years. Marijuana, legal or
not, and other drugs such as hallucinogens and Ecstasy are well known to
sometimes trigger chronic depersonalization. Second, there is evidence
that more people are experiencing depersonalization, or making it known,
than ever before, whatever the initial precipitant. Many of these people
have suffered in silence, perplexity, isolation, and shame for years. Then,
the advent of the internet prompted the founding of several depersonali-
zation support group websites. Consequently, thousands of people with
strikingly similar experiences and symptoms began congregating in the late
1990s with a hunger for information and comfort through this new venue.
One of the earliest websites, depersonalization.info, has received more than
200,000 hits since its creation in 2002. The posting below is typical of the
personal stories contributed by people who visit briefly, then return to their
solitary worlds:

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 con-
stantly 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 delusions.
 Strangers to Ourselves 11

This articulate, electronic expression of the strangeness of depersonaliza-

tion could have come right out of Amiel’s journal, written with pen and ink, or
from dozens of other philosophical or literary works through the ages. These
cries for help did not go unnoticed. In the 1990s, a few medical institutions
established research programs singly devoted to the study of DDD. These
included the Depersonalization and Dissociation Research Program at the
Mount Sinai School of Medicine in New York, and the Depersonalization
Research Unit at the Institute of Psychiatry, King’s College, London. These
programs were devoted to studying depersonalization in depth in all its
aspects, and to experimenting with new treatments that might offer relief to
those who found DDD an unbearable condition. Many of their findings are
examined in later chapters.
Throughout this book we will present numerous personal stories from
people suffering from dpdr. Some individuals can trace its onset to a spe-
cific trigger such as childhood maltreatment, or traumatic stress, or drug
use. Others may not be able to pinpoint when or where their encounter with
DDD began with any precision. Some may endure unbearable anxiety, while
others feel no anxiety at all. In any case, what they experience falls within the
guidelines for a diagnosis of DDD. The detailed case of Alex that follows is
one story of many.

The Story of Alex

From his earliest years, Alex felt destined for a life at sea. Growing up in a
depressed neighborhood in New York, his greatest pleasures were regular
drives to the beach or deep-​sea fishing trips with his father or friends. His
parents were strict and religious but also loving and fair. They successfully
raised him with virtues of honesty and tolerance that would later be admired
by many with whom he sailed.
Alex graduated from the U.S. Merchant Marine Academy with honors in
the late 1960s and immediately found work as a third officer aboard a large
tanker owned by a major oil company. Alex functioned comfortably in a
world of order, respect for authority, and a well-​founded regard for the in-
herent power and danger of the oceans of the world.
While the culture he left on land was now obsessed with the Vietnam war,
sexual experimentation, drugs, and long hair, there was nothing novel about
any of this to men who sailed the ocean regularly. Alex had seen people in
12 Feeling Unreal

India with hair that had never been cut; he had witnessed bloody skirmishes,
even an execution in Africa; and sailors ashore were known for their wanton
disregard for conventional morality. Despite many temptations, however,
Alex chose to remain morally upright, partly because of his religious beliefs
and partly because of the status he needed to maintain in front of the crew.
He had met his wife, Teresa, shortly before graduating, at a Sunday night
church service held near the academy. Long love letters between Alex and
Teresa accumulated during his earliest voyages, and within a year they were
married, despite his mother’s protestations. Together they purchased a small
house on Long Island, New York.
Between voyages Alex had plenty of time at home and plenty of cash be-
cause his expenses on land had been minimal. It was his choice when he
sailed again. But some of the major oil and shipping companies, where his
friends and classmates worked, were beckoning. He had quickly earned a
reputation as an officer with superior navigation and piloting skills, which
better assured an uneventful voyage for the monolithic, costly company
vessels. He had also been certified for increased responsibility. By his late 20s
he was qualified to be a first mate on the largest vessels in the world with only
the captain above him.
The first few stays at home with Teresa, after his regular four-​month
voyages, were like extended honeymoons. But the down payment on the
house and subsequent furnishings soon diminished his cash reserves. In
time, life on land seemed somewhat unsettling as well. At sea, an officer’s au-
thority was like that of a god. On land, people had little respect for authority,
were detached from the real power of nature, and were generally ignorant of
the realities of life in the rest of the world.
Teresa, who had once promised to continue her education and finish col-
lege, also began to change. She no longer exhibited much ambition except for
wanting to have children as soon as possible. The couple had talked of par-
enthood, but they had agreed to wait a few years. But Teresa was impatient;
her other friends all had babies with fathers who worked in the city and came
home each night. It became clear that this was what she desired as well.
After several voyages to the Far East and South America, Alex began to
feel increasingly uneasy during the months spent at home. His ship’s cabin
had become a compact sanctuary that called for his return. In the new sub-
urban home, Teresa watched too much television and talked on the phone
to her parents and friends to an annoying degree. Alex often went to the
beach to surf cast, and sometimes prayed for a sign of what to do next. The
 Strangers to Ourselves 13

relationship was strained within the parameters of marriage; it was so dif-

ferent from the days of dating and dreaming of the future. Finally, under
pressure from Teresa and her parents, he told her that he would complete one
last voyage, then look for maritime-​related work on land. An infusion of cash
and a break from each other seemed to be what both of them needed.
Alex’s last voyage was on Lake Superior, serving as first mate aboard a
moderately sized tanker. The money was good, but for Alex, the voyage was
uneasy. He didn’t know any of the officers or crew and the waters were rough
much of the time. He had never worked for this company before and sensed
some tendencies to take shortcuts with maintenance and safety. Still, he did
his job, remained businesslike, and kept to himself.
On the return voyage, with only days to go, Alex felt inexplicably uneasy
again, though some of his distress could be pinned to concern about the fu-
ture. He was at the moment tired of being on ships, but life on land held little
appeal. Perhaps his marriage had been a mistake. His mother had discour-
aged it; maybe she, as usual, had been right.
Then, in the early morning hours after his four-​hour watch, Alex
stood outside on the deck to think and perhaps pray. The lake was now
placid and glasslike, uncharacteristically still. A fog had rolled in so
that the water blended with the horizon to create a single, indetermi-
nate mass. An unsettling stillness overtook Alex as well. His mind was a
complete blank, as if awaiting a thought, or a vision. Then, in an instant,
he felt something he had never experienced before—​an intense sense of
panic and fear that seemed to physically begin somewhere in the inte-
rior regions of his body and work its way up through his spine into his
head. A sharp, blinding fear that he could never have imagined had him
looking at the rail before him with a complete and all-​encompassing urge
to jump over the side.
Stories of madness have always been part of the lore of the sea. Such
anecdotes were common in sailing times, when scurvy, poisoning from
tin cans, or year-​long voyages would trigger serious mental illness in many
sailors. Even today, Alex can recall instances of seamen going berserk, having
“the fits,” or jumping overboard to commit suicide.
His immediate thought on the deck was that this was “his turn.” This was
what it was like to go insane. The fear was so inextricably intense that his only
desire was complete obliteration. It was a fear not of anything that existed
before him, nor in the past or future of a life that was unfolding. It was a
fear of existence itself. “It was something like waking up to find that you’re
14 Feeling Unreal

in a coffin, buried alive,” he recalls. “Only the coffin is your body, your very
existence.”
Physically shaken, Alex raced to his cabin, only to find himself frantically
looking around in all directions as if to search for some anchor upon which
he could hook his sanity. He sat on his bunk and glanced at the pictures of
his wife and parents. He took deep breaths, and after some time the abso-
lute panic began to subside. Was he going insane? Was this what it was like?
Had he been poisoned or given LSD by this suspect crew? His mind raced for
explanations until, exhausted, he feel asleep.
Alex would never be completely the same again, though he would know
some periods of normalcy, or something close to it, in time. He returned
home safely and was now glad to be in his own house with Teresa by his side.
But his head did not feel right. He felt anxious and fearful of having another
attack like the one he’d had on deck. His confidence and self-​esteem were
gone, and he lay awake all night thinking endlessly about infinity of time
and space, the nature of God, and the strangeness of his own existence. All
the things he had accomplished, all the places he had been now seemed like
dreams, acted out by someone else. He was a fearful, lost, nonperson—​the
real Alex, who had existed beneath the façade of faith, courage, and action for
so many years.
Teresa noticed a difference, too. He couldn’t make love and had difficulty
showing interest in anything she said. Before long he went to see an internist
whom he had known for years. A complete physical revealed nothing out of
the ordinary. The doctor said it sounded like some kind of depression and
anxiety and, after going through his Physicians’ Desk Reference, prescribed
one of the older class of antidepressants.
Over a period of weeks, the medicine did have some effect. At first Alex
was sleepy most of the time and took long naps, looking forward to escaping
life in dreamless slices of nonexistence. In time, the free-​floating anxiety was
quelled, and Alex felt he was actually somewhat better. The beginnings of
hope began to emerge, but still his thinking seemed somehow separate from
the rest of his body. He was able to smile and begin to plan for the future,
but he felt like his mind was a radio that was not quite tuned into a station—​
noise and static and confusion often filled his head with an exhausting over-​
awareness of every small thing that went on within it.
“In the very beginning, even when the panic had subsided, I never had
a mood,” Alex recalls. “Everything felt was moment to moment, with every
thought overly conscious in my head. I went through numerous variations of
 Strangers to Ourselves 15

this for about a year,” he recalls. “I was able to function again, but only in the
daily hope that I would wake up one day and be myself again.”
Alex’s sense of time seemed somehow altered as well. Minutes some-
times seemed like hours; yet his whole life now seemed to have raced by
him in seconds. In the midst of all this, time continued on its own pace and
a decade came and went. On the surface, life looked good. Teresa got the
boy and girl she had wanted, and Alex joined up with an old classmate to
start a charter fishing boat service on Long Island. The family moved to an
established middle-​class neighborhood on the South Shore and everyone
appeared happy and prosperous. But inside, Alex’s private world, hellish at
times, continued.
When he felt better from the antidepressants, he stopped taking them with
no apparent ill effects. He was no longer the person he once was but tried to
somehow be content within the context of what he had become. If things got
rough again he could always go back to the medicine and sleep a few days
away and make another comeback of sorts.
For more than 10 years, well into the 1980s, Alex kept an encrypted diary
documenting what he felt and thought. Over the course of time, there seemed
to be some pattern to his condition. If his ailment had specific symptoms that
appeared regularly, there might actually be a name for the condition, he rea-
soned. With the analytic nature that he had not lost, he determined that he
was indeed human and, as such, could only be susceptible to known human
ailments. After all, even though he often felt like it, he wasn’t from another
planet.
To explore this reasoning, and also seek something even more effec-
tive than the one antidepressant he had tried, he visited a psychiatrist.
Unfortunately, he learned little more than he had from the internist he had
seen years earlier. The psychiatrist also suggested long-​term psychoanalysis,
which Alex viewed with skepticism, if not outright contempt. So he decided
to continue on his own. In his diary he broke down his specific symptoms
and concluded that they were sometimes predictable, even cyclical. This is
how he described his symptoms:

• Free floating anxiety that comes and goes, with a fear of the Panic. This
is the direct antithesis of how I once felt, when I was filled with a sense of
adventure, confidence, and willingness to go anywhere, do anything.
• Circular, pointless rumination about everything from existence itself to
something someone said, to the reasons for my illness.
16 Feeling Unreal

• Detachment of my inner voice from my body. Almost constantly, the

thoughts running through my head are loud and visible and completely
detached from my head. They seem up high in my head, somewhere
else. The act of thinking seems strange and foreign.
• The Aloneness. An acute awareness of being alone in my thoughts, a
prisoner in my own head. A shattering realization that no one, ever, has
shared my thoughts with me. I have heard them alone since I was born
and will hear them alone until I die.
• Fear of controlling my actions. I drive and wonder what prevents me
from intentionally crashing. I play with my children and wonder what
keeps me from slaughtering them.
• Over self-​consciousness. In crowds, at the mall, at parties, virtually any-
where, I am flustered by noise and crowds and feel that I stick out like an
ogre to be mocked in some way. My legs and arms move awkwardly and
feel foreign.
• The Voice. The exaggerated self-​consciousness initially felt like I was
seeing through myself all the time, as if someone was watching my
every move and making fun. In time, this manifested itself in the form
of an actual second voice in my head. For everything I thought on my
own, this little voice would make comments, usually derisive ones. This
strange presence persisted for about a year and seemed to replace all the
other symptoms. Everything was distilled into this second voice, which
made my life miserable, despite the fact that I knew that somehow, it was
me doing it. When it tried the medication again, it seemed to shrivel up
and disappear.

These core symptoms that Alex experienced sometimes appeared con-

currently, but most often a single one would manifest itself to the exclusion
of all others. When he was panicky, there was no voice. When he felt the
aloneness most, anxiety was minimal, except as a direct result of fearing
the aloneness. And through it all, he never considered himself depressed.
He dealt with that particular annoyance any way he could until either a de-
gree of normalcy or the next symptom took its turn. In time he also learned
something quite amazing. In periods of severe stress or heartache, such
as when loved ones died or catastrophic events hovered near, he became
the “strong one” and dealt far better with it than others around him. In
contrast, the smaller daily stresses of life—​financial problems, screaming
kids, house or car problems, bills, and noise—​were difficult to handle, and
 Strangers to Ourselves 17

whenever they were compounded, one or more of his symptoms was sure
to emerge.
It’s now been decades since that fateful morning on Lake Superior when a
first officer’s life was changed forever not because of something outside, but
rather something deep within. Alex worries little, but feels little. A kind of
emotional deadness inside seems to be the end result of a thousand mental
blows through the years—​and with it, a philosophical interpretation, of sorts.
“That sailor and everything he believed in so strongly no longer exists,”
Alex says. “And neither do I. I feel like the ‘I,’ for lack of a better term, is now
somehow situated across many moments. My identity is scattered every-
where; as if I am everyone, and everything, and the spaces between things.
And there is a sense of loss, because if this feeling is true, I ought to know
everything, feel everything, but I don’t. It’s like the reflection of the sun being
split into shards of light on the sea. I have dissolved, into a kind of ‘oneness’
with all that exists, but it’s a fragmented oneness. It isn’t yet complete.”
Alex’s experience mimics those of countless others for whom ongoing
stresses may have triggered dpdr, assuming some preexisting predisposition
was in place. The symptoms he describes fall into a category that has some-
times been called the “phobic anxiety-​depersonalization syndrome,” and
parallel those described in some of the literature dealing with depersonaliza-
tion that had appeared in the late 1950s and early 1960s. Unfortunately, Alex
never encountered a doctor who had even heard of his specific symptoms,
and at the time it was extremely unlikely that he would have.
On the surface, Alex’s feelings of dpdr came from nowhere. But persistent,
ongoing pressure and stresses clearly set the stage for his shipboard mental
crisis. For other people, drugs like marijuana or Ecstasy can sometimes have
the same effect, with symptoms similar to what Alex described. Regarding
the second interior “voice,” a study of 117 individuals with DDD indicated
that most (over 80%) reported no such voices at all.9 However, a minority
did experience an inner voice, a single one, best likened to an out-​loud
thought inside one’s head, accompanied by an awareness that the voice is the
person’s own thoughts experienced in an intense yet disconnected fashion
as a distinct “voice.” This voice typically sounds like the person, is not ex-
perienced as alien, and is a commentary on the person’s thoughts, feelings,
or actions as if coming from a detached other, the dissociated part of the
self. This infrequent experience of a “voice” in DDD distinctly differs from
that of individuals with dissociative identity disorder and its variants, who
often have multiple internal voices, experienced as less owned by the self and
18 Feeling Unreal

more alien, representing intrusions on the conscious self by the various alter-​
identities. The “voice” also differs from those of psychosis, typically experi-
enced as coming from delusional imagined others.
These case histories and others to come have shown various manifestations
of depersonalization within the context of individual lives. They by no
means cover the full range of possible symptoms that can and do appear
within DDD. It has taken more than a century of study for psychiatrists,
psychologists, and philosophers to disseminate the symptoms described by
many thousands of people. In the next chapter, we take a closer look at that
historical process and its results.
 2
The Path to Understanding
A Historical Exploration

The answers you get depend on the questions you ask.

—​Thomas Kuhn

People suffering from depersonalization often feel they are living on the brink
of insanity, or simply in some form of altered consciousness previously un-
known to them. While it may be examined from many different perspectives,
depersonalization/​derealization disorder (DDD) is nothing new. It isn’t
one of many trendy acronyms making the rounds on talk shows or in so-
cial media. Feelings of depersonalization, or loss of the self, have appeared
in philosophical and religious discussions for centuries (see Chapter 9). But
clinically, DDD has only been observed and seriously documented in the last
two centuries.
Today, the internet offers readily accessible information, but much of
it is lost amid half-​truths and self-​styled gurus promising a cure. All too
often people living with depersonalization, as well as their physicians and
therapists, remain in the dark, struggling to determine what could be wrong.
In years past, exhaustive searches in university or hospital libraries, or a visit
with one of the few savvy psychiatrists who really knew about the condition,
could reveal some answers. But even then, problems in achieving the correct
diagnosis sometimes arose. Of the dozens of clinical papers that could be
found, using just one could result in a wrong or misleading interpretation of
the condition. For instance, among his many astute observations, Austrian
psychiatrist Paul Schilder1 is also known for the highly subjective comment
that “depersonalization is the neurosis of the good looking and intelligent
who want too much admiration.” Taking this comment at face value and out
of context would not be helpful. Visiting a clinician unfamiliar with all the

Feeling Unreal. Second Edition. Daphne Simeon and Jeffrey Abugel, Oxford University Press. © Oxford University Press
2023. DOI: 10.1093/​oso/​9780197622445.003.0002
20 Feeling Unreal

literature, or at least the most relevant recently published findings, could be

equally fruitless, and sometimes even harmful.
This chapter provides an overview of how the definition of DDD has
evolved from the early nineteenth century to the 1970s. Through a slow
stream of patient investigations, certain prevalent core symptoms of deper-
sonalization began to emerge. Other symptoms, while as valid as they were
50 or 150 years ago, have periodically receded into the background only to
resurface and receive renewed attention. Some conclusions drawn from var-
ious studies have been subject to debate or later revision by those who in-
itially drew them. Some were downright wrong. Yet certain aspects of the
disorder have been agreed upon almost universally.
We are fortunate in that depersonalization enjoys a historical record in
the medical and psychological writings of Europe, beginning in France and
Germany. Much of this material developed in the mid to late nineteenth cen-
tury, when dramatic social changes gave rise to intellectual and philosophical
explorations the world had not yet seen.
Some of the earliest clinical observations of depersonalization came from
pioneering psychiatrists, sometimes referred to as “alienists” in the nine-
teenth century, physicians who studied the mind and assisted patients with
overcoming their mental “alienation” (illness). As far back as 1838, a German
doctor named Albert Zeller described five patients, all of whom “complained
almost in the same terms of a lack of sensations . . . to them it was a total lack
of feelings, as if they were dead . . . they claimed they could think clearly
and properly about everything, but the essential was lacking even in their
thoughts” (p. 525).2
At the same time, in France, psychiatrist Jean-​ Étienne Dominique
Esquirol quoted patients stricken with the deep sense of melancholy known
as lypemania: “An abyss, they say, separates them from the external world,
I hear, I see, I touch . . . but I am not as formerly was. Objects do not come
to me, they do not identify themselves with my being; a thick cloud, a veil
changes the hue and aspects of objects” (p. 414).3 Also in France, the al-
ienist Eugene Billod described a patient with similar recollections: “She
claimed to feel as if she were not dead or alive, as if living in a continuous
dream . . . objects looked as if surrounded by a cloud; people seemed to move
like shadows, and words seemed to come from a faraway world” (p. 187).4
Doctors observing these odd symptoms did not dismiss them as part
of something more common and familiar. They began sharing informa-
tion across the continent. In 1845, another German psychiatrist, Wilhelm
 The Path to Understanding 21

Griesinger (later known for his asylum reforms and efforts to integrate
the mentally ill into society), shared patient accounts with Esquirol and
noted: “We sometimes hear the insane, especially melancholics, complain of
a quite different kind of anaesthesia . . . I see, I hear, I feel, they say but the
object does not reach me; I cannot receive the sensation; it seems to me as if
there was a wall between me and the external world” (p. 157).5
A few decades later, writings specifically dealing with depersonalization
as a unique disorder emerged. In 1873, Maurice Krishaber, a Hungarian ear,
nose, and throat specialist, described DDD as a possible “cérébro-​cardiac”
malfunction.6 Shortly thereafter, French philosophy professor Ludovic
Dugas pulled all of the anomalies exhibited by this strange condition to-
gether under the umbrella of “depersonalization” for the first time.7 Writing
with neurologist Maurice Moutier, Dugas defined depersonalization as “a
state in which there is the feeling or sensation that thoughts and acts elude
their self and become strange; there is an alienation of personality; in other
words, a depersonalization” (p. 13).7
Indeed, for Dugas and Moutier, personalization was the normal
and expected mental faculty that simply made mental events personal.
“Personalization is the act of psychical synthesis, of appropriation or attri-
bution of states to the self ” (p. 13) they wrote.7 Depersonalization is the dys-
function of that process. Dugas and the others were highly observant and
curious, and no doubt influenced by each other, as well as by philosophers
and intellectual dilettantes. Despite the differences between modern med-
icine and that of the nineteenth century, many of the earliest observations
remain valid with few, if any, modifications, largely because what was being
described by patients then is described so similarly today. Depersonalization
is what it is, then and now.

Sensory Distortion Theories

As noted, records of patients suffering from “thinking without feeling,”8

a sense of detachment, incompleteness, or total lack of feelings began
accumulating in medical circles as early as the 1840s. Krishaber’s observations
were born out of a study of 38 patients showing a mixture of anxiety, fatigue,
and depression. More than one-​third of these patients complained of baffling
and unpleasant mental experiences consisting of the loss of the feeling of re-
ality.6 Krishaber theorized that these feelings were the result of pathological
22 Feeling Unreal

changes in the body’s sensory apparatus. Multiple sensory distortions would

therefore lead to experiences of “self-​strangeness.” “One patient tells us that
he feels that he is no longer himself, another that he has lost awareness of his
self ” (p. 171), Krishaber wrote.6 While Dugas didn’t use the term “deperson-
alization” until 26 years later, Krishaber’s case histories marked the first true
scientific study of the experience of DDD.
Another prominent theorist, Théodule Ribot, agreed with the sensory-​
distortion theory when he reported patients describing feelings of “being
separated from the universe, or feeling as if their bodies were wrapped in an
isolating substance that interposed itself between themselves and the external
world; underlying these experiences there were ‘physiological abnormalities
whose immediate effect is to produce a change in coenesthesia’ ” (the general
feeling of inhabiting one’s body that arises from multiple integrated bodily
sensations) (p. 196).9
In 1906, the German physician Carl Wernicke wrote about disorders of
body awareness and depersonalization called Somatopsychosen. Citing a pa-
tient whose body had become stiff and lifeless, he noted: “She had to keep
touching herself to feel the heaviness of her body. She felt as if she were
dead and numb, as if it was bereft of circulation, even though she could feel
her pulse and the beats of her heart. Such feelings also involved her sen-
sory organs; she could hear but felt that her eyes were fixed to her head, and
couldn’t move them” (p. 242).10
Czech neurologist and psychiatrist Arnold Pick, after whom a type of de-
mentia called Pick’s disease was named, agreed with the sensory hypoth-
esis. In an article, “Disorders of the Awareness of the Self,” he suggested that
depersonalization was accompanied by a disturbance of sensory percep-
tion.11 Otfrid Foerster, the innovative neurologist and disciple of Wernicke,
hypothesized that all sensations were composed of a specific sensory compo-
nent (e.g., visual, auditory) and a corresponding muscular sensation arising
from the movement itself. In healthy individuals, subjective feelings of reality
and vividness resulted from the synchronized experience of these two so-
matic elements. In depersonalized patients, Foerster suggested, “the propri-
oceptive component failed to reach consciousness” (p. 14).12 (Proprioception
refers to the awareness of bodily sensations, position, and movement.)
These observations, along with Krishaber’s sensory hypothesis, were
later challenged by others like Dugas and Pierre Janet, a major figure in
nineteenth-​century psychology. Janet pointed out that many patients with
clear sensory pathology, such as double vision (diplopia) or the loss of joint
 The Path to Understanding 23

sense caused by neurosyphilis, did not complain of any sensations of un-

reality, while many patients suffering from depersonalization were in fact
normal from the purely sensory viewpoint.13 Dugas wrote of a patient whose
own voice sounded foreign to him: “Although he knows that it is his voice, it
does not give him the impression of being his own . . . Acts other than speaking
are also involved . . . Every time the subject moves he cannot believe that [he]
is doing it himself . . . The state in which the self feels that its acts are strange
and beyond its control will be called here alienation of personality or deper-
sonalization” (p. 503).7
Dugas’ choice of words was perfect for describing the loss of “person-
hood.” But it was not the first time it was seen in print. The term originated
in Swiss philosopher Henri Frederic Amiel’s Journal Intime, an effusive
diary in which he wrote: “All is strange to me; I am, as it were, outside my
own body and individuality; I am depersonalized, detached, cut adrift”14
(see Chapter 9). Now christened with proper nomenclature, depersonali-
zation was for Dugas7 a blurring of what Blaise Pascal had defined centuries
before as two distinct elements of our being: “the willing mind and the au-
tomaton.” This blurring between the separation of the two renders all volun-
tary actions automatic.
“Depersonalization behaviors not only seem automatic; to an impor-
tant extent, they are,” Dugas wrote. “By automatic I mean any behavior to
which the self feels indifferent and foreign, and which it produces without
thinking or wanting, as might happen in states of total distraction or absent
mindedness” (p. 507).7 This “apathy,” a term that appears often in the litera-
ture that followed, marks the emotional deadness that is one of the hallmarks
of depersonalized people. It is not a decision to be indifferent or unfeeling; it
is automatic and unstoppable. “Depersonalization is not a groundless illu-
sion,” Dugas concluded. “It is a form of apathy. Because the self is that part of
the person that vibrates and feels and not what merely thinks or acts, apathy
can be truly considered as the loss of the person” (p. 507).7

Memories, Real or Unreal

Nineteenth-​century thinkers were also intrigued by the experience of

memories. Understandably, the mystery of depersonalization emerged amid
the prevalent theories about “déjà vu” phenomena (literally meaning “al-
ready seen”) and their opposite, “jamais vu” phenomena (“never seen”).
24 Feeling Unreal

In Germany, personal experience with DDD prompted psychiatrist Emil

Kraepelin to interpret it as a dysfunction of memory relating to déjà vu: “At
that moment it seems to us that all of a sudden the surroundings become
hazy, as something quite remote and of no concern at all . . . The impressions
from the surroundings do not convey the familiar picture of everyday reality,
instead they become dream-​like or shadowy . . . as if seen through a veil”
(p. 410).15
Dugas initially regarded the presence of depersonalization as evidence for
the view that déjà vu was a form of “double consciousness,” a popular term of
the era used to describe dual or alternating personalities. But he changed his
mind completely when he took a closer look at depersonalization all by itself.
Still, the compelling similarities between strange phenomena like hyp-
notic suggestion, dreaming, déjà vu, jamais vu, and depersonalization kept
these mysterious mind states swimming together in the same fishbowl, so
to speak, as observers watched, took notes, and tried to determine their pos-
sible connection. But all along, they sensed that there was something sin-
gular and different about depersonalization.

Hollow Selves

At an 1880 meeting with peers in Berlin, psychiatrist O. Shafer shared his

observations of patients with what he considered a subtype of melancholia
that he called Melancholia Anaesthetica: “When these patients complain of
their suffering, they relate it explicitly to an emptiness, hollowness in their
head, or in the pit of their stomach; of a discomfort of not reaching the sur-
roundings with their inner selves . . . [Patients] have lost the feeling of activity
or effort that used to accompany their thoughts and actions, and so they feel
in themselves like lifeless machines” (p. 242).16
Gustave Wilhelm Störring, a psychiatrist who turned to philosophy later
in life, believed that “coenesthesia” lay at the heart of self-​experiencing. He
argued that “organic sensations are a condition of consciousness of self; and
the awareness of one’s body, which is due to them, must be regarded as one
constituent of it” (p. 290).17 Hence, disturbed perception played a role in the
genesis of self-​strangeness. Coenesthesia, lack of activity-​feelings, and power
of perception were all involved in an altered experience of the self, Störring
theorized.17
 The Path to Understanding 25

A fellow German psychiatrist, Max Lowy, modified Störring’s ideas by

fine-​tuning the concept of activity-​feelings to one of “action-​feelings.” This
referred to a conscious mental representation of the experience of “what it
feels like to carry out a particular mental activity (including perception),
rather than to accompanying emotional feelings like pleasure or dislike”
(p. 460).18 For instance, during recollection of personal memories, there
is, in addition to the information retrieved, a distinct sense of what it feels
like to remember something, a feeling of delving into the past. Lowy wrote,
“The action-​feeling of psychological activity, or thought-​feeling; it normally
accompanies every psychological act, it provides altogether the awareness of
the reality of perceived objects . . . in its absence colours and tones become
distant and strange, things become unreal, as if from another world.”18
Janet, who as noted earlier challenged the sensory distortion theory, is also
well known for introducing the words “dissociation” and “subconscious” into
psychology’s terminology. He attributed the nineteenth-​century affliction
“hysteria” (later known as “conversion disorder,” in which a psychological
conflict manifests itself in the form of some bodily dysfunction such as hys-
terical paralysis or blindness) to imbalances in “psychic energy” and “psychic
tension” (the use of the word “psychic” simply means psychological, relating
to the mind). Janet considered depersonalization to be a manifestation of
“psychasthenia,” an antiquated term for any nonspecific condition marked
by phobias, obsessions, compulsions, or excessive anxiety (p. 318).19
Certainly, these mental anomalies often accompany depersonalization or
mark the beginnings of it. But Janet also stressed the presence of a sentiment
d’incompletude, an experience of incompleteness that many observers found
well represented in Dugas’ source for the term “depersonalization,” Amiel’s
Journal Intime.14 “What characterizes the feeling of depersonalization . . . is
that the patient perceives himself as an incomplete, unachieved person,” Janet
stated.13 This feeling of being incomplete is indeed a core part of the expe-
rience of depersonalization, in terms of one’s being out of sync with one’s
“normal” self-​experience. It can also be a secondary feeling, referring to
reflections of what the self and life “used to be” or “might have been” that can
emerge in people who have been depersonalized for a long time. As we will
see in Chapter 9, Amiel’s journal graphically depicts both these attitudes.
Overall, however, Janet’s theories brought about a major shift in the
predominant thinking on depersonalization. Janet believed that all psy-
chic activity was either primary or secondary. Primary psychic activity
26 Feeling Unreal

encompassed everything that was evoked by external stimuli—​from knee

jerks to memories. Secondary psychic activity was a background echo elicited
by representations of primary acts. By conferring upon primary experiences
a feeling of vividness (l’impression de vie), this secondary echo creates the
illusion of a continuous flow of psychic activity: “Thousands of resonances,
constituted by secondary actions, fill the spirit during the intervals between
external stimuli, and give the impression that it is never empty” (p. 126).19
Disconnection between these primary and secondary psychic processes
could result in depersonalization-​like symptoms, connoting a self not expe-
rienced as continuous. Janet’s language was different, but his theory remains
surprisingly contemporary.

From the Psychological to the Biological

As the twentieth century emerged, existing theories about depersonalization

still seemed inadequate because there were simply too many aspects of the
condition that remained unexplained. Depersonalization began to be viewed
in terms of the loss of some brain mechanism that causes the feeling of mental
experiences and attribution to the self as the agent who experiences them—​
the sense that “my experiences are mine,” commonly referred to as agency.
In the 1930s, Heidelberg psychiatrist Wilhelm Mayer-​ Gross’s now-​
famous paper “On Depersonalization” reviewed the theories, case histories,
and speculations up to that time, in an attempt to elucidate the nature of
the disorder.20 Mayer-​Gross was first to highlight the distinction between
depersonalization and derealization, two manifestations of what is now
considered the same disorder of DDD. Much of what Mayer-​Gross said was
referenced again and again by other writers in succeeding decades, up to the
present.
Mayer-​Gross believed that depersonalization was an expression of a
“pre-​formed functional response” of the brain, analogous to delirium, cat-
atonia, or seizures. He took exception to theorists who focused on isolated
symptoms of the disorder, such as increased self-​observation, loss of emo-
tional response, or impairment of memory: “It is a characteristic form of re-
action of the central organ, which can be set going by different causes. . . . The
difficulty of description by means of normal speech, the defiance of compar-
ison, the persistence of the syndrome in the face of complete insight into its
paradoxical nature—​all these point to something more than purely psychic
 The Path to Understanding 27

connections. Such a disturbance cannot be explained by the loss of a little

wheel out of the clockwork” (p. 118).20
Mayer-​Gross recorded another important observation, which holds par-
ticularly true for people who can remember the exact moment of onset of
their depersonalization, especially when the trigger was marijuana or some
other substance: “Depersonalization and derealization often appear sud-
denly, without any warning. A patient sitting quietly reading by the fireside
is overwhelmed by it in a full blast together with an acute anxiety attack. In
some cases it disappears for a short period, only to reappear and finally per-
sist” (p. 118).20
This sudden psychic blast from seemingly nowhere has appeared not only
in the annals of medicine, but in literature and philosophy as well. Years be-
fore Mayer-​Gross’s 1935 account, there was a description of a similar type
of panic onset in William James’s classic work, The Varieties of Religious
Experiences, published in 1902. In the chapter entitled “The Sick Soul,” James
relays the words of a French writer who has captured the flavor of the kind of
panic that can sometimes trigger chronic depersonalization:

I went one evening into a dressing room in the twilight to procure some
article that was there, suddenly there fell upon me without any warning,
just as if it came out of the darkness, a horrible fear of my own existence.
Simultaneously there arose in my mind the image of an epileptic patient
whom I had seen in the asylum, a black-​haired youth with greenish skin,
entirely idiotic, who used to sit all day on one of the benches, or rather
shelves against the wall, with his knees drawn up against his chin, and the
coarse gray undershirt, which was his only garment, drawn over them
enclosing his entire figure. . . . This image and my fear entered into a species
of combination with each other. That shape am I, I felt, potentially. Nothing
that I possess can defend me against that fate, if the hour for it should strike
for me as it struck for him. There was such a horror of him, and such a per-
ception of my own merely momentary discrepancy from him, that it was
as if something hitherto solid within my breast gave way entirely, and I be-
came a mass of quivering fear. After this the universe was changed for me
altogether.21

For some people, William James is describing with uncanny precision the
moment that marked the onset of their own depersonalization. The inex-
plicable panic that he is attempting to explain goes well beyond the clichéd
28 Feeling Unreal

images of sweaty palms and rapid heartbeat associated with panic or anx-
iety attacks—​the certainty of imminent insanity that, unbeknownst to the
victim, will pass after the attack lies at its heart. While James does not tell us
what happened to this particular person, the inclusion of this experience in
“The Sick Soul” seems particularly appropriate. Depersonalized people, who
sometimes say they have “lost their soul,” may well recall a single episode like
this as the very moment when their soul departed. Of course, others can ex-
perience this kind of incident once, or repeatedly, without the end result of
chronic depersonalization.
James refers more specifically to feelings of depersonalization and unre-
ality in the chapter titled “The Reality of the Unseen,” where he writes: “Like
all positive affections of consciousness, the sense of reality has its negative
counterpart in the shape of a feeling of unreality by which persons may be
haunted, and of which one sometimes hears complaint.” Drawing from other
sources, he then quotes the French poet Louise Ackermann, who wrote in
Pensées d’un Solitaire: “When I see myself surrounded by beings as ephem-
eral and incomprehensible as I am myself, and all excitedly pursuing pure
chimeras, I experience a strange feeling of being in a dream. It seems to me
as if I have loved and suffered and that erelong I shall die, in a dream. My last
word will be, ‘I have been dreaming.’ ” This sense of the unreality of things,
James comments, “may become a carking [perplexing] pain, and even lead to
suicide.”21
James the psychologist does not suggest any treatment for the condition
he explored only briefly, while Mayer-​Gross, ultimately convinced that de-
personalization was founded in some cerebral dysfunction, did not see a lot
of point in psychologically minded attempts to treat the condition: “Writers
make abundant use of hypotheses about narcissism, libido-​cathexis, etc.,” he
wrote. “I have found it difficult to gain any fruitful idea from such suggestions
or from the suggestions of psychoanalytic writers about depersonalization.
The disagreement between them is rather discouraging” (p. 118).20 This
did not discourage psychologists from continuing to propose new theories
for decades. But Mayer-​Gross concluded that depersonalization should be
regarded as a physiological disorder, summed up by his well-​known phrase
of a “non-​specific pre-​formed functional response of the brain.”20
While in some ways Mayer-​Gross’s assessment of depersonalization has
stood the test of time, especially when it comes to the acute automated deper-
sonalization that accompanies life-​threatening or near-​death experiences,
today’s thinking draws from both physiological and psychological
 The Path to Understanding 29

explanations, with a fresh understanding of the fact that they are not incom-
patible with one another—​the brain and the mind are not separable.

Psychoanalytic Theories

Psychoanalytic thinkers have formulated their own theories about the origins
of depersonalization for many decades, dating back to Freud. Most of these
writers have agreed on one point: depersonalization serves as a psychological
defensive strategy (“defense mechanism” in stricter psychoanalytic lingo)
of some sort. However, what depersonalization might be defending against
can vary greatly from person to person; hence the diversity and richness of
these theories, which can accommodate differing psychologies in different
individuals—​we are not all the same. Clearly, a lot of thought has gone into
trying to figure out the psychological processes underpinning what many
people, including physicians, have long perceived as an obscure condition, or
merely as a part of some other disorder.
As we touched upon in Chapter 1, Freud had something to say about
the condition after he had experienced intense though fleeting derealiza-
tion while he first saw the Acropolis in 1904, up close and in person. As he
later analyzed his experience at 80 years of age, in the now-​famous letter
to Romain Rolland “A Disturbance of Memory on the Acropolis” Freud
wrote: “These derealizations are remarkable phenomena which are still little
understood . . . These phenomena are to be observed in two forms: the sub-
ject feels either that a piece of reality or that a piece of his own self is strange
to him. In the latter case we speak of ‘depersonalizations’; derealizations
and depersonalizations are intimately connected.”22 “Their positive
counterparts,” Freud added, “are known as fausse reconnaissance, déjà vu,
déjà raconte etc., illusions in which we seek to accept something as belonging
to our ego, just as in the derealizations we are anxious to keep something
out of us.”22 According to Freud, “naively mystical” and non-​psychological
attempts to explain déjà vu phenomena interpret them as evidence of a
former life. “Depersonalization leads us on to the extraordinary condition
of ‘double conscience’ which is more correctly described at ‘split personality’ ”
(p. 245).22
Freud also referred to the defensive characteristics of depersonaliza-
tion and derealization in his famous case history that came to be known
as the “Wolf Man.”23 Considered one of Freud’s most complex and detailed
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of War cartoons
This ebook is for the use of anyone anywhere in the United States
and most other parts of the world at no cost and with almost no
restrictions whatsoever. You may copy it, give it away or re-use it
under the terms of the Project Gutenberg License included with this
ebook or online at www.gutenberg.org. If you are not located in the
United States, you will have to check the laws of the country where
you are located before using this eBook.

Title: War cartoons

Author: John Francis Knott

Release date: July 8, 2022 [eBook #68473]

Language: English

Original publication: United States: John F. Knott, 1918

Credits: Brian Coe, Brian Wilsden and the Online Distributed

Proofreading Team at https://www.pgdp.net (This file was
produced from images generously made available by The
Internet Archive)

*** START OF THE PROJECT GUTENBERG EBOOK WAR

CARTOONS ***
SKETCH OF THE ARTIST
By Himself
 WAR CARTOONS
BY · JOHN · F. · KNOTT
Cartoonist for the Dallas News

Grateful Acknowledgment is
made to A. H. Belo & Co.,
publishers of the Dallas News,
for permission to reprint in this
book the cartoons that first appeared
in the News.

Copyright 1918
by
John F. Knott
 To
C. L. K.
THEY BELIEVED IN PREPAREDNESS
THE PIONEER
January 26, 1917
JOHN BULL: “A HARMLESS SUBMARINE? THERE AIN’T NO
SUCH ANIMAL!”
July 13, 1916
SHADE OF LINCOLN: “I, TOO, HAD A STORMY VOYAGE.”
Feb. 12, 1917
THE TEMPTATION
March 2, 1917
THE MAD KING OF PRUSSIA
March 9, 1917
DISSEMBLING THEIR LOVE.
March 31, 1917
PART OF OUR PLAN.
April 15, 1917
CONSPIRATORS
April 22, 1917
STOPPED AUTOMATICALLY.
“NO INDEMNITY? NO ANNEXATIONS? WHAT DO YOU THINK I
STARTED THIS WAR FOR, ANYWAY?”
May 8, 1917
PEACE CHESTNUTS
May 24, 1917
AMERICANS REALLY OUGHT TO SEE AMERICA FIRST, BUT
——
(Many of our best people are going to Europe this summer.)