Courtesy of Masha Goncharova
Source: Courtesy of Masha Goncharova

Describing her feelings of unreality, Dorothy, a young dental assistant, blond, fit and avid skier, focuses on a “philosophical splinter in my head.”  She is neither a fan of Star Wars or The Matrix, where similar expressions are used, nor a philosophy enthusiast.  “Depersonalization feelings of an estranged mechanistic self and illusory world make me think What is reality? What is world? and Who I am?” Analyzing her thoughts and feelings in her dairy she ponders whether depersonalization is a disorder that ruins the simplicity and certainty of routine reality or a window that shows the complexity and uncertainty of true reality. Suffering from the pain of detachment she also acknowledge that depersonalization makes her understand deep “conflicts inside my self.” She concluded “Depersonalization turned me into a philosopher.”   

Dorothy is no exception. A Canadian student, a Berliner pilot, a Bostonian engineer and a Siberian librarian – people with depersonalization from all walks of life – share this interesting feature: feeling unreal merges with philosophical inquiry. 

The connection appears particularly representative for a certain type of depersonalization that is characterized by highly developed reflection. Reflection is a process of introspection or self-analyzing: thinking over and over about many different things. Reflection is driven by an urge to understand, clarify, and find sense and meaning. Typical reflection makes its questions “big”, putting them on a philosophical level. A good illustration of how reflection approximates depersonalization and philosophy is a sketch from Dorothy’s diary: 

“What is philosophy? Questioning: Who am I? Am I real?  What is the world? Is the world real?  What does it mean to be real?

What is depersonalization? Questioning basically the same questions: Who am I? Am I real? What is the world? Is the world real? What does it mean to be real?”

One could add to Dorothy’s comparison that philosophy asks these questions aspiring to understand the essence of self and world around. Depersonalization asks these questions in a feverish attempt to stop the disturbing turbulence of disappearing reality and regain the grounding assertiveness of self amidst world.

This type of philosophical depersonalization presents a disturbance of self-consciousness closely connected to overdeveloped reflection. Reflection itself could be seen as a natural experience of philosophical sensibility. It actually helps to feel real, contribute to self-integrity and the constancy of a self-core throughout the life span. However, burdening obsessional self-analysis includes the potential of the erosion of the feelings of reality and lost of self-integrity. An old saying pointed out that without reflection one would never find oneself, but overwhelming reflection leads to the pain of ever feeling lost of self.

People with this type of hyper-reflective depersonalization frequently experience signs of disturbingly intense self-analysis with dwelling on philosophical questions through out the life span. Their typical childhood feature is the combination of advanced intellectual development and high emotional sensitivity. They are thinkers and dreamers with affinity to deep “adult” areas. Thoughts and fears of death of themselves or their parents, questions of meaning of life, doubts about people’s intentions, interest in the unknown, inquiries about the magic of numbers or distant galaxies are frequently part of their early years. One patient said that as a child he, even though not knowing this consciously, already acutely sensed “some uncertainty and complexity of reality that became so alarmingly exposed to me in the form of depersonalization.”

This philosophical depersonalization corresponds to anxiety of a special kind - ontological insecurity, a term, coined by British psychiatrist R.D. Laing. Ontology is a part of philosophy that is focused on fundamentals of being. Ontological insecurity refers to the lost identity when self and world appear more unreal than real. One of my patients in his way captured the spirit of R.D. Laing by calling his depersonalization “turbulence of being.”

The core of depersonalization is the urge to overcome estrangement and find oneself which resonates with the ancient maxim Know Thyself that is often considered the beginning of the Greek philosophical tradition that paves the way to the European philosophy of today.  Depersonalization self-analysis “Who am I?” echoes with the central themes of philosophical introspection and how people with depersonalization are able to grasp the most intrinsic and profound aspects of self.  It is remarkable how depersonalization estrangement from self and world enables deeper understanding of authenticity and identity and how depersonalization opens the way to personalization. Many patients emphasize that in spite of its burdening pain, depersonalization also elucidates their comprehension of self, world and the meaning of life.

Interest in the proximity between search for self and philosophical thinking is rooted in the past. Almost a century ago the German psychiatrist Theodor Ziehen coined a term philosophical or metaphysical “intoxication.” He describes it as overwhelming preoccupation with self-introspection, obsessive analyzing of different issues and addictive involvement with philosophical inquiries. Philosophical intoxication, Ziehen believed, is characteristic for the puberty crisis and related to the process of personalization.

Regretfully in mental health care practice this intertwining between depersonalization and philosophical thinking often complicates the clinical situation. “Philosophical elements” of depersonalization appear too obscure and perplex, misleading a practitioner who might feel difficulties to connect with a patient. Typically highly sensitive to interpersonal stances a patient in her turn feels misunderstood and often embarrassed, not knowing how to convey her strange experiences. This inability to share the disturbing experience either with parents and peers or health care practioners increase the estrangement and unreality of depersonalization.

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