This is the fourth post of the series I and My Depersonalization.
What do I do with my depersonalization? After my life has been seized by an unknown disease of unreality, after I learned that this disease is depersonalization, and after my expectations to recover have turned into the realization that I must deal with this chronic treatment-resistant condition, I am again one-on-one with myself, with my – estranged, unreal, depersonalized – self.
I am anxious and exhausted, angry and ashamed, hopeless and helpless. I cannot look in the mirror: “Is this a reflection of myself? Is this “I”? I cannot take a shower: my arm does not feel like my arm. My body does not feel like my body. I cannot read a book: my thoughts are felt as if not mine. And the bitterest irony is that all these circles of unreality remain invisible for others. I look normal and act normal. Normal language does not have words to express my abnormal experiences of estrangement. So, now – after months of medications and therapies – I am stuck inside the unbearable reality of my frightening unreality. What can I do with my life? For what might I hope? What should I do?
A monologue similar to this can mark an important point in the life of a person with depersonalization: a potential to move from a position of being conquered by DP toward a position of being able to conquer it; from a patient’s paradigm ("How can I have a pill to get rid of my depersonalization?") toward a person’s paradigm ("How can I live with depersonalization?").
I know a number of people who have succeeded in living with depersonalization. Even though they still have DP, they are able to sustain the turbulence of unreality by a stronger core self-identity. The development of such a stronger identity can be reached through the process of thorough self-inquiry. Self-reconstructive psychotherapy serves as effective assistance and guidance throughout this process.
Self-reconstructive therapy stems from a characteristic feature of depersonalization, its possession of properties of two – often considered polarized – kinds of disorders: reactions and personality types. Reaction is a response to emotional stress or psychological trauma, such as post-traumatic stress disorder or mourning the death of a loved one. Personality type is a psychological profile of an individual such as obsessive-compulsive or histrionic. Depersonalization is often categorized as a reaction.
The DSM-IV conceptualizes DP as a dissociative disorder, and dissociation is a typical response to trauma. The DSM-IV also lists DP as an element of post-traumatic stress disorder and considers DP a coping style. At the same time, depersonalization is understood as a personality trait—a constitutional predisposition to develop depersonalization that once was named “depersonability.” People with “depersonability” are prone to subclinical micro-depersonalization: momentarily but distinctive episodes of estrangement, especially pronounced during adolescence. They often develop a flourishing depersonalization reaction in response to emotional trauma, physical stress, or the use of psychoactive substances. In many cases, symptoms of depersonalization combine properties of DP-reaction and DP-personality trait. During some periods presentations of depersonalization-reaction prevail, during other periods signs of depersonalization-personality trait dominate.
Self-reconstructive therapy addresses both of these sides of depersonalization. Consider a typical case. Steve seeks help with an acute depersonalization-reaction: “I feel as if I lost myself. I am dying; I am going crazy and the world is going crazy. Please, erase this detachment from reality.” At this stage, therapy regularly conducted together with psychopharmacological treatment is mainly supportive: a comforting emotional environment that alleviates catastrophizing and facilitates cognitive certainty: “My self remains the same and the world around me remains the same.”
Supportive therapy brings relief but does not eliminate depersonalization. On the contrary, the more Steve feels relieved from that acute depersonalization attack, the more he becomes aware of the different and complex phenomena of depersonalization he has been experiencing. So characteristic of depersonalization, the trait of introspection dominates at this stage. Steve thinks over and through his experiences of himself, reflecting on his memories, thoughts, feelings, and actions, comprehending their qualities of being mine and real. It feels like a search for lost personalization that unfortunately often only aggravates depersonalization.
Following these clinical dynamics from acute depersonalization-reaction to depersonalization-personality trait, the therapeutic approach moves from supportive to analytical. When Steve struggles with an attack of depersonalization the goal of therapy was to provide a relational container that holds “parts” of his dissociated depersonalized self. When Steve suffers from depersonalization hyper-introspection, the goal moves toward building a relationship of partnership that enables Steve to develop self-identity.
The therapy provides Steve with the tools of self-inquiry, allowing him to gain more awareness of his internal conflicts and their links to depersonalization. The more such conflicts become understood, the more unity and reality Steve feels with himself. Steve sees the connection between his depersonalization experiences and the development of his self in childhood and adolescence. He realizes that depersonalization cannot be erased. To “forget” about the pain of estrangement typically means to repress it. Steve also comes to comprehend the difference between repression of these conflicts, which is dangerously close to anxiety, and the ability to understand them and integrate them into his self.
The method of therapeutic self-inquiry is congruent to compulsive self-observation that so frequently seems to play a principal role in the pathogenesis of depersonalization. Employing the predisposition of people with depersonalization to reflection, therapeutic self-analysis helps the patient develop an authentic core of self-identity. Depersonalization could be seen as a reflection of the self in a distorted mirror of the patient’s disturbed consciousness. Accordingly, therapy could be viewed as a reflection of self in a reconstructive mirror of a therapeutic relationship. If an acute depersonalization-reaction is a terrifying flight through the hall of distorted mirrors and depersonalization-personality trait is a lasting presence in this hall with overwhelming introspection, then therapy appears as a professionally assisted walk through this hall of distorted mirrors, breaking the spell of frightening estrangement by uncovering hidden conflicts of development of self-identity. Therapy provides a way of understanding one’s self in its real complexity and with its real contradictions. Therapeutic self-inquiry often becomes self-discovery that allows a person to discover and accept prior unknown parts of her self.
Depersonalization is very painful, but also a very special experience that provides some truth about self and life that cannot be attained without depersonalization. Many people with depersonalization are talented, creative and productive. Jeff Abugel—a name known to everyone who has searched the web on depersonalization—writes on the enlightenment potentials of depersonalization. His books Feeling Unreal and Stranger to My Self prove the value of life with depersonalization. If a patient is trapped in a cage of his depersonalization, a person with depersonalization is capable of managing it. From a monster that is crushing a person’s life, depersonalization becomes a challenge that can deepen a person’s understanding of herself and her life.