What are amnesia and fugue?

Introduction

Amnesia involves the failure to recall a past experience, often because of an anxiety that is associated with the situation. Fugue states take place when a person retreats from life’s difficulties by entering an amnesiac state and leaving familiar surroundings. During a fugue state, a person may assume a new partial or whole personality. Although amnesia may be caused by organic brain pathology, attempts to cope with anxiety can also produce amnesia and fugue. Dissociation involves the ability of the human mind to split from conscious awareness. Through dissociation, a person can avoid anxiety and difficulty in managing life stresses. When stress and anxiety overwhelm a person, the mind may dissociate from a conscious awareness of the troubling situations. When this takes place, the individual loses memory of the event and may physically leave the stressful situation through a fugue state.

Amnesia and fugue are two of the dissociative disorders recognized by the American Psychiatric Association. The dissociative disorders are methods of avoiding anxiety through the process of pathological dissociation. In addition to amnesia and fugue, the dissociative disorders include dissociative identity disorder (formerly known as multiple personality disorder) and depersonalization disorder. In the former, a person develops a number of alter identities. Depersonalization disorder involves a process in which individuals suddenly feel that their bodies or senses of self have changed dramatically.

Amnesia Types

Another term for dissociative amnesia is psychogenic amnesia. This term conveys the concept that the amnesia is not due to organic brain pathology. Individuals developing psychogenic or dissociative amnesia often encounter a traumatic event or extreme stress that overloads their coping abilities. Four different types of psychogenic or dissociative amnesia can be identified. Localized amnesia is seen when a person cannot remember anything about a specific event. This is often seen after a person experiences a traumatic event, such as a serious accident, and then does not recall what happened. The second type of amnesia is called selective amnesia and occurs when only some parts of a certain time period are forgotten. Infrequently, generalized amnesia takes place and the person forgets his or her entire life history. The fourth type of dissociative amnesia is the continuous type. This form of amnesia is seen when a person does not remember anything beyond a certain point in the past.

Diagnosis

Reliable data on the prevalence of dissociative disorders are lacking, but it appears that women are diagnosed with the dissociative disorders at a rate five times that of men. To make the diagnosis of dissociative amnesia, a doctor must identify a disturbance in memory that involves the appearance of one or more episodes of inability to recall important personal information that is usually of a traumatic or stressful nature. This memory loss must be too extensive to be explained by ordinary forgetfulness. When people develop dissociative amnesia, they may not be able to remember their own names or the identities of relatives, but they retain a number of significant abilities. In psychogenic or dissociative amnesia, basic habits and skills remain intact. Thus, the person is still able to read a book, drive a car, and recognize familiar objects. The memories that are lost revolve around life events and autobiographical information.

The diagnosis of dissociative fugue requires sudden unexpected travel away from home or the customary place of work. Together with this travel, the person is unable to recall the past. During the fugue, the person shows confusion about personal identity or assumes a new one. The person’s activities at the time of the fugue can vary extensively, from short-term involvement in new interests to traveling to distant locations and assuming a new identity and work roles. The fugue can last for days, weeks, or even years. At some point, the individual will leave the fugue state and be in a strange place without awareness of the events that took place during the dissociative period. When a fugue state is taking place, the person appears normal to others and can complete complex tasks. Usually, the activities selected by the person are typical of a different lifestyle from the previous one.

The diagnosis of dissociative amnesia and fugue can be controversial, because it often depends on self-reports. The possibility that a person is faking the symptoms must be considered. Objective diagnostic measures for these disorders do not exist. The possibility of malingering or fabricating the symptoms must be considered in arriving at a diagnosis of dissociative amnesia and fugue.

When diagnosing dissociative amnesia and fugue, a number of other disorders and conditions have to be excluded. A number of medical conditions, such as vitamin deficiency, head trauma, carbon monoxide poisoning, and herpes encephalitis, can produce similar symptoms. Amnesia can also be found in conjunction with alcoholism and the use of other drugs.

Possible Causes

Normal dissociation is often differentiated from pathological dissociation. Normal dissociation can be an adaptive way to handle a traumatic incident. It is commonly seen as a reaction to war and civilian disasters. In normal dissociation, the person’s perception of the traumatic experience is temporarily dulled or removed from the conscious mind. Pathological dissociation is an extreme reaction of splitting the anxiety-provoking situation from consciousness.

There exist a limited number of research studies that seek to explain the causes of dissociation in certain individuals and predict which people are vulnerable to the development of dissociative amnesia or fugue during periods of trauma or overwhelming stress. The psychodynamic explanation emphasizes the use of repression as a defense against conscious awareness of the stressful or traumatic event. Entire chunks of the person’s identity or past experiences are split from the conscious mind as a way to avoid painful memories or conflicts. According to this explanation, some individuals are vulnerable to the use of dissociation because of their early childhood experiences of trauma or abuse. With the early experience of abuse, the child learns to repress the memories or engage in a process of self-hypnosis. The hypnotic state permits the child to escape the stress associated with the abuse or neglect. The abused child feels a sense of powerlessness in the face of repeated abuse and splits from this conscious awareness. This isolation of the stressful event leads to the development of different memory processes from those found in normal child development.

A behavioral explanation for the likely development of dissociation as a means to cope with stressful events focuses on the rewarding aspects of dissociative symptoms. The child learns to role-play and engage in selective attention to recognize certain environmental cues that provide rewards. Stressful circumstances are blocked out and disturbing thoughts ignored. Eventually, this process expands into a tendency to assume new roles and block out stressful situations.

The dissociative disorders appear to be influenced by sociocultural factors that depend on social attitudes and cultural norms. Acceptance and toleration of the symptoms associated with dissociative disorders depend on prevailing societal attitudes. Over time, cultures vary in the acceptance of dissociative symptoms and the manifestation of amnesia and fugue states. For example, historical reports of spirit possession can be interpreted as the experience of a fugue state.

Treatment

The symptoms associated with dissociative amnesia and fugue usually spontaneously disappear over time. As the experience of stress begins to lessen, the amnesia and fugue often disappear. When providing treatment for these individuals, it is important that caregivers provide a safe environment that removes them from the possible sources of stress. Some people are hospitalized for this reason. The institutional setting allows them to regain comfort away from the traumatizing or stress-producing situation. Occasionally the lost memories can be retrieved through the use of specific medications. One such medication is sodium amytal, which can be used during an interview process that attempts to restore the lost memories. Hypnosis is also used as a means to put the person in a receptive state for questions that may overcome the amnesia.

Hypnosis is also used in the treatment of fugue states. The goal when using hypnosis is to access important memories that may have triggered the fugue. Medications are sometimes used with patients who have a history of fugue. Antianxiety medications called benzodiazepines have been used with individuals showing dissociative fugue. The medication helps to alleviate the feelings of worry and apprehension.

Because amnesia does not typically interfere with a person’s daily functioning, few specific complaints about the lack of memory take place. Individuals may complain about other psychological symptoms, but not the amnesia. Consequently, treatment often does not focus on the lost memories. Some of the associated symptoms that occur with amnesia include depression and stress due to a fugue state. Treatment is often directed toward alleviating the depression and teaching a person stress management techniques.

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