THE AMERICAN JOURNAL OF PSYCHOANALYSIS 38:291-300 (1978)

DEPERSONALIZATION: AN EFFORT AT CLARIFICATION Judith Schweiger Levy and Paul L. Wachtel In much of our lives, we take action with relatively little thought about what we are doing. We live without observing ourselves living. At times, however, we are more aware of ourselves as actors and seem to be observing ourselves as we are acting. We are both observer and actor at the same time. The degree and kind of heightened self-observation varies widely both within individuals and between individuals. The experience can be mild or intense, pleasant or unpleasant, transient or long-lasting. In some respects, such experiences are actively sought and promoted in most forms of psychotherapy, but somewhat similar experiences can be a major impediment to change and must be dealt with by the therapist° In psychoanalytic therapies, the circumstances of the sessions promote a split between the "experiencing ego" and the "observing ego" which is critical for the therapeutic process. In behavioral therapies, "self-monitoring" is often a central feature of the therapy, and has been recognized as not just a source of data but a measure which is "reactive" i.e., the very act of closely observing one's behavior and experience seems to produce change in that behavior and experience. Heightened self-observation can also, however, get in the way of therapeutic change. In analytic therapies, patients may become so thoroughly observers of themselves that they fail to act or feel. An arid intellectualism then permeates the therapy. In behavior therapy, patients often are reluctant to role-play or try out new behaviors because they don't feel "real" in the new role. They watch themselves act in a new way and find it artificial because it contrasts with their image of who they really are. The experience of the patient who is thereby reluctant to try new ways of living, and the experience of the analytic patient who "notices" things about himself, but cannot really feel them or integrate the new observations into his life pattern seem to bear important resemblances to phenomena of depersonalization. Such phenomena in turn seem related to a number of kinds of complaints that seem to be increasingly common feelings of alienation, unrealness, fraudulence, etc. judith Schweiger Levy, M.S., Graduate Student in Clinical Psychology, CUNY, and Psychology interne, Albert EinsteinCollege of Medicine; Paul L. Wachtel, Ph.D., Professorof Psychology and Associate Director of the Clinical PsychologyPh.D. Program, CUNY. 291

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Phenomena of depersonalization are also of interest from the perspective of "altered states of consciousness," another topic of increasing concern and relevance. Depersonalization phenomena, then, seem importantly related to a number of practical and theoretical issues of current concern. The present paper will attempt to examine some of the efforts which have been made to understand such phenomena, and to point to further issues and questions which may be worth pursuing. Of the manifold problems related to the study of depersonalization, the most basic revolve around its definition. Virtually all writers on the subject appear to agree that the experience involves two main features: (1) a sense of unreality involving one's own person (depersonalization per se) or the external object world (derealization), and (2) a feeling of being split off or detached from oneself or one's body, which is experienced as observing oneself behave. However, while some writers emphasize the unreality, others emphasize the "split" between an observing and participating self as more central. This difference in emphasis is one of the initial causes for the diverse conceptualizations which different writers have used in attempting to explain the phenomenon. To further confound matters, different secondary characteristics of depersonalization are pointed out by different writers, e.g., the estrangement of particular body parts and/or numbness and sensations of change in size of these body parts, 18Aa feeling of dizziness, floating, or giddiness,19, 38 a feeling of being "dead, ''9 a loss of affective responsiveness, 1 a feeling of calm detachment, 2s, 36 "remoteness" or "flatness" of visual and auditory stimuli and slow subjective time. 28 Implied in this enumeration of varying symptoms is that depersonalization can become manifest in highly idiosyncratic ways. Another possibility, however, is that the various writers on the subject are, in fact, not writing about the same thing at all, but are, instead, confusing different sets of phenomena by calling them by the same name. Clearly, a major difficulty in defining depersonalization stems from its strange, ineffable, and ambiguous qualities. One reason for its ambiguity is that in contrast to many other disturbances, it is not marked by altered external or social behavior, but by an altered state of consciousness or perception. (The term "altered state of consciousness" may itself be a misnomer, and might more appropriately be called an "altered state of attention.") Thus, both those experiencing depersonalization and those attempting to understand it are limited by language considerations. When an individual describes what depersonalization is like, a semantic problem arises wherein it is difficult to discern if he is being literal, figurative, or is merely usingthe colloquialisms of the day. For example, what phenomenologically does a person mean when he says "1 feel unreal"? How can this sense of unrealness be measured? Is he perhaps using the word "unreal" because the experience he is having is so much out of his ordinary range of consciousness that he just doesn't have an

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adequate vocabulary to conceptualize or describe the experience? Perhaps the ordinary state of consciousness feels real because it is usual, while the state of feeling outside oneself, of observing one's own behavior, is associated with unrealness because it is unusual. This difficulty is compounded by the Western cultural assumption that altered states of consciousness are "unreal," "regressive," or "pathological. ''a Such experiences do not merely differ from everyday reality; they are also actively disparaged by the very language we use to describe them. Defining depersonalization is also made problematic by the common assumption that there in only one ordinary or normal waking state of consciousness. T a ~ 8 has pointed out that this is probably not the case at all, but that we may have many different states of consciousness during an entire day, and that it is misleading to assume that all "normal" people have the same state of consciousnessY The second part of the definition of depersonalization--that relating to the feeling of being split--also leads to difficulty. This split has been described in several ways, e.g., as a split between "body self-representation" and "mental self-representation," between the "body ego" and "mental ego," and between the "participating self" and the "observing self." These terms, however, are often used differently by different authors and somewhat inconsistently even by individual authors. In some instances, they seem to have phenomenological referents while in others they are treated as metapsychoiogical constructs. Our ability to describe "altered" states of consciousness is limited by the crudeness of our current efforts to describe "ordinary" consciousness. Depersonalization appears in the context of almost all varieties of psychopathology, and may be experienced by normal individuals as well. The incidence of depersonalization in children is unclear. While Salfield s° found it to be extremely rare in children, others 4' 23, 28 have written of some childhood cases. Perhaps depersonalization is relatively unseen in children, not because it doesn't occur but because it is unreported. The difficulty which adults have in describing their own symptoms would be compounded in children, who have even less verbal facility to explain precisely what they are experiencing than do adults. The personality characteristics of individuals manifesting depersonalization have been described in terms of emotional immaturity and selfcenteredness. Depersonalization has been attributed to "narcissistic personalities," "passive-feminine characters," and individuals with "oral strivings." (Jacobson, 1970; 16A'23. 38,4o It has been viewed by Guntrip TM as a prime characteristic of schizoid personality functioning. Such descriptions have been suggestive, but are often imprecise and based on a limited range of clinically observed correlations rather than on careful research. The observations

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emphasized by different authors are at times contradictory, and alternative rationales are often equally plausible. An approach to the issue of depersonalization and character structure via cognitive and attentional views of character (e.g., Shapiro 34) seems of potential value, since depersonalization is particularly a phenomenon involvingthe organization of experience. Here too, however, there is good reason to think that attempting to link depersonalization and a particular character style may be risky. One might, for example, postulate that the diffuse, global, selectively inattentive cognitive style of the hysteric could easily lend itself to depersonalized perception. It is easier not to see things as real if one's attention in general is unfocussed. However, an equally good case could be made linking depersonalization to other character structures. For example, the obsessional's overawareness of his role has the same quality of watching oneself as the split in depersonalization. The obsessional's constant doubti ng, which results in his loss of a sense of conviction, seems but one step away from the depersonalization experience of "1 don't feel real." Psychoanalytic writers on depersonalization have tended to conceptualize the causes of depersonalization in terms of its meaning, emphasizing its fantasy aspects, defensive function, wish-fulfilling properties, and etiological fixation points. Most analytic writers see depersonalization as in some way related to how the individual handles either external or psychic trauma. Depersonalization has been called a defense in its own right, has been seen to be the result of a breakdown of defenses, and has been related to other defense mechanisms. Explanations of depersonalization as a defense emphasize the role of the fantasy "This is not real; this is not happening to me." The denial of the reality of the body and the self banishes dangerous needs and impulses, while denial of the reality of the outside world enables the individual to detach himself from its dangers. TM 33.3TIn effect, the individual experiencing depersonalization detaches himself from a threatening internal or external reality by living out an unconscious fantasy of being dead, asleep, or an inanimate object.26. 32, 37 Several writers have suggested that depersonalization occurs when higher level defenses such as repression fail. ~' 3~ There is a variety of opinion concerning what depersonalization is a defense against. Freud 13 believed depersonalization to be a defense against internal impulses and thoughts that emerge in the ego and derealization to be a defense against threats from the external world which resonate with the ego's store of repressed memories and painful experiences. Freud himself experienced derealization upon viewing the Acropolis for the first time. He explained his experience as being due to the fact that he associated the Acropolis with guilty feelings about superseding his father. The sense of unreal ity he experienced was to him a defense against those feelings.

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Others have offered more complicated hypotheses, stressing complex layering of defenses against particular impulses, reactions to conflicting identifications within the ego, or experiences of loss which are viewed as equivalent to loss of part of the self?' 18A,23, 24. 2s Stamm36 suggested that depersonalization can both express and defend against wishes for fusion. He described depersonalization as a kind of partial regression in which one part of the ego maintains contact with reality while the other regresses into fantasy. The accounts referred to above tend to interpret depersonalization as stemming from particular types of confl icts. However, they fail to explain why depersonalization doesn't develop in all people suffering from these or similar conflicts, nor do they adequately account for why depersonalization sometimes causes considerable anxiety and at other times can be primarily pleasurable. Some effort to address this latter issue is made by Stamm2 6 Stamm suggests that "anxiety develops in the part of the ego which fears the passive, masochistic surrender" of fusion2 6 cp780~Stamm's discussion, however, contributes little toward understanding when anxiety will occur and when it will not. His suggestion that at issue is "an inherent capacity of a given individual to relinquish control of himself or to impede temporarily the operation of the synthetic function of the ego" is suggestive, but in order to be meaningful it must be shown that such a capacity can be indexed by something other that the occurrence of depersonalization itself. Otherwise, the formulation is circular and useless. The same goes for the relation between depersonalization and impeding the operation of the synthetic function. If no other sign of the synthetic function being impeded can be shown other than the depersonalization itself, then all one has is another name for something masquerading as an explanation. Formulations which stress the way in which depersonalization serves as a defense against the emergence of more threatening material would seem to imply that depersonalization leads to a reduction in anxiety. Oberndorf, 28 for example, views depersonalization as masking anxiety and causing the individual to feel bland. He sees the anxiety which sometimes accompanies depersonalization as secondary, i.e., as related to the individual's fear of insanity when he experiences depersonalization for the first time; once depersonalization has recurred several times, the secondary anxiety supposedly disappears. Both Oberndorf and West4° discuss the anxiety of depersonalization as being not as great as that which would be experienced if the unconscious impulses which depersonalization defends against broke through to consciousness. Blank, ~ on the other hand, suggests that the reason why anxiety is experienced with depersonalization is that depersonalization may be an inherently inadequate defense measure (i.e., the defense fails and the precipitating anxiety is consciously experienced). It is important to point out here that what look like divergent or conflicting

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explanations are more likely separate explanations of different sets of observations. For example, most of the patients of whom Oberndorf speaks did not have anxiety with depersonalization, so he tries to explain the anxiety as an anomaly which departs from the usual course, while Blank is discussing patients who usually experienced anxiety with depersonalization, so that he tends to view the anxiety as part of the nature of the defense. Formulations about a phenomenon which are based on only a small number of cases are risky, and there is an unfortunate tendency in our field to generalize broadly from very limited clinical data. Future research might well focus on distinguishing between anxiety which motivates depersonalization as a defensive reaction (and which might still be evident, in reduced form, even despite the defensive effort) and anxiety which is consequent to depersonalization, and is a reaction to its strangeness and deviation from ordinary ego controls. Do differences in anxiety upon experiencing depersonalization relate to differences in its success as a defense, to differences in characterological tolerance for altered experiences, or perhaps to differentkinds of depersonalization to begin with? Isthe individual who is more able tocontrol the experience less likely to experience anxiety, or is ability to tolerate lack of control more important (or are different considerations relevant for different individuals)? Such questions and distinctions have not been clearly addressed in the literature, and must be if we are to advance beyond idiosyncratic formulations. Much of the writing on depersonalization has dealt with the question of why it occurs and what function it services. There has been less emphasis on the question of how it occurs; in other words, what the mechanisms involved are. Formulations which do attempt to explain how the depersonalization process operates focus on specific ego functions which are presumed to be disturbed, particularly perception and attention. Many of these formulations appear to be highly speculative. A central assumption which they share concerns the notion of return to an earlier state. Roberts,28for example, suggests that in depersonalization and dereal ization there is a loss of the ability to imaginatively place or represent oneself in objects that are perceived (including one's own body as a percept). The ability to do this, while at the same time maintaining a framework of oneself as the "imaginer" is seen by Roberts as a developmental advance, and in depersonalization there is a return to "the brief developmental period of selfawareness before self-apprehensi0n." Levitanle. 2o, 21 describes depersonalization as a waking manifestation of a process which he says occurs in dreams as well. He suggests that in depersonalization, as in other altered states of consciousness (see also Stamm3O), there is a regression of the body ego to the infantile state of suckling and falling asleep at the breast. The state of sJeep is seen as a gratification of oral,

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narcissistic wishes for fusion with the mother, and depersonalization is seen as a similar kind of regressio n. From a cognitive perspective, he speculates that in depersonalization the individual returns to perceiving by way of the more archaic images by which the child first perceives the world. Explanations which assume that depersonalization is a return to something, a reoccurrence of something which earlier characterized the individual's functioning, are questionable. There is little reason to suppose that babies or children experience the world the way a depersonalized adult does. There may well be a role for some notion of regression in an adequate account of depersonalization, but there are difficulties with such formulations, and they should be regarded as hypotheses for which evidence is currently lacking rather than as grounding assumptions in approaching the phenomenon. Levitan 21 has also offered a physiological account of the process of depersonalization. He suggests that in depersonalization there is a blocking of sensory pathways due to the inhibition of the reticular activating system (RAS). In depersonalization, he says, the RAS brings about changes in images by altering the rate of elaboration of fresh aspects of the image. Such a formulation raises a number of questions: Which aspects go through this supposed change of elaboration? What exactly does Levitan mean by "image"? How does the RAS actually perform this change? Levitan himself asks: Why do only certain people have reticular systems that are capable of prolonged deactivation? Although the reticular formation is believed to be an important component of the a~entional mechanism, how it fulfills this role is still a mystery. According to Milner 2~(p29°I"The evidence for some such 'gating' of arousal by a continuously operating perceptual mechanism is largely behavioral, it is difficult to see how physiological confirmation of the theory can be obtained until we have a clearer understanding of what the neural basis of a concept is and can measure it." Finally, other attempts to explain the depersonalization mechanism have been primarily metapsychological. Following Freud, 12 a number of writers have described the loss of reality occurring in depersonalization and derealization in terms of vague cathectic shifts. Speige[, 35 for example, talks about depersonalization in terms'of the "pooling of cathexis"; jacobson ~6Arefers to hypercathexis of thought processes; Stature views depersonalization as a decathexis of external objects; and so forth. The use of the construct of cathexis to explain the depersonalization process is inadequate for a number of reasons. First of all, it is a quantitative model attempting to account for a qualitative experience. Explanations of depersonalization in terms of cathectic shifts aren't really explanations, but are simply descriptions using metapsychological terminology. 3,29'3~'39Furthermore, these supposed explanations fail to explain w hy depersonalization specifically, and not hypochondria, megalomania, orany other symptom takes place as a result of cathectic shifts.

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The prevalence of notions of regression in accounts of depersonalization highlights the strong tendency to view depersonalization in terms of conflict and psychopathology. No doubt such experiences are often a result of conflict; and in many instances, when extremely frequent or prolonged, or when experienced with little sense of control, depersonalization is legitimately viewed as a problem to which our models of psychopathology are appropriately brought. But it is important to keep clearly in mind that depersonalization is not only experienced by almost everyone on at least some occasions, but also may well be particularly prevalent in gifted and reflective individuals? 8 At times the experience of depersonalization may reflect a sense of newness, a novel organization or deautomatization of perceptual modes more than a regressive, conflict-related state of affairs. Brenman, 7 in discussing meditation, has described how deautomatizing and loosening of old ties and combinations may be valuable in bringing about positive therapeutic change. Similar positive changes may at times occur following transient depersonalization experiences. In this light, it is noteworthy that a number of therapeutic approaches in effect encourage the person temporarily to accept and to]erate experiences not very different from the experience of depersonalization. Proponents of assertive training and of Kelly's 17 fixed-role therapy urge the patient to enter into new ways of engaging in exchanges with others despite the feelings of strangeness and unreality that such interpersonal modes bring about. Frequently, if the patient can tolerate the experience of unrealness for a time, he can make for himself a new reality which is more solidly grounded in his own needs and perceptions, and in a sense more "real" than his old compromises were, however comfortable and familiar they might have felt. Depersonalization-like experiences may be induced by measures which alter the person's mode of attention, such as prolonged staring at one's image in a mirror, or at one's hand. Since attention seems to be a critical variable in bringing about such states, a cognitive perspective may be much more relevant in some cases than one emphasizing conflict and regression. It is also likely that studies of the varied subjective self-observing experiences which are engendered in biofeedback procedures should provide a useful perspective on at least some aspects of depersonalization. In general, much more effort is needed to separate formulations which have empirical content from those which are circular, and in which definitions are used as if they were explanations. Examples of the latter have been discussed above. Psychoanalytic accounts that have emphasized such notions as regressive fusion experiences have been particularly prone to such difficulties, but there is nothing intrinsic in psychoanalytic thought that requires such pseudoexplanation, and it is likely that some kinds of considerations along these lines will continue to be useful in understanding depersonalization

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phenomena. Progress is currently being made in such areas of investigation as biofeedback, meditation, and altered states of consciousness by employing a combination of approaches and points of view. Understanding the related problem of depersonalization is likely to benefit from a similar catholicity of approaches.

References

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23. Nunberg, H. Practice and Theory of Psychoanalysis. Nervous & Mental Disease Monographs No. 74. New York: Coolidge Foundation, 1948. 24. Oberndorf, C.P. Depersonalization in relationship to erotization of thought. Int. J. Psychoanal. 15; 271-295, 1934. 25. Oberndoff, C.P. The genesis of the feeling of unreality. Int. J. Psychoanal. 16: 296-306, 1935. 26. Oberndoff, C.P. The role of anxiety in depersonalization. Int. J. Psychoanal. 31 : 1-5, 1950. 27. Rapaport, D. Statesof consciousness: A psychopathological and psychodynamic view. In Problems of Consciousness (Transactions of the Second Conference, March 19-20, 1951). New York: Josiah Macy, Jr, Foundation, 1951, p 18-57. 28. Roberts, W.W. Normal and abnormal depersonalization. J. Ment. Sci. 106: 478-493, 1960. 29. Rubenstein B: Explanation and mere description: A metascientific examination of certain aspects of the psychoanalytic theory of motivation, in Holt R (ed) Motives and Thought: Psychoanalytic Essays in Honor of David Rapaport. [Psychol. Issues 5(2-3): 20-77, 1967]. 30. Salfield, D.J. Depersonalization and allied disturbances in childhood. J. Ment. Sci. 104: 472-476, 1958. 31. Schafter, R. A New Language of Psychoanalysis. New Haven: Yale University Press, 1976. 32. Schmideberg M. Hypocrisy, detachment, and adaptation. Psychoanal. Rev. 44" 401-409, 1957. 33. Searl, M.N. A note on depersonalization. Int. ]. Psychol. 13: 329-347, 1932. 34. Shapiro, D. Neurotic Styles, New York: Basic Books, 1965. 35. Speigel, L. The self, the sense of self, and perception. Psychoanal. Study Child 14: 81-109, 1959. 36. Stamm, J.L. Altered ego states allied to depersonalization. J. Am. Psychoanal. Assoc. 10: 762-783, 1962. 37. Stewart,W.A. Depersonalization.J. Am. Psychoanal. Assoc. 12:171-186, 1964. 38. Tart, C.T. States of consciousness and state specific sciences, In R.E. Ornstein (Ed.) The Nature of Human Consciousness. San Francisco: W.H. Freeman, 1973. 39. Wachtel, P.L. Psychology, metapsychology, and psychoanalysis. ]. Abnorm. Psychol. 74: 651-660, 1969. 40. West, L.J. Dissociative reaction. In A. Freedman & H. Kaplan (Eds.) Comprehensive Textbook of Psychiatry. Baltimore: Williams & Wilkins, 1967. Reprint requests to Dr. Paul L. Wachtei, Department of Psychology, City College of C.U.N.Y., 138th St. and Convent Ave., New York, NY 10031.

Depersonalization: an effort at clarification.

THE AMERICAN JOURNAL OF PSYCHOANALYSIS 38:291-300 (1978) DEPERSONALIZATION: AN EFFORT AT CLARIFICATION Judith Schweiger Levy and Paul L. Wachtel In m...
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