Emotion defeats physics

Depersonalization: Trapped in the unreal

As a research team led by Elaine Hunter from King's College London found out in 2014, people with depersonalization disorder tend to catastrophize various physical reactions and pay a lot of attention to them. When asked about possible causes of symptoms such as palpitations, a feeling of alienation, hunger or confusion, they mostly gave dramatic interpretations ("I'm going crazy"), while a healthy control group tended to try to normalize explanations ("I'm exhausted"). In this way, many get into a vicious circle: they see their condition as a sign of a serious illness, feel helpless and panic, which in turn worsens depersonalization.

The aim of therapy is to escape this spiral of fear. To do this, the patients train to face their fears. In addition, regular mindfulness exercises can help you to feel in your own body and in reality again.

In addition to psychotherapy, medication can help normalize the altered brain activity. However, this is not an easy undertaking, as very different neurotransmitters seem to be involved in the unusual activation and inhibition. For example, many patients receive anti-epileptic drugs, such as lamotrigine, which affect the glutamate system. But the study situation is contradictory. These agents seem to be most effective in combination with antidepressants of the serotonin reuptake inhibitor type. Antidepressants alone, on the other hand, only alleviate the symptoms in a few cases, but can make them more bearable by reducing the general level of suffering. The opioid system is also likely to be involved in the development of depersonalization.

The aftermath of "bad trips"

Many mind altering substances create states of depersonalization. In most cases, those affected find it pleasant, they feel "detached". In some people, however, drugs like marijuana, ecstasy, hallucinogens, or ketamine cause persistent depersonalization disorder. So far, scientists have not found a biological mechanism that could explain this, because the body normally breaks down these substances within a few hours.

Since the disorder usually develops after a "horror trip" experienced as frightening, the triggers are probably feelings of panic and helplessness. Similar to a flashback, the unsettling sensation of unreality keeps returning, which further increases the fear.

Break the vicious circle - with electricity

This supports the assumption that states of depersonalization protect us from threats. The body releases opioids mainly during periods of extreme stress in order to reduce pain. Initial studies with opiate antagonists, which block the effects of the body's own opioids, have produced positive results. But more research is needed here. Anti-anxiety agents such as benzodiazepines also prove to be helpful, since depersonalization is often associated with intense feelings of anxiety. These active ingredients are only suitable as a temporary measure, as they can lead to dependency if taken for a long time. Unfortunately, the success of the treatment of the different drug groups varies from person to person and can therefore not be predicted. What is a blessing for one can be almost ineffective for the next.

The situation is similar with transcranial magnetic stimulation (TMS). In this procedure, strong magnetic fields are aimed at the affected brain regions with the help of a coil in order to either inhibit or stimulate them. In 2011, researchers led by Antonio Mantovani from Columbia University in New York tested this method on twelve depersonalization patients by holding the coil at the transition from the temporal and parietal lobes, which is primarily responsible for alienation from one's own body. As a result, the symptoms were significantly reduced in half of the test persons. In a study published in 2016, London scientists targeted a different region of the brain: transcranial magnetic stimulation of the prefrontal cortex reduced symptoms in six out of seven patients. Despite these initial positive results, there are hardly any clinics that use TMS for states of depersonalization.

To experience oneself as strange and the world as unreal is a drastic and harrowing experience for many of those affected. Even those who are only temporarily in this state often remain unsettled. So it stands to reason that such experiences also found their way into art and literature. This is particularly evident in the literary works of existentialism. The chronic "disgust" that afflicts the protagonist from Jean-Paul Sartre's novel of the same name is in many ways similar to the symptoms of depersonalization.

It is no wonder that the Sartre phenomenon serves as the starting point for philosophical considerations - after all, depersonalization touches on fundamental questions of human being and consciousness. Apparently we are by no means the unitary person we normally perceive ourselves to be. A complex and sensitive interplay of different brain functions is necessary for us to feel ourselves in our own body and to be touched by the world around us.

People with a depersonalization disorder make it clear how fragile our ego is and how easily what we call reality can be lost. Julian Liebig has now taken the first steps back into a normal life. He receives medication and behavioral therapy. But the illness also made him pensive: "Sometimes it seems to me as if I have opened a forbidden door and seen a bitter truth that I can no longer ignore."

* Name changed by the editor