The nature and impact of depersonalization

Depersonalization is a dissociative symptom that encompasses certain feelings and experiences of oneself or the world as “unreal”. While the perception of reality remains intact, it is subjectively felt to take on a distinct character of flatness or lifelessness. The world is experienced as having a “dreamlike” quality, blunted and drained of vividness, and separated from oneself as if by a skin, veil, glass, or fog (symptoms collectively known as derealization). A sense of distance from one’s emotions is a core feature of depersonalization: sufferers are aware of their feelings, but may not experience them as “real” (emotional numbing – “I know I have feelings but I don’t feel them”). They may describe themselves as emotionally “dead” or feeling like a “zombie”, and perceive themselves as having a lack of agency in their own lives. There is a feeling of existing as a detached observer of one’s own thoughts, emotions, and actions, with a sense of “going through the motions” of life (detachment from self). For some, this is perceived as a kind of disembodiment, such as a feeling of seeing oneself externally in a kind of “out-of-body” experience (anomalous body experience) (American Psychiatric Association, 2013; Steinberg, Cicchetti, Buchanan, Hall, & Rounsaville, 1993; Sierra & David, 2011).

These feelings and sensations are noted to be particularly difficult to describe or convey to others; this fundamental alteration in the “texture” of conscious experience can generally be explained only by metaphors or “as if” statements. Some may not necessarily realize that they are experiencing a distinct and genuine symptom, believing that this is simply the normal feeling of life. For many, they’ve never experienced anything else.

This is not an innocuous condition. Sufferers find depersonalization to be highly distressing, not in spite of their alienation from their emotions, but because of their alienation from their emotions: “the distress is described as arising from the unpleasantness of the depersonalization experience itself” (Medford, 2012). The pervasive sense of disengagement from one’s life can result in what might be expected from perpetually feeling that life has little purpose. Those who experience depersonalization have elevated rates of depression, anxiety, and social and occupational impairment: they may feel that there is no point to career or academic pursuits. They are more likely to be unemployed, more often single, and more likely to live with their parents (Michal et al., 2016). Students with depersonalization show greater rates of academic underachievement and unhealthy avoidant coping strategies (Michal et al., 2015). Most worryingly, sufferers of depersonalization show a highly increased rate of suicidal ideation, active suicidal desire, suicide planning, and previous suicide attempts (Michal et al., 2010; Tosić-Golubović, Žikić, Slavković, Nikolić, & Simonović, 2017).

Depersonalization and dissociative conditions are also more frequent among transgender people who experience gender dysphoria (Colizzi, Costa, & Todarello, 2015). Depression and anxiety are highly comorbid with gender dysphoria, with a reduction in these symptoms following transition treatment (Costa & Colizzi, 2016). This appears to be the case for depersonalization as well: trans people who have transitioned report a lower rate of depersonalization (Kersting et al., 2003; Walling, Goodwin, & Cole, 1998), particularly after initiating hormone therapy (Colizzi et al., 2015). Numerous trans people, myself included, have publicly shared their stories of experiencing the specific symptoms of depersonalization, often with partial or total remission upon transitioning. Many unexpectedly experienced a near-miraculous change: coming out of that fog, sometimes mere weeks after starting HRT, and finally feeling like a real person for the first time.

For me, this change came as a surprise: I had gotten used to feeling separated from the real world by some impenetrable skin, robotic in the predictable script of life, having no choice but to listen to my nonstop self-critical inner monologue, always aware of the unbridgeable gap between myself and my emotions. I thought this was just what it was like to be me, and there was no respite to be had. I desperately wanted to close that gap, to feel whole and complete, like a normal person who was finally part of the world, but I had given up on the possibility that anything could free me from this suffocating and ever-present cage. I never expected that within a week after starting estrogen, I would suddenly feel myself slide into my place in the world, speak in only one voice, and just feel like a real person at last. My life had a real future, because I finally found my place in real life. I felt like I had never felt before.

The profound nature of this experience left me intensely curious about what could cause this change – and what exactly had been afflicting me before HRT. I found that my descriptions of this distressing emotional numbness and alienation resonated with hundreds if not thousands of other trans people. Many of them noted that it was specifically the depersonalization-like symptoms which helped them in consolidating their identity and embracing their transness. Viewed through the lens of depersonalization, it’s clear why this was unexpectedly useful to many in realizing their identity as trans. For a significant proportion of trans people, their gender dysphoria manifests more prominently in mental and emotional distress rather than obvious physical and bodily dysphoria. These mental and emotional symptoms can sometimes include depersonalization. It is possible to experience depersonalization and not be aware of this, due to being “habituated to it as normal” (Steinberg et al., 1993). Because of this, it is possible that many trans people experience their gender dysphoria in this non-obvious way as well, with specific dissociative symptoms such as “feelings of unreality” that are notably difficult to explain to others or even recognize in oneself. And greater awareness of depersonalization, particularly as a prominent symptom of gender dysphoria, can help some gender-questioning individuals consider whether these symptoms describe their emotional life and tie into their experience of their gender.

Yet despite the severe impact of depersonalization on sufferers’ lives, the condition remains underrecognized among trans people, the general population, and even clinicians, who may incorrectly believe this to be a “negligible variant” of depression or anxiety (Michal et al., 2016). And depersonalization has largely been under-recognized as an aspect of the experience of gender dysphoria, with public awareness of transness placing greater emphasis on discomfort with gendered body features or gendered presentation, and less on the psychiatric comorbidities of gender dysphoria.

Depersonalization deserves more attention as a symptom of gender dysphoria. Contemporary accounts of these experiences provided by trans people have in turn helped many others in understanding their discomfort with their body, their gender, and their emotions. Because of the highly consistent themes of their emotional experiences, I sought to find out whether descriptions of depersonalization were also present in much earlier trans memoirs and autobiographies by some of the most high-profile trans pioneers – those who had made history, like Christine Jorgensen and Jan Morris. I soon found that their experiences often echoed the distinctive psychic signature of depersonalization in a way that was almost uncanny. Even as the authors may have struggled to capture the essence of the experience or make themselves understood to others, a depersonalization-centered explanation helps make sense of many of the self-reported changes in their mental and emotional symptoms during transition.

“From a distance, or through glass”: Depersonalization in Jan Morris’ Conundrum

The acclaimed Welsh travel writer Jan Morris transitioned in 1972, publishing her memoir of the process, Conundrum, in 1974 (Morris, 2002). Throughout the book, she spends many pages vividly describing her strange sense of alienation from everyone else and a detachment from herself, as well as how her experience of reality changed after transitioning.

Anomalous “out-of-body” experience

In the book’s first chapter, Morris describes a childhood memory of what it was like to feel that she was perceiving herself from outside her body as she went about her day:

I was intensely self-conscious, and often stood back, so to speak, to watch my own figure stumbling over the hills, or sprawled out on the springy turf in the sunshine. (p. 4)

Detachment and alienation from the rest of the world

Early in life, Morris felt a distinct difference between the rest of humanity and herself, with a sense of isolation and exclusion from the world.

The people I could see from my hilltop, farming their farms, tending their shops, flirting their way through seaside holidays, inhabited a different world from mine. They were all together; I was all alone. They were members; I was a stranger. They talked to each other in words they all understood about matters that interested them all. I spoke a tongue that was only mine, and thought things that would bore them. (p. 3)

Lack of agency, “blurred” emotions, and a sense of being less than whole

Morris describes others as being comfortable in their lives, moving with determination and purpose, and she contrasts this with herself, feeling that she’s “lacking direction”. Additionally, she finds her emotions to be indistinct, and expresses a sense of having “a piece missing”.

My emotions, though, were far less distinct or definable. My conviction of mistaken sex was still no more than a blur, tucked away at the back of my mind, but if I was not unhappy, I was habitually puzzled. Even then that silent fresh childhood above the sea seemed to me strangely incomplete. I felt a yearning for I knew not what, as though there were a piece missing from my pattern, or some element in me that should be hard and permanent, but was instead soluble and diffuse. Everything seemed more determinate for those people down the hill. Their lives looked preordained, as though like the old de Havilland they simply stuck dogged and content to their daily routes, comfortably throbbing. Mine was more like a glider’s movements, airy and delightful perhaps, but lacking direction. (p. 4)

Viewing the world as dreamlike, “through a gauze curtain”, and a feeling of being unreal

Morris’ childhood was characterized by an experience of the world as seen through a veil, and she explicitly compares her childhood memories to a “dream”.

If I have evoked my childhood impressionistically, like a ballet seen through a gauze curtain, it is partly because I remember it only as in a dream, but partly because I do not want to blame it for my dilemma. It was in all other ways a lovely childhood, and I am grateful for it still. (p. 6)

She further states that the “grand constants of the human cycle” were “shut off” from her, and that she “had no part in them”, expressing a sense of distance and describing this as seeing the real world “through glass”.

Yet I was not indifferent to magnetisms of the body. Some of the nameless craving that haunted me still was a desire for an earthier involvement in life. I felt that the grand constants of the human cycle, birth to death, were somehow shut off from me, so that I had no part in them, and could look at them only from a distance, or through glass. The lives of other people seemed more real because they were closer to those great fundamentals, and formed a homely entity with them. (p. 21)

Hormone therapy: Casting off the emotional “hide” and experiencing reality directly

Morris describes the first changes she observed after beginning treatment with estrogen. She makes clear that these changes were something metaphorical and “less tangible”: finally emerging from the “rough hide” of emotional numbing. She celebrates her newfound ability to feel the sensations of the world “in a more directly physical way”, with “no armour” cladding her emotions.

The first result was not exactly a feminization of my body, but a stripping away of the rough hide in which the male person is clad. I do not mean merely the body hair, nor even the leatheriness of the skin, nor all the hard protrusion of muscle: all these indeed vanished over the next few years, but there went with them something less tangible too, which I know now to be specifically masculine—a kind of unseen layer of accumulated resilience, which provides a shield for the male of the species, but at the same time deadens the sensations of the body. It is as though some protective substance has been sprayed on to a man from a divine aerosol, so that he is less immediately in contact with the air and the sun, more powerfully compacted within his own resources. This suggestion, for it is really hardly more, was now stripped from me, and I felt at the same time physically freer and more vulnerable. I had no armour: I seemed to feel not only the heat and the cold more, but also the stimulants of the world about me. I relished the goodness of the sun in a more directly physical way, and for the first time in my life saw the point of lazing about on beaches. The keenness of the wind cut me more spitefully. It was as though I could feel the very weight of the air pressing on my person, or eddying past, and I thought that if I closed my eyes now the presence of the moonlight would cool my cheek. (p. 92)

Rumination and obsessive thoughts about the nature of reality, anxiety, and thoughts of suicide

Those experiencing depersonalization often find themselves unwillingly fixated on constant, anxiety-inducing philosophical thoughts about the nature of the the world or human existence. Morris, too, reports being troubled by these unpleasant thoughts, as well as feeling “dark with indecision and anxiety” and sometimes thinking about her own death.

But a change of the body must be a last resort, Dr. Benjamin counselled me. If it sounded like magic to me, to the world at large it would seem a fearful denouement. Try working out life as a man, he suggested. ‘Stick it out. Do your best. Try to achieve an equilibrium, that’s the best way. Take it easy!’ This advice I accepted, for I thought there might be layers to my conundrum which even he could not perceive. Perhaps I depended upon that very clash between sex and gender, so that to tamper with it would be gambling with my very per- sonality? Perhaps it was a condition of my gifts? Perhaps, if as I sometimes thought I was no more than a living parable of the times, to change myself would be to abort the truth—to abort, in a double sense, reality itself? For while I had no doubt at all which was my essential self, I could see that to most people an opposite reality was just as true. Heavens, I was a jumble, I used wryly to think—two people in one, two truths, the times sublimated, reality aborted! Yet how easily the rest of life seemed to come to me, how fluent if superficial was my pen, how few my mundane worries, so that people used to say I was born with that silver spoon in my mouth, and ask me for advice! My grandfather used to maintain that the essayist E. V. Lucas, a connection of ours, would have been a good writer if he had ever had a care in the world, and some people thought the same of me. In fact I was dark with indecision and anxiety. Sometimes I considered suicide, or to be more accurate, hoped that some unforseen and painless accident would do it for me, gently wiping the slate clean. (pp. 42-43)

A loss of self

Morris repeatedly describes her understanding of her gender as being primarily about her sense of self – a “fragment of unity” that constitutes “the essentialness of oneself”. The alternative to this unity is not another “self” – the alternative to this unity is nullity, a sense of not even existing as a person.

In any case, I myself see the conundrum in another perspective, for I believe it to have some higher origin or meaning. I equate it with the idea of soul, or self, and I think of it not just as a sexual enigma, but as a quest for unity. For me every aspect of my life is relevant to that quest—not only the sexual impulses, but all the sights, sounds and smells of memory, the influences of buildings, landscapes, comradeships, the power of love and of sorrow, the satisfactions of the senses as of the body. In my mind it is a subject far wider than sex: I recognize no pruriency to it, and I see it above all as a dilemma neither of the body nor of the brain, but of the spirit. (pp. 6-7) That my inchoate yearnings, born from wind and sunshine, music and imagination—that my conundrum might simply be a matter of penis or vagina, testicle or womb, seems to me still a contradiction in terms, for it concerned not my apparatus, but my self. (pp. 17-18) To me gender is not physical at all, but is altogether insubstantial. It is soul, perhaps, it is talent, it is taste, it is environment, it is how one feels, it is light and shade, it is inner music, it is a spring in one’s step or an exchange of glances, it is more truly life and love than any combination of genitals, ovaries, and hormones. It is the essentialness of oneself, the psyche, the fragment of unity. (p. 20)

Being a detached observer, a “non-person”, and an unpleasant sensation of remoteness from life

Eventually, Morris came to realize that she felt “utterly detached” from others, suggesting that she “feel[s] that reality itself is an illusion”. She compares herself to those who “lose all grasp of their own existences, and became non-persons even to themselves”. In addition to comparing her inner life to the torture of solitary confinement, Morris suggests that this experience was not necessarily a pleasant one, describing herself as in a “remote and eerie capsule” – always an “onlooker”, with “a detachment so involuntary that I often felt I really wasn’t there”.

I loved the Army, but I could never be truly of it. I enjoyed my excursions into that male society, but I knew I could not stay. And while, as I say, in some ways I liked this observer’s role, and came indeed to make a profession of it, still I pined sometimes to be a member somewhere. Just as, in possessing these two landscapes of my childhood, I had felt myself to belong to neither, so I felt now that I belonged to no segment of humanity. It is a fine thing to be independent in life, and a proud sensation to know yourself unique: but a person who stands all on his own, utterly detached from his fellows, may come to feel that reality itself is an illusion—just as the poor convicts of the 19th-century silence system, so isolated from their comrades that they were never allowed to see or hear another soul for years at a time, sometimes lost all grasp of their own existences, and became non-persons even to themselves. (p. 33) It was as though I deliberately held myself back from fruition, in work as in pleasure. If sexually I found myself isolated, professionally, as I watched the world go by, I found myself more than ever outside mankind’s commitments. More than ever those people down the hill seemed to be pursuing rounds of their own to which I was denied access—not minding their shops now, or sauntering with their holiday amours, but plotting revolutions, fighting elections, conspiring, warring, starving. I was there, by destiny it seemed as by vocation, only and always as an onlooker. An American colleague once described me as ‘so unobtrusive that one hardly knows he is there at all’, while an English critic remarked upon ‘an odd tendency to disappear as the person behind the style’. But it was not modesty that camouflaged me so, nor even professional technique: it was a detachment so involuntary that I often felt I really wasn’t there, but was viewing it all from some silent chamber of my own. If I could not be myself, my subconscious seemed to be saying, then I would not be. (pp. 47-48) Love rescued me from that remote and eerie capsule, as it rescued me from self-destruction, and everything they say about love, in dicta sublime as in lyric abysmal, is demonstrably true. (p. 49)

Life as acted out or scripted

Morris describes her life as a man as “cheap theatre”, stating that she wishes to step “into reality”: the world of life as a woman.

For myself, I suppose, I instinctively associated those deceits with the male condition, since then even more than now the world of affairs was dominated by men. It was like stepping from cheap theatre into reality, to pass from the ludicrous goings-on of minister’s office or ambassador’s study into the private house behind, where women were to be found doing real things, like bringing up children, painting pictures, or writing home: and though I know this is a footling simplicism, and that realities all too terrible hang upon the labours of public men, still I began to feel that the private part of any life was the only part that mattered. (p. 79)

Difficulty of describing experiences of depersonalization

Morris, an able and extremely vivid writer, expresses her difficulty finding the words to describe these lifelong experiences of unreality.

I present my uncertainty in cryptic terms, and I see it still as a mystery. (p. 5)

Feeling unreal

While Morris describes her existence as feeling “intangible” in her childhood, following her transition she states that she no longer feels “isolated and unreal”:

This was a bewilderment that would never leave me, and I see it now as the developing core of my life’s dilemma. If my landscapes were Millais or Holman Hunt, my introspections were pure Turner, as though my inner uncertainty could be represented in swirls and clouds of color, a haze inside me. I did not know exactly where it was—in my head, in my heart, in my loins, in my dreams. Nor did I know whether to be ashamed of it, proud of it, grateful for it, or resentful of it. Sometimes I thought I would be happier without it; sometimes I felt it must be essential to my being. Perhaps one day, when I grew up, I would be as solid as other people appeared to be; but perhaps I was always meant to be a creature of wisp or spindrift, loitering in this inconsequential way almost as though I were intangible. (pp. 4-5) From the beginning of my life I had felt that my state of detachment gave me a privileged view of things—a seat in the Royal Enclosure, or a two-way mirror. It was hardly an objective view, for I saw everything through the lense of my introspections, but it was always uninvolved. I shared, or allowed myself to share, so few of the emotions I described; I felt myself outside mankind’s preoccupations; I was a good reporter, because I was tightly circumscribed, like a racehorse blinkered against distractions, with its fierce eyes always on the winning-post. But when it came to literature more creative, I felt myself ham-strung. The book I am writing now is my very first attempt at a more liberated self-expression. Of course it is all about myself, and does not reach the ultimate freedom of fiction, but at least it is more than mere observation. For I no longer feel myself isolated and unreal. Not only can I imagine more vividly now how other people feel: released at last from those old bridles and blinkers, I am beginning to know how I feel myself. (pp. 134-135)

While we clearly can’t determine for certain whether Morris did indeed experience genuine symptoms of depersonalization throughout her life, these emotional experiences and changing sense of being in touch with reality are consistent with nearly all of the features of depersonalization. Likely due to the inherent difficulty of describing depersonalization, others have often felt her descriptions of these phenomena to be superfluous to her transgender narrative and overly verbose. Hausman (1995) critiques Conundrum: “it says so little with so many words”. She describes it as “overladen with expansive descriptions”, and claims Morris “prefers the mystical to the material”. Califia (1997) also regards Morris’ descriptions of her experience of gender as “a philosophical flight of fancy”. Understood in the context of depersonalization symptoms stemming from gender dysphoria, it’s clear that Morris actually was trying at length to explain an experience that’s known to be notoriously challenging to describe in anything other than metaphor. The “dilemma” of this condition – Morris’ titular conundrum – may be solvable after all.

Next: Depersonalization symptoms in the autobiography of Christine Jorgensen, one of the first trans women to come out and transition publicly in modern times.

Have you experienced these symptoms of depersonalization? Tell us about it in the comments!

References

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