Clinical Phenomenology and Cognitive Psychology by David Fewtrell

Author:David Fewtrell
Language: eng
Format: mobi
ISBN: 9780415859301
Publisher: Routledge
Published: 2013-10-21T21:00:00+00:00

SUMMARY

Not all distressing subjective states are associated with high autonomic arousal states, but conform to a pattern of low physiological output. Depersonalisation belongs to this category of problem, which possibly indicates an important feature in that, unlike the typical presentations of anxiety and panic disorder, interoceptive cues of raised cardiac output and increased respiration rate are unlikely to be present at the onset of a depersonalised episode; more research is badly needed in this area to clarify the sequence of internal events. The fact that relaxation approaches exacerbate the condition indicates that arousal reduction is largely unsuitable as a corrective strategy. However, cognitive approaches, which do not directly manipulate physiological activity, have not been tested.

The cognitions concomitant with depersonalisation include concern over the apparent inability to feel emotion and the impression that somatic sensation, thinking activity and the external world are somehow fading away, leading to such propositional statements as the commencement of madness, loss of the sensorium and imminent lapse into unconsciousness or oblivion. Patients yearn for the return of vivid sensation.

There is an established association between a number of psychopathological states and depersonalisation, including depression, post-traumatic stress disorder, self-injury and panic. It is suspected that some self-injury serves as an attempt to regain vivid sensation. Depersonalisation falls into the category of disorders which Jaspers (1963) terms ‘disorders of awareness of activity’. Diminution in the feeling of one’s own voluntary movement and thinking are particularly prominent in this disorder. Because disorders of awareness of activity are also present in the major psychoses, depersonalisation may provide a point of entry for cognitive psychologists to study this area of self-alienation, since depersonalised patients are usually co-operative and provide clear self-report data regarding their experiences of detachment.

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