Speaking of Depersonalization: Reality Testing, Language, and Lived Experience

The thesis of this essay is that the desire to categorize psychiatric patients in a binary way—as either recognizing that their bizarre experiences are subjective and unreal or wrongly believing them to be objective and real—has resulted in misleading ways of talking about depersonalization/derealization disorder (DPDR). This has, in turn, obscured how the disorder presents in severe and continuous cases. In particular, it has led researchers to describe DPDR as a subjective experience of unreality which the person knows is objectively untrue. Yet, statements like these fail to capture or even acknowledge a third possibility, namely, that those with severe and continuous DPDR might be best characterized as having not a conviction of the reality of the “objective” world, nor a conviction of its unreality, but a skepticism or doubt about its reality, driven by a disintegration of their lived experience.