“In the parallel universe the laws of physics are suspended…
…what goes up does not necessarily come down, a body at rest does not tend to stay at rest and not every action can be counted on to provoke an equal and opposite reaction. Time, too, is different. It may run in circles, flow backward, skip about from now to then. The very arrangement of molecules is fluid: tables can be clocks, faces, flowers.” ~ Susanna Kaysen
I only wish that I could be as eloquent with my own words. I sadly have never been quite as able to find the right words that would allow me to accurately articulate the way that I feel most of the time. I use the terms depersonalisation and derealisation with my psychiatrist. In my mind, they have always fallen too short though. They fail grievously at giving him or anyone else a true depiction, to give anyone a real understanding of the experiences that I and others have had living with depersonalisation-derealisation disorder (DPDR).
Derealisation is a form of dissociation from external reality. Reality feels unreal, distant, distorted, or falsified.
At its worst sufferers can be left in a state of constant reality testing; that means that they intensely and chronically question the reality that they are experiencing and whether or not if it is actually real. It can regularly feel like you’re on a knife-edge between sanity and insanity, psychosis and neurosis. “Am I sane… or, am I crazy?” It leaves you stuck in a seemingly never-ending dream-like state. Living permanently in William S. Burroughs’ Interzone. The majority of the time sufferers will report that everything just feels off, not profoundly but just ever so slightly. Imagine looking at a clock face and the minute hand is longer than the hour hand. It might not be immediately obvious what is different but eventually, the penny will drop. It leaves you feeling unable to fully connect. It’s a jarring phenomenon best described as eerie. Think uncanny valley vibes.
Depersonalisation is a detachment from the self. It feels like you are outside of your body and observing your actions, feelings, or thoughts from a distance, and in some more extreme cases that you do not have control over them.
A very weak analogy would be to describe it as like you are living in a video game, and instead of observing reality through your own character that you would normally have full control over you’re trapped inside of an NPC, watching everything from their perspective or alternatively sometimes in a third-person mode. A common shared experience that sufferers repeatedly talk about is that when they look into a mirror they do not recognise the reflection that they see as themselves.
Episodically and without warning some sufferers might have intense and bizarre experiences where they can become convinced of a whole manner of different delusions or beliefs. For me personally, these have mostly revolved around a range of diverse beliefs about reality, and its makeup, usually encompassing spiritual or religious theses.
I have been convinced on many occasions that I am a mere visitor to this reality and that I must find a way back to my own original, real, and true reality. Once for just over three weeks, I experienced an unbroken déjà vu. No matter where I went or what I did, I had the inescapable and intense feeling that everything was repeating itself and that I had been in that exact moment before. After frantically googling for answers to try and explain what was happening to me I was left convinced that I had a brain tumour or epilepsy and was about to have a grand mal seizure. I was so convinced that I attended A&E on at least three separate occasions during this episode very loudly demanding to be taken for an MRI and seen urgently by a neurosurgeon. During each visit, an A&E doctor or nurse would have to help get me to realise that I did not have a tumour or epilepsy and that I was in fact having a mental health crisis. Soon after they had left me though I would quickly fall back into the quasi-psychotic state and start kicking off again and they would have to come back and repeat the process of calming me down, over and over again, helping me to realise time and time again that I was actually very mentally unwell. Ultimately this ended up with me believing that I was stuck in purgatory, that nobody else was real and the only way for me to ever physically die and escape was to kill myself. Suicide was suddenly like a calling. It was what I was supposed to do… all I was supposed to do. I wasn’t killing myself because I was depressed though, but rather because I thought it was the answer to everything. Without a single doubt in my mind, it was the answer to every single question that I had ever asked or could ask. I was in fact euphoric about it- rolling around on the ground and laughing about it maniacally. I had finally at long last figured out the meaning of life and knew now exactly what I was supposed to do; kill myself. Thankfully I was with a family member at the crux of this all and was brought to A&E by them to have a mental health assessment after which I was very hastily plied with benzodiazepines and antipsychotic medication that slowly brought me back down to reality over the course of the preceding two to three days.
While my experiences have been existential and philosophical in essence, it is important to note that experiences can and will vary wildly between suffers. A friend has told me a story about one of her more severe episodes in which she ended up believing for nearly three months that she was living in her own version of The Truman Show. Unnerving.
“Is this real? Or has this been happening inside my head?” “Of course it is happening inside your head, Harry, but why on earth should that mean that it is not real?” ~ J. K. Rowling
It is estimated that around 1 to 2% of people will suffer from DPDR at some point in life. For most people, this is episodic in nature rather than a chronic malady. Onset generally occurs in young adulthood, late teens to early twenties. It is thought that in most cases that the condition is caused by a response to trauma such as childhood abuse, or rape- PTSD is a frequent comorbidity.
Treating chronic DPDR is difficult and can be refractory. There are currently no specific medications for the disorder. Sometimes antipsychotics or benzodiazepines might be prescribed as pro re nata (PRN), which is to be taken as needed by patients to help ease symptoms for a short period of time; typically when at a point of potentially falling into crisis. Paradoxically it has been found though that these types of medications invoke a rebound in effects if taken on a long-term basis. Some new emerging research has suggested that the wakefulness-promoting drug modafinil and opioid receptor antagonists such as naltrexone or naloxone might be useful in reducing symptoms for a small subgroup of sufferers, however more clinical trials need to be carried out.
The use of cannabis can exacerbate symptoms, along with the use of other psychedelics and dissociative drugs like ketamine, LSD, or PCP.
Cognitive behavioural therapy (CBT) can be helpful along with psychoeducation which aims to give patients and their loved ones a better understanding of the illness.
“Knowing the enemy is half the battle won.”
YouTuber and singer-songwriter dodie has talked openly in the past about her struggle with the disorder.
If you would like to learn even more about the condition, how to support suffers, or donate money towards research, unreal, is the main charity for the disorder in the UK.
