Depersonalization: Standing in the Spaces Between Recognition and Interpellation

Abstract

Depersonalization is the experience of profound estrangement and alienation from Self and Reality. Although highly prevalent in our postmodern world, the syndrome of depersonalization has been systematically understudied, misdiagnosed, and unsuccessfully treated. In this paper we summarize our theoretical conclusions after a decade-long empirical study of this population and discuss both etiology and recommendations for treatment. Our main objective here is to place what psychiatrically we would consider pathologies of personhood within the larger context of culture. We include a clinical vignette to demonstrate how we work with the premise that depersonalization is not only a private event. Perhaps more than other problems-in-living, it reveals the centrality of the individual's relationship to discourse, the State, and the culture in which we breathe. We discuss depersonalization and the dissociative structuring of the mind as psychological responses to particularly problematic experiences around subjection and conclude with the function of shame and humiliation in maintaining and resisting (in the political sense) this pressure to fragment.

Notes

This work was supported in part by NARSAD Young Investigator Award and Wollstein Fellowship to Orna Guralnik. We thank Muriel Dimen and Adrienne Harris for their engagement and extraordinary editorial help on this paper. Also, warm gratitude to our writing collective.

¹Much of the thinking collected in this paper is based on a series of NIH- and NARSAD-funded studies of the phenomenology, etiology, cognitive processes, biological correlates, and treatment of depersonalization. These were conducted over 8 years by a research group we founded at the Mount Sinai School of Medicine in New York City (Director: DS) with more than 350 patients for whom depersonalization was the primary symptom. Our main findings are summarized in a selection of our papers: Guralnik, Giesbrecht, Knutelska, Sirroff, & Simeon (2007); Guralnik, Schmeidler, & Simeon (2000); Simeon et al. (1997); Simeon et al. (1998); Simeon et al. (2000); Simeon, Guralnik, Knutelska, & Schmeidler (2002); Simeon, Guralnik, Schmeidler, Sirof, & Knutelska (2001); Simeon, Knutelska, Nelson, & Guralnik (2003); Simeon, Riggio-Rosen, Guralnik, Knutelska, & Nelson (2003).

²When we launched our study (see footnote 1) we were operating under the assumption that depersonalization was a rare syndrome. The literature systematically demotes depersonalization from its epidemiological prominence, repeating the defeated conclusion that little was known about its phenomenology, etiology, or treatment. Yet over time and after encountering so many people with hitherto undiagnosed chronic depersonalization as their primary symptom, we concur with Catell & Catell (1974) that it is the third most common psychiatric symptom.

³Neodissociation theories (Hilgard, 1994; Woody & Bowers, 1994) attempt to capture something of this register in describing dissociation as a weakening of highest order executive control functions, leaving “infrastructures” (perception, memory, consciousness, and identity that cohesively define selfhood) more freedom to operate independently and revealing the mind's underlying inherently fragmented nature.

⁴The mind's ability to segregate this way has been vastly generalized. We now easily refer to separate “self-states” to describe common psychological ways of organizing one's experience in response to particular contexts. This is not the experience we refer to in depersonalization, which has an unmistakable experiential flavor of unreality and distortion of the regular ongoing experience of self and surroundings.

⁵We are using discourse as derived from the work of Foucault and further developed in feminist studies, anthropology, cultural studies, and literary theory. Foucault (1972) defined discourse as systems of thought composed of ideas, attitudes, courses of action, beliefs, and practices that systematically construct the subjects and the worlds of which they speak. He traced the role of discourses in wider social processes of legitimating and power, emphasizing the construction of current truths, how they are maintained, and what power relations they carry with them. Power is always present and can both produce and constrain the truth. Discourse is the medium through which power relations produce speaking subjects.

⁶When emotional trauma was paired with sexual trauma, it predicted broader dissociation, such as amnesia.

⁷Little did Hacking know that by the time of writing this article, the popular TV network Showtime would air a new primetime series based on a protagonist with dissociative identity disorder (United States of Tara) that instantly became their number one popular show.

⁸In any discussion of psychopathology the question of symptom choice surfaces: why depersonalization and not another symptom in response to this constellation and impasse between self-in-itself and discursive context? The mysteries of human variation will obviously not be resolved in this paper. Typically such questions become less acute when the category itself becomes more familiar.

⁹Foucault and Chomsky's famous debate of 1971 (Chomsky & Foucault, 2006) articulates the dialectic of our position regarding the “innateness” of human nature. On one hand stands Foucault, whose subject does not possess any intrinsic nature but is entirely the product of social political forces. Foucault regards the humanistic premise that people have a true nature as dangerous, having been used to justify all acts of domination in society. On the other hand stands radical Chomsky, who is just as intent on deconstructing the violent societal forces exercising power, yet argues that humans should be attributed essential, even biologically based capacities, such as the ability to be creative in their use of language and, ultimately, to give expression to absolute justice. Psychoanalytic theory, particularly the notion of drives, leans heavily toward the Chomskian argument.

¹⁰A working term we coined with a nod to Kant's thing-in-itself, to refer to the philosophical realization that this is a concept, we cannot claim direct access to what we are trying to refer to in this notion of self.