Mindscapes: The woman who was dropped into her body

Mindscapes is our new column on brain science with a difference: we meet people who live with the world's most mysterious neurological conditions

Name: Louise Airey
Condition: Depersonalisation disorder

"I feel like I have been dropped into my body. I know this is my voice and these are my memories, but they don't feel like they belong to me."

It happened out of the blue. Louise Airey was 8?years old, off sick from school, when suddenly she felt like she had been dropped into her own body. "It's just so difficult to verbalise what this feels like," she says. "All of a sudden you're hyper aware, and everything else in the world seems unreal, like a movie."

She panicked, but told no one. The feeling soon passed but returned several times until, at the age of 19, a migraine triggered a sensation of being disconnected from the world that was to last 18 months. When she was in her 30s she was diagnosed with depersonalisation disorder ? an altered sense of self with all-encompassing feelings of not occupying your own body, and detachment from your thoughts and actions. It has come and gone throughout her life, but since a traumatic pregnancy 20 months ago, these feelings have remained constant.

"Other people seem like robots," Airey says. "It's like I'm watching a film, like I'm on my own in the centre of everything and nothing else is real. I'll be speaking to my children and I'll catch my voice talking and it seems really alien and foreign. It makes you feel very separated and lonely from everything, like you're the only person that is real."

Not so rare

Depersonalisation disorder is not as rare as you might think, says Anthony David at King's College London and the Maudsley Hospital: it may affect almost 1 per cent of the British population (Social Psychiatry and Psychiatric Epidemiology, DOI: 10.1007/s00127-010-0327-7). We've all probably experienced mild versions of it at some point, in the unreal, spaced-out feeling you might get while severely jet-lagged or hung-over, for example. Now neuroscientists are beginning to uncover what goes wrong in those who persistently feel unreal. Their findings could tell us something about how we all form a sense of self, and potentially, bring a treatment for those who have the disorder.

The sense of self has much to do with our awareness of our physicality and how we interact with the outside world. The brain integrates all the information coming in from the external world and from internal sensations and forms a default setting of "this is me here and now", says Nick Medford, who studies depersonalisation at the Brighton and Sussex Medical School, UK. "If that setting changes somehow, then you feel 'not right', in a way that might be very hard to put into words."

There are probably several ways that change can occur, but Medford's work is looking at on the emotional detachment characteristic of depersonalisation. In people who have the disorder, areas of the brain that are key to emotion are much less active than normal. These people also show unusual autonomic physical responses to external stimuli, such as evocative images (Emotion Review, DOI: 10.1177/1754073911430135).

David and his colleagues are also looking at why people with depersonalisation disorder report emotional "numbing" ? the feeling that the world is somehow alien. They have found that some areas in the brain's frontal lobes, which help keep emotions in check, are overactive, or too controlling.

Living the scream

One symptom related to this skewed brain activity is the sensation of all sounds competing against each other to be heard. It's like living inside Edvard Munch's painting The Scream, Airey says, which some critics have suggested is about depersonalisation. "The person and the landscape are screaming, you can't get any peace."

Another area of the brain that appears to be less responsive in depersonalisation is the anterior insula, responsible for integrating physical and emotional sensations. This might explain why sufferers don't feel in touch with the world, Medford says.

It's not only the outside world that seems strange, says Airey. The disorder makes it almost impossible for her to relate to herself. "Everything that you're familiar with yourself ? your thoughts, your memories ? become alien," she says. "Memories of things you've done don't feel like they belong to you; it robs you of your past. I know rationally that they're my thoughts, my voice, my memories, but they're all wrong ? that why it's so frightening. It takes away the core of who you are."

Airey says she would investigate any potential treatment. There is an epilepsy drug, Lamotrigine, that has shown some promise when combined with an antidepressant in trials. Transcranial magnetic stimulation ? in which an electromagnet stimulates or suppresses neuronal activity ? is also being explored by David's team to retrain the depersonalised brain.

"Rationally knowing that I'm real, that these memories are real, that my voice is my own, but not feeling like they all belong to me is somehow worse than being away with fairies," Airey says. "It's like I'm a sane person gone mad."

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