# Interesting article found on the net



## wandering star (Aug 17, 2006)

Now Capgras and Cotard are both rare syndromes. But there's another disorder, a sort of mini-Cotard's that's much more commonly seen in clinical practice (those of you here who are psychiatrists know this, or psychologists). It's called Derealisation and Depersonalisation. It's seen in acute anxiety, panic attacks, depression and other dissociative states. Suddenly the world seems completely unreal - like a dream. Or you may feel that you are not real - Doctor, I feel like a zombie. Why does this happen? As I said, it's quite common.

I think it involves the same circuits as Capgras and Cotard's. You've all heard of the phrase, playing possum. An opossum when chased by a predator suddenly loses all muscle tone and plays dead. Why? This is because any movement by the possum will encourage the predatory behaviour of the carnivore - and carnivores also avoid dead infected food. So playing dead is very adaptive for the possum.

Following the lead of Martin Roth and Sierra and Berrios, I suggested Derealisation and Depersonalisation and other dissociative states are an example of playing possum in the emotional realm. And I'll explain. It's an evolutionary adaptive mechanism. Remember the story of Livingstone being mauled by a lion.

Dr. Livingston, (picture courtesy of John Murray, Publishers)

He saw his arm being ripped off but felt no pain or even fear. He felt like he was detached from it all, watching it all happen. The same thing happens, by the way, to soldiers in battle or sometimes even to women being raped. During such dire emergencies, the anterior cingular in the brain, part of the frontal lobes, becomes extremely active. This inhibits or temporarily shuts down your amygdala and other limbic emotional centres, so you suppress potentially disabling emotions like anxiety and fear - temporarily. But at the same time, the anterior cingular makes you extremely alert and vigilant so you can take the appropriate action.

Now of course in an emergency this combination of shutting down emotions and being hyper-vigilant at the same time is useful, keeping you out of harm's way. It's best to do nothing than engage in some sort of erratic behaviour. But what if the same mechanism is accidentally triggered by chemical imbalances or brain disease, when there is no emergency. You look at the world, you're intensely alert, hyper-vigilant, but it's completely devoid of emotional meaning because you've shut down your limbic system. And there are only two ways for you to interpret this dilemma. Either you say the world isn't real - and that's called Derealisation. Or you say, I'm not real, I feel empty - and that's called Depersonalisation.


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## Dreamland (Jun 1, 2005)

I posted something similar a long time ago on a different board, specifically about soldiers going to battle and complaining about not feeling real. As far a brain disease or chemical imbalance cause DR or DP, if that were the case then other symptoms of this disease will probably be evident as well; moreover, a disease is usually progressive, and DP/DR is more of state of mind where you're in limbo--you're not always getting worse.


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## greatnavad (Feb 23, 2006)

As far i as i know..
Soldiers are very DPed..
in fact Training is Designed so..

I Can be a very good soldier..


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## Dreamer (Aug 9, 2004)

This is V.S. Ramachandran's theory. He is an evolutionary neuropsychiatrist. A hero of mine. I buy this theory. Makes a tremendous amount of sense to me.

I can see myself in chronic fight/flight mode most of my life due to verbal abuse, neglect, etc.

This fight/flight overreaction is also seen in Borderline Personality -- abused individuals are overrepresented, women as well. Men have their own version. Take a choice.

There is rage, oversenitivity to threats, etc.

Read any of Ramachandran's books, "A Tour of Human Consciousness", "Phantoms in the Brain" will give you a sense of where he's coming from.

A Ramachandrian to the core at the mo (thought things change daily)

D

PS: I also have many BPD traits, though I don't have BPD. But there is rage, identity confusion, and transient dissociation experienced by BPDers, will possibly be renamed "Mood Dysregulation Disorder".

Lamictal (a mood stabilizer) and DBT have helped me, though I am far from cured ... doubt I ever will be.) My anxiety is so damned high right now I can barely stand it. THe DP oddly enough is more in the "background" but still hounding me. 24/7, all the time. in my dreams as well, for really most of my life.


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## nemesis (Aug 10, 2004)

> During such dire emergencies, the anterior cingular in the brain, part of the frontal lobes, becomes extremely active. This inhibits or temporarily shuts down your amygdala and other limbic emotional centres, so you suppress potentially disabling emotions like anxiety and fear - temporarily.


Interestingly my SPECT tests came back showing that I had a grossly over active anterior cingulate gyrus during the resting test. This was also the time when the dissociative and 'brain fog' symptoms are at their strongest.

During the concentrating test however, the anterior cingulate was seen to be lower in activity, much the same as what you would see in a normal subject's reading. This also happened to be the moment when I was least DP's and most focussed externally on things within my environment.


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## Dreamer (Aug 9, 2004)

Dreamland said:


> I posted something similar a long time ago on a different board, specifically about soldiers going to battle and complaining about not feeling real. As far a brain disease or chemical imbalance cause DR or DP, if that were the case then other symptoms of this disease will probably be evident as well; moreover, a disease is usually progressive, and DP/DR is more of state of mind where you're in limbo--you're not always getting worse.


Dear Dream,
Everything is "in our head", in our brains, in our grey matter. IMHO. Most people/healthy people dissociate ... to one degree or another. What is wrong with us is that this has become disabling/pathological. Why we aren't sure.

In my experience of years with this, working on my DP and other problems has taken a combo of medication, therapy, work on the self, etc. But I have no doubt in my mind that I -- I will speak for myself -- have had a predisposition to anxiety, excessive dissociation, depression. Runs in the family.

I'm sort of looking forward to, yet not, lol, an MRI,not on my brain, but it is a full body. I wonder if they'll see something odd in my brain, but that's not what they're scanning.

We have givens -- and IMHO these are part of our adaptations as humans, they serve a purpose.

I recently read that fainting at the sight of blood actually has a purpose. It is in essense a type of survival mechanism I can't go into here.

At any rate, sexual attraction for example... that is IN OUR HEADS ... yes, it is in our primitive brain.

Dissociation is I believe present in most human beings in a variety of ways. PATHOLOGICAL dissociation is another story. It has "done too good a job" and becomes disabling.

In my extreme view, yes, we are our grey matter. That doesn't mean we are not unique human beings.

Best,
D


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## Dreamer (Aug 9, 2004)

Also, an excellent book. "Unholy Ghost: Writers on Depression" -- there are individuals who are depressed who are anxious, also DPd. When the brain doesn't function properly it can really go south.

Nothing exists in a vacuum. And again, I don't believe in "pure" DP, save in a minority of cases. It comes part and parcel with a whole bunch of other "adaptive" or "maladaptive" mechansims.

Clinical depression, schizophrenia, bipolar are medical conditions.

D


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## HalfAPerson (Aug 22, 2006)

Deleted this post and decided to make a new topic instead.


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## strigoi (Jun 27, 2006)

I enjoying reading different military genre books. In many books that talk about Special training such as "seal/ranger/SAS/ etc." (expecially one's that feature much sleep deprevation such as SEAL), they can usually tell who will make it the whole week and who won't by who gets spells of what sounded to me as DR/DP. Many seaman described it as seeing things but not 'feeling' them, many instances were gave when they talk about cold water exercise in partiular, seems they are so tired and miserable they fall into a DP state.


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## Dreamer (Aug 9, 2004)

strigoi said:


> I enjoying reading different military genre books. In many books that talk about Special training such as "seal/ranger/SAS/ etc." (expecially one's that feature much sleep deprevation such as SEAL), they can usually tell who will make it the whole week and who won't by who gets spells of what sounded to me as DR/DP. Many seaman described it as seeing things but not 'feeling' them, many instances were gave when they talk about cold water exercise in partiular, seems they are so tired and miserable they fall into a DP state.


Absolutely true. I asked my psychiatric resident who is my therapist about doctors who train for 3 days straight without rest. SOME get DP/DR, but get relief when they get sleep. Others don't get DP, or have only fleeting moments. I don't understand how if they do get it, they don't REMEMBER. I have had more GPs, neurologists, anesthesiologists, etc., in my life know what DP is than shrinks. SIGH. And shrinks have to do full rotations through all specialties.

Lack of sleep can potentially cause DP/DR for anyone. The pathology is when this becomes chronic/disabling. A college roommate of mine described it after we studied all night after an exam, but it went away when we went to sleep. She woke up fine, forgot about it. I of course woke up DP/DR as usual.

To this day, I can't go without a full night's sleep w/out terrible DP/DR.

Some soldiers end up w/PTSD as well, some don't. It depends on each of us as unique individuals.

It would seem dissociation is indeed a coping mechanism... it is for all animals -- "deer in the headlights", "playing possum", becoming completely still, playing dead when there is a threat. Also in humans, dissconnection from traumatic events can be beneficial in life-threatening situations as focus is on survival, and survival alone.

Again, when the mechanism goes bad, or when it accompanies other illnesses or is the result of a drug (Rec or otherwise) then you have a problem.


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## Dreamer (Aug 9, 2004)

Note the reason doctors must train for this, is they must work this way in many situations. Trauma, surgery, etc. can go on for hours at a time. A surgeon, nurses, etc. must be prepared as members of the military to adapt to this sort of stress.

Those who survive medical school and residency -- I'd rather have them take care of me in a trauma situation.

Some do get burnt out. Many thrive on it. We are all predisposed with various personalities/strengths that lend themselves to these types of jobs. Besides passion, one must have stamina.

Doctors, the military need counseling, etc., etc.


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