On Retaining the Sense of Reality in States of Depersonalization1

In previous papers I have advanced the view that a clash in identifications which go to make up the super-ego is an important factor in the phenomenon of depersonalization both in its milder forms, such as occur in normal persons, and in those cases where the symptom becomes the chief complaint of the patient. At the outset I would limit the term depersonalization to such conditions where the patient complains that he does not seem real to himself. The proposal of an addition to terminology made by Mayer-Gross (1) designating those situations where the outside world of environment appears strange or unreal as states of derealization in distinction to depersonalization seems advantageous. Some patients may suffer at different times or even at the same time from both depersonalization and derealization.

In my experience four mechanisms are concerned in this alteration of personality called depersonalization. They are: (1) parental identifications where a certain characteristic of one parent continues to be considered by the patient unconsciously as specific to the sex of that parent; (2) erotization of thinking and its excessive cathexis as characterized in such identifications. During this process there is a withdrawal of libido from the more vital human occurrences in the environment and from the body itself. It is invested in other activity, primarily thinking, either in form of abstractions or in fantasy. (3) Identification of thinking as a characteristic of the parent of the opposite sex—most often this occurs in the female child