Depersonalization in Response to Life-Threatening Danger

Russell Noyes, Jr. and Roy Kletti

D 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 descrip- tion 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

experiences during moments of life-threatening danger.” Their accounts, which were transcribed,

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 40-

item 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. Question-

naires 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). 1977 375

376 NOYES, JR. AND KLETTI

Table 1. Subjective Effects Experienced During Life-Threatening Danger

Percent Who Believed About to Die

Subjectwe Effects Yes’ NO’ Total

N= 59 N = 42 N= 101

1. Feeling of unreality 81 60 72

2. Altered passage of time 78 63 72

3. Increased speed of thoughts 68 50 61

4. Unusually vivid thoughts 65 55 61

5. Automatic movements 63 50 57

6. Sense of detachment 61 38 52

7. Lack of emotion 57 55 56

8. Objects small or far away 44 31 39

9. Panoramic memory 42 12 30

10. Controlled by external force 39 32 36

11. Detached from body 36 31 34

12. Sharper vision or hearing 34 37 35

13. Colors of visions 32 17 26

14. Unreality of world 29 32 30

15. Disbelief regarding accident 28 31 29

16. Voices, music or sounds 24 15 20

17. Vivid mental images 19 7 14

18. Body parts changed in size or shape 17 17 17

19. Thoughts blurred 16 7 12

20. Vision or hearing dull 14 19 16

’ 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 hear-

ing became more acute. I was unusually aware of my grip on the steer-

ing 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 re-

viewed information from driver’s 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.

DEPERSONALIZATION 377

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 hadn’t 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 didn’t 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 didn’t 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 in-

side 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 wasn’t 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 situa-

tion 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

engineer’s 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 wasn’t 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 suc- cession. 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 re-

membered being spanked when I brought home a bad report card. I re- membered 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 se-

quence. As far as I know they were memories of things that had

actually happened although I had not remembered a few early ones.

378 NOYES. JR. AND KLETTI

Most of them were happy. The slides were flashing by rapidly. I

don’t remember how many there were but, from the moment I saw the

accident about to happen, it seemed like I waited forever for the im-

pact. The whole thing seemed unreal. At first I was panicky but

after that I was watching the slides and that was all that was happen-

ing. . .

In this illustration of panoramic memory, scenes of the individual’s 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 hap- pen 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

down, my thoughts speeded up.” Suggesting a relationship between the two, an 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 dis- connected 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 aware- ness 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 didn’t exist, a void.” Thirty per cent indi- cated they felt “as though a wall existed between themselves and their feelings.” This emotionless state was often accompanied by a sense of assurance and, in- frequently, 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 confi- dence, 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 de- personalized 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-

DEPERSONALIZATION 379

larly a women who feared death at the hands of an assailant said that after receiv-

ing a blow, “my head was hurting badly but I didn’t 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 “blurred” or “dim” and their hearing “faint.” Occasionally sharpened visual im-

pressions took on a surrealistic quality; dullness rarely reached the point of a com- plete 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-threaten- ing 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 sensa- tion 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 deper- sonalized 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 au- tomatic (57%). “I no longer had control of my physical movements,” said an ac- cident 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 couldn’t fight.” These expressions of

380 NOYES. JR. AND KLETTI

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” main- tained 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 didn’t 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 “dream- like.” 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 wasn’t 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 fami-

liarity. 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 person’s 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

that events pictured were “relived.” These events, some of them not previously remembered, represented points of special significance in the person’s life. A young woman who nearly drowned in a lifesaving class gave the following descrip-

tion:

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 auto accident, one young man experienced an extensive revival of memories:

DEPERSONALIZATION 381

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 hap-

pened, 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 weigh-

ing 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 absorb- ing. The term panoramic memory, used by Wilson in 1928 to label an aura of tem- poral 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 person’s 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 indi- vidual felt like a spectator rather than participant in the events that were occur- ring. 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 conse- quences a physical separation from the scene and from the person’s 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 aware- ness 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 com- monly they seemed larger or closer at hand. Following a severe injury one man ob-

served that, “the ground seemed closer then farther away.” To a near-drowning victim the “shore seemed miles away,” whereas for an accident victim the ap- proaching “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 com- pleted questionnaires was 5.0. Questionnaire responses did not differ with age or sex.

DISCUSSION

The data presented suggest that depersonalization is, like fear, an almost universal response to life-threatening danger. It develops instantly upon the

382 NOYES, JR. AND KLETTI

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 con- sciousness 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 na- ture 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 par- ticipants 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 participat- ing 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 column and brake were magnified.” Similarly inner experience was fragmented by the restriction of awareness to a narrow focus.

A similar alteration in attention is produced by marihuana, a comparison specif- ically 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 conscious- ness may be likened to a movie in which each frame of the film merges with the

DEPERSONALIZATION 383

PARTICIPATING SELF OBSERVING SELF 1 rhoughra. m*“~mO”*f

speeded TIME 1. W&gl$,. m(lv*m*n*=

2. ~ayfied emotions. EMOTION 2. reduced or absent emotions, calm

3. heightened psrcsptoon. SE,“gAT,ON 3. perception. mental mental imagsry omsgery dulled

4 increarecl confrol of YOLlTlON 4 nla”*me”ts, thollghtr nlcvements. thoughts automatic

5. sense of mcraased familiarity IdW vu,

REALITY 5 feeling of strange ne*s. ““maw

Fig. 1. Diagram of the dissociation

between observing and participating self showing the subjective effects ac- companying 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 atten- tion 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 theobserv- ing 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-

384 NOYES. JR. AND KLETTI

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

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