by “You’ll think I’m crazy,” Callum said, looking down at his hands as he wrung them together in his lap. “Everything just feels like a dream. I know I’m not dreaming – I mean – I think I’m really here, but at the same time I’m not sure. Somehow everything doesn’t feel right.”
A deep sigh. “No one understands what I mean.”
The slim 18-year-old across from me looks defeated, dejected and utterly fed up. This is typical for my field. Not just because I’m a mental health professional, so I rarely meet people who are in the middle of the best times of their lives, but because I specialize in dissociation and depersonalization.
Callum, sitting in the armchair of my therapy room, meets the diagnostic criteria for depersonalization disorder: a disorder that is baffling in many ways.
Because its main symptoms are a deep sense of detachment and unreality, the disorder baffles those who suffer from it. “It just feels so strange!” one customer exclaimed. “It’s like being a few beers deep all the time, but much less fun,” explains another.
Common descriptions include being stuck in a bubble, trapped behind a pane of glass, or viewing the world from very far away. People also describe a feeling of unfamiliarity, as if their own thoughts and memories – even their own bodies – belonged to someone else.
It’s not surprising, then, that people with depersonalization disorder spend many hours thinking about what might have caused these strange sensations, why they return, and what they can do to stop them.
In my time I have come across more than one person who has even had a brain scan to look for tumors that they assume are causing the problem. It’s also quite common for people to explain that they had a ‘bad trip’ using cannabis and never returned to reality.
Ironically, these constant worries are believed to be responsible for the persistence of depersonalization disorder. By always focusing on the strange sensations of the disorder, people inadvertently guarantee that they will notice even the subtlest sensations. And by fearing them, they increase their vigilance – and their stress levels – even further.
Because the surprising truth is that the experiences of depersonalization and derealization that define depersonalization disorder are extremely common and completely normal, especially when under stress.
So why isn’t Callum the first to tell me that no one will understand his experiences? Why is it so hard to find someone who understands?
The most obvious answer is the lack of language we have for depersonalization and derealization experiences. They are subtle, subjective, slippery things that are difficult to accurately capture with words.
They are also aspects of our own, very personal sense of reality, which we rarely talk about with others. The early days of the COVID lockdown were probably the only time discussing the strangeness of everyday life became a social norm. (“It feels like we’re living in a movie, doesn’t it?” says the disembodied voice of a colleague over Zoom).
Not enough awareness or training
The trickier answer, however, is that the vast majority of mental health professionals do not receive training on dissociative disorders. As a result, it is unfortunately very likely that people who come to mental health services complaining of depersonalization will miss or misunderstand their symptoms.
This may be why it takes an average of eight to 12 years for depersonalization disorder to be correctly diagnosed in the UK. In the meantime, people may undergo (unsuccessful) treatments for depression or anxiety, or their symptoms may be dismissed as ‘just’ part of another disorder they may also have.
Many are switched between services as doctors struggle to understand how to help. Many are dismissed without support. Others have told me that they simply give up talking about the problem because they have learned that it doesn’t benefit them.
Professionals are not responsible for this. After all, you don’t know what you don’t know. And with increasing discussions about dissociative symptoms on social media, many mental health professionals are realizing they have a blind spot and are looking for advice, training and resources.
Unreal, the UK depersonalisation disorder charity, received multiple requests for organisation-wide training in the first week after introducing a ‘request a call’ button on its website.
Researchers are also doing their part. From creating a ‘cheat sheet’ infographic, to uncovering any crossed wires in communications between young people and NHS professionals, and delving into the physical brain to better understand the disorder – a lot of work is underway. Not least the efforts to develop and improve tailor-made talk therapy.
So when I look at Callum, hunched in his chair, I feel a deep empathy with his sense that the world doesn’t understand what he’s going through. But I also have a very real grain of hope that things will look better soon.
Emma Černis, Assistant Professor of Clinical Psychology, University of Birmingham
This article is republished from The Conversation under a Creative Commons license. Read the original article.
