Fugue state

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

Fugue state
Classification and external resources
ICD-10	F44.1
ICD-9	300.13

A fugue state, formally dissociative fugue or psychogenic fugue (DSM-IV Dissociative Disorders 300.13^[1]), is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality. The state is usually short-lived (ranging from hours to days), but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode. Additionally, an episode is not characterized as a fugue if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor (Dissociative Amnesia).

Clinical definition

The etiology of the fugue state is related to Dissociative Amnesia, (DSM-IV Codes 300.12^[2]) which has several other subtypes:^[3] Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.^[1]

Unlike retrograde amnesia (which is popularly referred to simply as "amnesia", the state where someone forgets events before brain damage), Dissociative Amnesia is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, DSM-IV Codes 291.1 & 292.83) or a neurological or other general medical condition (e.g., Amnestic Disorder due to a head trauma, DSM-IV Codes 294.0).^[4] It is a complex neuropsychological process.^[5]

As the person experiencing a Dissociative Fugue may have recently suffered the reappearance of an event or person representing an earlier life trauma, the emergence of an armoring or defensive 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^[1] 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^[6] 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^[6] 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.

Diagnosis

A doctor may suspect dissociative fugue when people seem confused about their identity or are puzzled about their past or when confrontations challenge their new identity or absence of one. The doctor carefully reviews symptoms and does a physical examination to exclude physical disorders that may contribute to or cause memory loss. A psychologic examination is also done. Sometimes dissociative fugue cannot be diagnosed until people abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retroactively when a doctor reviews the history and collects information that documents the circumstances before people left home, the travel itself, and the establishment of an alternative life.

Prognosis

The DSM-IV-TR states that the fugue may have a duration from hours to months and recovery is usually rapid. However, some cases may be refractory. An individual usually only has a single episode.

Case studies

Agatha Christie disappeared on 3 December 1926 only to reappear eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span.^[7]

Shirley Ardell Mason also known as "Sybil" would disappear and then reappear with no recollection of what happened during the time span. She recalls "being here and then not here" and having no identity of herself; it should be noted that she also suffered from what was formerly called "Multiple Personality Disorder".

Jody Roberts, a reporter for the Tacoma News Tribune, went missing in 1985, only to be found 12 years later in Sitka, Alaska, living under the name of "Jane Dee Williams." While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely suffered a protracted fugue state.^[8]

David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Channel Five's television series Extraordinary People. He entered a fugue state on December 22, 2005, and is still working on regaining his entire life's memories.^[9]

Hannah Upp, a teacher from New York, went missing on August 28, 2008. She was rescued from the New York Harbor on September 16 with no recollection of the time in between. The episode was diagnosed as dissociative fugue.^[10]

Pop culture references

Will Barrett, the protagonist of Walker Percy's novel The Last Gentleman suffers from frequent fugue states that keep him from having a stable personality.

During the Doctor Who episode The Next Doctor it is discovered by the Tenth Doctor that the future incarnation of himself is actually a man named Jackson Lake, suffering a fugue state after the loss of his family to the Cybermen.

In David Lynch's series Twin Peaks, a girl named Ronette Pulaski is found walking down train tracks in a fugue state (though the term is not actually used).

In Lynch's 1997 film Lost Highway, Bill Pullman's character suffers a fugue state.

In the Buffy the Vampire Slayer (TV series) episode Bring on the Night (Buffy the Vampire Slayer) (season 7 episode 10), Dawn says in reference to Andrew, "Or maybe he's in a fugue state?"

In the Star Trek: The Next Generation episode Tin Man, a telepath, having distantly communicated with the titular alien, is told in a follow-up medical exam “Your brain activity suggests that you're coming out of a sort of fugue, or seizure.” ^[11]

In the Film and Novel Primal Fear the supporting character Aaron Stampler appears to slip frequently in to and out of a fugue state but it is later revealed to be an act.

In the Australian television series Neighbours a main character Harold Bishop went AWOL for five years in a putative fugue state.

In Chapter 7 of The Maltese Falcon, by Dashiell Hammett, Spade tells Brigid a story about a man who, after a near-death experience, disappears, abandoning his wife and children, only to be found years later, settled down to the same kind of life with the same kind of family.

In the TV show Breaking Bad Walt claims to have been in a fugue state to account for the time he was kidnapped and held captive by his meth distributor. He appeared naked and confused in a supermarket in an effort to support his false condition.

See also

Psychology portal

• Structured Clinical Interview for DSM-IV
• Dissociative Disorders (DSM-IV Dissociative Disorders)
• Dissociative Identity Disorder (formerly Multiple Personality Disorder) (DSM-IV Dissociative Disorders 300.14)
• Psychogenic amnesia; Dissociative Amnesia (formerly Psychogenic Amnesia) (DSM-IV Dissociative Disorders 300.12)
• Depersonalization Disorder (DSM-IV Dissociative Disorders 300.6)
• Dissociation (psychology)

References

1. ^ ^{a b c} Dissociative Fugue (formerly Psychogenic Fugue) ( DSM-IV 300.13, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
2. ^ Dissociative Amnesia, DSM-IV Codes 300.12 ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )
3. ^ Dissociative Amnesia, DSM-IV Code 300.12 ( PsychNet-UK.com )
4. ^ Complete List of DSM-IV Codes ( PsychNet-UK.com )
5. ^ Background to Dissociation ( The Pottergate Centre for Dissociation & Trauma )
6. ^ ^{a b} Merck Manual 1999 section 15 (Psychiatric Disorders), chapter 188 (Dissociative Disorders)
7. ^ Adams, Cecil, Why did mystery writer Agatha Christie mysteriously disappear? The Chicago Reader, 4/2/82. [1] Accessed 5/19/08.
8. ^ [2]
9. ^ The Man With No Past
10. ^ http://www.nytimes.com/2009/03/01/nyregion/thecity/01miss.html?_r=3&pagewanted=1&ref=nyregion
11. ^ [http://www.livedash.com/transcript/star_trek__the_next_generation-(tin_man)/8058/SYFYP/Tuesday_June_08_2010/326671/ Star Trek: The Next Generation – Tin Man (transcript)

External links

• "Dissociative Fugue" from the Mental Health Matters website.
• "Dissociative Fugue" from the Merck & Co. website.