What does it mean when a person says he/she feels numb? Feeling numb indicates that a person lacks access to or is disconnected from emotions such as happiness or joy, and cannot feel love, care and concern or intimacy with others. When feeling numb, a person also cannot experience feelings of sadness, depression, guilt, low self-esteem, suicide or self-hatred. It should be apparent that a numb state does protect a person from feeling depressed. People who feel emotionally numb invariably report that they would prefer to be numb than depressed. Similarly, the numb state protects a person from feeling embarrassed or ashamed.

One frequent source of confusion for clinicians regarding the phenomenon of numbness includes the fact that patients often mistakenly report symptoms of depression occurring at the same time as feeling numb. The vast majority of individuals who are numb do not stay in that mood state all the time – they typically switch between feeling numb and feeling depressed, but they are not in both states simultaneously. Symptoms synonymous with numbing include feeling hollow, dead, shut down and empty-no feelings .

The term “dead” denotes a more profound state of emotional withdrawal and lack of relatedness to others. Individuals who feel dead may complain of difficulty falling asleep because lying still intensifies the feeling of “deadness.” These individuals may value being in a state of movement when alert. Numb individuals may self-medicate with street opioids such as heroin in order to feel energetic and active, which can lead to addiction to opioids. Interestingly, drugs such as heroin can have the opposite effect on people who are numb.

Individuals who feel profoundly hollow have reported to me that they experience their bodies as being transparent, and feel as though others can literally see through them. They also reported believing they could walk through walls because their bodies have no physical substance.

Numbing, just like depression, can manifest as a circumscribed complaint or as a syndrome with an array of associated symptoms. Both depression and numbing can be associated with a loss of interest, pleasure, motivation, apathy, impaired concentration and memory, mental fog and fatigue. A person who is numb will not, however, experience the other symptoms unique to depression such as loss of self-esteem, sadness, guilt and suicidal ideation. I have only encountered one individual who was suicidal while in a numb state. This person became suicidal and was consequentially hospitalized because she could not tolerate her inability to experience normal human feelings.

Depressed people are invariably troubled and preoccupied by memories and events that occurred in the past, whereas people who are numb are very present oriented and not concerned with the past or the future, unless they are consumed by anger and thoughts of vengeance and revenge for past perceived grievances. In a numb state, a person may only be able to experience intense emotions such as anger and rage. I became acutely aware of this while treating a Vietnam veteran who had completed three tours of duty and was persistently numb. While attending a funeral of a loved one, he exploded into a rage in front of others who were mourning. Rage was the only emotion he was able to access. When people who are numb go into a rage, the event is especially intense, explosive and long lasting. While in a state of rage, people can lose all feelings of care and concern for others and for the consequences of their behavior. Afterward, they typically become withdrawn and unresponsive for a protracted period of time. Oftentimes they experience amnesia and cannot recall the event. Others recall seeing the color red in the center of their tunnel vision during their rage.

There are also other profoundly numb people who are unable to access feelings of destructive anger and rage. They are completely unresponsive, like a rock; they have a flat affect and no facial expressions, their speech is monotonic. Many chronically numb individuals learn to pretend to have feelings which they do not truly experience. Others are unaware that they are projecting facial expressions, such as anger or sadness, that are disconnected from and do not accurately reflect the numb state they are in.

Cognitive impairments in people who are numb tend to be more severe than in depressed individuals. For example, a numb person may experience mental blankness, periods of amnesia, and loss of self-awareness and the ability to monitor his/her own behaviors. In the case of people who report having severe depression, it is crucial for a clinician to make certain that the person is truly depressed and not numb.

Antidepressants are not effective in treating numbness. Somatic symptoms are also different in people who are numb verses people who are depressed. For example, people who are numb may experience analgesia (loss of bodily sensations), pins and needles and transient periods of paralysis while awake. It is not unusual for people who are emotionally numb to feel disconnected from their own identities and to wonder who they are because they feel so detached from themselves.

Numb people may adapt to feeling disconnected by creating an image for themselves that is associated with a strong visual identity such as “fashion queen” or “combat warrior.” If a person who is numb is not cognitively impaired in terms of his/her concentration and memory, this person may be able to function well in a business environment that does not require relating to others empathically. These individuals may function well in the workplace but very poorly in a family environment.

What kind of situations may precipitate the numb response? First and foremost is exposure to serious injury or possible loss of life. Overwhelming stress in some individuals such as loss of income, divorce, or death of a family member may precipitate an acute numb response rather than depression. Chronic unremitting depression or physical illness may ultimately lead to a numb response. Numbing resulting from exposure to trauma is more likely to be a conditioned (automatic) response, which predisposes that person to becoming numb in reaction to future stressors. Numbness becomes the predominant mode of response. Individuals who are chronically numb may experience waves of numbness that appear to come out of the blue. In these cases, the numb response appears to take on a rhythm of its own which seems at times to be independent of any identifiable stressor.

Dreams can vividly portray the mental state of the dreamer. One World War II veteran dreamt that he saw himself in the passenger seat of a space capsule constantly orbiting the earth. What a powerful way of illustrating the veteran’s sense of isolation and emotional distance from others. Interestingly, somatic analgesia and paralysis are two responses that can be found in lab rats and mice when they are exposed to stressful situations. Somatic analgesia is referred to as stress induced analgesia, when, for example, a laboratory animal’s foot is exposed to an electric shock while inside of a cage. Once conditioned, merely placing the animal in the same cage will induce analgesia, even in the absence of being shocked.

Studies of stress induced analgesia gave me the first important clue as to what was causing emotional numbing in humans. First I reasoned that the body and mind are one. Therefore, what was causing numbing or analgesia of the body could also be causing emotional numbing centrally. I learned there are four different neurochemicals that can be associated with stress induced analgesia, but only endogenous opioids can induce a conditioned form of stress induced analgesia. This was an important step in my realization that numbing (both somatic and central) has to be mediated by the endogenous opioid system. Not all people who are emotionally numb also have somatic analgesia, but in people who have both phenomena, invariably it is the somatic analgesia that appears first. Thus, a milder stressor is likely to induce somatic analgesia first without necessarily also inducing emotional numbing.