Name: Louise Airey
Condition: Depersonalisation disorder
鈥淚 feel like I have been dropped into my body. I know this is my voice and these are my memories, but they don鈥檛 feel like they belong to me.鈥�
It happened out of the blue. Louise Airey was 8聽years old, off sick from school, when suddenly she felt like she had been dropped into her own body. 鈥淚t鈥檚 just so difficult to verbalise what this feels like,鈥� she says. 鈥淎ll of a sudden you鈥檙e hyper aware, and everything else in the world seems unreal, like a movie.鈥�
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She panicked, but told no one. The feeling soon passed but returned several times until, at the age of 19, a migraine triggered a sensation of being disconnected from the world that was to last 18 months. When she was in her 30s she was diagnosed with depersonalisation disorder 鈥� an altered sense of self with all-encompassing feelings of not occupying your own body, and detachment from your thoughts and actions. It has come and gone throughout her life, but since a traumatic pregnancy 20 months ago, these feelings have remained constant.
鈥淥ther people seem like robots,鈥� Louise says. 鈥淚t鈥檚 like I鈥檓 watching a film, like I鈥檓 on my own in the centre of everything and nothing else is real. I鈥檒l be speaking to my children and I鈥檒l catch my voice talking and it seems really alien and foreign. It makes you feel very separated and lonely from everything, like you鈥檙e the only person that is real.鈥�
Not so rare
Depersonalisation disorder is not as rare as you might think, says at King鈥檚 College London and the Maudsley Hospital: it may affect almost 1 per cent of the British population (). We鈥檝e all probably experienced mild versions of it at some point, in the unreal, spaced-out feeling you might get while severely jet-lagged or hung-over, for example. Now neuroscientists are beginning to uncover what goes wrong in those who persistently feel unreal. Their findings could tell us something about how we all form a sense of self, and potentially, bring a treatment for those who have the disorder.
The sense of self has much to do with our awareness of our physicality and how we interact with the outside world. The brain integrates all the information coming in from the external world and from internal sensations and forms a default setting of 鈥渢his is me here and now鈥�, says , who studies depersonalisation at the Brighton and Sussex Medical School, UK. 鈥淚f that setting changes somehow, then you feel 鈥榥ot right鈥�, in a way that might be very hard to put into words.鈥�
There are probably several ways that change can occur, but Medford鈥檚 work is looking at the emotional detachment characteristic of depersonalisation. In people who have the disorder, areas of the brain that are key to emotion are much less active than normal. These people also show unusual autonomic physical responses to external stimuli, such as evocative images ().
David and his colleagues are also looking at why people with depersonalisation disorder report emotional 鈥渘umbing鈥� 鈥� the feeling that the world is somehow alien. They have found that some areas in the brain鈥檚 frontal lobes, which help keep emotions in check, are overactive, or too controlling.
Living the scream
One symptom related to this skewed brain activity is the sensation of all sounds competing against each other to be heard. It鈥檚 like living inside , Louise says, which some critics have suggested is about depersonalisation. 鈥淭he person and the landscape are screaming, you can鈥檛 get any peace.鈥�
Another area of the brain that appears to be less responsive in depersonalisation is the anterior insula, responsible for integrating physical and emotional sensations. This might explain why sufferers don鈥檛 feel in touch with the world, Medford says.
It鈥檚 not only the outside world that seems strange, says Louise. The disorder makes it almost impossible for her to relate to herself. 鈥淓verything that you鈥檙e familiar with yourself 鈥� your thoughts, your memories 鈥� become alien,鈥� she says. 鈥淢emories of things you鈥檝e done don鈥檛 feel like they belong to you; it robs you of your past. I know rationally that they鈥檙e my thoughts, my voice, my memories, but they鈥檙e all wrong 鈥� that why it鈥檚 so frightening. It takes away the core of who you are.鈥�
Louise says she would investigate any potential treatment. There is that has shown some promise when combined with an antidepressant in trials. Transcranial magnetic stimulation 鈥� in which an electromagnet stimulates or suppresses neuronal activity 鈥� is also being explored by David鈥檚 team to retrain the depersonalised brain.
鈥淩ationally knowing that I鈥檓 real, that these memories are real, that my voice is my own, but not feeling like they all belong to me is somehow worse than being away with fairies,鈥� Louise says. 鈥淚t鈥檚 like I鈥檓 a sane person gone mad.鈥�
