I know everything but myself. I know my thoughts. I know my feelings. I know my actions. But I do not know the “I” who thinks these thoughts, feels these feelings and performs these actions. This “I,” like an invisible conductor, assembles the different instruments of a mental orchestra — thoughts, feelings, wishes, memories, and acts — into a harmony of personalization.
Enjoying the harmony of music, we hardly notice the conductor. Enjoying the harmony of life, a person hardly recognizes the “I” that holds different mental processes together, providing the harmony of personalization. It takes the break of the harmony — the dissonance of personalization — to look for that invisible conductor, that feeling of “I” that provides the grounding experience of presence and reality. The emblematic form of the experience of the dissonance of personalization is known as the disorder of depersonalization and derealization.
Depersonalization is a painful feeling of a changed, unfamiliar, and unreal “I.” It is a negative form of the discovery of “I.” The feeling of “I” gets found through the pain of its lacking or loss. A person feels different, incomplete, not real, and “not myself.” Thoughts, feelings, memories, actions, and the sensing of one’s own body feel strange and foreign, as if “not mine.” The experience of the unreality of one’s own “I” often occurs along with the feeling of unreality of the surrounding world. This is called derealization: Things around are perceived as removed, detached, or separated from “I” by an invisible barrier. People with derealization often say that they feel as if they were in a fog, a dream, or a movie.
Depersonalization-derealization has a reputation for being a peculiarly incomprehensive phenomenon that is almost impossible to describe. Especially surreal is its odd contradiction between the objective and the subjective.
One form of this contradiction is called the “as if” quality. The feelings that my “I” or the world around me are not real are perceived only as my own subjective experiences, with the clear recognition that objectively my “I” and the world around me are actually the same. This rational knowledge of objective reality makes the irrational feelings of subjective unreality even more frightening and uncanny. The inner dialogue between one “I” that subjectively feels unreality and another “I” that objectively cognizes reality often triggers overwhelming obsessive self-analysis.
Another form of the contradiction between the subjective and the objective manifests itself in the striking contrast between the normal way a person with depersonalization is perceived by others and the disturbingly sinister way she perceives herself. Outwardly, such a person looks and acts quite regularly. But inwardly, she suffocates from the eerie craziness of feeling strange, unreal, and not herself. Neither family and friends, nor even sometimes health care professionals, understand the hardship of sufferings of depersonalized people. They feel trapped inside the alienating bubble of unreality with the bitter realization that no one seems to take their condition seriously.
Nowadays, depersonalization-derealization appears to be diagnosed more frequently. Some attribute this to the modern trends that might provoke depersonalization, such us legality of cannabis, aggressive digitalization of life, and COVID-19 induced social isolation. But unfortunately, depersonalization is not frequently healed. It remains almost as infamously treatment-resistant as it was 15 decades ago when it was first described.
The current treatment tools from hi-tech electromagnetic brain stimulation to the antiquity-rooted psychedelic-enhanced meditation show dubious proof of efficacy. The standard set of pharmaceuticals — chiefly antidepressants and anxiolytics — often reduces anxiety, obsessions, and depression which accompany depersonalization-derealization, but rarely affects the feeling of unreality itself.
Psychotherapy lends a helping hand to ease the pain of depersonalization. Among the abundance of therapies, psychoanalysis holds a special advantage: It speaks the same language as depersonalization. This is a language of dissociation, the key psychoanalytic conception from which stems the current comprehension of depersonalization-derealization.
Originally formulated by the French psychiatrist Pierre Janet, and fashioned by the father of psychoanalysis Sigmund Freud, the conception of dissociation is based on the key psychoanalytic idea of the human psyche as the interrelatedness of conscious and unconscious processes. The contemporary mental health bible, the Diagnostic and Statistical Manual of Mental Disorders, borrows the psychoanalytic conception of dissociation and distinguishes the major class of Dissociative Disorders. Depersonalization and Derealization Disorder is presented as an essential category of this class.
Dissociation refers to the split of integral mental activity into separate processes: partially conscious and partially unconscious. The unity of one integral experience of “my thoughts” and my “I” that thinks “my thoughts” breaks into two separate experiences: the experience of my thoughts and the experience of “I” that thinks "my thoughts."
This split results in the uncanny feeling of disconnect — dissociation — between my “I” and my mental activity. People with depersonalization-derealization frequently describe the feeling of being divided into two “I”s: an “I” acting and another “I” observing and analyzing these actions. One of the most famous self-descriptions belongs to Freud himself, who thoroughly analyzed his own derealization developed during his visit to the Acropolis.
An ardent connoisseur of antiquity, Freud, for the first time of his life, stands on the Acropolis. The direct contact with a sacred symbol of the cradle of European culture becomes too overwhelming. Freud’s consciousness cannot hold conflicting emotions together. The layers of reality have shifted. A weird sense of illusoriness pierces him as he says, “What I see here is not real.”
Diagnosing this as derealization, Freud dissects his dissociation into one “I” who experiences unreality and another “I” who observes and analyzes the first “I.” Comparing derealization and depersonalization, Freud concludes that both relate to “double conscience” or “split personality,” when “we are anxious to keep something out of us.” This Freudian formulation conveys the psychoanalytic understanding of dissociation as a way to deal with the unbearable “something” by keeping it “out of us,” partially subconscious.
There are two forms to keep the unbearable “out of us:” repression and dissociation. Repression means a straightforward “delete,” with no room for conscious thinking about the repressed. Dissociation is way more complex. It sustains the unsustainable, the simultaneously painful and provocative duality of keeping the unbearable “out of us” with obsessive thinking about what is there “out of us.” Dissociation exacerbates thinking about the unbearable. It is like seeing something in the fog of depersonalization with the intense urge to break through this fog and finally see clearly. A person with depersonalization is often already conducting a dialogue with her unconscious, self-analyzing and trying to find out her underlying feelings and their meanings.
Depersonalization thus appears to be a condition that opens access to the exploration of the unconscious. The duality of “I” acting and “I” observing that is so characteristic for depersonalization stands very close to a dialogue with one’s own unconscious. Psychoanalytic therapy assists in developing this dialogue into a process of self-inquiry to understand the parts of one’s own “I” which are hidden as too complex or too shameful.
Psychoanalysis reveals these hidden parts of “I.” Often they are rooted in the disturbances of childhood pillars of a stable identity: experiences of being loved enough as a child and having one’s own love be accepted by others, primarily parents. Themes of death, illness, body distortions, and other threats to identity can be associated with the parts of “I” that remained not fully conscious.
The exploration of these unbearable themes and conflicts diminishes the tension that causes dissociation. The deeper the understanding and acceptance of the inner life, the less the intensity of depersonalization. The self-accusatory and frequently shaming tone of the observing-analyzing “I” makes depersonalization detachment and unreality especially wounding. Psychoanalytic therapy facilitates turning this harsh tone into respectful and containing understanding that enables the person suffering from depersonalization to hold the different parts of her “I” together.
Psychoanalysis does not have a magic wand to heal depersonalization. But it does attune to depersonalization’s most intrinsic features and is capable of addressing depersonalization’s most hidden roots.
 The quotations below are from the main Freudian paper on derealization: A Disturbance Of Memory On The Acropolis. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 22, transl. by J. Strachey, Hogarth, London, pp. 239-248.