Fugue state

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.

Interestingly, in music the word fugue implies multiple instruments (voices) that introduce the melody (personality traits) sequentially (thus suggesting motion), possibly later playing simultaneously with combinations of counter-melodies (counter-traits). There is almost certainly a linguistic relationship between these ideas (most likely the psychological notion was so named after the musical notion).

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, fugue state would be the situation of 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.

Prognosis
Fugues are usually brief and self-limiting, often ending after a short duration by their very nature, in particular once the stressor that caused the fugue has been sufficiently removed. A person may simply "wake up" from their fugue activity and find themself surrounded by seemingly unknown people in an unfamiliar surrounding, wondering why or how they got there.

Most people who suffer dissociative fugues regain most or all of their prior memories, although attempts to restore "intra-fugue" memories (those that occurred during the fugue state) are almost always unsuccessful. Since fugues are usually brief, people tend to suffer few after-effects, although with longer more complex fugues, people may have trouble adjusting to their past life, particularly dependant on their intra-fugue behaviour. For example, someone being charged with a crime whilst in a fugue may have serious consequences.

In general and popular culture
Non-psychologists more commonly use the term "fugue state" to refer to the state of mind attained by a gifted musician (or other artist) or athlete where the person attains a high degree of focus and attention to their art or actions. This is also a dissociation from one's surroundings, to concentrate on the work at hand, and frequently euphoria or a mild "high". Other names for the same basic concept include:


 * The mental state called "flow".
 * Being in the zone.
 * Hyperfocus

In film

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


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