What is a fugue state?
Dissociative fugue, also referred to as a fugue state or psychogenic fugue, is a dissociative disorder. It is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality, and other identifying characteristics of individuality. (definition- Wikipedia)
What causes it?
When the human brain is subjected to incredible stress or trauma it may protect itself by shutting off certain memories, particularly those of that particular stress or trauma. The person may be aware of periods that are a total blank, where they have no recollection of where they were or what they were doing and cannot account for the time that has passed.
War-time trauma, ‘shell-shock’, a serious accident, a brutal physical attack or a drastic emotional shock can trigger this type of state of amnesia. This is why it can take a while to sort out casualty figures of the missing after incidents such as a bomb-blast or terrorist incident. Some victims, while physically appearing to be in good health, may experience this form of amnesia and may not remember who they are, where they live or the events that led up to their memory loss. If they have wandered off as a result of the event it may take some time to find them and ‘bring them back’.
What are the symptoms?
The person can be extremely confused and have no idea who they are or how they came to be where they find themselves. Fugue means ‘flight’ in Latin and one of the characteristics of this state is that the person may wander off or travel impulsively. Whether this wandering is to escape the situation which has caused the memory loss or to search for their lost identity and memories is not clear. It is not the same situation as when a person with dementia goes wandering, although superficially they may seem the same.
This fugue state can last for hours, days or, in severe cases, months and years. In extreme cases the sufferer may take on a whole other personality and life, either in parallel or totally separately. They may create a fictitious past to fill in what they cannot remember. There is some overlap with what is sometimes called dissociative personality disorder or multiple-personality disorder.
The original memories are actually still there, locked up in the brain, but the person cannot access them. The past literally seems to be a blank. This lack of knowledge can be distressing. The person may manage to construct a new life for themselves, keeping the amnesia of their previous life secret out of fear of being thought ‘mad’.
How long does it last?
In most cases this phenomenon is short-lived but in others it can last for months or even years. Sometimes a trigger such as another incident similar to that which caused the memory loss in the first place can cause the lost memories to return. Sometimes memory returns piecemeal over a period of time as various stimuli bring it back. This is why if a person in this state is identified, their loved ones are encouraged to play known favourite music, take them to favourite places and so on to try to ‘bring back’ their recollections or unlock their memories of the past. Smells, tastes and sounds can help to trigger the return of memory in such situations.
No visible physical cause
Unlike retrograde amnesia caused by TBI (traumatic brain injury) or brain damage from a disease or illness, a dissociative fugue is a psychiatric condition and does not have a physical cause such as damage in the brain. It cannot be treated through medication and usually comes right over time. Counselling and psychiatric help may be necessary in severe cases, not just for the sufferer but also for their loved ones who may have difficulty in accepting the situation. If the person is very distressed and anxious about their situation, they may be given anti-anxiety medication but this in itself does not bring back memory and as such does not treat the fugue state.
Hypnosis and drug-assisted interviews where the person is given a sedative prior to being gently questioned can help people to recover their lost memory and identity if it does not come back by itself. This is quite a delicate procedure and requires a skilled professional as there is also the risk of implanting false memories rather than bringing back real ones.
Can it happen again?
In most cases it is a one-off episode but as with everything to do with the human mind, we are all unique and some of us are more susceptible than others. The way in which we process and respond to life events is entirely subjective and what may be a catastrophic trigger to one person may be handled in a totally different way by someone else, depending on what has happened before in their lives. It is important to remember that a dissociative fugue is not a voluntary response to a situation. The person has no control over it and it is also not a sign of some kind of emotional or mental weakness.