# Daphne Simeon and Orna Guralnik



## rightwrong99

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*Depersonalization: Standing in the Spaces Between Recognition and Interpellation*
Orna Guralnik, Psy.D.
New York University
Daphne Simeon, M.D.
Beth Israel Medical Center
Depersonalization is the experience of profound estrangement and alienation from Self and Reality.
Although highly prevalent in our postmodern world, the syndrome of depersonalization has been systematically
understudied, misdiagnosed, and unsuccessfully treated. In this paper we summarize our
theoretical conclusions after a decade-long empirical study of this population and discuss both etiology
and recommendations for treatment. Our main objective here is to place what psychiatrically we
would consider pathologies of personhood within the larger context of culture. We include a clinical
vignette to demonstrate how we work with the premise that depersonalization is not only a private
event. Perhaps more than other problems-in-living, it reveals the centrality of the individual's relationship
to discourse, the State, and the culture in which we breathe.We discuss depersonalization and the
dissociative structuring of the mind as psychological responses to particularly problematic experiences
around subjection and conclude with the function of shame and humiliation in maintaining and
resisting (in the political sense) this pressure to fragment.
The Human shows through in a moving and mysterious way only in those who are bereft of it.
- Baudrillard (1997)

Clive sometimes says he is looking at what's happening between us from a place other than his
chair. Sometimes he's on the ceiling, and sometimes it's hard to tell. Today his body-in-the-chair
seems to him heavy, numb, and of inhuman proportions. Hands too large.Aday like all other days,
O.J. Simpson's trial is all over the news. As he speaks I am aware of his black skin, my whiteness,
all accentuating the Vienesse décor that has managed to dominate my then-office. Clive tells me
what happened while he was in the waiting room; one of my also-white-suite-mates walked in, her
gaze on him for a brief moment, betraying silent fear: "She thought there's a black man gonna rob
the office." Clive is struggling to blow off shame, her gaze having morphed him into an intruder on
the perfectly White order. Now in my office, I seem to him very far, small, unfamiliar. He leansforward in his chair, and his shame is catapulted back to me. Now we both seem distorted in some
inexplicable way. He tells me he can hear his voice but his words have no meaning, even though I
thought I heard them loud and clear. Yet, the more I listen, the more his speech does sound kind of
hollow. Hollowed of what? I stare at his face looking for signs of the Clive I know, the Clive-and-I
we've had, and a queasy absence settles.
(Clinical examples in this paper are from the practice of OG)

*THE PHENOMENON OF DEPERSONALIZATION*1
Depersonalization can hit like a clap of thunder; in a split second all tilts toward the surreal and the
trusted sense of reality evaporates. It can seep in insidiously, settling in for relentless decades of profound
estrangementanddetachment.Someare propelled inandout of transient episodes in response
to triggering events, and some actually willfully induce states of depersonalization to avoid the
claws of unacceptable reality (Guralnik, 2008b). Phenomenologically, like Clive, people describe
witnessing their lives as if it were amovie or "from the ceiling," an experience often accompanied by
a bitter deadening of affect: "The emotional part of my brain is dead.&#8230;My laugh is automatic; there
just doesn't seem to be anything there&#8230;"(Patient reports, Mt Sinai; from here on: PRMS). The integrity
of time, space, mind and body falls apart: "The times have gone.&#8230;Everything around me is
very far away and tiny.&#8230;"(Shovron, 1946), "I enter the house I lived in for the past 7 years and feel
like I've never seen it before.&#8230;I look at my hand and it does not belong to me, it looks large and foreign.&#8230;"
(PRMS). The unity of intention and action fragments: "I can hear my voice talking, but it
does not seem to be coming fromme.&#8230;"(PRMS). The result of these various fragmentations is that
for the depersonalizedwhatused tobeimplicitly reliedonas "me"and"reality" is pulledfromunder,
leaving one de-clothed of a familiar self, in an alienated landscape.
Although prevalent,2 depersonalization is poorly studied and unfamiliar to even seasoned clinicians.
It is a subjectively felt altered state of consciousness, not an affect or a disturbance of
thought, yet the actual "symptoms" are terribly difficult to describe. It infects a rather abstract psychological
register in which one draws conclusions, grounds, and narrates what their Self, and ultimately
Reality, means to them3 (we return to this register in later sections). When mentioned in theliterature, depersonalization typically gets incorporated into existing categories and misattributed
as an epiphenomenon of more familiar disorders of affect such as depression and anxiety. The implication
is that depersonalization cannot be engaged with directly but will somehow lift when
other problems clear. Indeed, people with relentless depersonalization typically grow increasingly
alienated and hopeless after migrating from one mental health professional to the next,
misdiagnosed, misunderstood, and treated with no success.
As far as definitions, depersonalization should be distinguished from the concepts of dissociation
and repression. As a diagnostic category, depersonalization is classified by the Diagnostic
and Statistical Manual of Mental Disorders (APA, 2000) as one of four primary dissociative disorders.
All four come under the roof of dissociation because they share the mental operation of
splitting apart and excluding from consciousness psychic materials that are typically integrated
into one experience (self-states or "identities" in Dissociative Identity Disorder, a renounced self
in Fugue, autobiographical memories in Amnesia, personhood and real-hood in Depersonalization
and Derealization). Thus, depersonalization is a subtype of dissociation. Often when clinicians
refer to their patients' dissociation they are actually describing the very specific experience
of depersonalization.
As dynamic psychic mechanisms both dissociation and repression are ways to banish mental
contents from consciousness. They have different implications regarding psychic structure and
dynamics. In repression the hidden elements are thing-representations of particular contents. In
dissociation they are structures, potential ways of being a person in the world. Repression disallows
conscious representation of once-known, anxiety-provoking "things" like memories, wishes,
and fantasies. Under the supervision of the ego's censor, neurotic distortion renders these
thing-representations unavailable to the conscious mind. Dissociation, in contrast, segregates or
de-links "states" rather than things, matrixes of self-other relationships and their related affects.4
The parallel operator to the repressive censor in the case of dissociation would be avoidance of attending-
to and formulating into meaning (Stern, 1997). As a subcategory of the ability "to dissociate"
one also has the capacity "to depersonalize," whereby one becomes detached and certain aspects
of self become inarticulate or unavailable, instigating the subjective dis-ease of
depersonalization.

*AIM*
The purpose of this paper is to familiarize the reader with depersonalization and propose a model
in which we understand it as a response to the structuring forces of social discourse. In exploring
depersonalization, we expand beyond the traditional psychoanalytic focus on one's object world
and contend that the "editorial instructions" on what should be designated "Me" actually occur
largely outside the individual, in the cultural milieu in which we live. Our model does not come to
replace but augment other psychoanalytic approaches.We believe that in a successful treatment of
depersonalization analysts must grapple with how the social is implicated in the seemingly private
individual psychological sphere, as "if you go deeply enough into one, you come upon the other"
(Dimen, 1986, p. xv).
A few words to contextualize the language we are using to build our argument: When referring
to discourse we mean the culturally shared how to communicate (society's language and implicit
modes of communication) and what can be spoken of (the limits of acceptable speech).5 In "discursive
instructions" we mean the kind of cultural messages (often unconscious and implicit) that
sanction ways of being that are normative and acceptable (and therefore intelligible) and foreclose
others. Psychoanalysis is a discipline that has always paid close attention to language. In this paper
we lean into the poststructural and hermeneutic disciplines that situate language in the context
of one's place and time. From this perspective, language does not mirror reality but rather constructs
and reinvents it. Language is one of the discursive instruments that constitute what kind of
subject an individual can become: The subject will follow the contours and constraints of what is
speakable. Postmodern, Feminist, and Marxist theories help us keep in mind that individuality and
subjectivity are no simple matter and are always in the service of perpetuating large socio-political
structures and the power relations they embody.Weaving these perspectives implies that we do not
take subjectivity as a given (as assumed by modernist beliefs in an original true self) but see it as
constituted in discourse.
We believe depersonalization reveals how the very discursive instructions that constitute the
subject can also paradoxically be responsible for her psychic fragmentation. Good psychoanalytic
work with depersonalized patients must embrace this dialectic. Given our perspective, our use of
the category depersonalization is riddled with paradox, which we ask the reader to bear with; we
are simultaneously diagnosing and arguing that such hegemonic moves-designating what is
healthy and what is not-are what underlie pathologies of personhood. We now turn to a selective review of the psychoanalytic literature, which mostly discusses depersonalization
in the language of ego and object relations theory. Drawing on critical theory we
will introduce our model and then illustrate it with a clinical vignette. The final part of the paper
focuses on the role of shame in maintaining depersonalization and on clinical implications.

*A SELECTIVE REVIEW OF THE LITERATURE*
Classical formulations of depersonalization generally portrayed an intrapsychic drama in which
the ego made tyrannical attempts to deal with intersystemic conflicts in which the superego
starred. Traveling with his brother to the Acropolis, Freud (1936) was overwhelmed with the sensation
of depersonalization-incredulity and doubting reality. Freud interpreted his depersonalization
as an Oedipal symptom, a repudiation of reality that defended his ego from the forbidden
gratification of going further than his father. Later Searl (1932) saw depersonalization as an attempt
to escape superego punishment by assuming the immunity of inanimate objects, a theory
that Obendorf (1950) revisited as the formation of a superego inharmonious with the body ego. Somewhat relaxing the boundary of this hermetically sealed classical self, theories of the '50s and
'60s attributed depersonalization to conflicting or repudiated identifications with significant others
(Arlow, 1966; Jacobson, 1959). Other theoretical formulations that remained influential until
Sullivan's breakthroughs were variations on the ego splitting into an observing part of the ego
while defensively disowning the participating part (Bradlow, 1973) or discontinuity between the
ego and the self structure (Frances, Sacks, & Aronoff, 1977). The general notion of a supreme ego
that monitors internal homeostasis and acceptability continues to reverberate through much later
models of depersonalization and dissociation.
The interpersonal school influenced psychoanalysis to contextualize the person within their culture.
Fromm has particular historical relevance here. He spent formative years influenced by the
Frankfurt school, importing Marcuse's ideas into psychoanalysis and linking self and culture.
Fromm describes an individual that springs out of nature pure and free, yet due to gradual submission
to economic and socio-political conditions develops pseudo acts and feelings, and ultimately
escapes from freedom into automaton conformity. Fromm describes a large-scale alienated and depersonalized
society. Although a breakthrough for his time,Fromm's approach is a good example of
the Modernist binary that continues to reverberate through psychoanalytic discourse: The individual
originates as a pure and true self and clashes with potentially damaging societal forces outside.
James and Jane Cattell revisited this theme in the 1970s, writing specifically about depersonalization
being a reaction to "centralizedbureaucracies" thatwereroutinized, humiliating,anddehumanizing
(Cattell&Cattell, 1974). Per the Cattells, this process starts within the family but gets amplified
within theembraceof themoderncorporation that bindsemployees to their dehumanizing jobs. Sullivan further challenged psychoanalysis to deal with the fact that interiority develops in the
context of a communal life. He believed early interactive patterns with others are internalized and
responsible for the structuring of the self. Sullivan's "I" is structured around constraints of significant
others; "Not-me" experiences originate in responses to intense forbidding gestures by the
mother. What is not incorporated by the I and quarantined in the Not-me dissociated zone, he
termed the parataxic level of experience (Sullivan, 1953). Although he writes about dissociation,
Sullivan's parataxic experiences are often precise portrayals of depersonalized states in their uncanny
and bizarre quality. In many ways our project is to extend Sullivan's brilliant theory beyond
the mother-baby dyad, a dyad we see as always-already embedded within the constraints of social
discourse.

*TRAUMA: DISSOCIATION/UNINTELLIGIBILITY:
DEPERSONALIZATION*
Twentieth-century psychoanalytic discourse saw a gradual shift from a preoccupation with
intrapsychic conflict and fantasy back to the impact of "real" events on people's psyches. Trauma
gradually replaced drives as an explanatory factor, and dissociative mechanisms have become an
alternative model of mind to the repressive mechanisms relied on by earlier theory (Bromberg,
1998; Davies, 1998; Stern, 1997). Many empirical studies have supported the link between trauma
and dissociation. Specifically with regards to depersonalization, our studies established that a history
of childhood emotional maltreatment predicted severity of depersonalization symptoms;6 impingement and entrapment by other thinking minds are particularly implicated, including threats,
screaming and intimidation, humiliation and belittling, intrusion, double-binds, and mind-control
maneuvers (Simeon et al., 2001).
The dominant model weaving in and out of theories linking trauma and dissociation (that can
be traced back to Janet, 1889) contends that dissociative fragmentation protects the psyche from
affective overwhelm and dysregulation (Van der Kolk, 2002). Contemporary theories take psychic
multiplicity as a given and dissociation is understood as an expression a defensive in-articulation
of experience (Stern, 1997) or a refusal to mentalize by de-linking the declarative-symbolic system
from the subsymbolic (Bucci, 2007). Health has become the ability to "stand in the spaces"
and tolerate the affect that comes with the internal conflict multiple self-states generate
(Bromberg, 2003).
In its focus on the wider intersubjective field, relational theory makes it possible to consider the
role of one's discursive context in the formation of dissociation (Aron, 1996; Layton, 1995; Reis,
2005). Davies and Frawley's (1994) model implies that the context will mediate how the psyche
will respond to trauma; dissociation is partially attributed to the fact that the sexual abuse could
not be spoken about. Grand's (2003) thing-self register (a clearly depersonalized state, reminiscent
of Bradlow's, 1973, formulation of depersonalization) develops in response to being traumatized
and being pulled into an it-it relation; "Just as culture can give birth to, and organize the psyche-
soma, so culture can give birth to, and define a disembodied, nonhuman thing-self" (p. 330).
Ryle's (1997) Reciprocal Role Procedures model of dissociation similarly emphasizes that people's
ability to elicit reciprocation and confirming responses from others can protect them from
dissociation.
Here we would like to mull over another angle of how discourse can shape the psyche, and not
only through people's object relations. Consider the view that diagnostic categories, including the
categories of dissociation, do not simply describe intrapsychic reality but create new possible
ways of being. Hacking (1995) demonstrated how since the development of the multiple personality
disorder (MPD) diagnostic category one became able to "switch between alters."7 Rivera
(1989) described how alter personalities of MPD patients are not idiosyncratic but reproduce the
stereotypical ways gender is constituted in a patriarchal society; one will often find female-identified
personalities such as the vulnerable child, a seductress, and a masochistic-compliant alter, as
well as male-identified aggressive predators and protector selves. Thus, seemingly interior structures
and dynamics are actually made possible and greatly influenced by one's discursive context.
From our perspective, one's internal emotional economy is only one feature of what makes
events traumatic. A major aspect of what is traumatic for the depersonalized is being designated
socially unintelligible and having to incorporate what society wishes to turn its back on. What can
be formulated (hauled up and mentalized; Stern, 1997) is not only intrapsychically determined.
Experiences deemed less than human and unrecognizable to society are then unrecognizable to
one's internal regime, which is not so internal after all. The traumatized individual is holding what
others wish to repel, that which has no place in collective reality and which is situated outside the
symbolic order (society's excess and abject; Kristeva, 1982). Events that threaten the taboos of social
order (such as incest) or that make large demands on people's fragile compassion resources
(such as the unspoken grief of veterans; Guralnik, 2008b) are easier to disavow than to ingest. As
per Butler (2004), social norms of recognition deem some losses grievable and others not. From
this perspective depersonalization marks what cannot be grieved or processed and is melancholically
foreclosed as unthinkable, unspeakable or not-real.

*SUBJECTIVITY*
Depersonalization is not only a private event. The shape of one's subjectivity mirrors a battle occurring
in culture over what in a person will be intelligible, or what will be considered a livable
life. In our work with depersonalized people the battle around subjection has been very obvious
along categories such as sexual orientation, race, and class, where there are clear discursive instructions
that make certain possibilities "less than human," and to which some respond with depersonalization
(see clinical example). However our theory is generalizable to much subtler situations
once the complexity of the dynamics between the individual and their discursive context are
attended to.Why do certain individuals respond so painfully to these prevailing discursive instructions?
8We are arguing here that one of the central axes upon which one fragments is the degree to
which their self corresponds to "what-goes" in discourse.
Psychoanalysis is all about the seam between self and world.We use concepts like internalization,
identification, introjection, and recognition to mark the negotiation along the boundary inner/
outer, self/world. Bound by modern philosophical underpinnings, psychoanalysis for the longest
time assumed a singular self intruded on by a hostile and disappointing world. This Self is
often imagined as a true body-ego, whereas the symbolic and cultural are placed "outside the line
that divides inner from outer" (Winnicott, 1986 p. 36; see Kahn, 1986). When speaking of depersonalization we then ask, What gets depersonalized? Do we still imagine
a true self that gets split off and protected by its false, automated, depersonalized cover? Or do
we incorporate postmodern sensibilities and think of a self that is a social artifact?9 The position
we take here is that subjectivity is a state arrived at, the product of some originary potential being
constituted by discourse, rather than an essential, true state that then gets messed up by one's environment.
We do believe individuals come with a quasi-natural load or matter-their self-in-itself.
10 However closer to Stern's (1997) unformulated, or Kristeva's (1982) semiotic (the emotional
force or instincts that exist in the fissures and prosody of language), we also believe this originary matter has no meaning prior to being applied form. Meaning can emerge when the structuring
forces of language and the rest of one's discursive cultural context are applied to the
self-in-itself to constitute the subject, and, hopefully over time, her capacity for some internal
freedom and resistance. Holding this perspective also implies that as psychoanalysts we are not
only interested in how individuals respond to the hotbed of their attachment relationships.We are
equally interested in tracing the meeting of individuals and the social political context in which we
all breathe, shorthanded the State.

*RECOGNITION, INTERPELLATION AND THE SPACE IN BETWEEN*
Speaking from a psychoanalytic intersubjective perspective, Benjamin (1998) described recognition
as "that response from the other which makes meaningful the feelings, intentions, and actions
of the self. It allows the self to realize its agency and authorship in a tangible way" (p. 12). Bakhtin
described how one comes to know oneself in the eyes of another:
I am conscious of myself and become myself only while revealing myself to another&#8230;a person has
no sovereign territory; he is wholly and always on the boundary; looking inside himself, he looks into
the eyes of another or with the eyes of another. (as cited in Howell, 2005, p. 123)
Recognition is the life-giving exchange with the world.
Here we would like to introduce the concept of interpellation, a term coined to capture the process
by which one is recognized by the State to become part of the social order. Interpellation is a
relative of recognition. Briefly, modern Marxists like Gramsci described how modern democratic
societies maintain social order, no longer by way of violent force (army or police), but rather by
the collective belief in "ideologies"-false doctrines that present themselves as natural and necessary.
These ideological methods are soft and subtle and provoke no resistance; the collective comes
to share an unconscious secret that results in obedient and productive citizens (Foucault,
1988-90). Foucault actually sees psychoanalysis as one of the most intrusive methods to so control
subjects, through its circulation of dominant ideologies.
Althusser (1969/2000) used the term (rather than coined) Interpellation to describe the very
mechanism through which ideology takes hold of the individual. The authoritative voice of the
State recognizes the individual and hails him into social existence. From a psychological perspective
we can see how this voice meets the individual's basic need for recognition and allows them
their transformation into subjects. Althusser's famous example is of how we feel when hailed by a
policeman: "Hey you!" toward which we turn guiltily: "What did I do?!"We immediately morph
into self-as-criminal, thereby revealing where the force of the State and our identity as individuals
meet.
Interpellation captures a doubleness: In this society we share the ideological belief that we are
sovereign beings, autonomous subjects of ourselves. Yet in such moments we are exposed as defined
and possessed by forces beyond us. Our passionate attachment to the exact subordination
that deprives us of possibility is revealed; our need to invite regulatory powers in so we can be constituted.
Internalizing norms and developing a "superego" are essential to the production of psychic
interiority and to assuming any power and agency (Butler, 1997). Yet this doubleness is too
humiliating for us to be aware of and needs to be repressed. In sum, interpellation reveals a more
intimate connection between the Self and the State than psychoanalysis has cared to pursue.
The space between recognition and interpellation is where one's sense of personhood is repeatedly
carved out; it is where the psychological need for recognition in order to become, and the social
force of interpellation that allows one to be-meet, or collide. Our claim here is that this slippery
space is the psychological register in which depersonalization takes place. Being
interpellated provides a basic point of reference to "reality." Our self-in-itself responds to recognition
and to interpellation, nurtured into expansion and pressured into constraint. To resist interpellation
means to loosen that tether to reality-the chief complaint in depersonalization.
The experience of Personhood is a momentary expression of a harmonious and synchronous
relationship between one's self-in-itself and the world-context of language, social order and culture,
including their powerful ideological forces. The degree of reciprocity between one's cultural
context and ever-forming-interiority will determine how easily one will come to feel like a
three-dimensional person. The issue then becomes about the goodness of fit, which will vary
across individuals and across cultures.We are in a bind; a livable life requires norms, whereas living
outside the social order places one at great risk.
Depersonalization occurs when there is a serious impasse between social-linguistic structures
that represent the dominant social order, and the self-in-itself. We think of depersonalization as
both a failure to fit well into normative categories of intelligibility and as an act of resistance. As
resistance, depersonalization is the psyche's withdrawal and refusal to be interpellated by the
shaping forces of discourse; an attempt to shield the self from the traumatic demands of the social
order. As a brief example of this dual function, consider this recent moment in the life of a patient:
Baladine, a young Turkish woman suffering from a low-grade chronic depersonalization, has begrudgingly
started taking antidepressants to stabilize her mood and help her through law school.
At some point her physician added another medication to "help her sleep," to be used as needed.
Four months into this new regime and stable on her meds, by sheer coincidence Baladine discovered
the "sleeping pills" prescribed were actually antipsychotics. She responded with acute depersonalization:
"I forgot who I was. It's like I didn't have a name, or a past, and didn't even know
where I was standing." She felt gripped by the new implications of her as a crazy person. She described
her registry of "self" reorganizing from a person coping with stress to a broken, crazy person.
Like Robert Patrick's T-1000 character in Terminator 2, who morphed from liquid metal into
a humanoid structure, Baladine's metamorphosis was fast and furious and accompanied by an astonishing
evacuation of her previous notion of herself. Yet she also felt a simultaneous refusal to
take all of that on. The prescription pad and the dominant hegemonic structures behind it (the field
of medicine) now held defining power over her, which she hated. The sheer force of interpellation.
Depersonalization is a case of the reification of such relations into psychic structure; a portrait of
the State branded onto the psyche.
In importing the concept of interpellation into the psychoanalytic dictionary we are trying to
trace one's relationship to social discourse. Discord with one's discursive environment is very different
from problematic object relations. Interpellation is different from "portals" such as internalization
and introjection. The commodities negotiated through one's object relations have to do
with patterns of attachment and emotional coloring, whereas the commodities negotiated between
subject and the State, through interpellation, are mostly ideological instructions as to what is human
and speakable. This is why the suffering of the depersonalized is not mainly in the realm of
affects or interpersonal relations. It mostly affects the register in which one's personal epistemology
of self, reality, and world gets constituted; it is where "being in the world" as a citizen/subject
takes form.
We now turn to a clinical example (from OG's work) that illustrates the model we have been espousing
(for other clinical examples, see Guralnik, 2008a, 2008b; Simeon & Abugel, 2006). The
vignette will be described in first person from the viewpoint of OG.We have come to believe that
in many cases of depersonalization the most powerful therapeutic action lay in the dyad's ability
to analyze the discursive context that situates the patient's particular object relations.

*GRACE*
Grace was a smart and hilarious children's puppeteer of 35 when she started analysis.Warm, psychologically
minded, certainly able to hold in mind conflicting and intense affect, Grace was easy
to establish a good working relationship with. This bond afforded us a complicated and intense,
long analysis in which we slowly tracked and infused life into foreclosed aspects of her psyche.
Although her analysis took on many dimensions, for the purposes of this paper I focus on background
directly relevant to her depersonalization and then give an example of how we engaged the
discursive third.
Despite being a superpopular kid, Grace always felt different and separate from others. She
grew up a churchgoing, good Catholic girl who during adolescence was afflicted by unutterable,
foreign urges that years later translated into a lesbian lifestyle. Long into her rich and committed
relationship with Lila, she noticed she has been living as if in a dream for most of her life (what we
later diagnosed as chronic depersonalization). Grace described a lifelong of grinding preoccupations
centered on undoing sins and repairing a mysterious rupture. As an adolescent "receiving"
those unspeakable urges (Hartman, 2005) shewould invite her mother for dailywalks, obsessively
confessing and begging forgiveness for any stray thought: small theft, jealousy, masturbation. No
matter how reassuring her mother was, no confession hit the spot. Tormented, she often gave up
her attempts to "fix it" and resolved to spending long stretches in the bathroom holding her breath
till she "saw stars" or fixing her gaze in the mirror, till it "all went quiet." As an adult, her depersonalization
solidified into a mixture of chronic life-as-a-movie detachment, exacerbated in moments
of intense out of body experiences. Dissociation: the "escape when there is no escape"
(Putnam, 1994).
Grace grew up in a Christian world where people are straight and girls are not sexual. Although
she spent most of her life in New York City, she did not grow to identify with queer culture. She
came out to her parents in college. Although coming out went exceptionally well on the face of it,
there were other feelings, unspeakable and alienating, lurking in the prosody of perfect language,
music that conveyed the regulatory dimensions of the world they all belonged to. Grace was the
youngest of five. Both parents worshiped her flamboyant character. Her father, although a demanding
character, was mostly recalled as an admiring benign presence. Her mom took great delight
in her being rowdy, uninhibited, and breaking loose. Their love was deep and blue like the
ocean. With its undertow. There were certain places the two of them just could not go.
There are many dimensions to explore in Grace's history and object world that tie into her depersonalization.
Unpredictable raging outbursts of the WWII veteran dad, muted by the mom's
pleas for silence, the implicit demands from Grace to "be good" in order to preserve her dependent
relationships and the price she paid for these attachments. However, for our purposes we are advocating
a read of her depersonalization as intromissed by social discourse. The most powerful expression
of this impasse was in her life negotiation about the possibility of lesbian embodiment,desire, and maternality. Grace's parents, church, teachers and classmates, and educational system
were all hostily blind to that possibility. And Grace, the kids' puppeteer, believed her uterus was
not meant to bear children, being of an unnatural body that is lesbian. There were plenty other aspects
of her life that felt quite real and satisfying: her work, her friendships, the pleasure and
power she derived from pleasing her audience. There was nothing false about those experiences of
self. Yet she had been chronically hailed into melancholically evacuating too many other
possibilities.
Recently, Grace relayed the following incident. She and Lila were at their neighborhood dive
bar where they met with their straight drinking buddies, Joan and Joe. Becoming increasingly
comfortable with her life choices, Grace playfully asked the buddies if they knew Grace and Lila
were gay. Friends met play with play: "Duh&#8230;of course we knew!" Grace pushed on, sharing that
they were thinking of having a baby. Giddy and excited, the group erupted into a surprising turn of
conversation: Joan was offering Joe up for sperm donation. Grace and Lila exclaimed how attractive
Joe indeed was but coyly declined. Joan insisted. Grace and Lila refused. At some point in the
evening Grace found herself momentarily alone with Joe. He proceeded to come on to her, confessing
how attracted he was to her and standing alarmingly close. Grace wriggled away, and soon
after she and Lila left.
Grace came into session the next day in a state of excitement and confusion. Her depersonalizationwas
intense. Shewas both closer and further away from having a baby than ever.Agiddy mixture
of flattered yet befuddled, she told me the story, evoking the kind of countertransferential confusion
I have learned to understand as signaling the presence of mixed and seductive
transmissions from the great big hegemony. She was craving an interpretation that would anchor
her in the normative, a sign that she could terminate her exile. She was shifty and uncomfortable, a
thick smog of shame and unreality surrounding her.
If I were to focus on the object-related and interpersonal material packed in that moment I
would have missed a chance to track the forcefulness of interpellation at work. Instead I was interested
in analyzing what happened "out there" that ended up messing her up "in here." In coming
out to a straightworld, claiming the desire and entitlement to have what others do-achild of their
own-Grace and Lila were sending shockwaves into the social order. The shockwaves are to be
boxed back in. A quote from President Bush (2003) at the time of this phase of our work nails it:
"The homosexuals getting married leave the people with no recourse." There are people, and there
are homosexuals. And a snippet from our conversation:
G: Maybe I'm straight after all?
Me: It's reassuring to be embraced by the straight world, isn't it.
G: He was really coming on to me. Why am I ashamed?
Me: It's like he'd throw himself in front of a train to offer you some way back from being gay. You
follow, but rather than find you lose something.
I spoke with Grace about my read of Joe as fulfilling his hegemonic role, hailing her from the
locale of a heterosexual man: "hey, you woman, I want you," and of the destabilizing effects on her.
Grace and Lila's subversive choice compelled both Joe and Joan to "retaliate" with their desire to
straighten out the situation. This force was stronger than their lover's bond of monogamy and exclusivity!
The immediate effect such interpretations had on Grace was to move the smog of shame
from the very interior toward the transitional space between her and her environment. Ultimately,
these kinds of interventions were at the heart of Grace's slow emergence out of depersonalization.
What is a livable life? In this clinical vignette and political arena violence was waged against
Grace. Living outside the norm places one at risk of death, sometimes actual death, but more frequently
the social death of delegitimization.

*SHAME & RESISTANCE*
In the final parts of this paper we explore the connection between shame and the loss of cultural intelligibility
and suggest that humiliation and shame serve to petrify depersonalization into mental
structure. As discussed earlier, interpellation captures a doubleness; it constitutes and abjects; one
depends on it and resents it. The developing subject comes into contact with various sets of cultural
beliefs and values that define who they will be, what will be considered good, healthy, natural,
"passing" and socially mobile. These instructions help a person elaborate who they are and
gain strength from the power of being aligned with the social order. Grace, tiptoeing between
countless sources of shame in her life, has also proudly established herself armed with strong
friendships, a loving wife, a great education, and work she enjoyed. Shame (a most effective
interpellative tool) becomes relevant and invades the person's psychic landscape when he or she Shame is to the depersonalized what anxiety is to the repressed; it marks the return of the abject.
Depersonalization releases one from the burning experience of shame, leaving the subject untouched
but bereft. With her depersonalization Grace could detach from most experiences.
Baladine, the Turkish patient mentioned earlier, aptly described her earliest memories of depersonalization:
At age 7 she was standing at the top of the monkey bars, kids gathering below to
make fun of her: "Fatso! Fatso!" The kids that were originally up there playing with her slowly
dropped to the ground to join her taunters, and with each kid more and more of Baladine's self.
Her mind kept "falling back" into deeper and deeper states of detachment, by joining in with
"them." By the time the last kid jumped down, there was none of her left up there; she was with the
group, a great self-laughing-at-itself. Shame is always an expression of being subjected to the gaze
of the other and being found Other. It is the horrifyingly unanticipated sense of exposure of unrecognized/
unspeakable parts of oneself, to oneself, via the gaze of Others. Grace, held for a moment
in the eyes of another couple, morphed from a hopeful lesbian to a humiliated stray woman.
Baladine, bewitched by her doctor's prescription pad, became a "crazy person," and taunted by her
classmates became a self-mocking bully. Howeasily, abjected by the other, one can lose one's sovereign
equilibrium and fragment. Who does this personal identity really belong to?
Thinking of shame as a social phenomenon, it is a powerful method to keep the forbidden on
the margins. Ziv (2008) talked of shame as an interpersonal/societal tool and site, where the hegemony,
normative regulation conducts its negotiation with the elusive subject. Shame's function is
to shape the subject; the laws of social conduct are branded into desires, actions, and thoughts of
the subject by the threat of loss of recognition as human. Aspects of the self that do not align with
the social order are "decategorized," and their appearance will bring about shame. The resulting
fragmentation and retreat into depersonalization over time become calcified into away of being.
The late NewYork artist DavidWojnarovic incorporated in his visual art and journals extensive
texts about his own chronic depersonalization. In "Between C & D" he captures the power of the
state legal apparatus to interpellate, to utterly churn one's insides, and his depersonalized response.
He also offers the option of creative rage as resistance to subjugation. Here is the text:
A few months ago I read in the newspaper that there was a Supreme Court ruling which states that homosexuals
in America have no constitutional rights against the government's invasion of their privacy.
The paper stated only that homosexuality is traditionally condemned in America and only people
who are heterosexual or married or have families can expect these constitutional rights. There were no
editorials or nothing; just flat cold type the morning paper informing people of this. In numerous areas
of the U.S.A. it is possible to murder a man and when brought to trial one only has to say that the
victim was a queer and that he tried to touch you and the courts will set you free. When I read the newspaper
article I felt something stirring in my hands; I felt a sensation like seeing oneself from miles
above the earth; like looking at ones reflection in a mirror through the wrong end of a telescope. Realizing
that I have nothing to lose in my actions I let my hands become weapons, my teeth become weapons,
every bone and muscle and fiber and ounce of my blood become weapons, and I feel prepared for
the rest of my life; in my dreams I crawl across freshly clipped front lawns, past statues and dogs and
cars containing your guardians; I enter your houses through he smallest cracks in the bricks that keep
you occupied with a feeling of comfort and safety; I cross your living rooms and go up your staircases
and into your bedrooms where you lie sleeping. I will wake you up and tell you a story about how when
I was ten years old and walking around Times Square looking for the weight of some man to lie across
me to replace the nonexistent hugs and kisses from my mom and dad I got picked up by some guy who
took me to a remote area of the waterfront in his car and proceeded to beat me up because he was so
afraid of the impulses of heat stirring in his belly and how I would have strangled him but my hands
were too small to fit around his neck; and I will wake you up and welcome you to your bad dream.
brushes up against the boundaries of social intelligibility.
Many a depersonalized patient was encouraged by us to study this work of art as a manifesto of
our approach, a way to understand symptoms of depersonalization in their social context. One is
trapped into shame following the need for interpersonal recognition and meeting hegemonic abjection.
However, one may also wish to resist the shaming, to look straight back at its source.
Wojanrovic, upon transforming and connecting to his body as a weapon, wishes to wake his
interpellators up and tell them his story. Over the years, from a sheepish whisper of a step Grace
developed the capacity to storm into OG's office. Armed with this political awareness she went
through a pregnancy proudly pushing back against incredible scenes of disavowal. Agamben
(1998) discussed the dialectic of struggling against shame, the insistence on being recognized and
categorized:
It is nothing less than the fundamental sentiment of being a subject, in the two apparently opposed
senses of this phrase: to be subjected and to be sovereign. Shame is what is produced in the absolute
concomitance of subjectification and de-subjectification, self-loss and self possession, servitude and
sovereignty. (p. 107)
This ambivalent moment is the locale of resistance to the interpellative force of shame. It is an
indication of the subject's autonomy and agency. And this is the part we as psychoanalysts want to
hook up with to do our work.

*CLINICAL IMPLICATIONS*
Clinically, in working with depersonalization, moments marked by the struggle with shame are
the potential site to carve out a new sovereignty that will allow a fuller sense of personhood. Continuing
the legacy of psychoanalysis as potentially a revolutionary space, we seek to join such moments
of resistance (in the political sense) to redraft the person back into fuller existence. Individuals
are not free to recognize their subjugation. One's paradoxical dependence on their agents of socialization and interpellation is humiliating-the humiliation of not being self-sufficient and
sovereign, of having sacrificed their unique experience of Reality in favor of social inclusion (Butler,
1997). As discussed earlier, this humiliation prevents the subject from reckoning with being
constituted by interpellation and with how easily they turn and morph in response to being hailed,
"Hey you!"
Without getting into the vast literature on the analyst's authority, what is implied by our position
here is that whether we like it or not, we perform and are experienced by our patients as powerful
agents of interpellation. In our reactions and ability to recognize some and foreclose other,
we speak to the particular social order we are embedded in, with its prohibitions and consecrations
as to what is a livable life. In our self-analysis we should seek to grasp the degree to which we are
sealed within that matrix and cannot see beyond the speakable. Our gaze is the source of shame for
our patient. A traumatic reliving happens in the consulting room every time the patient's experience
and pain are again unseen and unintelligible to us, unsymbolized by the discourse expressed
in the language of patient-analyst. Such foreclosures are marked by the thick and bitter experience
of the patient's shame. A rupture, especially one blanketed by shame, is a signal to us that we
should be deconstructing our own gaze for its interpellative load (an impasse that differs from empathic
failure).
Working with our patients, we spend much of our time in this space between recognition and
interpellation. This is true not only in howwe analyze situations outside the office, but our analytic
gaze itself is layered with discursive determinants. Our own freedom to recognize and understand
an-Other is constrained by our discursive horizons. Importing the ideas of Levinas into psychoanalytic
discourse, Rozmarin (2007) described how the act of knowing is necessarily an act of aggressive
appropriation. There is no way for one subject to comprehend an other than through her
own lens. In this act of knowing, what is Other in the other cannot survive. Knowledge becomes
oppression, a means for forcing the other into my image of the world, and making her essentially
same. Our efforts to recognize and understand are multilayered. Indeed, people suffering from depersonalization
experience a profound dilemma when others make efforts to understand them, and
often respond with confusion and discomfort to mirroring interventions. Bromberg (1998) noticed
the dissociator's exquisite sensitivity and trouble withstanding the impact of another person's
mind, including their compassionate analyst. They suspect that their truth cannot take shape in the
intersubjective field. Caruth (1995) saw the crucial problem in treating traumatized people as
"how to help relieve suffering&#8230; without eliminating the forceful truth of the reality that they
face&#8230; to cure oneself&#8230;seems to many to imply the giving-up of an important reality, or the dilution
of a special truth" (p. vii). She called on the person listening "anew" to the traumatized other
to seek "different ways of thinking of what it means to understand and what kind of truth are we
looking for" (p. viii). A new way of listening would require listening for what our cultural-political
discourse disavows and abjects. Can we think of depersonalization as resistance, a stance of refusal
to be interpellated one more time by being "understood"?
The question we are left with then is whether we have any degrees of freedom to negotiate our
patient's otherness, our pressure on them to change, without only reproducing interpellation. This
is obviously part of a larger existential quandary: Could there be a Self that is in and of the world
but not damaged by it? When working with depersonalization, we believe we need to be committed
to thinking of mental syndromes as expressions of the "can and cannot" of discourse just as
much as other factors. Thinking of the analytic situation as a scene of address in which powerful
negotiations around subjection occur opens up an important dimension of analysis. We assume a transparent practice of examination and deconstruction of our socio-political positions, as reflected
in our way of understanding our patients and the very particular disruptions-to-social-order
they bring. Our patients' struggle to face our interpellative gaze. Their shame and rebellious
rage are moments of grace during which we might be able to cocreate new sites of sovereignty and
possibility.
-----------------------------------------------
*This work was supported in part by NARSAD Young Investigator Award andWollstein Fellowship to Orna Guralnik.
We thank Muriel Dimen and Adrienne Harris for their engagement and extraordinary editorial help on this paper. Also,
warm gratitude to our writing collective.*
*1*Much of the thinking collected in this paper is based on a series of NIH- and NARSAD-funded studies of the phenomenology,
etiology, cognitive processes, biological correlates, and treatment of depersonalization. These were conducted
over 8 years by a research group we founded at the Mount Sinai School of Medicine in New York City (Director: DS) with
more than 350 patients for whom depersonalization was the primary symptom. Our main findings are summarized in a selection
of our papers: Guralnik, Giesbrecht, Knutelska, Sirroff, & Simeon (2007); Guralnik, Schmeidler, & Simeon
(2000); Simeon et al. (1997); Simeon et al. (1998); Simeon et al. (2000); Simeon, Guralnik, Knutelska, & Schmeidler
(2002); Simeon, Guralnik, Schmeidler, Sirof, & Knutelska (2001); Simeon, Knutelska, Nelson, & Guralnik (2003); Simeon,
Riggio-Rosen, Guralnik, Knutelska, & Nelson (2003).
*2*When we launched our study (see footnote 1) we were operating under the assumption that depersonalization was a
rare syndrome. The literature systematically demotes depersonalization from its epidemiological prominence, repeating
the defeated conclusion that little was known about its phenomenology, etiology, or treatment. Yet over time and after encountering
so many people with hitherto undiagnosed chronic depersonalization as their primary symptom, we concur
with Catell & Catell (1974) that it is the third most common psychiatric symptom.
*3*Neodissociation theories (Hilgard, 1994;Woody & Bowers, 1994) attempt to capture something of this register in describing
dissociation as a weakening of highest order executive control functions, leaving "infrastructures" (perception,
memory, consciousness, and identity that cohesively define selfhood) more freedom to operate independently and revealing
the mind's underlying inherently fragmented nature.
*4*The mind's ability to segregate this way has been vastly generalized. We now easily refer to separate "self-states" to
describe common psychological ways of organizing one's experience in response to particular contexts. This is not the experience
we refer to in depersonalization, which has an unmistakable experiential flavor of unreality and distortion of the
regular ongoing experience of self and surroundings.
*5*We are using discourse as derived from the work of Foucault and further developed in feminist studies, anthropology,
cultural studies, and literary theory. Foucault (1972) defined discourse as systems of thought composed of ideas, attitudes,
courses of action, beliefs, and practices that systematically construct the subjects and the worlds of which they speak. He
traced the role of discourses in wider social processes of legitimating and power, emphasizing the construction of current
truths, how they are maintained, and what power relations they carry with them. Power is always present and can both produce
and constrain the truth. Discourse is the medium through which power relations produce speaking subjects.
*6*When emotional trauma was paired with sexual trauma, it predicted broader dissociation, such as amnesia.
*7*Little did Hacking know that by the time of writing this article, the popular TV network Showtime would air a new
primetime series based on a protagonist with dissociative identity disorder (United States of Tara) that instantly became
their number one popular show.
*8*In any discussion of psychopathology the question of symptom choice surfaces: why depersonalization and not another
symptom in response to this constellation and impasse between self-in-itself and discursive context? The mysteries
of human variation will obviously not be resolved in this paper. Typically such questions become less acute when the category
itself becomes more familiar.
*9*Foucault and Chomsky's famous debate of 1971 (Chomsky & Foucault, 2006) articulates the dialectic of our position
regarding the "innateness" of human nature. On one hand stands Foucault, whose subject does not possess any intrinsic nature
but is entirely the product of social political forces. Foucault regards the humanistic premise that people have a true nature
as dangerous, having been used to justify all acts of domination in society. On the other hand stands radical Chomsky,
who is just as intent on deconstructing the violent societal forces exercising power, yet argues that humans should be attributed
essential, even biologically based capacities, such as the ability to be creative in their use of language and, ultimately,
to give expression to absolute justice. Psychoanalytic theory, particularly the notion of drives, leans heavily toward the
Chomskian argument.
*10*A working term we coined with a nod to Kant's thing-in-itself, to refer to the philosophical realization that this is a
concept, we cannot claim direct access to what we are trying to refer to in this notion of self.

*CONTRIBUTORS*
Orna Guralnik, Psy.D., is Adjunct Assistant Professor, New York University; Assistant Research
Professor, Center for the Study of Depersonalization & Dissociation, Mt. Sinai School of Medicine;
Candidate, NYU Postdoctoral Program in Psychoanalysis; and in private practice in New
York, NY.
Daphne Simeon, M.D., is Associate Professor of Psychiatry, Beth Israel Medical Center;
Founder, Center for the Study of Depersonalization & Dissociation, Mt. Sinai School of Medicine;
Graduate, Columbia Psychoanalytic Institute; and in private practice in New York, NY.


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## insaticiable

Fuck this is long. I will have to go back and re-read it sometime when I can actually focus. >.<


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## kate_edwin

newyork - if you want, feel free to ask me about articles before you pay 30 bucks a pop, i have access to university libraries, they have subscriptions to many journals, i'm totally willing to send them to people, the cost to get them otherwise is ridiculous


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## noname

Whats the date of the article ? Ive not read completely, but the Mr educator tone employed at the beginning is funny.
And, at least, one article who reject dp fault on "society" and "other", thats great, this will help to release the general anger and hate I feel these time.


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## Rebekah

newyork, Your pm box is full and I'd like a copy of this article for easier reading? Can you, or someone else, send me one?

Thanks.


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