It’s not a novel concept that labels and diagnoses are often attached to a stigma. Aside from the medical danger of misdiagnosing patients, there’s a historically significant social stigma surrounding mental illness that is still deeply rooted in Western culture today.
Indeed, the Diagnostic and Statistical Manual, Fifth Edition (DSM-V), the clinician’s handbook of diagnostic criteria for mental health disorders, has faced criticism for high rates of misdiagnoses, comorbidity, and over-simplification among mental health disorders.
On the other hand, the DSM-V is held in high regard by many as a guide for research, treatment, and therapeutic practice. It allows for a standardization of patient care (and sometimes medication) for which insurance companies are more likely to cover costs when presented with a clear diagnosis.
But this isn’t an article on the pros and cons of the DSM-V. Google the debate if you’re curious. This is about an uncharacteristically sunny April afternoon four years ago in London.
When I was a junior in college, I spent five months living and studying abroad in a borough just outside of London. Since I lived in a flat with mostly English students, I grew close to several of them. One afternoon, while most students were still at home for the Easter holiday, a friend and I were sitting outside on a wooden bench. It was the spot we often chose to pass time drinking that wasn’t otherwise spent skipping class or exploring central London.
The two of us were discussing the topic of anxiety, a lifelong struggle we both shared to varying degrees. He gulped his can of cider in between cigarette puffs and looked up at the sky. Billowing gray and white clouds rolled past its blue backdrop, but the sun continued to peek through.
“You know,” he said, gaze still fixed upward. “I don’t mind how it feels when I’m about, but being alone is when you deal with the depersonalization bullshit.”
“What do you mean?” I asked.
His transfixion on the sky broke, and he looked back at me, confused at my confusion.
“You know,” he replied, taking another drag of the cigarette he had rolled himself. “Like when you’re detached from yourself? Like watching your body from outside, somewhere far away? Feels like a bad dream, really.”
My jaw fell slightly open. It was as if someone had just knocked the wind out of me. Before I could take a steady inhale, I said, “Wait. What did you say that feeling is called?”
“Who told you that?”
“Aw, I dunno. Some therapist I had in primary school, really.”
I must have looked bewildered, perhaps a shade so pale it was discernable even by British standards. “Well, you alright?” he asked. “You familiar with it?”
Familiar, yes. I was intimately familiar. But I didn’t know that until this moment.
Experiences of mind-body detachment had plagued me since childhood. It happened only when I was alone and only at night. The sensation of being mentally disconnected from my surroundings was sometimes so unbearably uncomfortable I would go to sleep still fully clothed on top of the sheets to avoid further motion.
Reality felt dreamlike, and an altered state of separation from my movements left me with a heightened awareness that something was off. Although it didn’t happen often, it was enough to stir up fear when it did.
I used to grow frustrated trying to explain it to others who simply had no idea. Although I had words to describe feeling afraid, anxious, and panicked, this was something entirely different.
Now, on the outskirts of London, a boy I had known for just several months uttered one word that changed everything. Depersonalization. He wasn’t a therapist or a pastor or a doctor. Quite the antithesis of all three if we’re being honest. But he gave me the language I didn’t know existed. He put a name to an experience I had grown up believing made me insane. And this unintentional gift was empowering and pivotal.
“Yes,” I finally responded, smiling. “I’m familiar.”
After some research, I learned that depersonalization can be a symptom of anxiety and depressive disorders. I learned it may be diagnosed as a dissociative disorder if it is frequent and severe enough to impair one’s daily functioning. Mostly, I learned that my personal experience was relatively common. Some research indicates that approximately 50% of the population will experience a transient episode of depersonalization at some point in their lives.
I think a far more interesting debate than whether we toss out the DSM-V is how we can use language to heal, grow, and understand rather than simply diagnose, categorize, or stigmatize. Shared experience shows us we’re not alone, and there is beauty in learning there’s a name for that.