Depersonalization Disorder: A Hypothesis
In one of our first sessions, Carl told me that his feelings of depersonalization began several years ago when he was reading a self-help or psychology book (he can no longer remember the name of it) and one of the author’s ideas gave him a sudden unpleasant insight into himself. He can’t recall exactly what he realized; but at that moment, he felt himself lift out of his body, into his head and out through the top of it where he has remained ever since. He’s now more or less constantly preoccupied with attempting to regulate how he appears to other people by mind-reading and “empathy.” Other than a pervasive feeling of anxiety, he has little idea about how he feels.
Since beginning to read Tomkins on affect and emotion, where he defines affect as a built-in physical reaction to a stimulus which tells us that we need to pay attention to that stimulus, I keep wondering: but what if we don’t pay attention? What if the physical response occurs but we don’t notice it? In my view, this possibility connects with Bion’s understanding of certain psychotic processes: when someone finds a fact or feeling too painful to be tolerated, he or she may attack the means of perceiving it — e.g., the capacity to see, hear, pay attention, etc. It also connects to my developing thoughts about defense mechanisms as the means of diverting attention away from psychic pain, and about the group project I want to do on pain and distraction.
I’m fairly confident that depersonalization (dissociation?), for Carl, is a defensive means to escape from his painful internal world, particularly the experience of profound shame. It isn’t only dissociation from memories but disengagement from the places in his body where he might register emotions. When I brought up mindfulness, suggesting he try to focus on his breathing and center his awareness on those places in his body where he might detect emotion — face, eyes, chest, belly — Carl seemed resistant. I think he’s afraid to come back into his body and thus into contact with the pain from which he fled. This whole issue of attention and where it’s located is fascinating to me.
Man sitting photo available from Shutterstock
Burgo PhD, J. (2012). Depersonalization Disorder: A Hypothesis. Psych Central. Retrieved on May 6, 2015, from http://blogs.psychcentral.com/case-notes/2012/10/depersonalization/