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 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.

In the field of psychology, a fugue state is usually defined by the term dissociative fugue and from the definitions above 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.

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. 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. In this sense, fugues seem to be the result of a repressed wish-fulfillment. 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.

In fiction

• In the 80s tv series "Miami Vice", the main protagonist, Detective James "Sonny" Crockett, develops total amnesia following the murder of his wife and unborn child, and the subsequent trauma of surviving an explosion. He finds himself relocating to Fort Lauderdale from Miami, where he assumes a completely new alter ego personality of his undercover persona, Sonny Burnett (a drug dealer). This identity being the mirror opposite of his former one. He then proceeds to engage in a psychopathically ambititous career path involving murder, drug dealing, and deception. It is only when three months later, his memory begins to return through a series of flashbacks that he returns to Miami and assumes his former identity.

• Nurse Betty: a 2000 comedy film depicting a waitress who experiences a fugue state from the stress of murder.

• In the novel Fight Club, the main character's condition is described as a 'psychogenic fugue state' -- in the movie, the nature of his disorder is merely left up to the audience to guess at.

• The main character in Lost Highway can also be described as going through a fugue dissociative state.

• In the end of David Eddings' novel Regina's Song, Twink's psychological breakdown is described as a fugue state.

• Siegfried Schtauffen, a main character in the Soul series of fighting games, goes through a dissociative fugue state following the unintentional murder of his father. He convinces himself that it was not he who killed his father, and does not recall the truth until Soul Edge is sealed for the first time.

• In Dan Simmons' Hyperion Cantos the cryogenic state is referred to as Cryogenic Fugue.

• In Philip K. Dick's We Can Build You, Louis Rosen experiences induced fugue states as part of a fictional psychiatric treatment called 'controlled fugue therapy'.

• The title character in The Story of Anna can be said to be experiencing a Fugue state, though the story suggests that the events experienced by Anna were perpetrated by God.

• In Charles Stross' Glasshouse, the main character, Robin, suffers from fugue events throughout the story due to purposeful memory deletion.

• In Walker Percy's The Last Gentleman, the main character, Will Barrett, suffers from fugue states.

• In the film Paris, Texas, an amnesiac who has been lost for four years tries to put his life back together.

• Documentary Unknown White Male deals with subject Doug Bruce's fugue state during his retrograde amnesia.

• In the novel Zen and the Art of Motorcycle Maintenance the main character displays many symptoms of a fugue state including travel and a new personality, but retains memories of his old life.

• Backstory regarding the Great Outdoor Fight in the webcomic Achewood includes the tale of Faultroy Brown, who (during the 1984 fight) entered a three-day Dutch fugue in which he killed or maimed 586 men. When Ray Smuckles entered the Great Outdoor Fight in 2006, single-handedly taking down Cody Travis, Ray was afraid he himself would fugue and become another Fauntleroy Brown.

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.

References

http://www.mental-health-matters.com/disorders/dis_details.php?disID=38/

http://www.merck.com/mmhe/sec07/ch106/ch106c.html