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), 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 typically amnesia for the fugue episode. Additionally, an episode of fugue is not characterized as attributable to a psychiatric disorder 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) which has several other subtypes: Selective Amnesia, Generalised Amnesia, Continuous Amnesia, Systematised Amnesia, in addition to the subtype Dissociative Fugue.

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). It is a complex neuropsychological process.

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 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 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 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, 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.

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 it is claimed she also suffered from what was formerly called "Multiple Personality Disorder." However, Mason's diagnosis has been challenged as a hoax.

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.

David Fitzpatrick, a sufferer of dissociative fugue disorder, from the United Kingdom, was profiled on Five's television series Extraordinary People. He entered a fugue state on December 4, 2005, and is still working on regaining his entire life's memories.

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.

Jeff Ingram, appeared in Denver in 2006 with no memory of his name or where he was from. After appearing on national television to appeal for help identifying himself, his fiancée Penny called Denver police identifying him. The episode was diagnosed as dissociative fugue. Jeff has experienced three incidents of amnesia: in 1994, 2006, and 2007.

In fiction

Possibly, the most profound example of extraordinarily prolonged dissociative fugue can be found in Iain Banks' the Culture series novels, where "the perfect mercenary" Cheradenine Zakalwe persists in such a state for more than a millennium, including almost one hundred lifetimes in simulated environments.

In the TV series One Tree Hill, the character Clay suffers a fugue state in season nine.

In the TV series Breaking Bad, the character Walter White fakes a fugue state to cover up his kidnapping.

In the TV series Teen Wolf, the character Lydia suffers a fugue state in season two following being bitten by a werewolf.

In the TV series Doctor Who, the character in the 2009 Christmas special, "Jackson Lake," suffers a fugue state after witnessing the death of his wife by a Cyberman attack.

In the TV series Bates Motel, the character Norman Bates suffers a fugue state episodes in which he can react violently to a stressor including attempt to kill but has no memory of it when he recovers from it.

In the TV series The Mentalist, the character Patrick Jane suffers a fugue state after nearly drowning.

In the short story The Shadow Out of Time by H.P. Lovecraft, the character Nathaniel Wingate Peaslee awakens after years of being the victim of an "identity swap" with a member of an ancient race of aliens.

In the third season of the TV series Lois and Clark: The New Adventures of Superman, Lois Lane goes into a dissociative fugue as a result of suffering a blow to the head while escaping from Lex Luthor, who had kidnapped her. Initially, in her fugue state she takes on the personality of Wanda Detroit, a fictional lounge singer from her novel. This occurs in the second episode of a five-episode plot arc; she loses the Wanda Detroit identity at the end of the third episode, but she does not fully recover her own true identity, personality, and memory until late in the fifth episode. (This arc was not popular with the audience and may have permanently damaged the show's ratings. In the teaser of an early fourth season episode, the show joked about this by having Lois hit her head on a kitchen cabinet door and then pretend to have amnesia, with Clark Kent responding, in a tone of desperate frustration, "No, no, no!", before she said to him, "Just kidding!")

Dissociative fugue affects many characters in David Lynch films with the most explicit example being the protagonist of Lost Highway.

In the game Assassin's Creed 3 the character Desmond Miles experiences a fugue state upon first entering the Animus.

See also

• 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)

External links

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