Joscha Bach says involuntary derealization or depersonalization can be highly stressful, and people experiencing it often end up in psychiatric institutions because they no longer feel real to themselves or have a meaningful sense of 'I'.

“And this is involuntarily. These people often end up in psychiatric institutions because it's very stressful to them, and they don't know how to deal with the fact that they are no longer real to themselves, and there is no "I" anymore that they can meaningfully refer to.”