Fugue
Fugue
How Do People with Fugue Function?
Do Other Conditions Resemble Fugue?
Fugue (FYOOG) refers to a psychiatric condition in which people wander or travel and may appear to be functioning normally, but they are unable to remember their identity or details about their past.
Keywords
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Dissociative fugue
Psychogenic fugue
Sigmund Freud, one of the fathers of modern psychiatry, believed that the mind has defense mechanisms, or built-in ways of experiencing reality, that prevent it from being overwhelmed by worry or depression*. In fact, Freud believed that people are not even aware of the way their minds take care of them. Dissociation (di-so-see-AY-shun) is a defense mechanism that allows people to separate or “go away from” thoughts, memories, emotions, or events that are highly stressful. This separation helps people successfully cope with situations that would otherwise be intolerable. With dissociation, people can “daydream” themselves away from their troubles or even develop a separate personality to cope with terrible life events.
- * depression
- (de-PRESH-un) is a mental state characterized by feelings of sadness, despair, and discouragement.
Fugue, sometimes called dissociative (dis-SO-see-a-tiv) or psychogenic (sy-ko-JEN-ic) fugue, is an uncommon dissociative disorder. Fugue is thought to be caused by the inability to cope with a severe long-lasting stress or conflict. People with dissociative fugue not only mentally “go away from” an intolerable situation through a dissociation defense mechanism, they actually remove themselves physically from the situation by wandering away from home and either partially or completely assuming a new identity. To be diagnosed with fugue, the wandering and memory changes must not be caused by substance abuse, medications, or other psychiatric disorders such as dissociative identity disorder*.
- * dissociative identity disorder
- (DID) formerly known as multiple personality disorder (MPD), is a severe psychiatric condition in which a person has two or more distinct sub-personalities that periodically take control of his or her behavior. The sub-personalities are thought to be caused by repeated episodes of an extreme form of dissociation.
How Do People with Fugue Function?
People diagnosed with fugue unexpectedly travel or wander away from home, work, or familiar places. They may take on new identities, enter new occupations, or develop new interests and hobbies. The degree of fugue can vary from mild to severe and may last anywhere from several hours to years. One study suggests that about half of all fugues last less than 24 hours.
People diagnosed with fugue are often able to perform complex activities and appear to be normal. People with fugue appear to be oriented and to have intact mental functions. However, when questioned, people with fugue are confused about their identity and their past. Some people experience fugue along with other psychiatric disorders such as schizophrenia*, which makes the diagnosis of fugue more difficult.
- * schizophrenia
- (skitz-o-FREE-neeah) is a serious mental disorder that causes people to experience hallucinations, delusions, and other confusing thoughts and behaviors, which distort their view of reality.
Do Other Conditions Resemble Fugue?
People with Alzheimer disease* also may wander away from home and lose touch with who they are. This condition, which is believed to be caused by a physical breakdown in the functioning of the brain, is different from dissociative fugue.
- * Alzheimer disease
- (ALZ-hy-mer) is a condition that leads to a gradually worsening loss of mental abilities, including memory, judgment, and abstract thinking, as well as changes in personality.
Some people who have temporal lobe epilepsy* may have periods of undirected wandering. Neurologists (doctors who study the brain and nervous system) can generally distinguish symptoms that are caused by damage to the brain from those caused by psychological trauma. Drug abuse can also cause fugue-like periods, but these are not considered true dissociative fugue.
- * temporal lobe epilepsy
- (EP-ilep-see), also called complex partial epilepsy, is a form of epilepsy that affects the part of the brain that is located underneath the sides of the head, near the ears. Epilepsy is a condition of the nervous system characterized by recurrent seizures that temporarily affect a person’s awareness, movements, or sensations. Seizures occur when powerful, rapid bursts of electrical energy interrupt the normal electrical patterns of the brain.
Some psychiatrists believe that fugue is a symptom of other psychiatric disorders, rather than a unique, separate disorder. Treatment, as for other dissociative disorders, generally involves psychotherapy* and the treatment of any other psychiatric disorders the person might have.
- * psychotherapy
- (sy-ko-THER-apea) is the treatment of mental and behavioral disorders by support and insight to encourage healthy behavior patterns and personality growth.
See also
Alzheimer Disease
Amnesia
Dissociative Identity Disorder
Schizophrenia
Fugue
Fugue
An episode during which an individual leaves his usual surroundings unexpectedly and forgets essential details about himself and his life.
Causes and symptoms
Fugues are classified as a dissociative disorder , a syndrome in which an individual experiences a disruption in memory , consciousness , and/or identity. This may last anywhere from less than a day to several months, and is sometimes, but not always, brought on by severe stress or trauma. Dissociative fugue (formerly termed psychogenic fugue) is usually triggered by traumatic and stressful events, such as wartime battle, abuse, rape , accidents, natural disasters, and extreme violence , although fugue states may not occur immediately.
Individuals experiencing a fugue exhibit the following symptoms:
- Sudden and unplanned travel away from home together with an inability to recall past events about one's life.
- Confusion or loss of memory about one's identity (amnesia ). In some cases, an individual may assume a new identity to compensate for the loss.
- Extreme distress and impaired functioning in day-today life as a result of the fugue episodes.
If the amnesia of fugue occurs without an episode of unexpected travel (fleeing), dissociative amnesia is usually diagnosed.
Diagnosis
Patients who experience fugue states should under-go a thorough physical examination and patient history to rule out an organic cause for the illness (e.g., epilepsy or other seizure disorder). If no organic cause is found, a psychologist or other mental healthcare professional will conduct a patient interview and administer one or more psychological assessments (also called clinical inventories, scales, or tests). These assessments may include the Dissociative Experiences Scale (DES or DES-II), Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), and the Dissociate Disorders Interview Schedule (DDIS).
The use and abuse of certain medications and illegal drugs can also prompt fugue-like episodes. For example, alcohol-dependent patients frequently report alcohol-induced "blackouts" that mimic the memory loss of the fugue state and sometimes involve unplanned travel.
Treatment
Dissociative fugue is relatively rare, with a prevalence rate of 0.2% in the general population. The length of a fugue episode is thought to be related to the severity of the stressor or trauma that caused it. The majority of cases appear as single episodes with no recurrence. In some cases, the individual will not remember events that occurred during the fugue state. In other cases, amnesia related to the traumatic event that triggered the fugue may persist to some degree after the fugue episode has concluded.
Treatment for dissociative fugue should focus on helping the patient come to terms with the traumatic event or stressor that caused the disorder. This can be accomplished through various kinds of interactive therapies that explore the trauma and work on building the patient's coping mechanisms to prevent further recurrence. Some therapists use cognitive therapy , which focuses on changing maladaptive thought patterns. It is based on the principal that maladaptive behavior (in this case, the fugue episode itself) is triggered by inappropriate or irrational thinking patterns. A cognitive therapist will attempt to change these thought patterns (also known as cognitive distortions) by examining the rationality and validity of the assumptions behind them with the patient. In the case of a dissociative fugue brought on by abuse, this may involve therapeutic work that uncovers and invalidates negative self-concepts the patient has (e.g., "I am a bad person, therefore I brought on the abuse myself").
In some cases, hypnotherapy, or hypnosis , may be useful in helping the patient recover lost memories of trauma. Creative therapies (i.e., art therapy , music therapy ) are also constructive in allowing patients to express and explore thoughts and emotions in "safe" ways. They also empower the patient by encouraging self-discovery and a sense of control.
Medication may be a useful adjunct, or complementary, treatment for some of the symptoms that the patient may be experiencing in relation to the dissociative episode. In some cases, antidepressant or anti-anxiety medication may be prescribed.
Group therapy , either therapist/counselor-led or in self-help format, can be helpful in providing an on-going support network for the patient. It also provides the patient with opportunities to gain self-confidence and interact with peers in a positive way. Family therapy sessions may also be part of the treatment regime, both in exploring the trauma that caused the fugue episode and in educating the rest of the family about the dissociative disorder and the causes behind it.
See also Dissociation/Dissociative disorders
Paula Ford-Martin
Further Reading
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Press, Inc., 1994.
Further Information
National Alliance for the Mentally Ill (NAMI). 200 North Glebe Road, Suite 1015, Arlington, VA, USA. 22203-3754, (800) 950-6264. http://www.nami.org.
fugue
Contrasts of key constitute an important element in fugal construction. In the exposition the subject first appears, naturally, in the tonic key; the 2nd v. to enter with it does so a 5th higher (or 4th lower), i.e. in the dominant key, the name answer now being attached to it; the 3rd is a repetition of the subject (in a higher or lower octave) and so on, subject and answer, tonic and dominant keys, thus appearing alternately, according to the no. of ‘voices’ engaged. One function of the episodes is to effect modulation to various related keys, so that the later entries may have the advantage of this variety, but once the exposition is over it is not considered necessary that further series of entries shall always alternate as to keys in the subject-answer manner.
In addition to the subject there is often a counter-subject appearing in the exposition and probably later in the fugue. It is of the nature of a melodic acc. to the answer and subject (generally in double counterpoint). The v. which has just given out the subject or answer then goes on to the countersubject whilst the next v. is giving out the answer or subject and so on.
Sometimes in later entries there is overlapping of the subject, each v., as it gives out, not waiting for the previous v. to finish it but breaking in, as it were, prematurely. This device, which is called stretto, tends to increase the emotional tension of the entry in which it occurs.
Occasionally, after the exposition (and possibly before the 1st episode) there is a counter- exposition, much like the 1st exposition in that the same 2 keys are employed. Appearances of the subject (in the exposition or elsewhere) are sometimes separated by something of the nature of the episode, but shorter, called a codetta.
The exist 2 types of fugue with 2 subjects (or double fugue), one in which the 2 subjects appear together from the outset, and another in which the 1st subject is treated for a certain time, the other then appearing and being likewise treated, after which both are combined. In choral fugues (e.g. in an oratorio movement) there is sometimes a free instr. part, an accompanied fugue. The device of pedal is often employed in fugue, especially near its close.
There are cases in which, instead of the answer being an exact replica of the subject (real answer), it is slightly changed in 1 or 2 of its intervals (tonal answer), resulting respectively in a real fugue and a tonal fugue (an absurdity since the tonal treatment may not extend beyond the exposition).
A shortened type of fugue is sometimes called a fughetta. A passage in fugal style, not in itself an actual fugue, is called fugato.
The above descriptions are of the academic fugue form, but the great composers have, naturally, varied it, e.g. Bach in Die Kunst der Fuge. Superb fugues occur in many works, e.g. Beethoven's Grosse fuge for str. qt., Op.133, in Elgar's Introduction and Allegro for str., and in many choral comps. Fugue-form is also used effectively in opera, e.g. the finale of Act 2 of Die Meistersinger von Nürnberg and the finale of Falstaff.
fugue
fugue / fyoōg/ • n. 1. Mus. a contrapuntal composition in which a short melody or phrase (the subject) is introduced by one part and successively taken up by others and developed by interweaving the parts.2. Psychiatry a state or period of loss of awareness of one's identity, often coupled with flight from one's usual environment, associated with certain forms of hysteria and epilepsy.DERIVATIVES: fugu·ist / ˈfyoōgist/ n.