When Things Feel Unreal, Is That a Delusion or an Insight?

The psychiatric syndrome called derealization raises profound moral and philosophical questions

Credit: Mads Perch/Getty Images

Have you ever been gripped by the suspicion that nothing is real? A student at Stevens Institute of Technology, where I teach, has endured feelings of unreality since childhood. She recently made a film about this syndrome for her senior thesis, for which she interviewed herself and others, including me. “It feels like there’s a glass wall between me and everything else in the world,” Camille says in her film, which she calls Depersonalized; Derealized; Deconstructed

Derealization and depersonalization refer to feelings that the external world and your own self, respectively, are unreal. Lumping the terms together, psychiatrists define depersonalization/derealization disorder as “persistent or recurrent … experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions,” according to the Diagnostic and Statistical Manual of Mental Disorders. For simplicity, I’ll refer to both syndromes as derealization.

Some people experience derealization out of the blue, others only under stressful circumstances—for example, while taking a test or interviewing for a job. Psychiatrists prescribe psychotherapy and medication, such as antidepressants, when the syndrome results in “distress or impairment in social, occupational, or other important areas of functioning.” In some cases, derealization results from serious mental illness, such as schizophrenia, or hallucinogens such as LSD. Extreme cases, usually associated with brain damage, may manifest as Cotard delusion, also called walking corpse syndrome, the belief that you are dead; and Capgras delusion, the conviction that people around you have been replaced by imposters.