Franz Knappik

University of Bergen, Department of Philosophy

franz.knappik@uib.no

Depersonalization Disorder and Implicit Self-Consciousness

Abstract: Depersonalization Disorder (DPD) is a psychopathological condition

in which subjects suffer from a massive alienation from themselves and the

world around them. In recent years, several philosophers have proposed

accounts that interpret DPD in terms of an alteration in global features of

normal consciousness, such as a sense of mineness or emotional coloring. This

article criticizes such accounts and develops an alternative to them. On the

account I present here, the symptoms of DPD are due to impairments in implicit

forms of self-consciousness that characterize many, but not all, types of

conscious mental states.

-----Unpublished draft----

It was a feeling of being fundamentally wrong in your own body. […] It was a

constant, continuous otherworldly experience […] The feeling was of having left

myself completely, constantly trying to grasp on to reality, trying to claw back what

I’d had a few daysc ago. Yesterday I had a life, and now I’ve got nothing. […] The

best image I could come up with was that I was a little man sat in the back of my head,

with the controls, and you can see the inside of your skull and you’re looking out of

these two eye sockets […]. (Swains, 2015)

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This is how a person suffering from Depersonalization Disorder (DPD) describes her

experiences. DPD is a chronic condition of massive alienation from oneself

(depersonalization) and the world (derealization). It is at least as frequent as schizophrenia—it

affects between 1 and 2% of the population (Hunter et al., 2004)—but is relatively little

known and under-researched (and hence also rarely diagnosed). This has not always been so:

DPD used to be much studied and discussed in the late 19th and early 20th century, and for

many authors in this period, it offered intriguing material for the study of phenomena like

self-consciousness and personhood (e.g., Ribot, 1888; Oesterreich, 1910; Schilder, 1914). The

philosopher Hippolyte Taine even found reports from patients with DPD “more instructive

than a volume of metaphysics on the substance of the I” (Taine, 1876, p. 294).

Only very recently has DPD become a topic in philosophy again. In particular, several

authors proposed over the last few years accounts that interpret DPD as alteration of one or

several global features that supposedly characterize all normal conscious experience, such as

a sense of ‘mineness’—a feeling that one’s mental states are one’s own (Billon, 2017,

forthcoming; cf. Guillot 2017)—or an ‘emotional coloring’ that is said to permeate our

conscious lives and to phenomenally mark evaluations of given contents of perception,

thought etc. in the light of our interests and preferences (Gerrans, 2017, 2019). Such accounts

are tied to particular views about the structure of conscious experience, a topic that has itself

regained considerable interest in recent years (e.g. Zahavi, 2003; Kriegel, 2009, 2013; Guillot,

2017).

In this paper, I argue that there is reason to doubt these explanations of DPD. Instead, I

propose an alternative account in terms of a dysfunctional implicit self-consciousness that is

involved in many, but not all, normal conscious mental states in virtue of the type of state they

are. As an initial example, consider episodic memory. When re-living a scene that is stored in

episodic memory, I am aware that I have already experienced the scene at some point in the

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past. Hence, recall from episodic memory involves a form of reference to the subject. But this

does not mean that I have to be explicitly thinking of myself while I am re-living the

remembered scene; rather, the self-consciousness in question is of an implicit kind. When this

form of implicit self-consciousness is for some reason absent, the subject may still recall a

scene from episodic memory and be aware that this scene belongs to the past, but she will not

experience the scene as one that she had already witnessed earlier; and this matches how

many patients with DPD describe their episodic memories. As I hope to show in this paper,

the others symptoms of DPD can be explained in a parallel fashion, as (direct or indirect)

results of a dysfunction in forms of implicit self-consciousness that characterize many (but not

all) types of mental states in health.

The paper is organized as follows. I first describe in some more detail the symptoms of

DPD (section 1). Section 2 critically discusses the currently best-elaborated theories that

explain DPD in terms of disturbed global features of conscious experience. In sections 3 to

14, I develop and defend my alternative account of DPD. Section 15 concludes by

formulating questions for further empirical research.

1. Symptoms of DPD

The following is an overview over the most salient and characteristic symptoms of DPD.

Some patients with DPD report many of these symptoms, others only one or few (with some

combinations being particularly frequent, as shown by the factor analyses in Sierra et al.,

2005, and Simeon et al., 2008). Symptoms (a)-(g) are normally classified under the

depersonalization dimension of DPD, symptoms (h)-(k) under the derealization dimension.

These two dimensions often co-occur, but they can also come apart. The reference in square

brackets after each item indicates in which section(s) of this paper I offer an account for the

symptom.

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a. Emotional and algedonic numbing. Patients complain that they feel no emotions, pains

and pleasures anymore (e.g. Raymond & Janet, 1903, p. 37; Shorvon, 1946, p. 783). In

a case described by Janet, the patient “claims that he does not have any sensibility

anymore, that he is not excited by absolutely anything” (Janet, 1908, p. 515). While the

patient shows normal pain behavior when pinched with a needle, he explains: “It is the

mental sensibility [sensibilité morale] which is lost, it is not myself who feels. I do not

care about that which I seem to feel; it is someone else than me who feels mechanically”

(Janet, 1908, p. 515; cf. Schilder, 1914, p. 26). [sections 10, 11]

b. Disturbed phenomenology of agency:

• The most frequent reports concern patients’ impression that their actions have become

automatic and mechanical, and that they relate as mere bystanders to these actions:

“It’s not me who acts, I see myself acting […]; I hear myself talking, it is someone

else who is talking, a machine who is talking instead of me. I am a jumping-jack, a

canard de Vaucanson [a once-famous automatic duck], I am myself surprised by the

precision of the automaton” (Janet, 1908, p. 515). [section 6]

• Some patients also report that they are not aware of their actions: “I feel everything I

do is unconscious” (Saperstein, 1949, p. 239). [section 6]

• Sometimes, patients also describe an inability to will something, a lack of goals,

ambitions and intentions: “I have no will power, do not want to do anything” (Meyer-

Gross 1935, p. 105); “I am terribly aimless, without desires and ambitions” (Meyer-

Gross 1935, p. 108). [section 6]

c. Disturbed phenomenology of thought:

• Patients frequently report a similar lack of agency over thoughts as has been described

for bodily actions: “The thoughts force themselves on me, it is not me who governs

the thoughts” (Schilder, 1914, pp. 50-51). [section 7]

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 • Some patients complain about feeling detached from their thoughts: “On the one side

are my thoughts, then a blanket, a sheet, and then myself” (Mayer-Gross, 1935, p.

109). [section 7]

• Some patients feel that their head is empty of thoughts (Shorvon, 1946, p. 784).

[section 7]

d. Disturbed phenomenology of memory:

• Episodic memories are relived as if the subject was not involved of them, as if it was

not her who had experienced the original scene: “I could clearly recall a scene of me at

the beach in New London with my family as a child. But the feeling was that the scene

was not my memory. As if I was looking at a photo of someone else’s vacation”

(Klein & Nichols, 2012, p. 686, interpreted as case of depersonalization by Gerrans,

2017). [section 8]

• Episodic memories are often retrieved from a third-personal perspective (‘observer

view’), i.e. the subject relives the scene from an observer’s viewpoint, not from his

own (‘field view’) (Sierra, 2009, p. 34). [section 8]

e. Disturbed mental imagery: Some patients complain about an absence of mental imagery

(Mayer-Gross, 1935, p. 110), others report colorless and lifeless imagery (Schilder, 1914, p.

50). [section 9]

f. Detachment from self. The feeling of having become alien to oneself, of not being oneself

anymore, of not having a self anymore, or of one’s self being unreal, was often treated as the

central symptom of the depersonalization-aspect of DPD in the earlier literature (e.g. Taine,

1876, p. 289; Schilder, 1914, p. 54; Schilder, 1928, quoted in Sierra, 2009, p. 26; Shorvon,

1946, p. 784; Saperstein, 1949, p. 236). Surprisingly, the more recent empirical literature

tends to bracket this phenomenon: there is no specific item on it in the standard assessment

tool for DPD, the Cambridge Depersonalization Scale (Sierra & Berrios, 2000), and as a

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consequence it does not show up in the empirical studies that employ this scale (Sierra et al.,

2005; Simeon et al., 2008). Still, it is well-documented in case descriptions both from the

earlier and the more recent literature: for example, a patient of Raymond’s and Janet’s “felt

that she became another person, or better, that she lost her person, that she was no longer

something. It seems to her that it is not her who sees, that it is not her who hears, that it is not

her who eats” (Raymond & Janet, 1903, p. 41); patients of Shorvon’s complain that “I can’t

think it is me. I used to feel I was someone. [...] I must be someone, I am someone, everybody

else feels someone, but I am not myself” (Shorvon, 1946, p. 784; cf. Simeon & Abugel, 2006,

p. 8). [sections 3, 4]

g. Disturbed bodily experience.

• Patients feel they disown (parts of) their body; Mayer-Gross cites a patient reporting:

“If I hold up my hand and look at it, it does not seem to be my arm”, and he adds: “On

questioning one learns that her throat gave the feeling of belonging to her, but below

that she felt nothing” (Mayer-Gross, 1935, p. 113). [section 5]

• Patients do not feel their body, or their body feels unreal; they touch and press

themselves in order to sense their body and its existence: “I touched my head, my

limbs, I felt them, and still it took me a great effort of mind and will to believe in the

existence of that which I was touching” (Taine, 1876, p. 293). [section 5]

• Patients feel they are ‘not there’ in their body (‘disembodiment’: Sierra, 2009, p. 30).

[section 5]

• Patients feel that their body is very light, they feel like walking on a cloud (Sierra,

2009, p. 31) or floating in the air (Simeon et al., 2007, p. 304). [section 4]

• Sometimes, patients see their body from the outside (out-of-body experience) (Sierra,

2009, p. 30). [section 4]

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 • Some patients have an abnormal body image, with distorted perception of the size of

limbs or the whole body (macro-/microsomatognosia; Schilder, 1914, Sierra, 2009, p.

31). [section 4]

h. Unreality of surroundings. The objects of sense perception, esp. vision and touch, are

experienced as unreal: “[I]t is the sensation of dreaming that was most painful for me; I

touched the objects around me hundred times; I talked very loudly to recall myself of the

reality of the outer world” (Krishaber, 1873, p. 9); “It often seems to me that I am not of this

world; […] when I see my hospital comrades, I say to myself: ‘These are the figures of a

dream’. Very often, I really do not know whether I am dreaming or awake” (Krishaber, 1873,

p. 30). Patients often report the feeling that there is some isolating material (veil, fog, etc.)

between them and the world (Sierra, 2009, p. 24), and that the things they touch feel unreal

(Schilder, 1914, pp. 257, 261). [section 3]

i. Distortions in spatial perception. Patients report that they see objects as abnormally distant

(teleopsia), big (macroscopia) or small (microscopia), or that things look flat to them (loss of

stereoscopic vision) (Mayer-Gross, 1935, p. 111; Schilder, 1914, pp. 50, 53, 276; American

Psychiatric Association, 2013, p. 303). The perceived distance of sounds, esp. voices, can also

be affected (Schilder, 1914, pp. 260, 262). A very careful report is given by a patient of

Krishaber’s, who was interviewed after his recovery by Taine: “The most remarkable thing

was the disturbance of vision. When looking into a strongly concave eyeglass lens, such as

number 2 or 3 [i.e., -19,5 / -13 diopters] (I have almost normal visual acuity), I experience

something analogous; except that objects seemed less small to me in that moment. It is the

same with looking through the other end of binoculars; this comparison is even more right;

but it needs to be corrected, too; I would say that the objects seemed less small to me but

much more distant” (Taine, 1876, p. 292). The same patient also compares his visual

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experience to the “appearance that objects assume when one looks at them, next to a very hot

cast-iron pan, through the layer of air that seems to vibrate” (Krishaber, 1873, p. 152).

Several authors understand such reports metaphorically, as images by which patients

try to communicate their feeling of being isolated from the world (e.g. Dugas & Moutier,

1911, pp. 22-24; Sierra, 2009, pp. 24-25, p. 38; Billon, 2017, p. 201). But lacking independent

motivation and coming from authors whose favored explanations of DPD are ill suited to

account for distorted spatial perception, this seems a mere ad-hoc move. Moreover, there are

many other cases of psychogenic perceptual distortions (Oyebode, 2015, pp. 91-94), including

visual distortions in dissociative experiences (of which DPD is one form) (Lipsanen et al.,

1999); and Guralnik and colleagues (2002, p. 107) report that some patients with DPD first

search help with ophthalmologists before they consult psychiatrists (cf. also Michal et al.,

2006). So on the basis of the available evidence, there is no reason to dismiss reports about

distorted spatial perception in DPD as merely metaphorical. [section 4]

j. Temporal disintegration. Some patients feel that events in the recent past are very far away

in time, that time passes unusually quickly or slowly, and/or that they lost their grasp of time

and the difference between past, present and future (Shorvon, 1946, p. 783). [section 12]

k. Disturbed feelings of familiarity. When encountering known objects, persons and places, it

can seem to patients as if they saw them for the first time (jamais-vu; Simeon & Abugel,

2006, pp. 7-8). Vice versa, déjà-vu experiences can also be frequent in DPD (Sierra, 2009, p.

13). [section 13]

l. Functional deficits and possible overlap with other conditions. The above symptoms all

concern the phenomenal dimension of patients’ mental lives. By contrast, patients with DPD

seem to have mostly intact perceptual, sensorimotor and cognitive abilities, and they show

normal emotional and pain behavior. There is, however, evidence for some deficits in short-

term memory (in visual tasks with overloaded visual scenes and in verbal tasks with whole

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sentences: Guralnik et al., 2000, 2007), attention (Guralnik et al., 2007), and imagery

(Guralnik et al. 2000; Lambert et al., 2001). In addition, patients with DPD often show

heightened self-observation (Schilder, 1914, pp. 45, 47; Sierra, 2009, pp. 31-32).

Such functional disturbances might to some extent be consequences of the

phenomenal abnormalities described above (for example, disturbed feelings of familiarity

could cause memory deficits: Guralnik et al., 2000, p. 107; the bizarre character of the

symptoms could induce self-observation). But it has also been suggested that these deficits, as

well as thought emptiness and temporal disintegration, may be not due to DPD itself, but to

absorption, a further dissociative disorder that affects some patients with DPD (Sierra, 2009,

p. 37; Simeon et al., 2007). There is clearly a need for further empirical research here, and at

the present point, not too much weight should be put on these latter symptoms when it comes

to assessing explanations of DPD. [section 9]

2. Critique of Existing Philosophical Accounts

The best elaborated high-level explanations of DPD in the current literature see the various

symptoms of DPD as resulting from a disturbance in one or several global features of

consciousness. Such global features are phenomenal features that contribute to the

phenomenal character of all conscious states in non-pathological subjects, independently of

state type and content.

2.1 Billon: DPD as Alteration in Mineness, Present Character and Actual Character

Alexandre Billon (2016, 2017, forthcoming) interprets DPD as alteration in three different

global features of consciousness. The depersonalization aspect of DPD is due, on Billon’s

account, to an alteration in ‘mineness’, by which Billon understands “a certain phenomenal

feature in virtue of which [our experiences] seem to be ours to us” (Billon, forthcoming). In

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order to explain the various aspects of depersonalization in DPD in terms of disturbed

mineness, Billon proposes, first, that an alteration in mineness will have as its immediate

consequence a lacking (or strongly decreased) awareness of ownership for mental states: “if I

do not feel like a given state is mine, I do not feel like I have it” (Billon, forthcoming). This

impaired awareness of ownership has several consequences:

• If I do not feel like having the emotions, pains and thoughts that I experience, these states

will feel “alien or lacking” (Billon, forthcoming), resulting in emotional numbing and

thought emptiness.

• A lack of awareness of ownership for bodily sensations causes the impression that bodily

parts are alien or missing.

• Billon assumes that states of episodic memory and first-personal imagination have I-

thoughts as contents, which are governed by the rule “An I-thought bears on its owner”

(Billon, forthcoming). When I am not aware of memories and images as being mine, I

therefore will not realize that these I-thoughts bear on me.

• A “substantial and global attenuation” of mineness will “estrange the patient from all his

experiences”, with the consequence that his “basic self-awareness” which grounds the use

of the first-person pronoun collapses (Billon, forthcoming). Hence, the person will feel

she is dead and/or non-existent.

Derealization is accounted for by Billon as alteration in two further global features of

consciousness. Normally, our conscious mental states involve, on Billon’s view, a sense of

these states “being present (as occurring now)” and of them “being actual (as occurring in the

actual world rather than a merely possible or imaginary world)” (Billon, 2016, p. 377). Billon

proposes that altered ‘actual character’ of the subjects’ experiences could “deprive the

subjects of the impression that the world in which this experience occurs is actual and (hence)

real” (Billon, 2016, p. 378), and that a lack of ‘present character’ could “prevent them from

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feeling the moment at which this experience occurs as present” (Billon, 2016, p. 378). Billon

thinks that both points together can explain the feeling that surroundings seem unreal in DPD,

and that the lack of present character is responsible for temporal disintegration (Billon, 2016).

Billon’s account is intriguing and sophisticated, but it faces several objections.

First, Billon’s account of derealization seems to misplace the experience of unreality.

What patients report is a feeling that the world around them, as it is given to them in

perception, is unreal, not that their perceptions of them feel unreal.

Second, Billon’s account is not apt to explain the full range of symptoms of DPD. It is

not well suited to account for the changes in spatial experience (Billon, 2016, p. 201, adopts a

metaphorical reading of such complaints, but as I argued in section 1, this move should be

resisted), the frequency of observer memories, disturbed feelings of familiarity, distorted body

image and the feeling of floating.

Third, derealization often occurs together with depersonalization, but since Billon

accounts for these two dimensions of DPD in terms of distinct features of consciousness, his

account does not explain the connection between both.

A fourth worry concerns Billon’s explanation for first-personal memory and

imagination. Remember that for Billon, patients do not realize anymore that their first-

personal memories and images bear on them because the first-personal contents of those states

are governed by the rule ‘An I-thought bears on its owner’, and in the absence of normal

mineness, patients do not realize that they are the owners of their memories and images. This

explanation presupposes that the only way for us to know that we are the owner of a given

mental state is that a feature of mineness phenomenally marks us as the owner of the state.

But other, simpler accounts are available. For example, in analogy with Reichenbach’s

popular idea that the first-person pronoun refers to whoever utters it, it is natural to suppose

that I-thoughts ‘bear’ on the subject who thinks them. In this case, it is easy for me to know

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that all I-thoughts I have bear on me, without any need for a phenomenal mark of my

ownership over the state.

Finally, the idea that all non-pathological conscious states, but not all conscious states

as such, involve mineness is quite controversial and open to attacks from different sides.

Some authors—most vigorously, Dan Zahavi (e.g., Zahavi, 2003, pp. 60-61; 2018, pp. 712-

713)—have defended the view that an elementary, pre-reflective form of mineness is an

essential feature of phenomenal consciousness. On this view, mental states in DPD cannot

lack mineness and still be conscious (cf. Zahavi, 2018, p. 713, for an analogous point on

thought-insertion).1 On the other hand, it is presently hotly debated whether there is a

phenomenology of mineness at all (e.g., Howell & Thompson, 2017). If the claim that

consciousness normally involves mineness provides the best explanation of depersonalization,

this adds of course a strong argument in favor of this claim (Billon, forthcoming). But this

argument loses its force if an at least equally good explanation is available that does not rely

on the claim—and as I hope to show in later sections, there is such an explanation.

2.2 Gerrans: DPD as Impairment of Emotional Coloring

Like Billon’s account of depersonalization (which draws on the work of Dugas & Moutier,

1911), Philip Gerrans’s view of DPD is an elaborated and updated version of an important

traditional approach to DPD, namely, affective theories (e.g., Dugas, 1898; Oesterreich,

1910). Such theories see DPD as disturbance in an affective dimension of experience that

normally colors our perceptions, memories, thoughts etc., and phenomenally marks personal

relevance for the subject. In the absence of such coloring, the subject is no longer able to

relate her experiences to her self. (Gerrans, 2017, identifies emotional coloring with mineness,

so there is some overlap between his and Billon’s account; but the way Gerrans explains the

various symptoms of DPD strongly differs from Billon’s account.)

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 In his version of the affective approach, Gerrans builds on a variant of an ‘appraisal

theory’ of emotions, on which emotional processes assess the relevance of given situations to

the subject and coordinate a range of responses including “autonomic physiology, action

tendencies, behavior and, crucially, the affective feeling characteristic of an emotional

episode” (Gerrans, 2019, p. 2). The resulting affective feelings are interpreted by predictive

coding processes as being due to changes in the self, which on this account is a “model

inferred by the human mind to predict and explain the way the world makes the organism

feel” (Gerrans, 2019, p. 2). Gerrans holds that in DPD, the affective feelings that are normally

involved in all conscious experience are absent (while other elements of emotional processing

are still intact). This immediately explains emotional and algedonic numbing. Subjects feel

uninvolved in episodic memories, on this account, because they are devoid of their normal

affective dimension (Gerrans, 2017). Moreover, when the predictive coding processes detect

the absence of predicted affective feelings, they infer that the entity that is responsible for

such feelings, the self, has disappeared (Gerrans, 2017, pp. 166-167; 2019, p. 3). The world

can seem unreal in that case because the mind expects it to be “affectively salient” (Gerrans,

2019, p. 4). Finally, persons lose the sense of being in charge of their actions, for without

predicted affective feeling, the person does not “feel the significance” (Gerrans, 2019, p. 2) of

her actions qua responses to emotional appraisals.

There are a number of objections against this view, too. First, like Billon’s, it accounts

only for a part of the symptoms of DPD. It does not seem apt to explain the reported

distortions in spatial perception and body image, the feeling of floating, and lacking

awareness of bodily sensations, actions, and conative states. It is also not obvious how it can

explain the frequency of observer memories and disturbed feelings of familiarity. (Disturbed

body ownership is not addressed by Gerrans, but seems more amenable to an explanation

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within his framework, e.g. as consequence of the perceived absence of the self that owns the

body.)

Second, Gerrans’s account of the loss of agentive feelings presupposes that normal

sense of agency is grounded in an experience of one’s own actions as responses to emotional

appraisals of given situations. But the literature on the sense of agency has identified several

other potential sources for experiences of agency, such as conformity between intention and

action, or sensorimotor cues. Moreover, there are other possible sources for appreciating the

‘significance’ of one’s actions beside emotional appraisals, for example intellectual judgments

about the instrumental value of given actions for the goals one knows to have. So it is far from

clear that a loss of affective feelings can explain the impaired experience of agency in DPD.

Third, Gerrans’s account presupposes that affective feelings are the only data available

to predictive processes which can support inferences to a self-model. But there are other

plausible candidates, such as thoughts, decisions, intentions, motor commands and/or their

efference copies, and reafferences. In the absence of affective feelings, such elements can still

provide plenty of data that support an inference to there being a self.

3. Alternative Account: Outline

In the rest of this article, I propose an alternative account of DPD that abandons the

assumption—common to Billon’s and Gerrans’s accounts—that DPD should be explained on

the basis of global features of ordinary consciousness. I introduce my account in broad strokes

in this section, and develop it in more detail in subsequent sections.

I start with an idea that is very common in the literature (e.g. Shilony & Grossman,

1993; Simeon & Abugel, 2006, p. 112; Billon, forthcoming): DPD is the chronic form of a

condition which, in its transient form, has the evolutionary function of a defense mechanism

in response to extreme stress and suffering. Given this idea, most symptoms of DPD can be

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seen as forming a hierarchy of means by which the system realizes the overarching function

of such self-defense. Among the symptoms of DPD, detachment from self and unreality of

surroundings stand out as symptoms that are more comprehensive than the others—they do

not concern particular aspects of mental life such as perception, emotion or action, but the

way the subject is connected with herself and the world in general. Detachment from self and

unreality of surroundings sever these connections and thereby exclude any potentially

threatening, stressful or otherwise disturbing contents from the level of conscious experience:

the depersonalized and derealized person has lost contact both with the world that could

trouble her, and with herself as subject that might experience a troublesome world.

Most other symptoms, by contrast, can be seen as more concrete impairments that, in

the context of DPD, have the function of bringing about detachment from self and unreality of

surroundings. The central idea of my account is that symptoms at this level are brought about

by disturbances of what I call ‘Implicit, Non-global, Embedded Self-consciousness’, or shortly

INES. Episodes of episodic memory present, as we saw in the introduction, a scene as having

been experienced, at an earlier point of time, by the subject of the memory state; the normal

experience of one’s body presents the body as belonging to the subject; feelings of agency

mark bodily or mental actions as brought about by the subject; and as I shall argue later, also

conscious perception, important forms of thought and mental imagery, emotional and

algedonic experience, and temporal experience involve analogous forms of self-

consciousness.

Such self-consciousness is non-global both insofar as it is involved in many, but not

all (cf. section 14), types of conscious mental states, and insofar as it is involved in these

states because of their type-specific structure, not simply in virtue of those states being (non-

pathologically) conscious at all.

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 Moreover, the self-consciousness in question does not consist in explicit reflection

upon or observation of oneself. Rather, the subject is implicitly present in the representation of

something else, e.g. a perceptual object or a remembered scene. In connection with DPD, this

is important for two reasons. First, patients with DPD seem to have an intact ability of making

themselves the explicit object of their thought and exteroceptive perception, as is witnessed

both by the symptom of heightened self-observation and by the constant and even obsessive

use of the first-person pronoun in patients’ reports (emphasized by Raymond & Janet, 1898,

p. 73). Second, while explicitly first-personal thought employs one and the same ‘I’-concept

across different domains and contexts, the forms of INES that I will describe in the following

are naturally seen as forms of self-consciousness that are specific for their respective types of

mental states. (This may be so because they do not draw on the concept ‘I’ at all, or because

they embed this concept in a determinate way—e.g., in the attitude-bit of a propositional

attitude—which is itself specific for a particular type of mental state.) Consequently, the

present account can do justice to the fact that patients with DPD show various combinations

of symptoms: INES may be disturbed in one kind of mental state, but not in another.

Finally, the self-consciousness in question does not present the subject to herself in a

‘free-floating’, isolated way; rather, it connects the subject to the explicit topic of the mental

state. Hence, the mental state (again, implicitly) presents that topic and the subject as standing

in some relation to each other—e.g., in the case of episodic memory, a relation of the

subject’s ‘having experienced earlier’ the remembered scene. This relatedness is what I call

the ‘embedded’ character of implicit self-consciousness.

The view that the subject is normally present in many aspects of her mental life in an

implicit and embedded fashion is apt to explain how a subject may have a ‘sense of self’ in

various dimensions (cf. Neisser, 1988; Gallagher, 2000) even though, as many philosophers

have argued, there is no such thing as an explicit and isolated experience of one’s self as

16
particular object. For example, the subject normally experiences herself as embodied self with

a particular spatial location in virtue of the INES that is implicit in perception and the sense of

bodily ownership (cf. sections 4 and 5); she experiences herself as agentive and rational self

in virtue of forms of INES that are involved in the phenomenology of bodily agency, thought,

and action-related mental imagery (sections 5, 7 and 9); and she experiences herself as

personal, narrative or autobiographic self that has particular interests and concerns and

persists across time, in virtue of INES that is involved in intentions, episodic memory,

emotional and temporal experience (sections 6, 8, 10 and 12). When some or all of these

forms of INES are impaired, while the subject still knows (although not necessarily in these

terms) that she is an embodied, agentive, rational and autobiographic self and that she used to

be in constant experiential ‘touch’ with these dimensions of herself, experiences of

detachment from the self in some or all of these dimensions will result.

At the same time, several forms of INES—in perception, bodily and agential

experience, episodic memory, and temporal experience—make it the case that the subject has

a sense of herself as standing in concrete relations (spatial, mechanical, temporal, causal) with

the world around her. This sense of relatedness is plausibly seen as intimately linked with our

experience of our environment as real. Sense perception, for example, normally provides us

with a ‘sense of reality’, a sense of the perceived objects and scenes as really there, here and

now (e.g. Huemer, 2001, p. 77). Similarly, bodily and agentive experience are plausibly

described as giving us a sense of our body being really there, and our actions really taking

place, here and now. And one can argue that in episodic memory recall, we have a sense of

the recalled episode as having been there, then and there, for the subject at some point in the

past. Contrast this with mere thought about reality, for example my belief that Rome is the

capital of Italy. While this belief commits me to belief in the reality of Rome, it does not

provide me on its own with a phenomenal sense of Rome being really there. I propose this is

17
at least partly so because the belief does not involve an experience of concrete (spatial,

temporal, mechanical, causal) relations between that part of reality and myself, and that the

experience of such relations is crucial to the ‘sense of reality’ that normally characterizes

perceptual, bodily and agentive experience. Hence, impairment of one or more forms of INES

in DPD will disturb or block the subject’s experience of such concrete relations between

herself and her surroundings, leading to unreality of surroundings.

This proposal is apt to explain why depersonalization and derealization very often

occur together, but at the same time, it is compatible with the fact that the two dimensions of

DPD can dissociate in both directions. If for a given subject, the disease affects only or

mainly forms of INES that do not provide an experience of concrete relations between the

subject and her real environment (e.g., forms of INES that normally characterize the

phenomenology of thought, cf. section 7), then impaired INES may only lead to detachment

from self, not to unreality of surroundings. Conversely, if a subject suffers from unreality of

surroundings because of impairments in relevant forms of INES, e.g. in perception, but INES

is intact in various other aspects of mental life, her overall experience may still provide the

subject with a robust sense of her self, such that she is derealized but not depersonalized.

Importantly, my approach to DPD is not committed to any particular account of INES.

INES might employ a non-conceptual representation of the self, or it might be due to

cognitive architecture (Recanati, 2007, pp. 145-148). It might belong to the mode-bit of

mental states (Recanati, 2007, p. 37), or to their content. It might provide the subject with a

form of awareness of herself that can explain the emergence of explicit first-personal thought

and self-knowledge, or it might merely amount to “implicitly self-relating information”

(Musholt, 2015, p. 56) that cannot on its own play such roles—but the absence of which may

still make important phenomenal differences. Moreover, different kinds of mental states with

18
INES might require a unified account with regard to such issues, or they could differ in these

respects.

It also bears emphasis that my account is compatible with views like Zahavi’s that

postulate an elementary form of mineness as necessary element of all conscious experience.

Zahavi understands such omnipresent mineness as distinctly first-personal “perspectival

givenness” (Zavahi, 2018, p. 706). Conscious states may be given in this way even while

some or all forms of INES are disrupted in DPD.

Finally, when I talk about forms of INES as specific for particular types of mental

states, I use an informal notion of ‘type’. In some cases, the relevant types coincide with

generally recognized psychological kinds, as in the above example of episodic memories. In

other cases, they are individuated in a more fine-grained way, e.g. in the case of imagery of

one’s own movements. I will leave it open whether such more fine-grained types are best

understood in terms of more specific kinds of attitudes or of a shared kind of content.

4. Perception

In this and the following sections, I will substantiate the explanation of DPD outlined in the

last section by arguing in more detail that various types of mental states in health involve

forms of INES, and that impairment of such INES can explain symptoms of DPD. Consider,

to begin with, perception. Perceptual experience is normally focused on things and events

around us. But in an implicit and embedded way, the subject is always present in such

experience. Conscious vision and hearing inform us about how things spatially relate to each

other, but also about how they relate to us and our bodies (Bayne, 2004, p. 222): we see

objects and hear sounds as being in front of us, or as moving towards us; touch informs us

about the shape, weight and consistence of objects, but also about where these objects are

19
located with regard to our bodies, and how they exercise pressure on the surfaces of our

bodies.

This presence of the subject in conscious perception is closely linked to the very

organization of perceptual space. Conscious vision, most notably, is perspectivally organized

around an origin at which we, the embodied subjects of perception, are located. This has often

been argued for on phenomenological grounds (e.g. Cassam, 1997, pp. 44-61; Bayne, 2004, p.

222; T, 2014), and it is also supported by various illusions and abnormal conditions in which

the processes of multisensory integration that underly conscious perception are disturbed or

misled (Blanke & Metzinger, 2008). In the full-body illusion, for example, subjects see, with

VR goggles and from a third-personal viewpoint, a virtual body being stroked at the back,

while they are themselves being stroked on their physical body (Ionta et al., 2011). Subjects

experience the virtual body as their own, while their visuospatial perspective remains the

same (they continue to see the virtual body from the outside). Some subjects also feel that

they are themselves located at the position of the virtual body; others report that they feel

located outside of it. In this illusion, multisensory integration is misled by the conflict

between visual and tactile sensations, and fails to correctly integrate three elements that

usually coincide in conscious perception—(a) the geometrical origin of egocentric perceptual

(e.g., visual) space; (b) the position of the subject’s own body; and (c) the subject’s position

(her sense of ‘where she is’) (Blanke & Metzinger, 2008).

It is not clear whether all aspects of conscious spatial perception are organized

egocentrically: for example, when walking around or jumping up and down, we experience

this as movement of ours within a space or with regard to an object (e.g., the ground) which

remain fixed. Such aspects of spatial experience may be better understood in terms of absolute

or allocentric representation, rather than egocentric representation. But still, they still inform

us about our position and movement with regard to the fixed point or frame of reference. So

20
they involve at least two of the above subject-relating elements, namely, (b) and (c) (location

of the subject’s body, and location of the subject herself).

Normal conscious perception therefore is plausibly seen as involving a form of INES.

I propose that some of the symptoms of DPD can be understood in terms of impaired

perceptual INES, where the presence of the subject in experience is either reduced or

eliminated (corresponding, at lower explanatory levels, to disturbances in multisensory

integration, in particular in the vestibular system: Lopez, 2013; Wong, 2017).

First, perceptual INES may be impaired insofar as the experience of spatial relations

between the subject and her surroundings is disturbed, while the locations of subject, body,

and geometrical origin remain correctly integrated. This is the case in some of the

abnormalities in spatial perception that are reported in DPD, namely, teleopsia, macroscopia

and microscopia, loss of stereoscopic vision, and distortions in the perceived distance of

sounds. These are all phenomena in which the normal spatial relations (distances and angles)

between objects and the subject (body, geometrical origin) are distorted in a systematic,

pervasive and persistent way, such that the subject literally gets detached from reality. A

striking account of the alienating nature of this experience is provided by the patient of

Krishaber’s cited in section 1.i, who describes an episode from the onset of his disease as

follows: “Objects seemed to shrink and to move infinitely far away; men and things were at

unmeasurable distances. I was myself very far away, I looked around with dread and

astonishment, the world escaped me. I left the house and took a cab; it took me superhuman

efforts to recall that I was in my street […]” (Taine, 1876, pp. 291-292). Distortions in the

body image (macro-/microsomatognosia) may form a somatic counterpart to those perceptual

distortions (cf. Blom, 2020, p. 54), for there is a mutual dependence between the perception of

body size and the perceivedf sizes of objects around one (as is witnessed by the familiar fact

that when returning to the places of one’s childhood, everything looks surprisingly small). So

21
macro- and microsomatognosia in DPD may be further aspects of a disturbed perception of

spatial relations between the subject and her surroundings. And the feeling of floating (or of

walking on clouds or cushions) can be seen as distortion of the mechanical relations between

the subject and the surroundings (namely, the subject’s body being pulled towards the ground)

as they are presented in normal perception.

Second, in out-of-body experiences the experienced position of the subject at the

geometrical origin of perspectival space comes apart from the position of the body, as the

subject sees her own body from a visual viewpoint that is spatially distinct from the body’s

position (Blanke et al., 2004). In this case, perceptual INES is impaired because the

integration of the above elements (a)-(c) (i.e. origin of egocentric space, the position of the

subject's body, and the subject's position) is disrupted—the subject has withdrawn from her

body. (In addition, the subject may also feel that the body isn’t hers any longer, which

amounts to a further dimension of impaired INES; cf. section 5.)

Third, INES might also be disturbed insofar as the origin of egocentric perceptual

space is correctly identified with the experienced position of the body, but the subject herself

is either completely absent from conscious perception (i.e. not localized at all within the

perceived scene), or localized at a distance from the origin. In this case, the subject will feel

withdrawn from perceptual experience as such. This may explain reports about particularly

dramatic experiences of detachment from self in the context of sense perception. Some of

them suggest a complete absence of the subject from conscious perception: “[i]t seems to her

that it is not her who sees, that it is not her who hears” (Raymond & Janet, 1903, p. 41);

others suggest a spatial distance between the origin of visual space and the location of the

subject: “you can see the inside of your skull and you’re looking out of these two eye sockets”

(Swains, 2015); “as soon as I relax I get an intense feeling of ‘ME’ being located in my brain

just behind my eyes” (Roberts, 1960, p. 481; cf. Simeon & Abugel, 2006, p. 143).

22
5. Bodily Ownership

Much recent empirical and philosophical work has addressed illusions and pathological

conditions in which subjects have the impression that one of their limbs is not theirs, or that a

limb of someone else is theirs. These conditions include the alien-hand-syndrome, where

subjects feel that a hand of theirs does not belong to them (for review, see Scepkowski &

Cronin-Golomb, 2003), and the rubber-hand illusion, where subjects mistake a rubber-hand

for their own hand (for review, see Tsakiris, 2010). Such conditions are standardly interpreted

as disrupting or manipulating a ‘sense of (body) ownership’ that characterizes our normal

bodily experience (e.g., Tsakiris, 2010; Serino et al., 2013; de Vignemont, 2007). It is very

natural to interpret the experiences of patients with DPD who feel that their bodies or parts of

them do not belong to them anymore (see section 1.g) in the same way (cf. Billon, 2017).

Most philosophical accounts agree that the sense of body ownership is an experience

of (parts of) one’s body as being one’s own.2 For example, even the influential, very

parsimonious account of Martin (1995), which explains the sense of body ownership in terms

of the spatial characteristics of bodily sensations, acknowledges that “in having bodily

sensations, it appears to one as if whatever one is aware of in having such sensation is part of

one’s body” (Martin, 1995, p. 269, emphasis added; cf. also Gallagher, 2017; de Vignemont,

2007; de Vignemont, 2017). The sense of body ownership therefore seems to involve INES,

and when such bodily INES is disturbed, subjects will be unable to feel (parts of) their bodies

as belonging to themselves—as is the case in DPD.

Furthermore, such an impairment of the sense of body ownership will also have

consequences for how the bodily sensations that are normally qualified by the sense of body

ownership (Martin, 1995, p. 273)—e.g. pains that are felt to be located at some place of one’s

own body— are experienced. Subjects may still have such sensations, and these sensations

23
may contain information about spatial location in a body, but the subjects will not any longer

experience those sensations as relating to their bodies. As a consequence, they literally will

not feel their body anymore, and hence, they will feel disembodied and/or have the impression

that their body does not exist or is unreal (Sierra, 2009, p. 28).3

6. Phenomenology of Bodily Agency

That patients do not feel their body anymore (because of impaired sense of body ownership

and bodily INES) can also explain to some extent their abnormal phenomenology of agency.

The experience of the bodily movements by which we act is coarse-grained and non-focal as

long as things go well (Pacherie, 2008), but it still constitutes an important element in the

phenomenology of agency: deafferented subjects, whose brain receives reduced or no

somesthetic input, report a massive disruption in the experience of acting (Cole & Paillard,

1995). So we may hypothesize that patients who do not feel their bodies will also lack normal

agentive experience of what they are doing with their bodies. One report that supports this

idea comes from a patient of Sierra’s: “When I move I see the movements as I move, but I am

not there with the movements. I am walking up the stairs, I see my legs and hear footsteps and

feel the muscles but it feels as if I have no body; I am not there” (Sierra, 2009, p. 28). This

patient does feel bodily sensations (“I […] feel the muscles”), but not as sensations in his own

body. The patient therefore lacks agentive experience of what (s)he is doing, and is forced to

observe his (her) own movements as a mere bystander (“I see the movements as I move”).

In addition to lacking agentive experience of what they are doing, patients with DPD

often complain about a lacking will, and a feeling of acting automatically and robot-like

(section 1.b). Regarding the lacking will, those elements which the patients find missing—

goals, ambitions etc.—are all naturally analyzed in terms of (individual) intentions 4, and

intentions involve a reflexive element that points to the person who has the intention. For

24
example, when intending to write an article, a person does not merely have some positive

attitude towards articles being written; rather, the intention is fulfilled only if the agent herself

writes the article (Searle, 1983, p. 91). On the plausible assumption that conscious intentions

make us aware of intentions qua standing attitudes, this first-personal element must also be

present in conscious intention: a conscious intention to ϕ makes me aware of ϕing as an action

that I am committed to perform myself, not merely as something that I want to be done by

someone. There can be cases where this first-personal element is salient to the subject (‘I

don’t want him to pay for the meal, I want to do this myself’), but most of the time, our focus

is on the intended action, not on the fact that we intend to perform it ourselves. Conscious

intentions therefore seem to involve a form of INES: they make the subject implicitly aware

of herself as agent of an action that should and will be done by her. When such INES is

impaired, the subject will no longer form and have conscious intentions, and hence not

experience herself as having and exercising a will.

The elements we discussed so far in this section already go some way towards

explaining the third aspect of disturbed phenomenology of action in DPD, the feeling of

acting robot-like. Being unable to feel their body, patients need to observe their own actions

like bystanders; and since there typically is no other agent to whom they can ascribe these

actions, they will experience them as taking place automatically, without being caused by

someone’s mental states. A similar effect can be produced by the lack of conscious intentions

that we just discussed. This is suggested by the ‘illusion of control’, which is induced in an

experimental setting where a subject and an experimenter together keep an object in their

hands and move it alternately (Wegner & Wheatley, 1999). Depending on conformity and

temporal contiguity between their current conscious intentions and perceived movements of

the objects, subjects can experience movements of the object that are brought about by the

experimenter as their own, and fail to experience some of the movements that they caused

25
themselves as such. Hence, the conformity and contiguity between conscious intentions and

perceived events is one cue for the sense of agency, the experience of being the agent of a

given action (for review, see Pacherie, 2008). In the absence of conscious intentions, subjects

may fail to experience the sense of agency while there is no one else around to whom their

actions could be ascribed, resulting once again in the experience of automatic, robot-like

agency.

In addition, sense of agency seems to involve a form of INES itself: it phenomenally

marks events as actions that are intentionally caused and controlled by me, as opposed to

other agents’ actions and mere happenings (Gallagher, 2000). When this form of INES is

impaired, subjects will lack sense of agency, too, and feel that their actions are robot-like.

Importantly, since INES is a feature of conscious mental states, impairment in INES

involved in sense of body ownership, conscious intentions and sense of agency is compatible

with intact abilities of body and action attribution at the subpersonal level, and of action

planning at the level of standing attitudes. In addition, patients may also form explicit first-

personal thoughts about actions as theirs. The present account is therefore consistent with the

fact that patients are capable of intentional agency.

7. Phenomenology of Thought

As we saw in section 1, patients with DPD report missing experiences of agency in thought,

detachment from thoughts, and thought emptiness. The discussion of these symptoms, and

especially of detachment from thoughts, is made difficult both by the lack of more detailed

descriptions and empirical studies on this point, and by the large number of candidates for

INES in normal conscious thought. In the following, I will merely present the hypotheses that

I find most plausible. Further empirical research on this aspect of DPD is needed before it is

possible to further narrow down the options. I will bracket thought emptiness, for which I

26
follow Sierra’s suggestion that this symptom is really a part of absorption, not DPD (see

section 1.l).

Reports on missing experiences of agency in thought are most plausibly interpreted, on my

view, in terms of impaired agentive phenomenology for intentional mental actions, such as

acts of remembering, of concentrating on a question, solving a problem, going through an

inference, etc. Agentive phenomenology for such intentional mental actions can be seen as

sharing two key dimensions with agentive phenomenology for bodily actions: conscious

intentions and sense of agency (on the latter, cf. Proust, 2008). Both involve INES for the

same reasons as their counterparts for bodily actions. Impairment of these forms of INES will

make the patient feel a lack of agency in and control over her mental life: “I have no active

thoughts” (Mayer-Gross, 1935, p. 109); “Thoughts come and go without personal effort”

(Shorvon, 1946, p. 780). Since it is through intentional mental actions like the above that we

directly govern the stream of our thoughts, impaired agentive phenomenology for such actions

can give patients the impression that they lack control over their thoughts in general (cf. the

quote from Schilder in section 1.c). (Alternatively, the experience of such general lack of

control over thoughts could be explained on the basis of a form of the sense of agency that

normally comes with all our thoughts, as has been argued by some authors in the context of

thought insertion in schizophrenia; for an overview and defense, see Sousa & Swiney, 2013.)

By contrast, reports about felt detachment from thoughts (“On the one side are my

thoughts, then a blanket, a sheet, and then myself”: Mayer-Gross, 1935, p. 109) might merely

be another way of describing the lack of agentive phenomenology for thoughts. Alternatively,

they may describe a detachment that is due to impaired INES in some types of attitudes and

processes within conscious thought. Generally speaking, it seems possible to divide types of

conscious thoughts into those that do and those that don’t involve a form of INES. Merely

entertaining a proposition seems a case of INES-free thought. Conscious intentions are a case

27
of INES-involving thoughts, as we saw already. Further candidates for this second class are

judgments and intuitions. It has been argued that the phenomenal character of judgments

involves a sense of ‘committing’ to the content of the judgment, and of ‘being rationally

compelled’ to judge this way given available evidence (Kriegel, 2013, pp. 65, 67). On such an

account, it would seem that these features phenomenally mark a propositional content as

something that the subject is committing to, and as something that the subject is rationally

compelled to believe. The phenomenal character of intuition that p has been argued to involve

a sense of ‘being pushed to believe that p’ (Koksvik, 2017), a feature which signals to the

subject that she ought to believe that p. So in cases like judgment and intuition (and there may

be many more), phenomenal character can be seen as normally indicating an epistemic

relationship between propositional contents and the subject, and this amounts to forms of

INES. When some or all these forms of INES are impaired, the subject will not feel related

anymore to thought contents in the normal way, and this, too, may explain the feeling of

detachment from thoughts in DPD.

There is also a third possible explanation. On many views, inner speech makes an

important contribution to the phenomenology of thought, and in one prominent form of inner

speech (‘inner speaking’: Hurlburt et al., 2013), the subject experiences an auditory (and

sometimes also proprioceptive) simulation of herself speaking. Such inner speaking is

therefore an instance of imagery that includes a form of INES, and may be affected by DPD

(cf. the closely related case of imagery of one’s own bodily movements: section 9). Subjects

may still experience the simulated voice, but feel alienated from it, and this, too, could explain

the detachment from thoughts in DPD.

8. Episodic Memory

28
Endel Tulving, the psychologist who first recognized episodic memory as a distinct memory

subsystem and introduced the very label ‘episodic memory’, influentially argued that episodic

memory involves a particular form of self-consciousness, which he calls ‘autonoetic

consciousness’. As Tulving points out, when a person remembers an event in episodic

memory, “he is aware of the event as a veridical part of his own past existence” (Tulving,

1985, p. 3, emphasis added). Tulving also argues that this self-consciousness—a form of

INES in my terminology—is part of what sets apart episodic memory from semantic memory:

“The essential difference” between both “is between knowing that something is such and

such, or occurs so and so, on the one hand, and remembering that one had a particular

experience (witnessed, or felt, or thought something) in a particular place at a particular time”

(Tulving, 2005, p. 16, emphasis added; that DPD seems to affect only the phenomenology of

episodic memory, not of semantic memory, gives further support to the present approach to

DPD). A subject with impaired mnemonic INES may still relive the episodes that are stored in

episodic memory, but she will not longer experience them as something she has herself

perceived at an earlier point. This matches reports of patients who feel they are not ‘involved’

in their memories: “I can remember things, but it seems as if what I remember did not really

happen to me” (Sierra, 2009, p. 33).

In the context of the present approach, it may seem tempting to interpret the

dominance of observer view memories in DPD in terms of impaired INES, too—namely, as

failure to reconstruct the egocentric structure of the perceived scene. Against this speaks the

fact that many healthy subjects, too, have observer view memories (Nigro & Neisser, 1983).

Instead, the dominance of observer view memories in DPD may be a consequence of

emotional numbing (cf. section 10), for most studies on the relation between observer/field

view and emotionality of episodic memories suggest (pace Sierra, 2009, p. 34) that the

observer view (or an intentional switch from field to observer view: Robinson & Swanson,

29
1993) tends to correlate with emotionally neutral or less intense memories (Nigro & Neisser,

1983; Robinson & Swanson, 1993; Talarico et al. 2004; Eich et al., 2009).

9. Mental Imagery

In a questionnaire-based study of visual imagery in DPD, Lambert and colleagues (2001)

found (a) that patients have generally poor visual imagery as compared to healthy controls,

and (b) that their imagery is especially reduced when they are asked to imagine performing

movements. Finding (a) corresponds to reports from patients who complain about faint or

absent imagery (e.g. Schilder, 1950, p. 14; Mayer-Gross, 1935, p. 110), and may be accounted

for as a further consequence of emotional numbing (Lambert et al., 2001, p. 262). Finding (b),

by contrast, may be due to an impairment in INES that is normally involved in such imagery:

when imagining walking, or reaching for something on tiptoe (which are items on the

movement questionnaire used by Lambert et al., 2001), the subject herself figures within the

imagined content, namely as agent of those movements and possibly also as owner of the

body that performs them. Impaired INES of this kind will make it difficult if not impossible

for the subject to produce an image of such actions.

There is a strand in the literature on the closely related topic of imagination which

suggests a more pervasive role for INES in mental imagery (Vendler, 1979; Recanati, 2007).

Just as episodic memory presents to the subject what it was like for her to be in a particular

situation in the past, imagery, one might think, presents to the subject what it would be like for

her to be in a particular situation. Visualizing a sunrise, for example, consists on this view in

imagining seeing a sun-rise, i.e. in the subject’s imagining what she would experience if she

saw a sunrise. Hence, normal imagery would always involve INES because it presents the

subject as “experiencer” (Recanati, 2007, p. 196). The fact that patients with DPD often have

poor imagery in general might then be accounted for in terms of an impairment in this

30
pervasive form of imagistic INES, rather than (or in addition to) emotional numbing.

However, on this hypothesis one should expect that disturbances of imagery in DPD mirror

those of episodic memory, i.e. there should be patients who feel they are not involved in their

imagery as they normally are. There are no reports of this kind in the literature as far as I can

tell, and this speaks against drawing the above close analogy between imagery and episodic

memory with regard to INES. Instead, mental images may by default merely simulate relevant

perceptual features (e.g. the colors and shapes of a sunrise), i.e. present to a subject what it

would be like to experience the relevant object or scene, and not necessarily what it would be

like for her to experience them.

10. Emotional Experience

Accounts of emotional experience range from views that see it as feeling without intentional

structure, over accounts that interpret it as interoceptive perception, to theories on which

emotional experience represents objects or scenes as having evaluative properties (for an

overview, see Deigh, 2009). Correspondingly, there are various different ways in which it

may be either argued or contested that emotional experience involves INES. Instead of

attempting a comprehensive discussion, I will merely present what I find to be the most

plausible way of locating INES in emotional experience.

Many contemporary theorists (e.g. Goldie, 2000; Helm, 2001; Roberts, 2003; Döring

2007; Tappolet, 2016) agree that emotional experience makes us aware of evaluative

properties or facts—in a stock example, my fear of a snake in front of me makes me aware of

the snake’s dangerousness. But such awareness does not merely consist in some abstract grasp

of the danger that some snakes can present to humans in general. Rather, when fearing the

snake, I am aware of the danger it presents to me. In other cases, the relation between the

evaluative property and the subject is less direct: when I see from a safe distance how my

31
friend is threatened by a snake, I am also afraid of the snake, but because I fear for my friend.

What is common to both examples is that the emotion makes me aware of an evaluative

property that matters to me because it consists in something’s (here: the snake) being (actually

or potentially) good or bad for something I care about (Helm, 2001)—my own health in the

first case, my friend’s in the second case. Call this feature of the evaluative property its

‘relevance’ for the subject who has the emotion. Contrast the two snake-examples with a case

in which I recognize that a big wave coming from the sea is about to destroy a heap of cobbles

on the beach, the existence of which is completely indifferent to me. Here, I become aware of

an evaluative property of the wave that is not relevant to me, and indeed I would not normally

feel anything like fear or concern for the heap (while I might feel such an emotion if the wave

was threatening a beautiful sand castle that took me hours to build).

The general lesson that is suggested by these examples is that emotions often, if not

always, make us aware of evaluative properties that have relevance for us. But such

awareness will involve a form of INES only if it amounts to an awareness of the evaluative

properties as having relevance for us. Do emotions constitute such awareness? Or do they just

track relevance by some subpersonal mechanism, without this becoming conscious for us? I

think that the former is the right answer, for (at least) the following two reasons. First,

emotions are mental states with a particularly ‘personal’ character, they immediately speak to

and express our autobiographic selves with their interests and concerns. When we feel

emotions concerning something that we thought we would not or should not care about (e.g.

sadness about the misfortunes of a person we thought we didn’t care about anymore), there is

a contradiction that we should realize and resolve (either by revising our belief about our

indifference, or by seeing the emotion as inappropriate). If it is granted at all that emotions

make us aware of evaluative properties, then the most straightforward explanation for

32
observations like these is that emotions make us aware of evaluative properties as having

relevance for us.

Second, it is generally recognized that emotions play an important motivational role—

they have a potential for causing actions that are intelligible as responses to the emotion. That

emotions make us aware of evaluative properties as such is not sufficient to explain this

motivational role: when recognizing that something is actually or potentially good or bad for

someone or something in general (e.g., bad for the heap of cobbles), why should I do

something about this? If, instead, it is granted that emotions make us aware of evaluative

properties as having relevance for us, the motivational role is easily understood—I should act

in response to the emotion because the emotion signals to me that something is good or bad

for something I care about (Döring, 2007, pp. 372-374).

I therefore conclude that conscious emotions are plausibly seen as mental states which

make us aware of evaluative properties as having relevance for us. In virtue of this latter bit—

relevance for us—conscious emotions make the subject aware of how given objects (e.g. the

snake or the wave) matter to her, and therefore involve a form of INES. Suppose that this

emotional INES is impaired in DPD: in this case, subjects will lack the emotional experience

of things as mattering to them that normally permeates their mental lives—a result that fits

well with patients’ complaints about emotional numbing. (Notice that the predicted lack of

experience of relevance to oneself is compatible with some amount of emotional processing at

unconscious levels. Hence, the present hypothesis is compatible with the fact that patients can

show intact expressive behavior.)

11. Algedonic Experience

On a popular view, bodily pains have two components: a sensory one, in virtue of which such

states make us aware of some state or event in (a particular part of) our body, and a further

33
emotional and/or motivational dimension that assesses this state/event as good or bad for the

subject (e.g., Cutter & Tye, 2011), and/or as calling for some action (e.g., Martinez, 2011).

The distinction between both dimensions is motivated by cases like pain asymbolia and

morphium treatment, where subjects have pain-related bodily sensations but do not

experience them as painful. For some reason, pleasure has received much less philosophical

attention than pain, but it least some authors have proposed parallel accounts for it (e.g.,

Cutter & Tye, 2011). Both dimensions of pain and pleasure seem to involve INES. In virtue of

their sensory dimension, pains and pleasures are bodily sensations, and as such, they inform

us about some state or event as located in our body (cf. section 5). And if the second

dimension is understood in emotional terms, the argument about emotions from the last

section applies (cf. also Helm, 2001). If, by contrast, the second dimension is seen as purely

motivational, then pains and pleasures signal to their subject that she should do something,

which, too, involves INES.

Impairment of either of these forms of INES in DPD can have the result that subjects

do not feel pain and pleasure at all, or alternatively, that they notice something, but do not

experience it as painful or pleasant (cf. the reports in section 1.a)—because they fail to feel

the algedonic sensations as located in their body, and/or because they fail to experience the

relevance or motivational significance for them.

12. Temporal Experience

Many types of conscious mental states contain a ‘temporal index’ that informs us about a

temporal relation between the present time t at which we experience the state, and the time at

which the content of the state is represented as taking place or obtaining. For example, any

given state of perception that we experience at time t not only informs us about spatial and

mechanic relations between us and our environment, but also about a temporal relation of

34
synchronicity between the represented state of affairs and our present, t. (Perception presents

its objects as being really there, here and now.) A state of episodic memory that is

experienced at t presents its contents as having been experienced by the subject at some point

before t. A prior intention that is conscious at t presents an action as due to be done by the

subject at some point after t. Indeed, it has been argued that our conscious experience

involves not only spatial, but also temporal ‘self-location’ (Metzinger, 2003, pp. 311-313)—

or, in other words, that experience presents things as standing not only in spatial, but also in

temporal relations to the subject (in its present state). If something like this is correct, the

‘embedded’ aspect of INES involved in states like perceptions, episodic memories, and prior

intentions also has a temporal dimension, and as a consequence, an impairment in INES in

these kinds of states might explain the disturbances of temporal experience in DPD:

experiences such as abnormally fast and slow flow of time and a lacking grasp of time with its

dimensions might be seen as abnormal or absent experience of spatial relations between

objects of perception, memory etc., and the subject, due to an impaired ability to implicitly

experience the subject as relatum in such temporal relations.

13. Feelings of (Un-)Familiarity

Experiences of déjà-vu and jamais-vu are plausible analyzed as consisting, at the phenomenal

level, of two conflicting elements (cf. S, 1987, pp. 306-307). In cases of déjà-vu, we feel a

sense of ‘familiarity’ that qualifies a perception, thought, image, etc.; at the same time, we are

(or quickly become) aware that the object of our perception, thought etc. is not really familiar.

Vice versa, in cases of jamais-vu, we feel a sense of ‘novelty’ that qualifies a given mental

state, even though we are (or quickly become) aware that the object of the mental state is not

really novel.

35
 It can easily seem that these elements—the sense of familiarity/novelty, and the

conflicting awareness of actual novelty/familiarity—involve INES, for it is very natural to

characterize their content in terms like ‘I have (not) seen this before’. In this case, however,

déjà-vu and jamais-vu in DPD would pose a problem for the present approach: this approach

would predict that such experiences are absent in DPD because the INES involved in them is

impaired. But instead, these experiences are more frequent in DPD than in health.

However, there is independent reason to believe that the experiences involved in déjà-

vu and jamais-vu actually are of a simpler nature, and do not involve INES. A promising

strand in recent psychological research on déjà-vu explains the phenomenon in terms of

processes of metacognition, and more precisely metamemory, i.e. processes that monitor

memory performance (Kusumi, 2006; Moulin, 2018). In déjà-vu, as understood by such

approaches, an initial mnemonic assessment yields the result that a content matching the

presently perceived (thought, …) content is stored in memory, and this assessment is made

conscious in virtue of a metacognitive feeling (identical with or akin to the ‘feeling of

knowing’: e.g. Koriat & Levy-Sardot, 1999). However, in subsequent, more explicit memory

retrieval, it either turns out that there is no such content in memory, or that a stored content

that was accessed by the initial assessment is not sufficiently similar, leading to an awareness

that the object in question is really not familiar after all. Several authors have argued that

memory monitoring does not require an ability to represent oneself as subject of memories,

perceptions etc. (e.g. Koriat & Levy-Sardot, 1999; Proust, 2018). On this view, we should

expect that the metacognitive experiences involved in déjà-vu and jamais-vu are

representationally quite rudimentary and lack INES. The initial sense of familiarity/novelty

might merely signal a content of the kind ‘Something (nothing) like this is in memory’, or

‘This has (not) happened before’, and the subsequent awareness of actual (un)familiarity

might merely consist in a failure or success in retrieving relevant results from memory.

36
 Disturbed feelings of familiarity in DPD therefore require a different explanation. In

the present framework, this disturbance can be understood as side-effect of impairments of

INES. Such impairments require, at a lower level in the explanatory hierarchy, interventions

in the mechanisms that are responsible for INES in normal experience, and these interventions

may have additional effects, too, because of how the mechanisms underlying INES are

hardwired and/or functionally linked to other mental processes. In particular, there is evidence

for an anatomic or functional connection that links the mechanisms responsible for

experiences of (un)familiarity to the mechanisms underlying perceptual and/or temporal

INES: in the so-called Alice in Wonderland Syndrome (AIWS, reviewed in Blom, 2016, and

Mastria et al., 2016), a transitory and sometimes chronic condition in connection with

migraine or virus infections, déjà-vu and jamais-vu occur together with the temporal and

perceptual disturbances that are found in DPD (including teleopsia, macro-/micropsia, loss of

stereoscopic vision, macro-/microsomatognosia, out-of-body experiences, feeling of floating),

as well as several further visual distortions. (Detachment from self and unreality of

surroundings, too, occur in AIWS, but this is consistent with the view proposed in section 3

that these two phenomena are consequences of other symptoms, such as the perceptual

distortions.)

14. Isn’t INES Global, After All?

Views that explain DPD in terms of absent mineness or emotional coloring are partly

motivated by the intuition that our normal experience has a subjective or personal tone (Ribot,

1888, pp. 167-169; Dugas & Moutier, 1911, p. 13; Billon, forthcoming). Since the forms of

INES that I have described permeate most of our conscious mental lives, they may be

responsible for this intuition (cf. Howell & Thompson, 2017, pp. 120-123, for a similar point).

Still, my account spells out this intuition in a way that is very different from ‘mineness’ and

37
‘emotional coloring’ accounts. INES does not phenomenally mark a mental state as mine, nor

does it color it with emotion. And it is not a global feature of consciousness, both because it

depends on the particular structure of each INES-involving type of mental state rather than on

some general fact about (non-pathological) consciousness, and because there are mental states

that lack INES. The clearest instances of the latter are states of entertaining a proposition,

especially when they do not serve a doxastic aim (and hence do not involve agentive

phenomenology), but are states of mere ‘contemplation’ (Kriegel, 2013, p. 112), and simple

states of mental imagery (e.g. visualizing a triangle or a banana) that picture neither the

subject’s body, movements etc. nor a perspectivally organized perceptual scene. In addition, if

an austere view of the phenomenology of conscious attitudes like judgment and intuition is

combined with the view that such attitudes do not necessarily involve inner speech (cf. section

6), such attitudes will count as lacking INES, too.

15. Questions for Future Empirical Research

Since my account predicts that INES-free states will, other things being equal, have normal

phenomenology in DPD, one might think that they offer a great opportunity for empirically

testing the account. But unfortunately, it is unclear whether it is actually possible to test this

prediction. For one would have to assess instances of the above INES-free kinds of states

where the content is emotionally indifferent for the subject—otherwise, the phenomenology

could be affected by emotional numbing. But since the ecological validity of the resulting

kind of situation is low—why should someone spend time imagining or contemplating

contents that are completely without interest—it is very unlikely that patients can actually tell

whether episodes of this kind feel different in disease from how they used to feel in health.

Hence, it seems that the existence of INES-free states is more of philosophical than of

empirical interest.

38
 However, there are at least three other respects in which this account raises questions

for future empirical research. First, there is a need for a more detailed understanding of the

phenomenology of thought in DPD: how exactly do patients feel detached from their

thoughts? Does abnormal phenomenology of thought in DPD affect particular aspects or

modes of thought, or is it more pervasive? Does it depend on the contents that are being

thought about? Such and similar questions are important in their own right for an

understanding of the phenomenology of DPD, but more knowledge about them is also needed

to assess whether abnormal phenomenology of thought in DPD is plausibly accounted for in

terms of impaired INES.

Second, future empirical analyses of the symptomatology of DPD should include one

or more items on detachment from self, which is absent from the Cambridge

Depersonalization Scale. Data about how the various other symptoms correlate with

detachment from self and unreality of surroundings would allow to assess my account of the

explanatory relations between these symptoms (section 3).

Third, even though the available evidence speaks against them, metaphorical readings

of reports about perceptual abnormalities in DPD have always enjoyed some popularity (cf.

section 1.i). This is also reflected in the Cambridge Depersonalization Scale, where one of

two relevant items (#2 and #19) is formulated in a way that suggests a metaphorical reading in

terms of lack of emotion: “What I see looks ‘flat’ or ‘lifeless’, as if I were looking at a

picture” (#2, Sierra & Berrios, 2000, p. 160, emphasis added). Since this point has

considerable impact on how the empirical adequacy of theories of DPD is assessed (do they

have to be able to account for perceptual disturbances or not?), future empirical research

should clarify the issue.

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1
Billon (forthcoming) points out that conscious states in DPD might possess mineness in a
diminished form, but I find it difficult to conceive of “perspectival givenness” as something
that comes in different degrees.
2
One exception is Bermúdez’s theory; see, e.g., Bermúdez, 2017, pp. 124, 126. But cf. Billon,
2017, p. 204, who argues that the phenomenology of DPD speaks against Bermúdez’s theory.
3
Billon (2017, p. 195) discusses this aspect in terms of sense of ownership, too, but he accounts for it as
disturbed sense of ownership over mental states, namely the bodily sensations, while on the present account, it is
a consequence of disturbed sense of ownership over the body.
4
“Individual”, because on some views there are irreducible ‘we-intentions’. Since the
phenomenology of plural agency (and of intersubjectivity in general) in DPD still awaits
empirical investigation, I bracket this topic from my following discussion.

48