Depersonalization in Response Life-Threatening Danger

Russell Noyes, Jr. and Roy Kletti

to

EPERSONALIZATION is a subjective mental phenomenon having as its central feature an altered awareness of the self. Its occurrence in a variety of psychopathological states, particularly those accompanied by extreme anxiety, has been well documented. .8.2.14 It has also been reported by normal persons under a variety of circumstances including drug intoxication and environmental stress. 5.n.15 Previously a series of accounts of depersonalization occurring in response to life-threatening danger was examined and the essential features of the syndrome identified. I The purpose of this article is to provide a detailed description of the phenomenon as it develops under these circumstances and to interpret it as a response to extreme danger.
MATERIALS AND METHODS

The material on which this report is based came from personal interviews conducted by the authors with 61 persons who offered descriptions of their experiences during extreme danger. These persons responded to an advertisement in the University of Iowa student newspaper for accounts of subjective Their accounts, which were transcribed, experiences during moments of life-threatening danger. formed the first portion of a semistructured interview designed to elicit detailed information about their response to dangerous circumstances. In addition each respondent was asked to complete a 40item questionnaire. These were also completed by 21 persons to whom they were mailed when it was learned they had nearly drowned and by 19 others who were contacted informally. The responses from these groups did not differ from thoseof persons interviewed. The questionnaire contained 40 questions calling for yes or no answers. The first four dealt with factors presumed to influence the experience. The first asked each individual whether or not he believed he had been about to die during his accident. Three more questions dealt with the meaning attached to the experience; the remainder inquired about a variety of subjective phenomena commonly reported during depersonalization. The life-threatening circumstances responsible for experiences reported were as follows: automobile accidents, 40; drownings, 32; falls, IO; serious illnesses, 8; and miscellaneous accidents, Il. Questionnaires were completed by 62 men and 39 women having a median age of 22 years at the time of their experience. Persons who responded to this inquiry may have been prompted to do so by curiosity about their experiences. Consequently, whay they reported may not be representative. The uniformity of their responses, however, suggests that they are typical. R ESU LTS

Depersonalization, as described by the subjects of this investigations, consisted of a series of contrasting effects upon the fundamental experiencing of the self and its immediate environment (Table I). Tendencies toward enhancement and diminution of experiencing occurred at different times or simultaneously as a part of this alteration in consciousness. For example, perception often became sharper or duller than it had been previously. Changes were most commonly reported in the experience of time, emotion, sensation, volition, reality, memory, attachment,
From the Department of Psychiatry, University of Iowa College of Medicine. Iowa City. Iowa. Russell Noyes, Jr., M.D.: Associate Professor of Psychiatry; Roy Kletti, M.A.: Clinical Psychologist, Department of Psychiatry, University of Iowa College of Medicine, Iowa City, Iowa. Reprint requests should be addressed to Dr. Noyes, Department of Psychiatry, University of Iowa College of Medicine, 500 Newton Road, Iowa Cit.v, Iowa. 52242. ? 1977 by Grune & Stratton, Inc. Comprehensive Psychiatry, Vol. 18, No. 4 (July/August).
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Table 1. Subjective Effects Experienced During Life-Threatening

Danger

PercentWho BelievedAbout to Die

Yes NO

Subjectwe Effects
1.

N= 59 81 78 68 65 63 61 57 44 42 39 36 34 32 29 28 24 19 17 16 14

N = 42 60 63 50 55 50 38 55 31 12 32 31 37 17 32 31 15 7 17 7 19

Total N= 101 72 72 61 61 57 52 56 39 30 36 34 35 26 30 29 20 14 17 12 16

Feeling of unreality

2. Altered passage of time 3. Increased speed of thoughts 4. Unusually vivid thoughts 5. Automatic movements 6. Sense of detachment 7. Lack of emotion 8. Objects small or far away 9. Panoramic memory 10. Controlled by external force 11. Detached from body 12. Sharper vision or hearing 13. Colors of visions 14. Unreality of world 15. Disbelief regarding accident 16. Voices, music or sounds 17. Vivid mental images 18. 20. Body parts changed in size or shape Vision or hearing dull 19. Thoughts blurred

First column shows persons who believed they were about to die and the second those who did not have this belief.

and space. A series of accounts will illustrate these effects which will then be described in detail. A 23 year old student recalled an accident that had occurred four years earlier. He was driving an old car at 60 mph when the steering gave out. . My mind speeded up. Time seemed drawn out. It seemed like five minutes before the car came to a stop when, in reality, it was only a matter of a few seconds. I remember that my sense of touch and hearing became more acute. I was unusually aware of my grip on the steering wheel and of my body touching the seat behind me. The grass brushing the door was unusually loud. On the other hand, my vision was blurred except for an instant when my attention became focused on the abutment ahead.. My mind was working rapidly and reviewed information from drivers education that might bear on what I should do to save myself. It seemed to be working on more than one level, however, for at the same time I had a clear image of myself being killed. I saw this as though watching it on a television screen from an unusual angle; that is, I saw it from a distance of about 50 feet as though looking at the car from the side. I pictured this wreck occurring in slow motion. While all this was taking place I felt calm, even detached. This account illustrates the expanison of time and space, speeding of mental processes, heightening of sensation and imagery, and sense of detachment. Similar changes were reported by a 24 year old man whose car entered a skid rounding a rain-slicked curve, placing him in the path of an oncoming vehicle.

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I remember, like in slow motion, the sound of glass shattering. As the car started spinning I came up out of my seat and looked at the ceiling of the Volkswagen. I remember being very interested in the roof like I hadnt seen it before. The whole thing must have happened super quick but seemed to take a tremendous amount of time. As the car was spinning I had a relaxed kind of feeling like being stoned on pot or something. I gave no consideration to the danger, itjust didnt exist. I had a sensation of floating. It was almost like stepping out of reality. I seemed to step out of this world, where you feel the sensation of your body in the seat and the air you breathe, into some other state. In that state I seemed to have no control over myself but everything seemed to be working in harmony. For example, I didnt have the fear that in the next second the ceiling was going to rush in and crush me which would have been very realistic. Rather it seemed as though a machine or a physical law of nature was swinging me around and was going to bring me down unhurt. My attention was focused on what was happening inside the car and the rest of the world seemed very far away.

Particularly striking in this account are the emotional calm, feeling of unreality, and coexistent sense of loss of control and invulnerability. A dramatic account of the sense of detachment was provided by a 21 year old truck driver who narrowly escaped hitting a train. Cresting a hill at a high rate of speed he found himself 100 feet from a train he felt sure would kill him.
The next thing I knew I wasnt in the truck anymore; I was looking down from 50 to 100 feet in the air. From there I saw the truck smash into the train. Then it flashed to another scene and I was looking down from a different angle. This time the truck slid into the train and it derailed. Then I popped to a different situation and saw myself go flying out the windshield into a boxcar. Finally, I had a vision of the truck from behind and saw it shudder, turn over on its side and blow up. It was strange. I was watching subjectivelyPlooking at the situation happen-but was not actually a part of it. When the truck actually hit the train I was back in it. As the train went by I saw the engineers face. It was like a movie run slowly so the frames progress with a jerky motion. That was how I saw his face.

A 20 year old motorcyclist reported an accident in which he believed he would be killed when he was 16. He was traveling at 40 mph on a dimly lit road when he became aware of a stalled vehicle a short distance in front of him.
I had a feeling that this wasnt really happening to me. Then I started seeing good and bad things in my life. They were scenes that flashed rapidly before my eyes like lantern slides shown in rapid succession. They started when I was about two years old. A funny thing, I remembered dumping a bowl of cereal upside down on my head. I remembered being spanked when I brought home a bad report card. I remembered high points like the first time I kissed a girl, the first time I got drunk and other things like that. With each one I had the feeling like I had then. It was like living them over again. With each one I, at first, found myself in the picture; but then I was detached like you would sit and look at the pictures of yourself in a family album. I was removed like in the third person. The pictures seemed to follow a sequence. As far as I know they were memories of things that had actually happened although I had not remembered a few early ones.

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Most of them were happy. The slides were flashing by rapidly. I dont remember how many there were but, from the moment I saw the accident about to happen, it seemed like I waited forever for the impact. The whole thing seemed unreal. At first I was panicky but after that I was watching the slides and that was all that was happening. . .

In this illustration of panoramic memory, scenes of the individuals past life were accompanied by contrasting feelings of familiarity and detachment. Seventy-two per cent of persons in this study reported an altered awareness of passage of time (Table 1). With few exceptions they referred to a slowing. Time was described as strung out, expanded, endless, an eternity. One minute seemed like five and ?econds seemed like hours. Events seemed to happen more slowly and appeared as one accident victim claimed, to happen as in a slow motion film. This apparent slowing of environmental events was in contrast to a speeding of mental processes (61%). The victim of a life-threatening injury reported that as the time in which everything was happening seemed to slow a relationship between the two, an down, my thoughts speeded up. Suggesting accident victim claimed, my thinking processes increased at an incredible rate so that my movements, in relation to them, seemed extremely slow. Others described their thoughts as rapid, racing, and a lot of thoughts in a short time. When greatly accelerated, thoughts and mental images often took on a disconnected quality. The thoughts that went through my mind were very rapid and disjointed-disjointed like there was no time, said one person. Another said her thoughts jumped around. Occasionally persons described a diminished awareness of time as a dimension of their experience, even to the point of feeling apart from it. One women said she felt, as though I were in limbo, like there was no time. Others described time as not a reality, suspended, and not existing. A blunting or absence of emotion was reported by 56% of persons in this study. This was described in terms of detached calm or peacefulness. A mountaineer claimed that during a fall he felt calm and detached. I felt no emotion. Even the thought of his death was a completely dispassionate observation. Occasionally a person spoke of feeling as though he were cut off from his emotions: . . suddenly everything was empty in me, as though I didnt exist, a void. Thirty per cent indicated they felt as though a wall existed between themselves and their feelings. This emotionless state was often accompanied by a sense of assurance and, infrequently, by a degree of euphoria. When the latter occurred it was likened to the experience of drug intoxication. During two accidents a man claimed the most striking thing was the calm, almost womb-like warmth. It was like a musing on a warm, late spring afternoon in the country. I had a complete sensation of confidence, assurance, stability. I would compare it to a morphine high; I once had morphine after an operation. Eighteen per cent gave questionnaire indication of pleasurable emotions. In contrast to the emotionless calm, fear (69%) or other intense emotions were described immediately before, after, or even during the depersonalized state. Fear was described as intense, debilitating, and extending to panic. Other emotions including anger, loneliness, and sadness were of similar intensity. During a fall one young man reported that the numbness he felt was not from a lack of emotion but rather an overload of them. It was like the emotion machine was turned to full blast and they all came simultaneously. Simi-

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larly a women who feared death at the hands of an assailant said that after receiving a blow, my head was hurting badly but I didnt feel it. It was like there were too many other emotions crowding it out. Marked and contrasting alterations in sensory experience were reported. Vison and hearing were described as sharper than usual by 35% and less sharp by 16%. Vision was frequently described as clearer, sharper, or more distinct. My hearing was especially sharp, recalled an accident victim. If someone knocked their teeth together it sounded like a crash. Others reported that their vision was sharpened visual imblurred or dim and their hearing faint. Occasionally pressions took on a surrealistic quality; dullness rarely reached the point of a complete absense of impressions or darkness. A narrowing of the focus of attention appeared to be involved in these apparently contradictory effects. Several persons described their vision as blurred or absent peripherally but unusually sharp centrally. According to a young man approaching what he viewed as life-threatening surgery, the things I was seeing were blurry to the right and left but right in front they were very clear. A young woman claimed that the movements she made trying to avoid an accident were very clear and precise but other things such as people and scenery were blurred. Thus, wherever the immediate focus of attention turned-whether on bodily sensations, visual perceptions or mental imagery-the impressions were unusually vivid, while apart from this focus sensation became dull or failed to register in awareness. When a man attempted to rape her, one young woman found her visual awareness of the scene limited to the color of the upholstery, the shirt, and a dark green tree behind me. An absence of sensation below the neck or throughout the body was often reported by depersonalized individuals. I felt numb, a near-drowning victim claimed. There was no sensation from my arms or legs. I seemed to be all head. An accident victim reported no sensation in my body. Immediately after the accident he said he had to send out feelers from my brain to see if everything were all right. The pain of injuries did not reach awareness while this alteration in sensation persisted. Thoughts were described as unusually distinct or vivid by 61% and blurred or dull by 12%. The sharpening of mental imagery was such that images approached the character of perceptions. Fourteen per cent claimed to imagine people or scenes so vividly that they almost seemed real, Additional unusual or strange sensory experiences were reported including colors, sounds, and a variety of difficult-to-describe physical sensations. One woman reported that a loud noise ran all through me. It was indescribable. A boy recalled that as an accident was taking place, my sight seemed filtered through a blue piece of tissue paper with spots of red and yellow. A sense of helplessness was reported by many persons during their accident and was accompanied by a feeling that movements or thoughts were mechanical or automatic (57%). I no longer had control of my physical movements, said an accident victim. I knew what I was doing but was not in control of it. Another claimed that, it seemed as though there were no thoughts received by my body for me to make movements. Thirty-six per cent described a more dramatic loss of volition in terms of feeling as though they were controlled by some outside force. In the midst of an accident one man said, I felt helpless as though something or someone were in control. A near drowning victim said, it seemed like I was under a terrific natural force that I couldnt fight. These expressions of

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volitional loss were, paradoxically, often associated with a sense of invulnerability or magical control. One man described the feeling as follows: I never felt such control, like I could do anything, like I was immortal. A woman in the course of being assaulted said, At the same time that I felt I was going to be killed, I was also thinking that everything was going to be all right. I had the assurance of safety. In a similar situation still another woman had a feeling of power come into me. It was difficult to determine whether the sense of loss of voluntary movement ever resulted in motor paralysis. Curiously, several claimed that, while their observing self had seemed to resign itself to its fate, another self maintained rescue efforts. One woman reported that her mind was functioning on more than one level. Nearly drowning herself in the midst of attempting a rescue another said, toward the end I kept thinking I should leave the child and get to shore myself but my body didnt respond and 1 held onto her. The most common feature of depersonalization from quesitonnaire responses was a feeling of strangeness or unreality. Seventy-two per cent applied this description to themselves while 30% identified the world around them as unreal. Both were included in such terms as weird, strange, unreal, and dreamlike. One said he felt not a part of reality. It is hard to explain. The ineffable quality of the entire experience was most noticeable in attempts to describe this feature. For most it was a feeling unlike any they had previously encountered. It included disbelief regarding immediate circumstances. Many felt as though the accident was not actually happening (29%). In the course of almost drowning one young woman reported, I kept thinking this really wasnt happening but I knew all along that it was. As she suggested, it is doubtful that a complete separation from reality occurred. Rather, there was an as if quality to the description of many aspects of the depersonalized state. In contrast to the feeling of strangeness or unreality just described, the phenomenon of panoramic memory carried with it an impression of unusual familiarity. It occurred in 30% but developed almost exclusively in those who believed themselves about to die during the accident (42%). It consisted of scenes from the persons past life that flashed by in rapid succession as though on a conveyer belt or a film sprung loose from the camera. They were vivid and framed or disconnected but often followed a sequence from early to later life or vice versa. Each was usually accompanied by intense emotion appropriate to its content such These events, some of them not previously that events pictured were relived. remembered, represented points of special significance in the persons life. A young woman who nearly drowned in a lifesaving class gave the following description:
Then my life-everything I had done, seen and people I had known-passed right in front of my eyes. The memories were pleasant and happy. They seemed to pass slowly enough to give me time to react emotionally and with senses. Everything seemed real, as if I could reach out and touch it.

In an ambulance on his way to the hospital following a serious young man experienced an extensive revival of memories:

auto accident,

one

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The one I remember most was that year I had been on the basketball team. I canned a 35footer at the buzzer. I went through it, it happened, I remembered what it was like and, bang, I was thinking about my parents. I thought about bad and good stuff, just like I was weighing the odds on whether or not I wanted to cash this life in or not. I saw myself doing these things. At the time it was like I was there. It was as
if I saw it happening through my own eyes.

The emotional response to these memories was described as intense and absorbing. The term panoramic memory, used by Wilson in 1928 to label an aura of temporal lobe epilepsy, appears to be a misnomer when applied to depersonalization in response to danger. In addition to the life review described, a preview of death occurred in some instances. Included in the rapidly flashing scenes were vivid fantasies of the developing accident and the reactions of loved ones to the persons death. A sense of detachment was reported by half (52%) of the persons who contributed to this study. They described a feeling of separation from the world, from themselves and, particularly, from the accident taking place. Often an individual felt like a spectator rather than participant in the events that were occurring. According to one woman, It was as though I was separate from myself and watching, like in a dream when you are watching yourself. Another said, 1 felt as if I were watching this happen to somcone else. However, in addition to the seeming indifference or lack of concern for the accident and its personal consequences a physical separation from the scene and from the persons body was commonly reported. Accident victims reported the following experiences: I seemed to be looking at the whole scene from outside my body. I felt partially removed mentally from my body and from the friend sitting next to me. I stood about 50 ft off and saw myself from the side; I looked small. Thirty-four per cent claimed that their body seemed detached in this manner. As in the last example a few reported watching themselves and the accident from variable distances much as a third person might. The detached observer reported no subjective awareness of the observed self or of its own spatial bounderies. Spatial relationships of the environment were also distorted. Most commonly expansion was reported. Thirty-nine per cent indicated that objects seemed small or far away. Less commonly they seemed larger or closer at hand. Following a severe injury one man observed that, the ground seemed closer then farther away. To a near-drowning victim the shore seemed miles away, whereas for an accident victim the approaching train seemed huge and overpowering. From questionnaire responses the presence or absence of eight basic features of depersonalization including alterations in time, emotion, sensation, volition, reality, memory, and attachment space was established. Sixty-six per cent reported 5 or more, and 33% 7 or 8. The average for the entire group that completed questionnaires was 5.0. Questionnaire responses did not differ with age or sex.
DISCUSSION

The data presented suggest that universal response to life-threatening

depersonalization is, like fear, danger. It develops instantly

an almost upon the

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recognition of danger and vanishes just as quickly when the threat to life is past. Its contrasting subjective effects appear to be manifestations, as Roth and Harper have suggested, of heightened arousal on the one hand and dissociation of consciousness from that arousal on the other. I3 Depersonalization appears to be an adaptive mechanism that combines opposing reaction tendencies, the one serving to intensify alertness and the other to dampen potentially disorganizing emotion. This view was supported by persons interviewed who described themselves as functioning effectively under extraordinary circumstances .aided by a sense of calm objectivity. Their claim of little traumatic aftermath from their experiences (e.g. nightmares, anxiety, phobias, etc.) was further evidence of the adaptive nature of this mechanism. The precise mediator of depersonalization is, of course, not known. It could develop in response to anxiety or to the symbolic appreciation of danger. Extreme anxiety is often accompanied cognitively by fear or imminent death; on the other hand, the threat of death is associated with extreme anxiety. The two are intimately associated and, in this sense, both participate in the development of depersonalization. The split between the observing and participating self that has been hypothesized to account for the depersonalized state received support from participants in this study.2 As they became detached observers, they felt distant from their bodies and seemed to lose contact with their emotions and bodily sensations. Thus, distancing or dampening effects appeared to accompany the experience of the observing self. It was this self that the depersonalized individual identified as himself and the one he maintained subjective awareness of throughout. As shown in Fig. 1, effects suggestive of increased arousal appeared to accompany the experience of the participating self. These were most evident while struggle for survival was in progress. Occasionally this effort was carried on by the participating self after the observing self had seemingly discounted the possibility of rescue. Janet explained depersonalization on the basis of altered attention.7 References to narrowing and sharpening of the focus of attention were frequently made by the participants in this study. Within a restricted field sensations, perceptions, mental images, etc., were intensified while sensory impressions that were normally within the sphere of immediate attention, even if on its periphery, were excluded from awareness. The victim of an assault said, The whole world seemed to narrow down and my thoughts focused on how I was going to get away. My vision for the direction I was headed was very clear but elsewhere everything was dull. AS an automobile accident approached a young woman reported that, space was concentrated to the area of the car I was occupying. Every dial, the steering by column and brake were magnified. Similarly inner experience was fragmented the restriction of awareness to a narrow focus. A similar alteration in attention is produced by marihuana, a comparison specifically referred to by several persons in their accounts.g James compared the change in attention occurring in marihuana intoxication to the effect of observing events taking place through a microscope. 6 Passing at their normal rate, events seen through the high powered lens would be seen vividly but would appear to flow more rapidly and lose their context within a larger field. The character of panoramic memory may be understood by the same analogy. Normal consciousness may be likened to a movie in which each frame of the film merges with the

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PARTICIPATING SELF 1 rhoughra.m*~mO*f

speeded 2. ~ayfied emotions.

TIME
EMOTION

OBSERVING SELF 1. W&gl$,. m(lv*m*n*=

2. reduced or absent emotions, calm perception. mental omsgery dulled nla*mets, automatic thollghtr

3.

heightened psrcsptoon. mental imagsry increarecl confrol of nlcvements. thoughts sense of mcraased familiarity IdW vu,

SE,gAT,ON

3.

YOLlTlON

5.

REALITY

feeling of strange ne*s. maw

Fig. 1. Diagram of the dissociation between observing and participating self showing the subjective effects accompanying each.

next to give an impression of continuity. In the mental state under consideration frames appear to become isolated and disconnected from those which preceded or followed them. They tend, in the process, to become distinct in themselves and, as a result, to lose their continuity or location in time. As a result of narrowed attention and heightened arousal, memory sequences become vivid and the emotional response to them intense.3 The interpretation of depersonalization as a defense against the threat of extreme danger or its associated anxiety seems inescapable. Arlow, commenting on the split of the self into participant and observer, hypothesized that theobserving self, by dissociating itself from the remainder of the ego, produced a feeling of estrangement thereby creating the fantasy that danger, though real, was threatening a stranger. Freud believed a general tendency existed for persons to eliminate the threat of death by becoming, in a sense, detached observers.4 Our own death, he said, is indeed unimaginable and whenever we make the attempt to imagine it, we can perceive that we really survive as spectators. Thus, in the face of life-threatening danger, persons become observers of that which is taking place and effectively remove themselves from danger. Detachment appears to be a major adaptive mechanism which, in the depersonalized state, is seen in bold relief.
SUMMARY

Basic features of depersonalization, including alterations in the experience of time, emotion, sensation, volition, reality, memory, attachment, and space, were elicited from 101 persons who had encountered life-threatening danger. Sixty-six per cent reported five or more of these features pointing to the extremely frequent appearance of this adaptive mechanism under dangerous circumstances. Contrasting effects were reported by depersonalized individuals that appeared to reflect heightened arousal on the one hand and attenuation of potentially disor-

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ganizing emotion on the other. A dissociation between an observing and a participating self was hypothesized to account for these fundamental alterations in the experience of the self and its immediate environment.
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