Feelings of Unreality

Feelings of unreality, most authorities agree, are extremely widespread and of infinite variety. They occur in acute and chronic forms, some so mild as to be scarcely noticed and some at the other extreme so severe as to be totally incapacitating. They occur commonly in schizophrenia, depressions, organic brain disease, in all types of neurosis, and in essentially normal people. Although common in psychotic patients, feelings of unreality belong to the neurotic part of the personality, not to the psychotic. In such patients they must be distinguished from somatic delusions and visceral hallucinations, which, although having a similar content, are entirely different in structure and meaning.

The most common names used to describe feelings of unreality are depersonalization, estrangement, alienation, and derealization. Some authors include in the group the condition known as déjà vu and its variants, such as déjà raconté.

Nunberg (13) was one of the first psychoanalysts to write on depersonalization, and his 1922 paper still stands as one of the best. He defines depersonalization as the state 'in which the ego and the external world appear different, changed and foreign to the patient'. He stresses the feeling of loss in all cases of unreality and equates loss of reality with loss of the ego and loss of the mother, the breast, and the penis. Nunberg's clinical cases are particularly illustrative of the disorder.

Federn (2), (3: 1926–28) says that depersonalization occurs as a result of a withdrawal of cathexis from what he calls the ego feeling (either body ego or mental ego). Cathexis of the boundaries of the body ego and mental ego is essential in distinguishing reality. The external world is perceived clearly only in so far as the body and its organs are clearly delineated. In the beginning of life the infant cathects certain functions and body parts, and only gradually extends this process to the entire body and to the mental image of the body