The author tries to interpret these phenomena from his study of a case as related elements in a pattern of defence.

The patient's major attacks of depersonalization were always preceded by hypomanic episodes. They may therefore be regarded as an emergency defence after failure of the hypomanic defence. Since minor episodes of depersonalization occurred without anxiety, while in the major attacks the anxiety developed as the feelings of unreality increased, it is likely that the depersonalization was a defence against anxiety. This anxiety would be most simply explicable as the precipitating anxiety of the attack. Such anxiety could, however, also be regarded as due to the threat of disintegration to the ego implicit in feelings of unreality. Perhaps this second view would be correct where depersonalization precedes schizophrenia.

The author goes on to consider the relationship of depersonalization to confusion, and to the phenomena of normal sleep.