Prof. Dr. W. K. van Dijk: Psychopathological and psycho-analytical aspects of depersonalization

In recent years the term deprsonalization has become rather popular to indicate all sorts of mystical, ecstatic and transcendental experiences. In the framework of psychopathology, however, it is useful to restrict the meaning of depersonalization to the particular phenomenon which may be best described in a negative way, i.e. as an absence of the quality of familiarity and 'mine-ness' which normally accompanies all experiences.
When described in a positive way the core of it consists in a feeling of strangeness and distante. Principally, depersonalization can be distinguished from anesthesia, from obsessive and cenesthetic experiences, and from the schizophrenic experience of not being one-self.
The psychopathological structure of depersonalization is discussed on the basis of the Akt-model (Schilder): depersonalization consist in the being thwarted of acts by contradicting motives, feelings, attitudes, etc . .
According to the integration-model (Ackner) an experience is depersonalized, if it is not integreted within the normal, familiar frame of experiencing, nor, on the other hand, within the pathological modes of experiencing of delusions or hallucinations. According to both models, depersonalization can only occur, if the core of the personality (ego) has remained unimpaired. Mutual correspondentes between the two models, as well as relations between the two models on the one hand and the psycho-analytic (genetic, topical, structural, dynamical, economical and adaptational) models on the other, are discussed. Then depersonalization is discussed more in full according to the psycho-analytical models, starting from Freuds letter to Romain Rolland: "Eine Erinnerungsstiirung auf der Akropolis".
From the clinical point of view several forms of depersonalization syndromen (D.S.) may be distinguished: 1. D.S. in organic and symtomatic states (including sensory deprivation, overstimulation, psychasthenia and the hyperesthetic-emotional syndrome); 2. D.S. in schizoid disturbances of identity; 3. D.S. in borderline states; 4. D.S. in hysterical states; 5. D.S. in obsessive states; 6. D.S. in depressive states; 7. D.S. in anxiety neurosis and anxiety states; 8. D.S. in psychotraumatic states; 9. Multiple D.S.; 10. Last but not least D.S. in normal people, which is promoted by fatigue, boredom, lack of stimulation, shift of stimuli and frustration.
Many people are able to provoke experiences of depersonalization at will.
Prognosis and therapy of depersonalization depends on the syndrome within which it occurs.