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Freud had DP at the Acropolis; Today Teens at Venice Beach

Physical Precipitators of Unreality. Post II of the Series on Causes of DP-DR.

Post published by Elena Bezzubova on Jul 22, 2015 in The Search for Self

Freud was intimately familiar with depersonalization. His three episodes of unreality become the matter of his repeated careful analysis. All three were caused or triggered by a mixture of physical and psychosocial factors. In all three new unfamiliar and meaningful environments played a particular role. The most famous episode of Freud's derealization happened in the Acropolis. The contemporary teen's Acropolis - a dream place - is arguably Venice beach.

An excited with his first trip to California, though somewhat jet-legged sixth grader from Ohio feels "overcooked" in the August heat on Venice beach. Watching the sunbeams glare on the water he is suddenly smitten with a frightening experience. Things are going wrong. The ocean, the sky, the world - everything around him has changed. Removed. Different. Unreal. Is it sand in his eyes that "makes world blurred and distant?" He does not feel well, he is anxious and "the strange emptiness in my head" enhances his unease. Concerned parents bring the boy to the ER. The medical conclusion is probable dehydration, overheating and tiredness.

The next morning this passing spell of depersonalization was lost among the bright kaleidoscope of Californian amusements. Some dozen years later the young men recalls this episode during his therapy, connecting it with his full blown depersonalization and derealization.

The case illustrates three points. First, is the closeness of derealization and depersonalization. The boy feels that world around is unreal, that is formally derealization. However, the deeper experiences were "the changes inside," "fog in the head" and other signs of unreality of self - the signs of depersonalization. Phenomenologically, the unreality of world and the unreality of oneself belong to the one continuum. As experiences of I and the surrounding world present themselves in one experience I-am-in-the-world, the feelings of unreality of I or world present themselves in one experience of unreality of I-am-in-the-world. So derealization and depersonalization mean two sides of one experience. Sometimes, one side is more noticeable than another.

The second point is a phenomenon of transitory episodic depersonalization: a miniature twinkle of unreality that can never come back again or can be a forerunner of full-blown clinical disorder. Transitory depersonalization is generally considered as common, non-pathological experience, more characteristic for adolescents, perhaps in connection with their imaginative sensitivities and active search for identity. The process of personalization is characterized by the interplay between feelings of reality and unreality. Healthy feelings of identity often include elusive and fleeting sparks of unreality that actually can solidify the stability of the core identity.

The third point is the cause of that miniature depersonalization. Of course, as almost in every case, the precise cause is not known. But precipitating factors appear probable: physical and emotional exhaustion due to traveling, time zone changes, significant climate changes, overheating, intensive lighting, and the like. The age between ten and twenty seems most vulnerable to physical factors, which often provokes elements of derealization or depersonalization.

Let's summarize characteristics of physical or physiological precipitators of depersonalization. In contrast to psychoactive substances, these factors are not immediately involved in the neurometabolic processes. The physical factors affect bodily processes, including blood circulation, vasomotor functions or autonomic nervous system activities, which lead to the changes in central nervous system and the development of feeling unreal. The physical factors comprise all types of environmental physical stressor - temperature, atmosphere pressure, mechanical traumas, acoustic stressors, visual stressors (bright light, glare, moving or spinning images), vestibular stressors, and the like.

Bodily physical stressors could be distinguished as physiological stressors: fever, overheating, dehydration, lack of sleep and the like. Derealization and depersonalization-like experience - "room seems strange and unreal;" "body feels light and foreign" or "loss sense of my legs, as if they are not mine" - emerge in the verge of fever during a flu or other infections. Often - as in the case of the boy from Ohio - transitory elements of depersonalization are precipitated by the a combination of several physical and physiological factors

Children seem to be more susceptible to physical as well physiological stressors. Again - episodes of light transitory depersonalization can be a forerunner of late developed chronic depersonalization, but also very well can be merely signs of a particular physico-psychological constitution. Adults also experience non pathological episodes of derealization and depersonalization. The case of Freud's depersonalization that was introduced at the beginning of this post is one of them. This Freud's case - with its intersection of physical, psychological and mystical elements - will be explored in the next post.

Elena Bezzubova received her M.D. summa cum laude and Ph.D. with a dissertation on depersonalization. She completed a residency in psychiatry and training in psychoanalysis. Her 30 years of clinical, teaching, and research experience includes inpatient and outpatient adolescents and adults, encompassing a broad range of mental health issues. Throughout her career, depersonalization and identity disturbances have been a central focus of her practice and scholarship. She has taught child, adolescent, and adult psychiatry, psychoanalysis, history of psychiatry, social psychiatry, clinical psychology, literature and psychiatry, medical ethics, and the art of doctoring. She has published more than 50 book chapters and articles, and has organized and presented at numerous conferences around the world. Dr. Bezzubova maintains a private practice as a psychoanalyst in Newport Beach, CA, and teaches at the University California, Irvine, and the New Center for Psychoanalysis in Los Angeles.

To quote the late great robin williams in good will hunting "Next time I'll explain why freud did enough cocaine to kill a small horse"
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