Depersonalization, derealization and psychedelics

This article looks at derealization as a effect of meditation and psychedelics, both wanted and unwanted.

The first two thirds of this article - on derealization and psychedelics - are free. The last third, on virtual reality and mass de-realization, is for paid subscribers only.

Twin Peaks: The Return, which I watched before going on an ayahuascca retreat. I then experienced the derealization explored in the series.

In 2017 I went on a 10-day ayahuasca retreat in the Peruvian Amazon. The retreat itself went great, except for one trip where, for a few minutes, I completely dissociated and forgot my name, body and species. Apart from that I was A-OK. The real problems arose in the days after the retreat. I took three flights to get to the Galapagos Islands, where I intended to do my ‘integration’. But during that journey, I decided I wasn’t in ordinary reality. Time distortions, uncanny events, and a strong feeling of unreality convinced me I was in some alternate reality. What I couldn’t figure out was what reality I was in. Was I dead? But I was still conscious. Was it the afterlife? A bardo state? Was I in a dream, a coma, perhaps even an artificial reality created by one of the shamans on the retreat.

This sense of being in a dream or bardo state lasted for about three days. I didn’t freak out but felt a sense of nausea, numb dread and forlornness at being separated from my loved ones (perhaps forever, if I was indeed dead). Then, a friend back in London picked up that I wasn’t well (probably when I texted ‘I feel like I’m in a dream’) and told me to come home. So back I went, on three fake planes, on one of which I upgraded to fake first class with my fake credit card. When I finally arrived back in London (which looked fake), my friend was waiting for me in the arrivals lounge. The moment I hugged her, and smelled her hair, I decided she was probably real. It was emotional connection with my loved ones that brought me back into this reality, though still, over the next week or so, I had moments where my sense of reality wobbled. My friends would ask ‘how real is this feeling? 70%?’ Two weeks after I left the retreat, I was 100% back in consensus reality. Well…maybe 95%.

If you want a longer account of this experience, check this book out

It was one of the most bizarre experiences of my life. But what I’ve realized, while working on the Challenging Psychedelic Experiences Project, is it’s far from unique. Earlier this year, we sent out a survey asking people if they’d ever experienced post-trip difficulties lasting longer than a day, and if so, what was it like and what helped them cope with it. We’ll publish our full findings in a couple of months. We got 608 responses, laying out a cartography of purgatories and hell-spaces. Jesus said: ‘In my father’s house are many mansions’, . We can map those mansions of the mind, including some of the darker rooms.

Two of the most common sorts of extended difficulty were depersonalization (feeling your identity has fragmented, become untethered, or dissociated from your body) and derealization (feeling external reality is unreal, that you’re in a dream, purgatory, movie, computer game or some artificial world). 15% of our respondents reported depersonalization and 14% reported derealization (often people reported both). That doesn’t mean that 15% of psychonauts experience depersonalization / derealization. But it does mean it’s one of the most common sorts of extended difficulty, and some evidence suggests that people who use psychedelics and other mind-altering drugs (especially cannabis) experience Depersonalization Derealization Disorder more than the general population, where the incidence of chronic DDD is around 1%.

Here are some of the accounts from our survey. I’m struck by how similar they are to my experience:

I had a very bad trip on LSD. I felt like I had no grip on reality...Throughout the next 2 months, though, I sometimes had moments when something just didn't feel quite right. I felt anxious or like I had to flee certain situations for no reason…Then, almost exactly 2 months after the trip, something happened. I was in a restaurant and I began to feel like something was wrong…I went to the bathroom. All of a sudden, the bathroom was not real. It just looked WRONG. I had to get out of there. But when I left the restaurant, the street outside was not real either. The whole world was simply not real, and I felt like I had to vomit. I still knew on some level that it all HAD to be real, and that the feeling of unreality was an illusion. But I could not escape the suffering…Every morning for a week or two after that, I woke up suffering. My body could not stop being on edge…I was constantly feeling anxious and my body felt full of sick, nervous energy. The world around me kept becoming unreal. It just looked WRONG… It was like I had been transported to a horrible alternate universe and didn't know how to get home…It took an astonishingly short amount of time for me to feel like I truly understood, for the first time, why someone would kill themselves. I was not suicidal, but I felt that if this went on I eventually would be.

Some of the reports sound like Capgras Syndrome – a neurological condition in which you believe loved ones have been replaced by imposters. For example:

From the moment I entered this psychedelic experience with DMT (changa), I had an immediate and overwhelming conviction that I had displaced myself into a different, yet very similar, reality. While I knew I appeared to be in the same place and with the same people as before the experience, I was completely convinced that I was not in the same reality/dimension. For two days following the experience I continued to believe this, and felt intense paranoia and helplessness.

Or it can sound a bit like Cotard’s Syndrome, in which people think they are dead (although in our post-psychedelic reports, people are more likely to believe they are in the afterlife, hell, purgatory or a bardo state). For example:

I couldn’t differentiate between reality and the experience. I felt I had passed away and was stuck in purgatory.

There are some famous cases of derealization / depersonalization in drug literature. The first time Timothy Leary took LSD, he had a nightmarish dissociative experience which affected him for the rest of his life. He went to his daughter’s bedroom, where she looked up and said she loved him:

A shock of terror convulsed me. This was my daughter and this was the father-daughter game. A shallow, superficial, stereotyped, meaningless exchange…The plastic doll father and the plastic doll daughter both mounted on little wheels, rolling by each other around and around on fixed tracks…

He goes downstairs where his son is watching TV, and a character on the TV show looks at him and says ‘You’ve been dead for two seconds’.

Ever since that day I have had a recurring science fiction paranoia which comes up in almost every LSD session…I am suddenly on camera in an ancient television show directed and designed by some unknown intelligence. I’m the pathetic clown…

John Horgan, the leading science journalist, has also written of an experience of derealization after an extremely powerful psychedelic experience:

My most serious, sustained bout of derealization occurred after a drug trip in 1981, which left me convinced that existence is a fever dream of an insane god. For months the world felt wobbly, flimsy, like a screen on which images were projected. I feared that at any moment everything might vanish, giving way to—well, I didn’t know what, hence the fear. These feelings over the years have lost their visceral power over me, but their intellectual aftereffects linger.

Part Two: The latest science on Depersonalization-Derealization Disorder

What are we dealing with here? I asked Professor Anthony David, director of the UCL Depersonalization Clinic and a world expert on the condition, to tell me more about it.

He says:

Today the condition is known as Depersonalisation Derealization Disorder (DDD). There’s a decent consensus that it is a psychiatric condition that’s seen all over the world and been recognized for over a hundred years.

The name depersonalization was introduced 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’. Henri Frédéric Amiel, the 19th century Swiss philosopher and writer, described what may be the first written account of DDD in his journal: “All is strange to me; I am, as it were, outside my own body and individuality; I am depersonalized, detached, cut adrift. Is this madness?,” he writes. But he answers his own question with a resounding “No”: “I have been able to look at things with the eyes of a blind man recently operated upon.”

What, I asked Professor David, causes DDD? He says:

A lot of the research now sees it as part of a spectrum of anxiety disorders that then leads to dissociation. There’s an emerging consensus over mechanism and etiology. At the physiological level there are a few signals – something about having a dampened physiological response to certain emotional stimuli, and that leads to the sense that things don’t feel quite real.  There’s a theory that DDD emerges from an evolutionary trauma response. Something happens and you feel cut off, unnaturally calm, as a defence response.

In other words, some forms of dissociation are normal – they just naturally occur, especially when we’re tired, or if something potentially traumatic occurs to us. One study found that just over 70 per cent of people reported experiencing brief, transient depersonalization or derealization at some point in their life. It might not always be unpleasant.

With chronic DDD, people get stuck in that dissociative state for weeks, months or years. This seems to occur to around 1-2% of the general population, but the incidence is higher among certain groups. One study by Professor David and others found higher rates of DDD among victims of interpersonal abuse. Drug users and former drug addicts also show higher rates of DDD. Professor David told me his clinic sees particularly high rates of DDD among young cannabis users:

A typical story will be ‘I used cannabis from time to time. There was this one time I felt quite uncomfortable and nauseous. I went to bed, woke up, and it was still there, and has been there ever since’.  

It also seems to happen more often to meditation practitioners – it is a sort of experience of ‘no-self’ or anatta, which is actually one of the goals of Buddhist meditation. But it can occur unexpectedly to meditators and be deeply unpleasant. The Varieties of Contemplative Experience Project at Brown University interviewed meditators about adverse experiences, and 30% reported a disturbing loss of sense of self and agency, like this interviewee:

It basically felt like whatever personality I thought I had before just disintegrated. And it wasn’t an expansive disintegration into unity or bliss or anything like that. It was a disintegration into dust. And I really had the feeling of being in a very, very, very narrow, small, limited psychological space. […] I didn’t believe in all the things that people do to tell themselves that ‘something is worth it’ or ‘just be you’…I came to this conclusion during that time period that personality is just a structure without any real substance to it.

Sometimes, respondents to our survey felt very frightened they had done permanent damage to their brain. Is that true, I asked Professor David. Is it a neurological disorder?

The answer is…we don’t know. We don’t know if it’s the chemical effect or a traumatic mental state or panic attack…We just don’t know.  What makes it a bad experience is the feeling of loss of control.

And what is it like to experience it, emotionally? I experienced derealization for a week or so, and it was both fascinating but also deeply disconcerting – I felt cut off from the human race, and especially from my loved ones. Everyday reality was uncanny, sickening. I can’t imagine what it would be like to be in that state for months or years. Professor David says:

At its most severe it can lead to anxiety, depression and suicidal ideation. But there’s a lot of people out there who have persistent DDD, but they’re just carrying on and you wouldn’t necessarily know. It’s only because of the internet that you find their accounts. They might feel they’re life isn’t 100% but they just carry on.

Another issue our respondents reported is the fear they are losing their mind and going psychotic. Is it a psychotic disorder, I asked Professor David. He said:

The distinction is that DDD sufferers feel ‘as if’ they are dead or in a movie etc. But it’s a metaphor. They know it’s not real. When a person stops being able to objectively look at the situation, when it starts to feel really real, that is becoming like a psychosis. The same metaphors will be used, except they’re not metaphors for that person.

This is not a hard-and-fast distinction. Several of our respondents – myself included – emerged from psychedelic experiences not able to tell what is real for a few days. They may not be totally convinced they’re dead, say, or that other people are imposters. But they’re not totally sure. However, thankfully the ontological uncertainty is usually transient.

What treatments are available? Professor David says:

There is not really a reliable, tested, evidence-based treatment. Cognitive Behavioural Therapy can be helpful, because people get stuck in an anxiety vicious circle, worrying about the condition and thereby exacerbating it. CBT can help break that cycle and lessen rumination.

What about medication?

Every medication you can think of has been tried. We use anti-depressants quite a lot, and they help, but we don’t know if it mainly helps with secondary depression. Anxiety drugs like Xanax also help some people. A drug called Lamotrigine seems to block the effects of ketamine, so we tried that on its own, which didn’t help, but a combination of Lamotrigine and SSRIs seemed to give some benefit.  There’s also a support group for people with DDD, called Unreal. We don’t see many people who are completely cured. We see people coping with it better but rarely do they say they are back to normal.

This is a difference to the respondents in our survey, who on the whole have short-to-midterm derealization, and sometimes at least it passes. It did for me, and for others, like this redditor: ‘I had severe DP/DR for about 6 months following a really bad trip on LSD + weed. It’s since gone away.’

What did our respondents find helpful in dealing with DDD? We will publish our results soon, and we may do a paper specifically on post-psychedelic DDD (if you want to help us fund that, get in touch). But, from our initial results, people found three things helpful in coping with extended psychedelic difficulties including DDD:

1)     Support from others, including therapists, friends and peer group circles. People found it helpful to share their stories, to feel listened to without judgement, and to hear similar stories and realize they’re not alone. Emotional connection was key in bringing me back from transient DDD.

2)     Cognitive strategies. People reported all sorts of coping cognitive strategies, especially acceptance and remining oneself it will pass; or reality-testing and reminding oneself that external reality is real (some people literally repeat ‘this is real’) to themselves.

3)     Somatic strategies. People also reported using practices to feel back in their body and this sensory reality, including breathing, relaxation, exercise, yoga, martial arts, bathing, and walking in nature. These are techniques for re-realization.

It’s important to note that we only gathered reports from people who reported post-trip difficulties. It may be that some people experience post-trip extended depersonalization or derealization and find it liberating. That’s the case with meditation-induced DDD.

One study by Castillo looked at several meditators who reported depersonalization arising through their practice. Some found it unpleasant and disturbing, but others expected it and welcomed it. That was what they were seeking – an insight into the constructed and illusory nature of the self and ordinary reality. The Atlantic magazine interviewed Alice, a 59-year-old accountant who has experienced depersonalization for over two decades:

 “It’s helped me in my life,” she says. Over the past few years, she has learned to interpret her experiences in a Buddhist context, and she describes depersonalization as a “deconditioning” of sorts: “The significance I place on the world is all in my mind,” she tells me. While Alice doesn’t exactly equate depersonalization with enlightenment, she sees it as a sort of halfway, formless state. “I believe I am on the path to enlightenment,” she says.

Alan Watts took a similar view. In ‘The Value of Psychotic Experience’, he wrote:

I talked with a psychiatrist in England just a few weeks ago. One of the most charming women I've come across, an older woman, very intelligent, quite beautiful, very reasonable. And she was discussing with me the problem of the LSD psychosis. I asked her what sort of treatments they were using, and all sorts of questions about that, and she appeared at first to be a little on the defensive about it. We got onto the subject of the experience of what is officially called "depersonalization," where you feel that you and your experience - your sensory experience - that is to say all that you do experience: the people, the things, the animals, the buildings around you - that it's all one. I said, "Do you call this a hallucination? After all," I said, "it fits the facts of science, of biophysics, of ecology, of biology, and much better than our ordinary normal experience fits it." She said, "That's not my problem." She said, "That may be true, but I am employed by a society which feels that it ought to maintain a certain average kind of normal experience, and my job is to restore people to what society considers normal consciousness. I have no alternative but to leave it at that."

Some may agree with Watts and feel that depersonalization and derealization is not a disorder but a deep insight into the nature of things. Here, ‘disorder’ would simply mean ‘unexpected, undesired and disruptive to your life-functioning’. Some do not seek or expect this experience, and they find it profoundly upsetting.

Part Three: Virtual Reality, psychedelics and mass de-realization  

The final third of this essay is only available for paid subscribers, who also get a free ticket to this online event on Aldous Huxley this Sunday.