Depersonalization: A Review and Rethinking of a Nuclear Problem

Depersonalization (DP) and derealization (DR) have been, and are still, neglected in the literature and in research. What makes these phenomena untouchable in clinical research is that they are not measurable. They are subjective experiences of an individual's feeling life. Since these experiences can be transient and often are buried in a myriad of other clinical complaints, the clinical problems are of a wide variety and tax the philosophical orientation of the researcher. Ambrosino, James, and Roth 1-3 have discussed this problem from a purely clinical point of view. In some studies by Sim and Houghton4 and Gelder et al.5 those unmeasurable clinical aspects were removed from the symptom complex. Their manipulation with the data base represented a clinical emasculation and subtly emphasized that data had to be quantifiable to be admissible as clinical evidence. Kubie6 had wisely pointed out that quantitative concepts in psychology can be “fallacious” since subjective descriptions cannot be trusted and also that “counting devices” are just not infallible. Kubie emphasized that measurements tell us nothing about a patient's suffering and how this suffering can be used for growth of the person.

Depersonalization and derealization are real human experiences. They have form, content, duration, and are associated with affects. They have been considered diseases, symptoms, and even a way of life. All too often explanations are given as if they were sufficient and necessary causes for their existence. Mac Curdy7 related that “the feeling of the reality attaching to any idea is proportionate to our emotional interest in it.” William James8 had expressed this idea some time before, but the essence of his concept is that there must be an investment of the self, the affective elements, in another object for the object and the self to be experienced as real.

This paper is proposed not only as a review of these phenomena, but also in the hope that by reviewing their history from