Philosophy, Psychiatry, & Psychology 9.3 (2002) 287-288
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Filip Radovic and Susanna Radovic
The comments offered by Morris and Modigh in this issue give us an opportunity to clarify some of the views and topics discussed in our paper.
One of Morris' objections is that we on some occasions characterize depersonalization complaints in a way that indicate delusion. Although one of the criteria of depersonalization syndrome is intact reality testing (APA 2000), it is nevertheless the case that patients with depersonalization complaints may at the same time be delusional, a fact that Modigh also points out: "The border between unreality feelings with largely intact reality-testing ability and psychotic disorders with grossly disturbed reality-testing is, however, not absolute and patients with psychotic disorders may of course experience feelings of unreality or depersonalization."
Morris is also critical of the idea that feelings of unreality in the quasi-sensory sense (or in sense [a3]) may tempt patients to doubt the reality of the items experienced as unreal. We suggest that the experience of the self or the world as unreal may actually give rise to an impulse to believe that the self or the world does not exist. This, however, need not imply that a person who has such a belief is delusional. For example, consider the following cases, which include patients with intense unreality feelings but who exhibit largely intact reality testing. One of Sierra and Berrios' (2000) patients says: "I have to touch myself to make sure that I have a body and a real existence." Lindqvist (1966, p. 171) describes two cases of the "mirror syndrome," which he recognizes as a typical behavior seen in cases of severe depersonalization. The patients want to confirm that they are real by looking in a mirror. Such cases strongly indicate that a person with otherwise intact reality testing can be so overwhelmed by feelings of unreality that he or she can come to doubt his or her own existence. The reason we do not want to call this state delusional is that the patient constantly tries to compare the experience of reality with some other mark of reality (e.g., by using a mirror), thus indicating that, on a higher cognitive level, he or she still understands that his or her belief may be incorrect. The image in the mirror works as an assurance that the fear of not existing is, after all, just a fear.
Merleau-Ponty's (1962) description of Stratton's inverting spectacles experiment is indeed relevant to our analysis. The experiment seems to indicate that the feeling of unreality corresponds to the degree of unfamiliarity with seeing the world upside down. Stratton's subjects report that after a couple of days objects still appear inverted but less unreal than they did before. This seems to suggest that unreal in this circumstance approximates not normal. An inverted world is after some time accepted as normal. (See also note 3 in our paper.)
Let us conclude with a few comments on an important methodological issue. Our methodological [End Page 287] approach is not equivalent with a classical ordinary language approach because our main concern is language use in psychiatric contexts. A classical ordinary language analysis aims to explicate how terms actually are used in everyday language; our primary concern is to try to understand the phenomenology underlying descriptions of felt unreality given by patients suffering from depersonalization. However, we do start by looking at the terms from an everyday angle, but this only gives us a coarse approximation of what the depersonalization patient may mean by such expressions. The strange and unpleasant phenomenology of the condition in combination with the variety of characteristic expressions make it likely that the role of unreal in connection with depersonalization complaints is quite different from its use in everyday language. When a person undergoes a depersonalization episode for the first time, he or she encounters a quite new and perhaps unexpected phenomenological reality. When the person attempts to describe these perplexing feelings he or she, naturally, uses terms found in everyday language, but the changed...