The Rôle of Anxiety in Depersonalization1

Depersonalization still remains a challenging problem in the field of psychic phenomena, and the earlier literature, to which every new writer on the subject dutifully refers, is inconclusive and contradictory. Recent contributions to the topic based upon clinical cases lean to elaborate descriptions of symptoms and analysis of ego development—especially the pathology of the body ego. Two recent, strictly analytic contributions on the subject are concerned with patients who were schizophrenic to the extent of having been at times distinctly psychotic.

Descriptions of depersonalization in terms of genital level characteristics, or as a narcissistic regression phenomenon, or its occurrence in schizophrenic or hypochondriacal depressions where paranoid projections or hallucinatory wish-fulfilments have made their appearance, seem to contribute little to the dynamics of the function of depersonalization. Inasmuch as depersonalization, and to a minor degree derealization, is the ultimate representation of withdrawal of the sense of reality, it seems to me that greater light on the genesis of the symptom can be gained through the analysis of lesser manifestations of the same general tendency, such as the analysis of déja vu, déja dit, co-conscious mentation, feeling of unreality, or of depersonalization in patients whose personality integration and adaptation to reality is only slightly disturbed. This I have pointed out in a previous paper.2

In 1937 Freud analysed a personal experience of déja vu in which he regards estrangement and depersonalization as defence mechanisms tending to hide something from the ego. Although Freud classifies these feelings as defence mechanisms, at the same time he calls them parapraxic symptoms with a structure pathologic as dreams.3 Of course, it is perfectly possible for a symptom to be a defence mechanism, but the cases reported in analytic literature say little of the tendencies against which the symptom of depersonalization protects