First, my most sincere thanks to all who support this blog with their notes, remarks and comments. I owe you deep gratitude for your ideas, advice and stories. And I owe you my apologies for tardiness with this post.

 Stories of people with depersonalization demonstrate four stages of a relationship between a patient and his or her disease of unreality of self and world. The first stage is anxious uncertainty prior to depersonalization having been diagnosed. The second stage comes with hopes for recovery after the diagnosis of depersonalization has been made. Unfortunately, in many cases the second stage is not resolved by recovery, but instead followed by the third stage: distress on realization that in spite of extended, diligent (and frequently very expensive) treatment, depersonalization still persists. Finally a person with depersonalization has an opportunity to enter the fourth stage: living life with depersonalization at its most optimal level. The first and second stages have been described in two previous posts. This one tells about the third stage.

The third stage of relationship between “I” and my depersonalization comes with realization that identifying a disease does not mean you can get rid of it. A patient learns the hardship of clinical reality — depersonalization is highly resistant to nearly every treatment. “Experienced” patients notice that after several months of struggling with depersonalization, and many trials of different remedies, they develop a sort of “treatment nihilism.” If some medications or therapeutic techniques seem to alleviate debilitating unreality and estrangement, these patients “know better” than to assume that the cure has been found. Instead they are grateful to “merely enjoy a few weeks or months of feeling more real.” Unfortunately, in many cases, after a while the fog of depersonalization returns to cloud their life again.  

The third stage is characterized by complication and extension of the clinical picture. The symptoms of depersonalization itself are aggravated by the patient’s emotional and psychological a reaction to having those treatment resistant symptoms. In addition to struggling with feeling unreal and detached, a person suffers from distress of not being able to move toward recovery. The signs of this distress vary from annoyance and frustration to anger and despair. Reflection that are so typical for people with depersonalization, frequently dramatically advance to a near-obsessive analysis of the process of treatment. Again and again a patient goes over and thinks through the story of trying to fix her depersonalization, scrutinize all details of psychiatric consultations, effects of medication and comments of therapists. In many cases, the more a patient ruminates, “why do I keep failing to gain relief from depersonalization?”, the more pessimistic, disappointed and angry the patient feels.

Three types of negative emotional and psychological reactions to ineffective treatment of depersonalization could be discerned. This typology is based on the direction of patient’s frustration and other negative feelings. Patients with the first type of reactions direct their negative feelings outside, accusing “incompetent physicians,” “unskillful therapists,” “wrong medications” and “unsupportive families.” The patients feel mistreated, neglected and disregarded. They experience resentment, mistrust and anger toward mental health practitioners or their own families and friends. The patients complain that “it hurts to find yourself left without support, just one-to-one with the suffocating pain of unreality.” As a result, the patients might develop a confrontational attitude to treatment ranging from dry irony to defensive opposition. Such attitudes negatively interfere with treatment, compromising the best therapeutic efforts. However, an attentive and listening professional is able to see, behind this defense, the true pain of a suffering patient who is exhausted and desperate for understanding and help.

The second type of the negative emotional and psychological reactions to ineffective treatment of depersonalization is one with the negativity directed inside. A patient blames himself, his “evil habits,” “wrong life style,” neglecting medical advice or family warning. The patients experience signs of reactive depression with sadness, hopeless, self-belittling and self-criticism. Embarrassment and shame intertwine with guilt for being “so bad that ended with debilitating depersonalization.” Patients search their past, looking for things which caused depersonalization or prevented healing. For some the first episode of depersonalization seems to be connected with smoking marijuana. Even though the association between depersonalization and marijuana has been known almost as long as depersonalization has been described, there is still no “final” answer regarding the nature of this association. Nevertheless a good part of these patients find themselves obsessively analyzing this association and sometimes blaming themselves for “the transgression that cause the horrible mental break of depersonalization.

The third type of the negative emotional and psychological reactions to ineffective treatment of depersonalization combines the features of the first and the second. A patient directs his negativity in both directions — outside, criticizing his treatment, and inside, accusing himself. Usually at some periods a patient is angrier with health care and at other periods with himself.

At the third stage of the relationship between “I” and “my depersonalization” a patient, already exhausted by a long battle with DP, suffers a double blow of depersonalization itself, as well as his own negative emotional and psychological reaction to lack of progress in treatment. This negative reaction intensifies the symptoms of depersonalization and in turn, these symptoms exacerbate the negative reaction. The possible resolution of this vicious circle is the move toward the fourth stage of relationship between “I” and depersonalization: Living with Depersonalization. This stage is described in the following entry that is to be posted in three weeks.

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