Depersonalisation — when nothing feels real

Australia Broadcast Center

02-08-2025

Sana Qadar: This episode contains discussion of suicide. Take care while listening.
Nathan Dunne: I was living in London in 2008, and I was a student, and I was in this brand new relationship with this completely enchanting woman called Maria, and in a fit of spontaneity and real excitement, we decided to go for this midnight swim. So we jumped on our bikes, and the spot of water that was close by was in Hampstead. Something happened to me during that swim which I've been trying to work out ever since really. It's taken a couple of decades, but really that moment, that particular onset, was when, it's not hyperbole to say that my life really changed forever. There's like a before and after that moment. What happened was I had a severe out-of-body experience. It was incredibly traumatic. I had no idea what was happening. I completely lost my sense of self, my identity, didn't recognize objects or the landscape around me as the same as before. Reality completely changed. Reality came into question, and my life really collapsed afterwards, honestly.
Sana Qadar: Have you ever felt like things were not quite real? That you were separated from your body, outside yourself, like you didn't know who you were? Maybe it was a fleeting feeling, lasting hours or even days, but what if that feeling went on for longer? For months or even years?
Nathan Dunne: I had no idea that people like myself are caught in limbo with misdiagnoses for years and sometimes decades.
Sana Qadar: And what if the very nature of these feelings made recovery a very steep trek uphill?
Dr Emma Cernis: It's really disabling. I think people really struggle with feeling connected to the experiences that they're having in life, and that's pervasive. So that affects their relationships, that affects their enjoyment of life, that affects their pastimes, their work, their education.
Nathan Dunne: The last thing that I want to do is surrender to this illness. I want to, the instinct is to fight. You know, I want to fight this, but I have no energy left. I don't know how to fight anymore.
Sana Qadar: This is All in the Mind. I'm Sana Qadar, and today we're covering a disorder called depersonalization. Senior producer James Bullen is reporting this one. Hi James.
James Bullen: Hey Sana.
Sana Qadar: What are we going to hear today?
James Bullen: So today we're going to hear the story of one man, Nathan Dunne, and his experience with this disorder. Its full name is depersonalization, derealization disorder, but most commonly people just call it depersonalization.
Sana Qadar: Right.
James Bullen: And the most current scientific research says that about 1% of the population experience this disorder.
Sana Qadar: Oh right, that's similar to schizophrenia, isn't it? Like that's about 1% of the population?
James Bullen: Yeah, yeah, it's about the same, and that's probably a bit shocking to hear for some people, but what they think is that it's often misdiagnosed or missed, and that means that a lot of cases of this go unreported or unnoticed.
Sana Qadar: Okay, yeah, I don't think I've heard much about depersonalization before. Sounds fascinating.
James Bullen: Yeah, Nathan published a book really recently about his experiences with it. So we're going to hear from him about some of his journey, and then we're also going to hear from a researcher about the symptoms, the causes, and the treatments for depersonalization.
Sana Qadar: Alright, let's get into it.
Nathan Dunne: There was an incredibly strong physical sensation, heart palpitations, muscle palpitations, but the strongest and most overwhelming sense that I had was that something was being removed from me, some piece of me was being vacated, and the way that manifest in terms of my perception and my experience was that I was able to look at myself on the bank. So I was a spectator of the event rather than a participant in the event, and that's incredibly terrifying because at once you feel like, am I having a stroke, am I dying, but it was just as though everything of which I understood about reality in the way that I saw it visually and in a tactile manner, that completely shifted. There's really two components, one is this incredibly strong physical sensation, but that is then overridden by the fact that my knowledge and understanding of a reality completely changed, like in a moment, like a switch being flipped.
James Bullen: In that early morning light up on Hampstead Heath, Nathan's life changed. There was a clear, obvious split before that moment and after it. And in the days following this split, this distortion of his sense of self, it didn't diminish, it got stronger.
Nathan Dunne: I experienced an incredibly sharp decline in my mental health, my understanding of the world, this perception shift of reality and everything that was exacerbated in the domestic environment at home, back in my flat. So I kept asking myself and Maria, who am I, where am I, and she had to leave for work, I mean we had everyday lives to get on with, I was meant to be at the library, reading, taking notes, sharpening my pencils.
James Bullen: When Nathan says the decline was incredibly sharp, he means it. Soon after that night at Hampstead Heath, he would try to take his own life.
Nathan Dunne: There was a moment where I felt like I was very quickly moving towards the end of my life. So I felt like, because the sense that I had of being outside of myself was as if I was not my own actor, when I came to the point where I decided to end my life, then it was though the decision had already been predetermined, like it wasn't as though I was making it, it just seemed like the next inevitable step. So it was a very extreme moment, the darkest or lowest point in my life really, but it was as though I myself was not present. It was as though I was just going through the motions as though a robot would dictate the next series of minutes, hours. And so what happened is I found myself in hospital after this attempt and they were as bewildered as I was, the clinical staff, and I underwent a series of tests and there was no particular clarity that came with looking at the MRI or other scans and other kind of basic tests.
James Bullen: In the weeks after this first batch of tests, Nathan would create a document he called the possibles, listing all of the possible conditions that might be causing these bizarre symptoms.
Nathan Dunne: Initially I thought that there must be some kind of extreme mental illness, like I was having some kind of psychotic episode or some kind of bipolar disorder or something, and then it became all of these lesser known and obscure illnesses, I really went down a real rabbit hole. I was so in need, in real dire need of clarity and understanding.
James Bullen: We've all googled symptoms before, but this was 2008, the internet was a little less comprehensive and the same goes for the research literature around this condition. It didn't click for Nathan that depersonalisation could be a possible diagnosis. He would visit one doctor, then another, then another. Most commonly they would say he had anxiety or depression, and so he'd be treated for those conditions.
Nathan Dunne: So I was told very simply that it would be quickly cured, it would be all over with if I took these blue pills. Initially I was very excited, I really did think that I had presented well, I had articulated myself even ham-fistedly, and then I was going to get the help that I needed. The question seemed almost rhetorical, like, here I am, this is my problem, okay, you're a doctor, you will tell me what's wrong with me, and then ergo, we progress to the next stage. I had no idea people like myself are caught in limbo with misdiagnoses for years and sometimes decades.
Dr Emma Cernis: Whenever I speak to people with depersonalisation, they have always had another label beforehand, or they get very frustrated. They're trying to describe this sensation and people keep jumping to conclusions and saying, oh, okay, well, that's depression. I think in particular things like feeling numb, feeling detached, that does sound a lot like depression. I think it takes a lot of curiosity and kind of maybe some precise questions on the clinician's part to really tease that apart.
James Bullen: Dr Emma Cernis is an Assistant Professor of Clinical Psychology at the University of Birmingham in the United Kingdom.
Dr Emma Cernis: And I think that's why often people sort of give up trying to describe it, because they get frustrated that they're trying to get across this very difficult to describe feeling. They feel like they're being brushed aside with, oh, that's just anxiety, that's just depression, when it feels a lot different to that.
James Bullen: So if depersonalisation disorder isn't anxiety or depression, what is it?
Dr Emma Cernis: It's an experience that's really hard to put into words. So the way that we try to define depersonalisation is that it's an experience or a group of experiences where people don't feel quite right in themselves in terms of feeling disconnected, detached, unreal, strange. And what we mean by that is in relation to either their physical body or even kind of a bit more abstractly their sense of self, their identity. People use a lot of metaphors to try and describe it. So they might talk about feeling like they're stuck in a dream or feeling like they're trapped in a bubble. So really, we're talking about this disconnection or separation feeling from all of the things that make us kind of who we are.
James Bullen: You might recognise this feeling in yourself because short spells of depersonalisation aren't uncommon. You might have experienced symptoms as a result of anxiety or depression or witnessing a traumatic event.
Dr Emma Cernis: It is a very normal thing for our brains to do. I think it can be a bit confusing and a bit bewildering at first because we don't really talk about it that much. We talk about anxiety and things like that a lot more. But over 70% of people will experience depersonalisation at some point in their life. And that's not to say it will be a depersonalisation disorder, but it's one of those experiences that is quite common.
James Bullen: What distinguishes Nathan's experience and that of other people with depersonalisation disorder is the length and severity of these symptoms of dissociation. They occur again and again and they're harmful to the person's psychological health. Emma Cernis says there are a few different ideas about what causes depersonalisation disorder.
Dr Emma Cernis: What I see the most is chronic stress. People have got lots of things going on in their lives and each one of those individually probably isn't that alarming or distressing. But it's the combination of having so many things to deal with for so long. And then the other really common thing that people talk about with depersonalisation is perhaps using cannabis or other kind of street drugs that might also then result in them feeling very detached and very depersonalised. And it's quite a common pattern that people then talk about that sticking around or becoming a sort of episodic type presentation.
James Bullen: Some people listening might wonder what differentiates depersonalisation from psychosis, say, or mania. What makes this different?
Dr Emma Cernis: I think one of the key differences between depersonalisation and psychosis or schizophrenia is what we would call the insight. Clinicians talk about insight, which basically means do you have an awareness that the experiences you're having might be a mental health difficulty or due to stress or due to trauma? Do you understand where it's coming from? And you can see that there's something different happening from your kind of normal way of being. And in depersonalisation, that's absolutely the case. People are very aware that the experiences they're having are the way that they are experiencing things. It's the way that they're seeing things. It's not that the world has actually changed, actually become two dimensional. They're not actually detached from their body. It just feels that way. So that level of insight is something that might be compromised or even completely missing in psychosis, where people might be more likely to believe that the world is a simulation or something, for example.
Sana Qadar: I'm Sana Qadar. This is All in the Mind. And today we're looking at a disorder called depersonalisation. So James, coming back to Nathan Dunne's story, he's been searching for what is happening to him. He can't make sense of it. What happens next?
James Bullen: What happens next is something that often happens with people who have a severe depersonalisation disorder, and that is relationship breakdown. Because until this point, he had been with Maria, the woman he took that midnight swim with, up until now. We're going to hear what happens next.
Nathan Dunne: It was very difficult to articulate even to myself what was happening, let alone within the flat when you're preparing, you know, penne pasta or something, trying to say to your partner, look, I don't feel like myself. I don't even feel like I'm here. I feel like I'm somewhat invisible. These are very abstract and philosophical notions, but at the time were very strongly felt by myself. And so Maria basically just left. She just said, look, I can't cope. And after that relationship broke down, I spent at least 18 months, if not longer, trying to recover the relationship. It was a longing not only for this intense early love that we were experiencing, but also a real quest to get back to myself, to really find my way back to the before time, to before this happened, before this midnight swim, before the onset of this illness. But yeah, I found myself completely alone.
James Bullen: That marked several years in Nathan's life where he felt disconnected and divorced from reality. There were good days and bad days, but on the whole, things got pretty bad. But it was a trip back to Sydney that set Nathan on the path to recovery.
Nathan Dunne: I came back to Sydney and I saw Dr. C and he had a background in treating depersonalized patients and also in obsessive compulsive disorder. He kind of was able to read my medical history, hear my patient testimony, and then very quickly recognize that as part of the patients that he'd treated in the past. And so that was a truly illuminating moment, but I was also skeptical at first because as soon as he said the word for the first time depersonalization, it sounded so right on to me. It sounded like here we have this kind of golden name of diagnosis. And yet because of the multiple misdiagnoses I'd had in England, I was very wary of believing that this was going to solve all my problems. And so with Dr. C, he outlined this treatment plan and I was completely on board with it, but I did kind of tread cautiously in terms of my hope.
James Bullen: There were a few different treatments he tried. One is called exposure and response prevention, ERP.
Nathan Dunne: It's basically like an exposure response where typically if say a patient has a fear of being contaminated by dirt or by excrement for example, as strange as it might sound to people who don't have this kind of illness, the treatment is say you have a tissue. You fold a piece of dirt up in the tissue and you carry a tiny piece of it with you around. So it's this very slow exposure to the fear of the patient so there's no flood of symptoms. And so for me it was obviously water. And so the initial prescription was to have a piece of cloth to wet this cloth and to wrap it around my hands and just for at certain times of day and then to use what's called a Stebb's diary to record my emotions and the level of which my symptoms would become exacerbated.
James Bullen: That helped a bit, but the one that really changed things for Nathan was something called repetitive transcranial magnetic stimulation, RTMS.
Nathan Dunne: And basically what that means is that a doctor and a technician is able to locate areas of the brain which have been identified as dysfunctional. Over a series of treatments there are these very low magnetic pulses which are performed on these areas which have been identified. RTMS, this magnetic stimulation, in a way, I mean a colloquial way of describing it would be to say that it kind of attempts to wake them up to their baseline.
Dr Emma Cernis: I think what we're beginning to understand is that there's an area at the front of the brain, sort of near your forehead, called the prefrontal cortex and that is the control room of the brain and it makes those higher level decisions about what's important, what to prioritize, how to respond.
James Bullen: Dr Emma Cernis again, who researches and treats depersonalization disorder and dissociation more broadly.
Dr Emma Cernis: But we've also got these really deep kind of areas of the brain that are much more involved with survival and they just respond and get us into safety if we need to be in safety. What we're beginning to understand about dissociation is that what might happen is that those deep areas of the brain about thinking about survival respond to something. They're on alarm, they're on alerts, they're trying to tell us to do the fight or flight response, they're raising our anxiety levels to get us to move and do something. But the prefrontal cortex pours cold water over everything essentially and squashes down all of those sensations and impulses and urges. And what we think in dissociation is that maybe the prefrontal cortex is doing too good a job at toning all of that alert system down. So that can end up making people feel very numb and understimulated as opposed to sort of anxiety where we might be feeling overstimulated.
James Bullen: Emma says research into depersonalization disorder has focused on treatments grounded in talking therapies. So treatments like cognitive behavioral therapy where you talk through some of your problems and attempt to reframe your thinking.
Dr Emma Cernis: I'm working with a team in UCL to help develop a very specific targeted form of cognitive behavioral therapy which will help with depersonalization disorder. And that is one of the few research teams I think globally that is working on a treatment for this. But I think the important thing for clinicians to realize is that they can still work with depersonalization disorder without having specific treatments at hand. So there's a lot of very helpful strategies that help with anxiety for example that would be very very helpful for people experiencing depersonalization.
James Bullen: Emma says the RTMS that Nathan got is still not fully proven as an approach but anecdotal evidence suggests that it can be helpful.
Dr Emma Cernis: It's an innovative approach. I think it's the evidence base for it is still building. But a lot of people who've had it say that it's been really helpful. So it seems really promising. I think because the evidence base is still building it's not widely available everywhere. More research is needed to just double check that it is as good as it seems to be. And it's certainly like any treatment it's going to work better for some people than others. So it's not a sort of magic bullet in any way.
James Bullen: Nathan's symptoms of depersonalization under these treatments started to lessen after about four weeks. It took six months for them to really meaningfully reduce.
Nathan Dunne: One morning I was with my mother. I was staying in the garage in Sydney. I was incredibly low point. I really was very isolated. I didn't have any friends etc. But it was one morning over a simple splashing of milk with some cereal in the bowl. I told my mother I really feel as though I'm becoming myself again. And that was an incredibly ordinary domestic moment. But it was when I really began to feel as though the world was becoming more illuminated again.
James Bullen: You write in the book about recovery, the possibility of recovery. Can you tell me a bit about how you think about that and kind of perhaps where you're at now?
Nathan Dunne: The way that you think about your experience in the world has to change. At least that was my case. And so one of the things that I became incredibly frustrated with and that I heard all the time was this acceptance. Acceptance and commitment therapy. Oh you have to radically accept. I could not relate to any of that. That did not help me at all. I had such pushback when it came to framing what I was experiencing in those terms. And I resisted that idea of looking at it in that way for so long because the last thing that I want to do is surrender to this illness. The instinct is to fight. I want to fight this. But I have no energy left. I don't know how to fight anymore. And when you're really at the baseline, when you're far below the base, when you've fallen right to the bottom and you can't fight anymore, then I can't accept this. I don't want to accept this. It's more surrendering to it was a portal to the real acceptance that I was being told about. So lying down in the fit of the storm is a way that I often think about it. When the symptoms are at their most extreme and their most distressing, and you feel like there's really no hope, nowhere to turn, as though this better health that you've experienced has again regressed, then it is surrender most that I relate to. And for those who know anything about chronic illness, this is the experience of it. This pattern, this oscillation is what makes for a chronic illness, which embeds itself in your life. Because I had this very extraordinary experience, as I've said, after midnight in the middle of winter, it was so freezing cold. And then I completely lost my sense of self and my identity afterwards. It was so intrinsically tied to this experience of water that even when I was in a car or on a bus, on a train, and I would go past a body of water, it would begin to trigger symptoms in me. The feeling of being outside myself would become more extreme. I would move further away from myself. I would begin to see myself becoming smaller and smaller, kind of on the street. And so, washing my hands is a very simple task. Having a bath, having a shower, these were incredibly ordinary everyday things, which became very distressing because they took me back to this initial kind of traumatic event. And so, wrapping a cloth around the palms of my hands and my wrists as an initial form of exposure was very difficult. But over time, it was as though I was able to sit with it, and I was able slowly, very slowly, to get used to it, in a way. So, water was... I mean, to this day, I kind of fear it in a way, but I fear it at a kind of core place in my memory, rather than water itself. I am able to swim now, take showers, etc. But it was only years later, in the final stage of my treatment, where I was able to return to that place in Hampstead, and swim again after so many years of difficulty and groping for answers, and be able to swim again, and feel much more like myself. Like I was coming back to this self that was vacated. This kind of split sense of self that I had, that was so profound, so pronounced, was finally beginning to cohere again. Water has played such a profound, like a seismic shift in the before and after of my life, but my wife and I recently became parents to a baby girl, and I have such a longing to be able to... She's still only a few weeks old, but to be able to take her to the beach, you know, such a very Australian thing to do. I mean, it's winter now, but in these summer months that are ahead, it will mean so much for me to be able to do that, and to be immersed in that salt water too. So I come to see water as a very powerful thing, but an element of incredible beauty.
Sana Qadar: That is Nathan Dunne. His book is called When Nothing Feels Real, A Journey into the Mystery Illness of Depersonalisation. You also heard from Dr Emma Cernis, Assistant Professor of Clinical Psychology at the University of Birmingham. And if you want to hear more of Nathan's story, he did a full interview with Richard Fidler over on Conversations. You can find that on the ABC Listen app. This episode of All in the Mind was reported by Senior Producer James Bullen. Thanks also to Producer Rose Kerr and Sound Engineer Tegan Nicholls. I'm Sana Qadar. Thank you for listening. I will catch you next time.