The making of Consider Falling

Consider Falling is one of the first pieces greeting visitors to ON EDGE: Living in an Age of Anxiety. Rooted in research about depersonalisation disorders (DPD) and interviews with service users at King's College London's Depersonalisation Research Unit, artist Sarah Howe has created an immersive environment of mirrors, fragments of interviews, and repeated gestures of anxiety.

Sarah and  Elaine Hunter from the DPD Unit at King's explain the impact of depersonalisation disorders and how they worked together to create the piece. 

Sarah Howe, artist

I became interested in DPD when I was thinking about anxiety more generally
Brexit had just happened, Trump was elected and a lot of belief systems  I may have taken for granted were being thrown into question.

I had been watching a lot of videos online, depicting emotional outpourings, and people revealing their anxieties publicly, particularly as a reaction to trauma. And it was here, whilst listening to other people’s experiences, that I first came across the term DPD. Interestingly I found this to be a common way that even those with the condition first come to learn of it, as DPD is underdiagnosed generally.

I was drawn to the impossibility of fully explaining what it is like to inhabit DPD, and in turn anyone’s subjective experience - the limits of empathy are a common thread throughout my work. When it comes to describing DPD, the verbal and written accounts  largely draw on metaphor to help explain the inner experience where both emotional processing and visual perception are dramatically altered.  Thinking about these descriptions as a visual artist, I immediately drew links to my experience of the photographic image, the flattening and altering of perspective and the impenetrability of the frame.

After coming across the term, I began to embark on interviewing people with DPD after meeting with Elaine Hunter.  
I wasn’t sure how it might manifest but I wanted to speak with someone with in-depth clinical knowledge of the condition with the potential to meet people who had be diagnosed or were in treatment. Elaine gave me a broad understanding of DPD from her vast experience with many patients. I was also reassured that if anyone I spoke to needed advice or were negatively affected by working with me, this would be immediately caught and resolved. I don’t believe this was ever the case, but as an artist and not a trained professional in mental health, I was very conscious of this aspect of the work. 

I was struck by the generosity of all those who spoke to me about their condition.
In the installation the two sound pieces and the large photographic portrait draw specifically on individual interactions. I think the sound pieces can be seen as exercises in empathy – I wrote the script from the perspective of an interviewer or conversational partner and bringing the inability of the narrator to fully comprehend the experience of the subject, and vice versa. I think what comes from this and the installation as a whole is the idea of giving space to, sitting with and acknowledging a person despite these barriers of comprehension.  

I actually started out making videos of repetitive gestures, much like the ones you see in the installation
These were informed by anxiety gestures but also therapeutic videos for anxiety online. The ones selected to form the installation were informed by the actions many of the people I interviewed said that they did consciously or unconsciously in times of unease or anxiety.

The conversations I had with people with DPD centred on themes of fragmentation
I was interested in mirrors as at once both a barrier and portal and wanted to make the viewer discover new elements to the work as they went around the space

The brightness of the screen and the colours used in the videos relate to a description by someone with DPD
They described “coming to” and experiencing the world without DPD for a short period. In this moment everything became saturated with colour and extremely vibrant and alive. I wanted to reference this through the splashes of colour seen partially obscured in the mirrors.

I hope those with DPD can get something from the experience of seeing the work
Even if it’s just that someone has taken the time to think about their experience and try and understand. And for those who don’t have and experience of the condition I hope it can be much more open and for some other conversations present in the work to be thought about and added to.
I would like to thank all those who helped me to realise the work, Elaine and all of the people I spoke with and interviewed. And to curator Mette Kjaegaard Praest and Science Gallery London  for commissioning the work for ON EDGE.


Elaine Hunter, Consultant Clinical Psychologist and researcher of Depersonalisation-Derealisation Disorder (DPD)

DPD is a very distressing set of symptoms where people feel a sense of unreality about themselves and the outside world.
People may describe feeling as though they are living in a dream, or as if they are cut off and not fully ‘present’ in the moment. People often feel dissociated or detached from the world and from other people, as well as their own personal history. They often describe feeling profoundly emotionally numb so that they feel almost robotic in their responses. They may also experience physical numbing and difficulty processing information as if their brain has ‘switched off’. Visual and perceptual disturbances are common too. Although these experiences are relatively common in the general population for very brief moments especially at times of stress, with the clinical condition of DPD these symptoms are persistent, get in the way of daily living and may last for years if the person does not receive help.

The main therapeutic approach for DPD is Cognitive Behavioural Therapy (CBT)
Treatment at The Depersonalisation Clinic starts with a comprehensive assessment during which the key factors that are likely to have led to the symptoms starting are identified, as well as any factors that might be perpetuating the symptoms. Cognitive Behavioural Therapy (CBT) has been shown to be effective in significantly reducing symptoms in two separate studies. CBT looks at how a person’s thought processes and behaviour may contribute to their difficulties and works to change unhelpful cycles into more helpful patterns. Treatment at The Depersonalisation Clinic may also use other types of therapies depending on what the individual needs. These might include Schema Therapy (where there is more of a focus on difficulties that originated in childhood), Mindfulness Based Cognitive Therapy and Trauma-focussed approaches.

I have talked to literally hundreds of people with DPD
I was able to help Sarah in her development of the piece because I am able to give an overall context to the detailed information that she might have got from specific people with lived experience. From hearing from so many people talk about their experiences of DPD I could talk about typical patterns in symptoms, what tends to trigger these and how people recover. I agreed to ask some of the people I knew with lived experience of DPD if they might be interested in talking to Sarah so she could get multiple perspectives which would give her piece more depth and validity.

People with DPD who have seen the artwork have told me that it really gives a sense of what their experience is like
The piece is a beautiful visual representation of the sense of disconnection and fragmentation that people with DPD describe. I’m hoping that if people have had their own experiences of DPD they will be able to identify with it or if they have never encountered the condition before that it will spark their curiosity about DPD. Although DPD has been written about in the psychiatric literature since the 19th Century it is still not common in conversations about mental health - even amongst mental health professionals - and this is very unhelpful for those with the condition as well as for people like me who are trying to put pressure to increase resources for treatment and funding for research. Raising awareness and doing it in such an engaging way as Sarah has been able to do in her artwork really helps to start these conversations to get DPD better recognised and understood.

Sarah Howe is a UK based artist whose installations situate still and moving image within sculptural space. Her work stands in the crossing between a material and psychological landscape, in a reach to illustrate heightened inner states. Howe is a graduate of the Royal College of Art, London. Recent exhibitions include Rehearsing the Real, Peckham24, London UK (2019) Present Tense, Matéria Gallery, Rome, Italy (2019) Lets go through this again, Portland Works, Sheffield UK (2019) and Consider Falling, Brighton ONCA Gallery, Brighton UK (2018) 

Elaine Hunter is a Consultant Clinical Psychologist who has been researching Depersonalisation-Derealisation Disorder (DPD) since 1999 in Kings College London’s Depersonalisation Research Unit at the Institute of Psychiatry, Psychology and Neuroscience. She also runs a specialist clinic in London where she offers assessment and therapy and is a Trustee of a new charity specifically for DPD called Unreal.