Critical: Early Intervention

A mental illness is no different from any other physical illness; the earlier it is treated, the better the outcome. Early intervention can improve long-term quality of life. Because psychological factors are inextricably linked to brain function I stress the importance of both medications and some form of talk therapy. Each case is unique and treatment must be specifically tailored to the individual. The greatest crime my parents committed was in not getting me appropriate help in the form of therapy or medications when I was very young. I also needed, at minimum, some form of explanation as to why my parents fought endlessly, why my father was exiled from the house, why this somehow had something to do with me. I never fully understood "private family matters" and was admonished to keep such matters a secret, even from relatives and my closest friends, with threats of punishment and abandonment. My mother is particularly culpable as she was a psychiatrist, a medical doctor, who had acquired the bulk of her training at a Clinic for Child Study. She was an expert in child abuse assessment and often testified in the County Juvenile Court on behalf of abused children. Abuse can be physical, mental, or both and each child responds differently depending on his or her personality. My mother was quite aware of this, and aware that I was a "sensitive" and "introspective" child, "intelligent" and "creative" -- words she herself used to describe me. I was an easy target for her emotional blackmail and she knew this and somehow reveled in her power over me as she reveled in the power she had over her "weak" sick patients.

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Therapy At this stage in my life, I can't believe that any form of talk-therapy alone, will ever cure my DP/DR, depression, and anxiety -- in my particular case. My symptoms are neurological disturbances (which came about from a complex interaction of Nature and Nurture) that I believe will continue to require treatment with medications (perhaps indefinitely). Had I received counseling of some sort at a very young age -- perhaps behavioral therapy to decrease my anxiety and improve my self-esteem -- this might have changed the course of my illness. I will never know. At minimum, absence of love, fear of abandonment, and constant verbal abuse, created psychological scars (not perceptual distortions) that persist to this day. In other words, I would have sought therapy at some point in my life simply to deal with problems in social interaction and occupational functioning, even if I had no psychiatric symptoms such as the depersonalization and severe anxiety. For many years I was nearly convinced (especially when working in psychoanalysis) that my abuse had brought about my depersonalization as a coping mechanism; it was an escape of some sort, a rejection of the pain of the real world. Yes, dissociation is clearly a coping mechanism in healthy individuals during times of stress, when in the Fight/Flight mode, but this is very different from depersonalization which remains a chronic and disabling condition. Therapy however has had a very important role in my treatment over the years. Verbal and mental abuse created many personality problems for me. Therapists have helped me "see" the dysfunction in my family, validate my sense that my parents were both ill, see that my childhood was far from healthy. But I never "repressed" memories or events -- I simply "filed them away" without the appropriate emotions attached to them. I have serious problems with my self-esteem, expressing my own opinions, dealing with rage and grief. I experience extreme hopelessness or elation and cannot find a middle ground. Currently I work on feeling comfortable being more assertive, feeling I can speak my own mind without losing friends or being attacked. I am also examine on why I become overly anxious in certain situations that do not merit such anxiety. This seems to stem from a fear of failure, rejection, and abandonment instilled by my mother. I am addressing these problems with behavioral therapy. I must practice being confident and assertive in all situations. I'm still struggling with simply being myself. This sounds so simple, yet has been extremely difficult for me my entire life. I am finally learning to take risks, and finding I won't be punished for stating my needs and wants. These are things that should have been nurtured in me by my parents; my mother did the exact opposite by destroying coping skills and self-esteem. I have two distinct issues to deal with: psychological problems and perceptual distortions. I still don't know for certain if my dysfunctional upbringing brought about my depersonalization; I know it caused serious psychological problems and I would have sought treatment for these regardless.

1975-1976 (Last year of high school, age 16): First visit to any therapist -- an M.D. psychiatrist chosen by my mother. Diagnosis: depersonalization as a result of smoking pot (which I never did), and depression. Treatment: weekly visits for talk therapy. Prescribed Tofranil (imipramine). This was the first time anyone had told me what was wrong with me, the first time anyone had given a name to what I called "feeling weird." The moment I returned from my session I flew through one of my mother's massive psychiatric texts. In those days, there was little more than a paragraph on depersonalization, but the minute I read a case history I knew what was wrong with me. For me there was nothing more comforting than to know I was not alone, not "making this up," not going mad. Neither the psychiatrist nor the imipramine did anything for me though I saw this doctor dutifully, once a week. He was intimidating, arrogant and dismissive and often said, "Your mother isn't on trial here." 1976-1979 (Away at university, then took one year off from university due to inability to function.): No therapy during this period though my mother irresponsibly continued to provide me with imipramine herself while simultaneously saying I was "acting." She never mentioned my inability to function other than that I was obviously lazy and mainly ignored me for the year I stayed at home in her guestroom -- no longer my room. I was so ill and dependent on her, I passively accepted the situation and began to become increasingly depersonalized and depressed. I kept this information from family and friends. I don't think I told my father why I left school for a year; it was around this time we started to become more emotionally and physically distant. 1979-1983 (Final two undergraduate and two graduate years at university): Second psychiatrist, whom my father paid for but never discussed with me. (He filed for divorce from my mother when I turned 18.) This psychiatrist was an empathetic fatherly figure. Diagnosis: depersonalization and depression. He held a theory of DP as a defense mechanism against abuse and tried working through it with "talk therapy," not specifically psychoanalytic. I had weekly visits for medication experimentation and coping. This man gave me the strength to have hope and constantly encouraged me to pursue my studies and my dreams. Though we tried a number of medications, none touched the DP or depression. I was frequently despondent and sometimes suicidal, still appearing "normal" to my friends and keeping my illness secret. I credit him with helping me get through university -- not letting me give up; he would say that I did it with my own strength. There are some decent psychiatrists out there. 1983-1989 (Move out of home-state for career): My move across the country was the most Hellish experience of my life. I was seriously depersonalized most of the time. I wandered blindly through each day, and fought to stay in a prestigious job, but literally became incapable of interacting with people. I became increasingly isolated and planned suicide if I did not improve by my 30th birthday. I began psychoanalysis with an M.D. psychiatrist. Diagnosis: Depersonalization Disorder. He had a firm belief that my DP was a defense mechanism against abuse. He had little faith in medication for my symptoms, but prescribed Xanax and other benzodiazepines for anxiety. My DP and depression became worse, though I sincerely believed in his theories of dissociation. I was doubtful of firm belief in Multiple Personality Disorder (now called Dissociative Identity Disorder -- DID) as a means of protection from abuse. He never felt I had MPD, but believed I might have developed it and developed DP instead. 1987 (A Significant Turning Point): A psychiatrist filling in for my vacationing psychoanalyst prescribed Klonopin (clonazepam). This was a dramatic turning point as this was the first drug to lift some of the DP/DR. I wanted to continue work with this doctor however he was moving out of state. I found some hope that I had a chance to improve significantly with this medication. 1989-1994: Gradual breaking away from my psychoanalyst and long, frustrating search for a new psychiatrist. 1994-2001: Psychiatrist/Psychopharmacologist for medication experimentation and monitoring. Diagnosis: GAD (Generalized Anxiety Disorder), depression, and depersonalization. Some belief DP could be a result of chronic stress and verbal abuse. Greater emphasis on the biological model of all mental illness and the use of psychopharmacology for treatment. 1999-2001: Clinical Psychologist for CBT (Cognitive Behavioral Therapy) and coping. Working around the limitations of the depersonalization and depression. This combination of aggressive trials with various medications and CBT as a coping tool has been the most successful in treating my anxiety depersonalization -- to a degree. But I am far from cured. I don't believe I will see a cure in my lifetime, but I am more "stabilized" than I have been in years. I have a significantly improved quality of life, one worth living. But I have many limitations functioning socially and occupationally. 2001 to Present: In 2001 I moved away from my husband (various personal reasons - we are very good friends) and returned to my home state. It was a gut-wrenching experience. I had initially planned to go back to keep closer tabs on my mother who was still in her Nursing Home in the last stages of Alzheimer's, but as noted in "Postscripts" my mother died on September 12, 2001; I got the keys to my new apartment on September 3, 2001. A lot happened that week! Her influence of course extended from beyond the grave (again in the form of insult and control). Suffice it to say she had informed her attorney and financial consultants (for years) that I was not to be trusted re: finances, personal affairs, and the like. I have spent the past 5 years proving to them that is not the case. This has only perpetuated a shame I should never have felt, a shame that began in childhood, that I was an evil, worthless individual. I have returned to one on one talk therapy for medication monitoring and support with a resident at the local university medical school. I go once or twice a month as needed. I found great value as well in group therapy. When a close friend of many years took her own life in December of 2004 I attended a structured 12 meeting "Survivors of Suicide" program. This reinforced a skill I've always lacked -- that exchanging feelings honestly with others is acceptable. I shared many confused emotions with many grieving individuals; it was truly cathartic. Coincidentally, earlier that fall, I started a structured four-month program of Dialectical Behavioral Therapy. A summary of this variation on Cognitive Behavioral therapy is described as follows at the link below: "Dialectical Behavior Therapy is based on a bio-social theory of borderline personality disorder. [Marsha] Linehan hypothesises that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the 'Invalidating Environment'." From: (www.priory.com/dbt.htm) The four month program addresses: Core mindfulness skills. Interpersonal effectiveness skills. Emotion modulation skills. Distress tolerance skills. DBT is actually based on simple Buddhist principles delineated by Zen master Thich Nhat Hahn, and put to great scientific scrutiny by Marsha Linehan. See the link below to read about this in depth: Extensive Description of Marsha Linehan's Dialectical Behavioral Therapy Update: 2008 I have decided I no longer wish to pursue therapy unless my symptoms get worse. I am stable, still on my medications, and meet with a psychiatrist every few months to touch base.

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Medication History Current medications: Klonopin, 6mg/day is my mainstay, it has always kept serious chronic DP/DR at bay; it is a benzodiazepine/anti-anxiety agent, originally marketed as an anticonvulsant. Lamictal, 200mg/day is in the anticonvulsant class; for me it acts as a mood stabilizer and decreases anxiety; it makes me feel "less afraid" of the DP/DR. Celexa, 40mg/day is an SSRI (like Prozac) with fewer side effects; it is an antidepressant.

The overall effect of this "cocktail" is less anxiety, less "catastrophic thinking", less debilitating depression, and a slight decrease in my DP/DR symptoms. I am not cured of my DP/DR -- it still limits all areas of my life -- but I have a significant increase in the overall quality of my life and my ability to live with my symptoms. There is no specific medication approved for the treatment of depersonalization. It is up to you and your psychiatrist to experiment with various drugs to find the right medication for your individual case. We are all unique.

Medications I have tried with little response or some negative side-effects: I do not recall doses, but many were taken long enough to determine they had little effect, gave me bad side-effects, or caused more DP/DR. Note, I may have left some out simply because I have experimented (under medical supervision) with so many over the years. This does NOT mean that any one or any combination of these drugs can't work for you. We are all different. One drug that has no effect on one person is a "miracle" for another. Never give up experimenting if you are up for it. Give medications a chance if you wish to take this treatment route.

Tricyclics Imipramine (I may never have been given a high enough dose), Desipramine. Anafranil (incapacitating sedation). MAOIs (Monoamine Oxidase Inhibitors): Marplan, Nardil, and Parnate. No effect on any symptom and caused severe postural hypotension -- low blood-pressure which caused fainting when standing up. Benzodiazepines Valium, Xanax, Ativan. Helped ease some panic and anxiety at higher doses but did nothing for the DP/DR symptoms. SSRIs (Selective Serotonin Reuptake Inhibitors) Paxil (some anti-depressant effect, sense of a "perceptual shift" but no DP improvement). Zoloft. Prozac (tremors, irritability, hyperactivity). Anti-Convulsants Tegretol, Depakote, Neurontin. Miscellaneous Before Current Cocktail Note, some of these medications were taken alone or in conjunction with others when appropriate. Risperdal. Serzone. Remeron. Cytomel (a thyroid medication which gave me a serious rash). Ritalin (made me a hyperactive DPd person with incredible motivation/3 hours of sleep a night). Inderal. Buspar. Wellbutrin (seriously exacerbated my DP/DR). Lithium. Stellazine, and one or two other neuroleptics (anti-psychotics) all of which caused serious exacerbation of my DP/DR. NB: there are new neuroleptics on the market now that give much relief to some individuals; at this time, I'm reluctant to try them.

Also have a look at: The Chemistry of Mind-Altering Drugs: History, Pharmacology, and Cultural Context Daniel M. Perrine, American Chemical Society, 1996 The Rx Internet Drug Index A superb medication search engine. A comprehensive database of medications and herbal remedies.

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© Sandy Gale, 2000-2008 The Pear Blossom Project

April 17, 2008