Ii’s been six months now. You still don’t like the episodes, but you feel safe enough to be curious. “I have to admit it’s interesting. I mean, why does my brain do this?” Derealization and depersonalization: Perceived madness – exploring. Let’s do some.

The mind may be saying, ‘Um, getting a tad overloaded up here. So to save us a ton of aggravation, I’m going to flip the switch on a filter. Hang in there, we’ll be alright.’

No doubt, derealization and depersonalization can be mega-scary.

But like so many symptoms of emotional and mental illness, terror can lesson in intensity over time.

By the way, have you had episodes?

Intro

We began this three-part series on derealization and depersonalization (DD) two weeks ago. It’s actually an update to the original series, written 14 years ago.

Part one features interesting general DD information, part two is largely about causes – and we’ll satisfy some curiosities – explore – here in part three

In case you don’t know, some quick info: DD are most often dissociative symptoms of other conditions. However, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) has a diagnostic code for depersonalization/derealization disorder.

Let’s get after it…

Dr. V.S. Ramachandran on derealization and depersonalization

Dr. V.S. Ramachandran

When I was exploring my DD and thinking about going to grad school a number of years ago, the work of neuroscientist V.S. Ramachandran, PhD caught my attention

In his book, A Brief Tour of Human Consciousness: From Impostor Poodles to Purple Numbers, he sets the table for his thoughts on DD by mentioning two interesting neurological disorders.

Now, the only reason I’m going to share this is I know you’ll resist the temptation to overgeneralize and catastrophize over having either. Know what I mean?

Capras syndrome (delusion) and Cotard’s syndrome (delusion)

Those neurological disorders: the first, Capgras syndrome (delusion), is characterized by the patient being convinced a close family member or friend is an impostor. The patient has no problem grasping familiarity of appearance and behavior; however, the relational significance isn’t there – and they’re fully aware of the disconnect.

Ramachandran then mentions Cotard’s syndrome (delusion), characterized by the patient believing they have lost everything, even parts of their body, and believes they may be dead – and are walking about as a corpse.

Ramachandran suggests DD may well be caused by the same altered brain circuitry that generates Capgras and Cotard’s – even to the point of referring to DD as “mini-Cotard’s.”

The two alternatives

In the face of a life-threatening emergency, a piece of anatomy in the frontal lobe of the brain, the anterior cingulate cortex (also involved in the processing of physical pain), becomes active.

Its ensuing action pulls in the reins on the brain’s fear circuitry. As a result, disabling phenomena such as fear and anxiety fall by the wayside.

But it doesn’t stop there, as the anterior cingulate then ramps-up alertness just in case we need to defend ourselves.

Well, the bottom-line is, we’re left in this emotionally void and hypervigilant state.

Ramachandran proposes we then have but two alternatives to account for what’s happened: “The world just isn’t real,” presenting in the form of derealization, and “I’m not real,” presenting in the form of depersonalization.

Our mind, our protector

I find all of this really very fascinating, especially when you consider that something that feels so horribly frightening, and that holds the potential to cause such major dysfunction, may actually be the mind’s naturally intended way of protecting itself – and its assigned human.

The mind may be saying, “Um, getting a tad overloaded up here. So to save us a ton of aggravation, I’m going to flip the switch on a filter. Hang in there, we’ll be alright.”

“Don’t worry, everything’s going to be just fine – I’m Mighty Mind.”

To me, assigning a personality, if you will, to the mind gives its distressing phenomena a softness and gentleness – making them seem so much less threatening.

I mean, it’s like the mind is this living, feeling, protecting being we can communicate with. And it’s a reciprocating relationship based on mutual respect.

I really believe in this relationship with the mind, and it’s my opinion that the only thing that keeps us from realizing its fullest two-way potential is overcoming our misinterpretations and overreactions to its naturally occurring protective mechanisms.

Yes, as soon as we sense the beginning of sensations such as DD, and the alarms sound, we think our way to exaggerated and inappropriate reactions. And that’s what causes all the hubbub, not the perceptual alterations themselves.

How to manage derealization and depersonalization

Okay, so what are we going to do to cope with DD in the immediate, and to prevent return visits?

First of all, we’re going to accept DD for what they are – not Capras, Cotard’s, and so many more disorders (I’ve heard ’em all).

And then we’re going to make the focus of our intervention the underlying pathology that’s generating DD – anxiety, depression, bipolarity, high-stress, trauma, migraines, substances, etc. In this context, DD are symptoms, not independent diagnostic entities.

During an episode, we’re going to keep cool and understand we’re not going mad, and what’s happening is not a permanent arrangement. And always, always, always – we’re going to keep moving forward.

One other note. There are meds that may provide some assistance. Certainly the antidepressants and mood stabilizers may address the foundational issues that generate DD.

And, of course, the benzodiazepines (Xanax, Ativan, Klonopin, etc.) may bring temporary relief, but is that a road you really want to travel? And then, the atypical antipsychotic, olanzapine (Zyprexa), has been used in particularly stubborn cases of DD. But really think long and hard before hitting that highway.

The saner we’ll feel

So that’ll do it for the series. And I believe a very important series it is, because derealization and depersonalization – so often misunderstood – can wreak havoc on millions of lives.

Surely, the more information we absorb and circulate, the saner we’ll feel.

Again, lots of helpful DD general information in part one and it’s all about causes in part two.

In addition to finding him on YouTube and web searches, check out Dr. Ramachandran’s books. He’s an interesting guy.

If you’re up for even more emotional and mental illness info and inspiration reading, peruse the titles on the articles page or by category below.

Dr. Ramachandran image: Creative Commons Attribution 3.0, no changes made, author Biswarup Ganguly.

After a decades-long battle with panic, generalized anxiety, fluctuating moods, and alcohol dependence; Bill finally found his life’s passion and work – lending a hand to those in the same boat. At age 49 he hit grad school and earned his counseling credentials. And he continues his service through Chipur and other projects.