Writing-Induced Fugue State



Who is this, wandering around the crowded street, afraid of everything, trusting no one?

“There must live something wrong, somewhere.”
But peradventure I’m safer since I await disheveled.

Who are these people? Where is this place?
Did I write that? When did that happen? I don’t remember.

I can’t halt writing. I can’t halt walking, either, which is a job because it’s difficult to write together with walk at the same time.



In the early on 1940s, Austrian Psychiatrist Dr. Erwin Stengel wrote a dyad of papers on fugue states, a type of dissociative disorder involving loss of personal identity together with aimless wandering (Stengel, 1941):
THE peculiar status designated “fugue state,” of which the primary symptom is compulsive wandering, has puzzled psychiatrists since it was get-go described. Nothing is known of the aetiology of this well-defined condition. Fugue states occur inwards epileptics, hysterics, together with sure enough psychopaths. Bleuler has described their occurrence inwards schizophrenia, together with they accept been recorded inwards cases of full general paralysis together with of altered personality due to encephalon tumour.  ...  Kraepelin recognized that it was impossible to distinguish betwixt the states of compulsive wandering associated alongside diverse mental disorders. Janet tried to distinguish betwixt hysterical together with epileptic fugues past times pointing out that brusk fugues are to a greater extent than probable to live epileptic than hysterical.  

He was disturbed past times inaccurate utilization of the term, which was widespread (Stengel, 1943):
...the next atmospheric condition accept been described equally fugues: U.S. of wandering, inwards accordance alongside the classical conception; states of double personality; all kinds of transitory abnormal demeanor of functional origin; hysterical loss of consciousness together with of memory; twilight states; confusional states of hysterical nature; delirious states inwards schizophrenia. The vogue to telephone telephone transient states of altered consciousness fugues, irrespective of the demeanor of the patient, is obvious. This is a most unsatisfactory province of affairs. 

Stengel presented dozens of cases inwards these papers together with was obsessed alongside finding mutual etiological factors, no thing what the underlying medical status (e.g., epilepsy, “hysteria”, schizophrenia):
The intimate similarity of fugue states associated alongside dissimilar mental disorders suggests that at that topographic point must live aetiological factors mutual to all. However, no endeavour has been made hitherto to ascertain such factors. I accept been engaged inwards investigations concerning this job for more than 8 years...
...and (Stengel, 1943):
Clinical studies carried out over many years accept convinced me that at that topographic point is no justification inwards differentiating betwixt hysterical together with epileptic wandering states, equally the demeanor of the patients together with the bulk of the etiological factors are fundamentally the same inwards all fugues alongside the impulse to wander (Stengel, 1939, 1941).

Since Stengel was trained equally a psychoanalyst together with considered Freud equally a mentor, yous mightiness gauge the mutual etiology:
This was a disturbance of the environs of kid life. Influenza A virus subtype H5N1 serious disturbance inwards the child-parent relationship, unremarkably of such a nature that the human relationship to 1 or both parents was either completely lacking or solely partially developed, had occurred inwards nearly every case.

Beyond the mommy/daddy issues, symptoms of severe depression (suicide attempts, failure to eat, lack of hygiene) and/or mania (elation, hypersexuality) were commonplace. Here's 1 especially tragic example:
CASE 9. M. due east , female, born 1906. The patient was normal until her 20 get-go year. At that fourth dimension she all of a abrupt became unstable together with wanted to alive apart from her mother, alongside whom she had been happy hitherto. She went to Paris, where she constitute occupation equally a secretary, but after some months she returned domicile again. When she was 22 she experienced for the get-go fourth dimension an urge to wander, which reappeared afterwards ii or 3 times every year. For no adequate reason, sometimes after an insignificant quarrel, she left domicile together with wandered almost for some days. During these states she was non fully conscious, slept little, together with neglected herself. When normal consciousness returned, after 3 or iv days, she constitute herself inwards the province far away from home. These states were followed past times profound depression, lasting for several weeks, when the patient indulged inwards self-reproaches, ate real little, lost weight, together with could non work. ... The patient was a typical daydreamer. In her daydreams a fantasy of a homo disappointed inwards dearest committing suicide frequently appeared. (Her manlike individual bring upward had committed suicide.) ... The patient, who was of odd intelligence, suffered real much from her abnormal states, which appeared at intervals of iv to 5 months, together with were always followed past times melancholic depression. In 1 of these depressions she committed suicide past times poisoning.

Period Fugue

Stengel (1941) asserted that the bulk of his woman individual patients started their wandering premenstrually, but his Definition of what this meant was sort of liberate (and meaningless): “usually seem earlier menstruation”, “usually simply earlier menstruation”, “usually commences presently earlier her menstrual period”, “at the onrush of menstruation”, “about the fourth dimension of menstruation”.

He had no explanation for this, other than the implication that it's an unstable lady thing. One specially fun illustration (Case 14) was a missy alongside a previous bout of encephalitis lethargica. But it was determined that her menstrual time period together with an Oedipus Complex drove her to wander, non her illness.


The written report for Case 35 (Miss May S. M, aged 18, fellow member of the women's armed services service) was accompanied past times a iv page excerpt from her diary, which is illuminating for what it tells us almost bipolar disorder (but fugue, non together with then much):
1940.  12.1: Had a drink, sang all the means home. 13.1: The matinee went off well. Feeling together with then horribly sad, a terribly empty feeling, felt similar crying my pump out. Home is similar the terminate of the world. 21.1: Tried to commit suicide. Instead wrote to G. telling him to compass me some ideas how to larn to America. Feeling simply frightful, experience dead. 27.1: No feelings at all. 30.1: Have a mad wishing to larn actually common, lipstick, scarlet nails together with alongside equally trivial clothe equally possible.

Modern conceptions of fugue states (including dissociative amnesia) focus on trauma, retentivity systems, together with underlying neurobiological causes, instead of dysfunctional child-parent relationships (MacDonald & MacDonald, 2009).



Who is this? How did I terminate upward here?

You hateful there’s a footing exterior my head, beyond the computer, exceeding all page limits together with formatting errors?

Writing-Induced Fugue State



ADDENDUM (March seven 2016): I should clarify that inwards DSM-5, dissociative fugue no longer has its ain category. Now it's a subtype of dissociative amnesia (DSM-5 diagnostic code 300.12):

Sub-Specifier: Dissociative Amnesia alongside dissociative fugue (300.13)


This occurs when an private travels or wanders, either inwards a seemingly purposeful or bewildered fashion, without knowing who they are. Dissociative fugue involves amnesia of a person’s entire identity or for other of import autobiographical information.

Another salient divergence from Stengel's twenty-four hr time period is that the fugue province must non due to a full general medical condition, similar temporal lobe epilepsy.



References

Stengel, E. (1941). On the Aetiology of the Fugue U.S. The British Journal of Psychiatry, 87 (369), 572-599 DOI: 10.1192/bjp.87.369.572

Stengel, E. (1943). Further Studies on Pathological Wandering (Fugues alongside the Impulse to Wander) The British Journal of Psychiatry, 89 (375), 224-241 DOI: 10.1192/bjp.89.375.224





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