Fugue state

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For the New York City-based publisher, see Fugue State Press.

In the field of psychology, a fugue state is usually defined by the term dissociative fugue. It is etiologically related to dissociative amnesia (which in popular culture is usually simply called amnesia, the state where someone completely forgets who they are).

A fugue state is therefore similar in nature to the concept of dissociative identity disorder (DID) (formerly called multiple-personality disorder) although DID is widely understood to have its conception in a long-term life event (such as a traumatic childhood), where sufficient time is given for alternate personality representations to form and take hold. Sudden neurological damage would thus seem to fit more closely the onset of a fugue state.

As the person experiencing a fugue state may have recently suffered an amnesic onset - perhaps a head trauma, or the reappearance of an event or person representing an earlier life trauma - the emergence of a "new" personality seems to be for some, a logical apprehension of the situation.

Therefore, the terminology fugue state may carry a slight linguistic distinction from dissociative fugue, the former implying a greater degree of motion. For the purposes of this article then, a fugue state would occur while one is acting out a dissociative fugue.

The DSM-IV defines Dissociative Fugue as:

sudden, unexpected travel away from home or one's customary place of work, with inability to recall one's past,
confusion about personal identity, or the assumption of a new identity, or
significant distress or impairment.

The Merck Manual ^[1] defines Dissociative Fugue as:

One or more episodes of amnesia in which the inability to recall some or all of one's past and either the loss of one's identity or the formation of a new identity occur with sudden, unexpected, purposeful travel away from home.

In support of this definition, the Merck Manual ^[1] further defines Dissociative amnesia as:

An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.

1 Prevalence and onset
2 Treatment and prognosis
3 Cases
4 References
5 External links

[edit] Prevalence and onset

It has been estimated that approximately 0.2 percent of the population experiences dissociative fugue, although prevalence increases significantly following a stressful life event, such as wartime experience or some other disaster^[1]. Other life stressors may trigger a fugue state, such as financial difficulties, personal problems or legal issues. Unlike a dissociative identity disorder, a fugue is usually considered to be a malingering disorder, resolving to remove the experiencer from responsibility for their actions, or from situations imposed upon them by others. Similar to dissociative amnesia, the fugue state usually affects personal memories from the past, rather than encyclopedic or abstract knowledge. A fugue state therefore does not imply any overt seeming or "crazy" behaviour.

[edit] Treatment and prognosis

Most fugues last for hours or days and disappear on their own. Dissociative fugue is treated much the same as dissociative amnesia, and treatment may include the use of hypnosis or drug-facilitated interviews. Most people who suffer dissociative fugues regain most or all of their prior memories; however, efforts to restore memories of the fugue period usually are unsuccessful.

The goal of treatment is to help the person come to terms with the stress or trauma that triggered the fugue. Treatment also aims to develop new coping methods to prevent further fugue episodes. The best treatment approach depends on the individual and the severity of his or her symptoms, but most likely will include some combination of the following treatment methods:

Psychotherapy — Psychotherapy, a type of counseling, is the main treatment for dissociative disorders. This treatment uses techniques designed to encourage communication of conflicts and increase insight into problems.
Cognitive therapy — This type of therapy focuses on changing dysfunctional thinking patterns and resulting feelings and behaviors.
Medication — There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
Family therapy — This helps to teach the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
Creative therapies (art therapy, music therapy) — These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.
Clinical hypnosis — This is a treatment method that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness (awareness), allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds. The use of hypnosis for treating dissociative disorders is controversial due to the risk of creating false memories.

[edit] Cases

David Fitzpatrick, who suffered a psychogenic fugue in 2005.

William Bates – Physician and opthalmologist William Bates experienced several episodes in his life when he disappeared without a trace and was found to be living under a different name and identity. While never diagnosed with psychogenic fugue in his lifetime (his obituary wrongly referred to his loss of memory as "aphasia"), similarities can be found with other cases.
Joe Bieger – On 5 October 2006 Joe Bieger wandered the streets of Dallas, Texas, for 25 days.^[2]
Doug Bruce – The documentary Unknown White Male (2005) deals with subject Doug Bruce's fugue state during his retrograde amnesia.^[3]
Agatha Christie – Mystery writer Agatha Christie went missing for eleven days in 1926. Her car was found abandoned on the road with some belongings strewn about the area. She was later found living in a hotel under a different name. In a 2006 biography, author Andrew Norman proffered the theory that the mysterious disappearance of Christie was attributable to a fugue state.
David Fitzpatrick – David Fitzpatrick, a 25-year-old British man, suffered a psychogenic fugue on 4 December 2005 which wiped his entire memory clean, leaving him with no identity. The television documentary Extraordinary People: The Man with No Past^[4] followed Fitzpatrick as he tried to recover the life he had before, and discovered he had a dark past – heavy drinking, unemployment, sponging off family and friends, and failed relationships (one of which resulted in the birth of a daughter, now aged six years) – as well as a unique opportunity to start all over again.
Jeff Ingram – Jeff Ingram, a 40-year-old Olympia, Washington, resident suffered a dissociative fugue on 6 September 2006. He somehow made his way to Denver, Colorado, and wandered the streets before 'waking up' and asking doctors and police there for help in learning his own identity.^[5]
Kevin Mura found out who he was after searching the internet for missing persons ^[6]