FUGUE STATE

An amnesic dissociated state characterized by physical flight from an unbearable situation.A fugue is a more extreme form of escape than the more common types of amnesia, since the patient not only loses his identity but actually leaves his normal surroundings for days, weeks or even years. In fugues of short duration he is likely to wander aimlessly about in a highly emotional state, and to be confused and agitated when found. In some cases he may perform wish-fulfilling activities such as going on a fishing trip or attending four movies a day. Episodes of this general type may be recurrent.Although long-repressed desires may be acted out during these periods of fugue, crimes are rarely committed. The claim of amnesia during criminal prosecution should, therefore, be regarded with suspicion.During the more extended fugues, the individual may travel widely, assume the name and identity of an admired person, take up an occupation he always wanted to pursue, get married, and raise a family. Although his past is a complete blank, he usually appears normal in all other respects during these episodes. He unconsciously avoids communities or situations where his identity might be revealed, and he may fabricate a story about his past if he is questioned.The psychodynamics of the fugue state are the same as for other dissociative reactions. In some cases a history of lying and hysterical reactions can be found. Some studies suggest that the purpose of the fugue is to ward off a depression. Most authorities, however, believe these states arise out of an unconscious desire to escape a threatening or intensely distasteful life situation.When the fugue state is terminated either spontaneously or through hypnosis or sodium amytal techniques, the patient regains either a full or a partial memory for the period before the episode. In some cases he becomes amnesic for the fugue period itself, but in others he can gradually recall and integrate the episode with his total life. Interviews under hypnosis or sodium amytal may be helpful not only in restoring the memory, but in revealing the emotional factors which led to this escape reaction. These findings are useful in initiating a program of psychotherapy when it is considered necessary. See DISSOCIATIVE REACTION.Illustrative Case: FUGUE STATE I was sitting at a bar having a beer when the juke box began belting out the tune “Because.” That music certainly snapped me out of it. It happened to be the melody that they played at my wedding. In that instant, I recalled that I had a wife and two daughters in San Antonio! But what was I doing in this bar when I had never frequented bars before (at least not since my college days)? I had many puzzling questions to ask of the group of tavern habitues who were equally puzzled about my bizarre behavior. What town was this? And how did I ever get to St. Louis? Why was I so suntanned and why were my hands so calloused? And where had I been for fifteen months? Soon I was in telephone contact with my jubilant wife and, in two hours more, I was on a plane bound for San Antonio to resume my life after that mystifying, troublesome, blank gap of over a year. The joyous reunion with my family at the airport permitted a temporary postponement of such nagging worries. Once more, my life fell into the routine that I had formerly known so well, with its familiar faces, places, and duties. I was installed again as president of a chemical company and took up my life where I had interrupted it. Lucky fellow!Things went well, my business prospered, and I went back to my duties as Sunday School superintendent again. Within six months I could even relax for long weekends with my family, in order to get reacquainted with them and to make up for lost time. The leisure and rest that I enjoyed were a luxury but not an unmixed blessing, by any means, because now the problem of the gap in my life began to press upon me and insinuated itself into my moments of pleasure and fun with my beloved wife and children. Here’s where Dr. X stepped in with his help. Over many weeks, we had long sessions with and without hypnosis. At first, with great difficulty, but soon with increasing facility, hypnosis helped one thought to attract another until eventually they tumbled over each other, and I was able to recall many aspects of my fifteen-month fugue. Furthermore, I was able to retain them in the posthypnotic condition as well. Retracing my steps hypnotically convinced me that my fugue was an unwitting attempt to run away from certain problems and conflicts. I recalled the uneasiness and guilt that I frequently felt as I would walk through my chemical plant and observe men, not as fortunately situated as I, doing menial work. After all, what right did I have to a cushy job that I had merely inherited from my father-in-law? Another problem centered in my married life. The tenderness and passion that Marjorie and I constantly expressed for each other for several years had gradually burned itself out. Our marriage seemed on the verge of bankruptcy. Then, one night, a violent argument developed and lasted until 2:30 in the morning. My fugue occurred the very next day.What had I done in the intervening fifteen months? Under hypnosis I learned that I had gone to St. Louis and worked as a laborer at a chemical plant there. In fact, it was the same job I had held summers when I worked my way through the university. It was here, too, that I had led a frivolous, unrestrained Bohemian life in my younger days, frequenting bars and cocktail lounges. Apparently, I had returned to the scene of the crime and tasted once more a bit of the fast life. Some of the incidents of my fugue that I recalled caused the Sunday School superintendent to blush. (Dorcus and Shaffer, 1945)