Dissociative Disorder in the Iranian Culture: The Lawless Utopia

Epidemiologic and etiological studies of dissociative disorders are a challenging area in psychiatry. These challenges become more complex when noting that the existing theories cannot explain the differences observed in certain cases; for example, studies in Iran have reported the prevalence of dissociative disorders (dissociative amnesia, dissociative fugue, and depersonalization disorder) as less than 0.6%, and there has been no reported case of dissociative identity disorder (DID) in this country; meanwhile, the prevalence of all dissociative disorders in the general population of the US has been reported as 18.3%, and the prevalence of DID as about 1.1%. Although several studies indicate the high prevalence of dissociative symptoms in many Iranian psychiatric illnesses, dissociative disorders as a stand-alone disorder have a very low prevalence in Iran. The present article attempts to propose a possible hypothesis for the answer to the above questions through a different cultural conceptualization and seeks to be of some help to future studies in this area. Certainly, this hypothesis requires a careful study to be validated.

Whatever Next and Close to My Self—The Transparent Senses and the “Second Skin”: Implications for the Case of Depersonalization

In his paper “Whatever next? Predictive brains, situated agents, and the future of cognitive science,” Andy Clark seminally proposed that the brain's job is to predict whatever information is coming “next” on the basis of prior inputs and experiences. Perception fundamentally subserves survival and self-preservation in biological agents, such as humans. Survival however crucially depends on rapid and accurate information processing of what is happening in the here and now. Hence, the term “next” in Clark's seminal formulation must include not only the temporal dimension (i.e., what is perceived now) but also the spatial dimension (i.e., what is perceived here or next-to-my-body). In this paper, we propose to focus on perceptual experiences that happen “next,” i.e., close-to-my-body. This is because perceptual processing of proximal sensory inputs has a key impact on the organism's survival. Specifically, we focus on tactile experiences mediated by the skin and what we will call the “extended skin” or “second skin,” that is, immediate objects/materials that envelop closely to our skin, namely, clothes. We propose that the skin and tactile experiences are not a mere border separating the self and world. Rather, they simultaneously and inherently distinguish and connect the bodily self to its environment. Hence, these proximal and pervasive tactile experiences can be viewed as a “transparent bridge” intrinsically relating and facilitating exchanges between the self and the physical and social world. We conclude with potential implications of this observation for the case of Depersonalization Disorder, a condition that makes people feel estranged and detached from their self, body, and the world.

Being for no-one

Can there be phenomenal consciousness without self-consciousness? Strong intuitions and prominent theories of consciousness say “no”: experience requires minimal self-awareness, or “subjectivity”. This “subjectivity principle” (SP) faces apparent counterexamples in the form of anomalous mental states claimed to lack self-consciousness entirely, such as “inserted thoughts” in schizophrenia and certain mental states in depersonalization disorder (DPD). However, Billon & Kriegel (2015) have defended SP by arguing (inter alia) that while some of these mental states may be totally selfless, those states are not phenomenally conscious and thus do not constitute genuine counterexamples to SP. I argue that this defence cannot work in relation to certain experiences of ego dissolution induced by potent fast-acting serotonergic psychedelics. These mental states jointly instantiate the two features whose co-instantiation by a single mental state SP prohibits: (a) phenomenal consciousness and (b) total lack of self-consciousness. One possible objection is that these mental states may lack “me-ness” and “mineness” but cannot lack “for-me-ness”, a special inner awareness of mental states by the self. In response I propose a dilemma. For-me-ness can be defined either as containing a genuinely experiential component or as not. On the first horn, for-me-ness is clearly absent (I argue) from my counterexamples. On the second horn, for-me-ness has been defined in a way that conflicts with the claims and methods of its proponents, and the claim that phenomenally conscious mental states can totally lack self-consciousness has been conceded. I conclude with some reflections on the intuitive plausibility of SP in light of evidence from altered states.

The Varieties of Self-Transcendent Experience

Various forms of self-loss have been described as aspects of mental illness (e.g., depersonalization disorder), but might self-loss also be related to mental health? In this integrative review and proposed organizational framework, we focus on self-transcendent experiences (STEs)—transient mental states marked by decreased self-salience and increased feelings of connectedness. We first identify common psychological constructs that contain a self-transcendent aspect, including mindfulness, flow, peak experiences, mystical-type experiences, and certain positive emotions (e.g., love, awe). We then propose psychological and neurobiological mechanisms that may mediate the effects of STEs based on a review of the extant literature from social psychology, clinical psychology, and affective neuroscience. We conclude with future directions for further empirical research on these experiences.

Dissociative Disorders

In this chapter topics related to dissociative disorders are reviewed including dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder and derealization disorder