Derealization and Depersonalization: Perceived Madness | Part 3

What is derealization

Let’s handle the final piece of our three-part series on derealization and depersonalization. We’re going to finish strong with incredible insight from Dr. V.S. Ramachandran, along with some relief ideas. Onward…

I mean, it’s like the mind is this living, feeling being to which we can show compassion as it’s hurt, confused, worn-out, and desperately in need of rest and care.

Before we get rolling, I want to say how much I enjoyed putting the series together. I find the details fascinating. And as one who’s had many knock-down, drag-outs with derealization and depersonalization (DD), I’m grateful to be able to share my personal experience.

And, by the way, you’re going to get your money’s worth. I went long on this one.

Oh, be sure to read part one and part two, okay?

Incredible Insight from Dr. Ramachandran

In his book, A Brief Tour of Human Consciousness: From Impostor Poodles to Purple Numbers, neuroscientist, Dr. V.S. Ramachandran, sets the table for his thoughts on DD by mentioning two interesting neurological disorders.

Now, the only reason I’m going to share this is because I believe you can keep overgeneralization and catastrophic thinking at bay. Know what I mean?

The first, Capgras delusion, is characterized by the patient being convinced a close family member or friend is an impostor. The patient has no problem grasping familiarity of appearance and behavior; however, the relational significance isn’t there – and the patient is fully aware of the disconnect.

Ramachandran then mentions Cotard’s syndrome, a neurological disorder characterized by the patient believing she has lost everything, even parts of her body, and believes she may be dead – and is walking about as a corpse.

Ramachandran suggests DD may well be caused by the same altered brain circuitry that generates Capgras and Cotard’s – even to the point of referring to DD as “mini-Cotard’s.”

The Two Alternatives

In the face of a life-threatening emergency, a piece of anatomy in the frontal lobe of the brain, the anterior cingulate cortex (also involved in the processing of physical pain), becomes active. Its ensuing action pulls in the reins on the brain’s fear circuitry. As a result, disabling phenomena such as fear and anxiety fall by the wayside.

But it doesn’t stop there, as the anterior cingulate then ramps-up alertness just in case we need to defend ourselves.

Well, the bottom-line is we’re left in this emotionally void and hypervigilant state.

Ramachandran proposes we have but two alternatives to account for what’s happened: “The world just isn’t real,” presenting in the form of derealization, and “I’m not real,” presenting in the form of depersonalization.

Our Mind, Our Protector

I find all of this really very fascinating, especially when you consider that something that feels so horribly frightening, and that holds the potential to cause such major dysfunction, may actually be the mind’s naturally intended way of protecting itself.

Indeed, the mind may be saying, “I’ve got a bit more than I can handle here, could someone please help me out?”

To me, assigning a personality, if you will, to the mind gives its distressing phenomena a bit of softness and gentleness – making them seem so much less abysmal.

I mean, it’s like the mind is this living, feeling being to which we can show compassion as it’s hurt, confused, worn-out, and desperately in need of rest and care.

I really believe in this relationship with mind, and it’s my opinion that the only thing that keeps us from realizing its fullest two-way potential is overcoming our misinterpretations and overreactions to the mind’s naturally occurring protective mechanisms.

Yes, as soon as we sense the beginnings of sensations such as DD, and the alarms sound, we think our way to exaggerated and inappropriate reactions. And it’s this dynamic that causes all the hubbub, not the perceptual alterations themselves.

How to Manage Derealization and Depersonalization

Okay, so what are we going to do to cope with DD in the immediate, and to prevent return visits?

First of all, we’re going to accept DD for what they are – not Capras, Cotard’s, and so many more disorders (I’ve heard ’em all). And then we’re going to make the focus of our intervention the underlying pathology that’s generating DD – anxiety, depression, bipolarity, high-stress, trauma, etc. In this context, DD are symptoms, not independent diagnostic entities.

During an episode, we’re going to keep cool and understand we’re not going insane, and what’s happening is not a permanent arrangement. And always, always, always – we’re going to keep moving forward.

One other note. There are meds that may provide some assistance. Certainly the antidepressants and mood stabilizers may address the foundational issues that generate DD.

And, of course, the benzodiazepines (Xanax, Ativan, Klonopin, etc.) may bring relief (though is that a road you really want to travel?). And then, the atypical antipsychotic, olanzapine (Zyprexa), has been used in particularly stubborn cases of DD. But really think long and hard before hitting that highway.

We Did It

That’ll do it for the series. And I believe a very important series it is, because derealization and depersonalization – so often misunderstood – can wreak havoc on millions of lives.

Surely, the more information we circulate, the better off we’ll all be.

Speaking of more information, tap away for hundreds of Chipur mood and anxiety disorder titles.

  • nathan cruise July 23, 2010, 11:43 am

    Im going through derealization and i must say it is the most terrible thing someone could ever go through…..

    • Bill July 23, 2010, 12:21 pm

      I’ll tell ya’, Nathan – as you read in the first of the series, I’ve been there/done that, as well. And it’s for sure a horrible experience. I’m very thankful neither derealization or depersonalization have knocked on my door for many years. But DD still has a negative impact on my life, as there isn’t a whole lot I can recommend for relief for those who ask me about it. The only things I can emphasize – and they’re still incredibly important – are to understand it isn’t a major neurological situation, it can definitely exit for good, and make sure we address the underlying pathology that may be causing it. Thank you so much, Nathan, for commenting. You’re welcome anytime. Oh, don’t ever hesitate to drop me a private note if you need to…

  • Rufus Sear April 16, 2011, 9:40 pm

    Lovely articles
    Helped indubitably

    • chipur April 16, 2011, 10:14 pm

      Thank you for your kind words, Rufus. And I sure appreciated your wonderful email. You know, we’re all here to help and support each other. There isn’t a one of us who hasn’t been in the midst of deep/dark despair and hopelessness. And it’s up to us to reach out to our mates as we’ve found our sea legs. Great having you – come on back again!

  • Harris Harrington April 21, 2011, 7:56 pm

    I also suffered from depersonalization. What I found, in the course of researching DP, was that it is largely caused by abuse and trauma in childhood. Processing this trauma is one of the most important aspects of recovery.

    I have created a ten-hour program that goes through this process and much more. I also have a lot of free articles and videos on the topic of depersonalization. You may be interested in my website:


    • chipur April 21, 2011, 8:58 pm

      Harris – sure appreciate your visit to chipur and your comment. I visited your website and read your story. I appreciate your openness. chipur readers – this is not an endorsement of his philosophy and program; however, Harris’ site is worthy of a look-see. Again, Harris, thank you for participating.

      • I-suffer February 8, 2013, 5:37 pm

        Why don’t you endorse Harrington’s philosophy?

      • chipur February 8, 2013, 7:13 pm

        “…this is not an endorsement…” simply means I’ve not put the time in to thoroughly review Harrington’s philosophy and program. At least not enough to offer an endorsement. It may well work for some – not for others. I will, however, say I have a hard time with websites for programs/products that address emotional/mental health issues that propose a “cure.” I mean, who wouldn’t jump at that if they were suffering horribly? Hey! As I said, his program may work for some. Who knows? I’m simply not willing to provide a well-considered endorsement. Thanks for visting Chipur and participating!

      • I-suffer February 9, 2013, 2:49 pm

        Thank you for your prompt reply! Can you recommend a book that can help me deal with depersonalization? I have suffered from it for many years and none of the therapists that I have seen understand. It has become debilitating for me for the past 3 winters. I am on the verge of taking a leave of absence from work. I was traumatized as an infant when my parents left me with caretakers when I was only 8 months old for 3 months! I experienced several more traumas during childhood and early twenties. Unfortunately, I married a man who is financially irresponsible and want to leave him but my parents and siblings offer no support. I am filled with fear that continues to escalate.

      • chipur February 9, 2013, 7:49 pm

        Hi Laura!
        Always happy to reply as quickly as possible – no sweat. Thank you, actually, for visiting Chipur and contributing. It’s participation such as yours that helps everyone.

        Ah, depersonalization and derealization (I’ll go with DD) – those dissociative states that bring such great despair. And, believe me, as a past “victim,” I can sure understand why. When it comes to recommending a book that will help you deal with your depersonalization experience I’m going to beg off, and I’ll tell you why. Frankly, there isn’t a whole lot out there that offers much on treatment. And that’s because no one really knows how to treat it within the context of DD being an independent pathology/diagnosis. But it’s my opinion that DD within the context of a mood/anxiety/trauma disorder isn’t an “independent pathology/diagnosis,” rather a manifestation – yet one more symptom. That said, treating DD is about addressing and managing the foundational mood/anxiety/trauma issue. If that’s done effectively, there’s no need for the veil of DD – and it goes away. Does that make sense?

        I’m not trying to toot my own horn, but my three part series on DD is about as good as it gets. And that includes Mr. Harrington’s “cure” (still bugs me when folks use that word when marketing something to those enduring emotional/mental health issues) program. Interesting, I have a client who bought Mr. Harrington’s program some time ago. She stated it’s full of information; however, it just didn’t work for her. Still, it may help others (no offense Mr. Harrington, should you read this).

        Tell you what. If you’d like, I’d be happy to chat a bit on the phone with you. Perhaps it’ll put your mind at ease. Won’t charge you a cent. If that’ll work for you, email me at and we’ll arrange a time. K?

        Don’t give up!


      • I-suffer February 9, 2013, 10:13 pm

        Bill, your 3-part series on DD and DR are the most helpful articles that I have read on the two conditions. As you know, they are horrific to experience. Your light-hearted approach is comforting. Why don’t many psychologists or psychiatrists understand how to help people who suffer from DD and/or DR?
        Thank you for your important insight. I feel much better after reading your articles!

      • chipur February 10, 2013, 1:56 pm

        Thank you for the kind words regarding my series on derealization and depersonalization. Sure am glad the articles got you feelin’ better. You know, it’s hard to say why so many emotional/mental health professionals shy away from helping those experiencing these troubling dissociative states. Maybe it’s because they truly don’t understand them – and have never experienced them – so in some manner they attempt to “deny” them. Maybe they elect not to become proficient regarding subject matter they perceive to be over their heads. Or maybe it’s about not wanting to work difficult cases. For example, it’s no secret that many emotional/mental health professionals don’t like working with those enduring borderline personality disorder. It can be very difficult and dicey work, and some just don’t want to deal with it. So who really knows, Laura? At any rate, that phone chat offer still stands. Again, thank you for your contribution!

  • raw + peace + love. June 5, 2011, 3:26 am

    Bill, thanks again for taking the time to post this :] I hope it helps others as much as it helped me.


    • chipur June 5, 2011, 12:39 pm

      You’re welcome, Maggie. It sure is a frightening set of circumstances. But when you find out what’s going on – and that others have experienced it – you can grab a piece of comfort.

  • Megan June 22, 2012, 10:34 pm

    Hey, nice article! I am a long time sufferer of chronic Depersonalization and Derealization accompanied by Panic Disorder and Agoraphbia, The most likely cause my family can surmize for this is trauma I underwent as an infant. I have seen quite a bit of this information before, but not all of it. I have also seen brain scans done on people with this condition headed by Dr. Daphne Simeon. There’s not a lot of study done into this disorder which upsets me terribly because it really disrupts my life with the terrible terror is causes on a daily basis. Simple things are no longer simple. I have been on the lookout for things to help but I found that that is really not applicable to my particular predicament most of the time. However, I am all for doctors looking into this. It is FREQUENTLY misdiagnosed as a psychotic condition, which it is not. The “DSM” clearly puts it under dissociative disorders. I have been misdiagnosed as psychotic but three doctors overturned this diagnosis although my painfully inept psychiatrist keeps pursuing the idea. He even landed me in the hospital by pushing antipsychotics on me over and over again. Currently, I am back on Zyprexa once again. Well, you can’t beat the system! :) Anyhow, thank you for your work. It means A LOT to folks like me to see that some people really do care about this commonly misunderstood and overlooked disorder. It is Hell and has robbed me of the ability to have a normal life and is even disrupting a romantic relationship. I wish for a cure, but I am not going to tell myself one is anywhere around the corner. I don’t believe it will happen in my lifetime. I just wish there was a reasonable way to control the manifestations of this disorder so that I might live a normal life and have the normal things I desire. However, there is no use feeling sorry for myself. A lot of mental illnesses rob people of their joy and happiness. It’s not as if I am the only one to ever be afflicted or visited by pain. Thank you again for the article! I enjoyed reading it. I am also sorry that I wrote so much! :) Have a nice day!  

  • Megan June 22, 2012, 11:03 pm

    I’m sorry, I went back and read this a second time! Brilliant work, Dr. Ramachandran. Taking into fact that this disorder is notoriously resistant to
    medication, (there is NO prescribed course nor cure) your conclusion
    makes GREAT sense! Dr. Ramachandran concludes that this disorder may be a
    neurological disorder caused by “altered brain circuitry”. If the glitch is in
    the brain and not due to a chemical imbalance (such as a mental illness is)
    then that explains why we cannot cure it! That is not good news for me, but it
    is at least a breakthrough of sorts! It means, basically, that my brain’s connections are faulty. It makes sense that psychiatric
    drugs can’t cure anyone with this disorder if it is a neurological anomaly.
    That would be like trying to treat Parkinson’s with cough syrup! I’m not happy
    that I will never be cured but this sure makes a lot of sense. Yes, this disorder is
    classified in the “DSM” as a dissociative disorder. However, psychiatrists have
    only proven one thing concerning this disorder: They CANNOT treat it in any way
    and they OFTEN misdiagnose or misunderstand it gravely.  

  • Thaler March 4, 2013, 7:54 pm

    Ejecting certain people out of my life got me out of it, and getting better sleep. Night and day difference. I appreciate your light touch on this topic. Thank you for the wonderful articles.

    • chipur March 4, 2013, 9:48 pm

      You’re more than welcome, Thaler. And thank you for visiting Chipur and participating!!!

  • Peter Kretschman June 23, 2013, 10:48 pm

    Thank you for writing these articles. I’ve been in a constant state of DD since 1996, and up until now I’ve only sought treatment from mental health professionals, and never on the Internet. But, I’m finally overcoming my intense anxiety about seeking information in this way, and it’s good to see that I’m not alone.

    Actually, the main reason I’ve avoided using the Internet for DD research up until now is that I’ve been afraid of what I might discover. The duration of my condition is a major concern, and my greatest fear is that it might be permanent. Do you have any advice for someone who’s been suffering for as long as I have?

    • chipur June 24, 2013, 8:30 am

      Hi Peter! Glad you decided to challenge your anxiety and step-out. And what do you know? You didn’t discover anything horribly upsetting. Not only that, you found you weren’t alone in your suffering. That’s great! I guess my priority piece of advice is continue to reach-out and learn about what’s going on. And accept that it’s a symptom of your anxiety/depression – and not a permanent arrangement. However, you have to work hard toward insight, keeping your mental edge. Oh, I’m hoping you have a relationship with a counselor who knows you well and can challenge you to keep moving forward. Thank you for visiting Chipur, Peter – and contributing!

    • Patricia Miller June 24, 2013, 10:29 am

      Hey, Peter…. I just wanted to offer some encouragement that this does not have to be a permanent state of affairs for you. Counseling has proven helpful for me, with some targeted steps along the way. I absolutely started on medication for my depression, and when the anxiety took me to a place where I just thought I was reaching a place that was untenable, I went back to my prescriber and asked for a prescription there too.

      I used the anti-anxiety meds PRN (as needed) more at the beginning, and very little now as I developed new tools and strategies in counseling. I gathered confidence as I did this, and my fear diminished over time. Now the depression was of a long standing nature and I know enough about depression to recognize the damage a long-standing, untreated depression can do to the hypothalamus, so I’ve not even considered stopping my antidepressants. My antidepressant medication (Viibryd) is working well and does not provide me any side effects, so there is no push within me or from any of my support team (medical doctor or counselor) to even go there.

      I just want to give you some hope from the other side Peter. You don’t have to expect your future will always be this way; you have the power to change the world in which you live and there is relief possible. Cling to that possibility.


      • chipur June 24, 2013, 7:02 pm

        Thank you, Patricia! Very thoughtful…Bill

      • Peter Kretschman June 25, 2013, 12:55 am

        Thank you both for responding. :) I have indeed built a rapport with a small group of counselors, and feel I have been slowly moving toward recovery. That slowness is what gets to me, though, and what prompted my searching for info on Google. There are times when I feel that the worst is behind me, and that all signs show that I’m making significant progress, and then there are other, sadly more numerous times when I feel as though I’m stuck in the mud.

        However, I’m determined to keep plugging away. I’ve been at this for close to 17 years, and I’m not about to stop now. Learning that there are others out there with similar experiences is extremely helpful. :)

      • chipur June 25, 2013, 8:44 am

        So glad to read you’re involved in counseling, Peter. And it seems as though there’s a good match. That’s really so important. Yes, progress can seem to be slowing down at times, and that bothers us because we want to move beyond the pain and suffering as quickly as possible. But rest assured, though things may seem to bog down, positive things will continue to occur within if we keep our minds and efforts on the prize. Wishing you the best, Peter – and Chipur will be here for you! Bill

  • Chelsea July 30, 2014, 5:03 am

    I’ve had this happen to me on several occasions. I might walk by a mirror and I stare at myself and think “Is this really me in the mirror, is this really my life” it usually takes a few minutes before the fog lifts and I’m back in reality, but I’ve never freaked out when it happens. I usually just stare at my hands, myself or look around in awe because in the back of my mind I know its real I just have an overlay of dreamy fog. I’ve also done this while talking to people and wonder if they’re real. Its such an alien sensation! Thank you for the article!

    • Chipur July 30, 2014, 5:21 pm

      Hey, Chelsea! Thanks for happening-by and contributing. The more info we can accumulate, the better for all. No doubt, an “alien sensation” – mega-spooky. However, as you know – benign, and not a permanent arrangement. More than welcome for the article. May I ask, do you still have episodes? And you manage well? Sure seem to have in the past…