![]() The parallel operator to the repressive censor in the case of dissociation would be avoidance of attending-to and formulating into meaning (Stern, 2007). Dissociation, in contrast, segregates or de-links “states ” rather than things, matrixes of self-other-relationships and their related affects. Under the supervision of the ego’s censor, neurotic distortion renders these thing-representations unavailable to the conscious mind. ![]() Repression disallows conscious representation of once-known, anxiety provoking “things ” like memories, wishes and fantasies. In dissociation they are structures, potential ways of being a person in the world. In repression the hidden elements are thing-representations of particular contents. They have different implications regarding psychic structure and dynamics. Often when clinicians refer to their patients’ dissociation they are actually describing the very specific experience of depersonalization.Īs dynamic psychic mechanisms both dissociation and repression are ways to banish mental contents from consciousness. Thus, depersonalization is a sub-type of dissociation. All four come under the roof of dissociation because they share the mental operation of splitting apart and excluding from consciousness psychic materials that are typically integrated into one experience (self-states or ‘identities’ in Dissociative Identity Disorder, a renounced self in Fugue, auto-biographical memories in Amnesia, personhood and real-hood in Depersonalization and Derealization). As a diagnostic category depersonalization is classified by the DSM-IV-TR (2000) as one of four primary dissociative disorders. Indeed, people with relentless depersonalization typically grow increasingly alienated and hopeless after migrating from one mental health professional to the next, misdiagnosed, misunderstood and treated with no success.Īs far as definitions, depersonalization should be distinguished from the concepts of dissociation and repression. The implication is that depersonalization cannot be engaged with directly but will somehow lift when other problems clear. ![]() When mentioned in the literature, depersonalization typically gets incorporated into existing categories and misattributed as an epiphenomenon of more familiar disorders of affect such as depression and anxiety. It infects a rather abstract psychological register in which one draws conclusions, grounds and narrates what their Self, and ultimately Reality, mean to them (we will return to this register in later sections). ![]() It is a subjectively felt altered state of consciousness, not an affect or a disturbance of thought, yet the actual ‘symptoms’ are terribly difficult to describe. The result of these various fragmentations is that for the depersonalized what used to be implicitly relied on as “ me” and “ reality” is pulled from under, leaving one de-clothed of a familiar self, in an alienated landscape.Īlthough prevalent, depersonalization is poorly studied and unfamiliar to even seasoned clinicians. The unity of intention and action fragments : “I can hear my voice talking, but it does not seem to be coming from me…“ (PRMS). The integrity of time, space, mind and body falls apart: “ The times have gone… Everything around me is very far away and tiny…” (Shovron, 1946), “I enter the house I lived in for the past 7 years and feel like I’ve never seen it before… I look at my hand and it does not belong to me, it looks large and foreign…” (PRMS). Phenomenologically people describe witnessing their lives as if it were a movie or “from the ceiling”, an experience often accompanied by a bitter deadening of affect: “ The emotional part of my brain is dead… My laugh is automatic there just doesn’t seem to be anything there…” (Patient reports, Mt Sinai - PRMS). Some are propelled in and out of transient episodes in response to triggering events, and some actually willfully induce states of depersonalization to avoid the claws of unacceptable reality (Guralnik, 2008). It can seep in insidiously, settling in for relentless decades of profound estrangement and detachment. Depersonalization can hit like a clap of thunder in a split second all tilts towards the surreal and the trusted sense of reality evaporates.
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