SelfhelpMagazine

by Marc D. Feldman, M.D.

Each year thousands of Americans simply disappear. Their families distribute flyers and plaster billboards with their pictures. Within a day or two, the local media may report expectantly that the person's abandoned car has been located or that sightings have been phoned in to the authorities.

But all too often, these clues seem to lead to dead ends. Fears of foul play usually arise, but there may be little actual evidence to suggest abduction. Ultimately, as time passes, media and finally even police interest fades.

Another missing person case is added to the tally even as families struggle to keep up their hopes. Some will never return: they may indeed have been crime victims, or they may have ended their own lives. But most of those who vanish do eventually come back.

At one end of the spectrum are elderly people with Alzheimer's disease who have simply wandered off and are later located. At the other end of the spectrum are those who have chosen deliberately to flee and establish new lives elsewhere.

But in rare cases, none of these explanations for the disappearance applies—not crime, suicide, loss of intellectual faculties, or willful planning. Instead, the answer is found in a psychiatric condition in involving total amnesia called dissociative fugue.

The Phenomenon of Fugue

In dissociative fugue, a person suddenly travels away from home or workplace and, during this time, is unable to recall some, or even all, of his or her own past. The travel can range from a brief trip lasting hours to extensive wandering lasting weeks or months.

Indeed, in the most extreme cases, individuals experiencing dissociative fugue have literally crossed national borders and covered thousands of miles.

Fugue, then, results in a kind of "wandering John (or Jane) Doe," a person who, even as he or she travels, is thoroughly unaware of his or her personal identity, including name, family, and occupation.

In especially remarkable cases, these patients assume brand-new identities, as in the Woody Allen film Zelig, without having consciously decided to do so. Taking up a new residence and career, they give no outward appearance of having a mental disorder.

Fugue and Its Causes

True dissociative fugue does not stem from physical causes. Head injuries, seizures, chemical abnormalities in the body, and street drugs can all result in confusion, wandering, and amnesia. However, such physical explanations are lacking in dissociative fugue. Instead, everything checks out, and the cause is thus considered to be "psychological."

Finding the Way Back

Dissociative fugue rarely ends as a result of intervention by a psychiatrist or other health professional. Rather, a chance encounter or idle comment provides the magic key that, sometimes instantaneously, unlocks the past. In other cases, the events and feelings that precipitated the fugue ultimately resolve through tincture of time; with the monster no longer looming, the person can safely resume his or her former identity.

No single medication has emerged as a reliable aid in the treatment of fugue, so clinicians usually end up treating fugue ex post facto, offering psychotherapy to help the patient withstand the kinds of conflicts that originally provoked the fugue state.

With enhanced coping skills, the risk of a recurrence is theoretically reduced. But patients, families, and therapists should also feel reassured that, regardless of the type of treatment offered, fugue tends to be a one-time (though sometimes lengthy) occurrence in a person's life.

References:

Feldman MD, Feldman J.M. Stranger Than Fiction: When Our Minds Betray Us. Washington, DC, American Psychiatric Press, 1998

Hennig-Fast K, Meister F, Frodl T, et al. A case of persistent retrograde amnesia following a dissociative fugue. Neuropsychologia 2008; 46:2993-3005

Jasper F.J. Working with Dissociative Fugue in a general psychotherapy practice: a cautionary tale. Am J Clin Hypn 2003; 45:311-322

About the Author:

Marc D. Feldman, M.D. is the author of "Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder" (2004) and co-author of "Stranger Than Fiction: When Our Minds Betray Us" (1998).