A brief history of dpafu

Descriptions of the symptoms of depersonalization disorder have appeared in books since the early nineteenth century, several decades before the condition was given a name. For example, an early letter written by a patient described her symptoms as follows:

I continue to suffer constantly . . . My existence is incomplete. The functions and acts of ordinary life, it is true, still remain to me; but in every one of them there is something lacking. That is, the sensation which is proper to them . . . Each of my senses, each part of my proper self is as if it were separated from me and can no longer afford me any sensation.

The name depersonalization was suggested by Ludovic Dugas, a French psychologist, at the end of the nineteenth century. It was intended to describe ‘a state in which the feelings or sensations which normally accompany mental activity seem absent from the self; there is an alienation of the self; in other words a depersonalization’. Dugas thought that depersonalization reflected an abnormality of a normal mental function he called ‘personalization’.

Early theories proposed that depersonalization was caused by a physical or neurological disorder. Doctors believed they were unable to identify the exact nature of the condition due to unsophisticated equipment and lack of technology. Others argued that depersonalization was really just an absence of emotional feelings. Later ideas drew attention to the fact that depersonalization is commonly associated with anxiety or feelings of being under threat, as seen for example in the accounts of people who were imprisoned in concentration camps and of survivors of other traumas such as road traffic accidents. This association was seen as suggesting that depersonalization served as a protective mechanism. Given the fact that extreme states of anxiety can cloud judgement and lead to reckless behavior, it was proposed that depersonalization served to dampen down such potentially disruptive emotions.

The following case provides a good illustration of the way depersonalization can work to protect us:

A man was driving at some speed on a wet road and, as he turned a corner, the car skidded. He immediately experienced a dream-like detachment and found himself steering mechanically. He was also aware of his actions as if he were viewing some other unfortunate victim from a distance. After spinning round several times, and narrowly avoiding oncoming traffic, the car finally came to a halt facing in the opposite direction. The driver felt quite calm but when the bystanders spoke to him their voices seemed muffled and the surrounding countryside appeared still, remote and unreal. His own voice also sounded unfamiliar. He drove on feeling quite calm and arrived at work. After a few minutes of being involved in his daily activities, his depersonalization suddenly lifted and he became aware that he was perspiring, trembling severely and his heart was pounding at a rapid rate.

Such theories didn’t really explain how some cases of depersonalization become long-lasting – once the anxiety or threat had gone, you would expect that the DPAFU should disappear as well. But long-lasting cases were believed to be the manifestation of an accompanying psychiatric condition such as depression. Such was the view proposed by the German psychiatrist Mayer-Gross. He viewed depersonalization as a symptom that could be triggered by a whole range of different neurological or psychiatric conditions. In 1946, H. J. Shorvon, an eminent British psychiatrist, disagreed with this view and suggested that there was a distinct group of patients who appeared to experience the symptoms of depersonalization with no other discernible psychiatric cause. However, the fact that patients with long-lasting depersonalization also suffered from anxiety led the psychiatrist Sir Martin Roth to suggest that depersonalization may be an anxiety condition and he came up with the name ‘phobic-anxiety-depersonalization syndrome’. Like earlier writers, he suggested that depersonalization may have been intended by nature as a form of coping mechanism to help us deal with extreme situations.

Unfortunately, for most of the second half of the twentieth century there was much less interest in depersonalization. It became almost accepted that severe depersonalization was extremely rare, and that when it was experienced, it occurred as an almost irrelevant symptom of another condition such as depression or schizophrenia. Not surprisingly, such assumptions had a negative effect on the amount of research being done, and it is fair to say that up until the mid-1990s our understanding of this condition had changed little since 1950. Fortunately, this gloomy scenario has dramatically changed over the past fifteen years following renewed interest in the condition. There have been major advances on several fronts. Larger than ever numbers of patients with depersonalization disorder have now been carefully studied, resulting in a thorough tracking of the clinical manifestations and clinical course of the condition. New questionnaires designed to detect and gauge the severity of the condition have been created, which have allowed doctors to make a more accurate diagnosis of the condition. In turn, this has also enabled more rigorous research into DPAFU. In fact, for the first time doctors are beginning to understand the mechanisms in the brain, which are involved in depersonalization. Recent large-scale surveys of the general population are also starting to reveal that, far from being a rare condition, depersonalization disorder may in fact be as common as well-known psychiatric conditions such as schizophrenia or manic depressive illness. Lastly, but not least, the last decade has seen important advances in both the psychological and pharmacological (i.e. drug-based) treatment of this condition.