A Re-Evaluation of the Fugue

Abstract

The fugue has received little recognition in the literature in recent years. Stengel (1941, 1943) defines the fugue state as consisting of “transitory abnormal behaviour characterized by aimless wandering, and more or less marked alteration of consciousness, usually, but not necessarily, followed by amnesia”, According to Henderson and Gillespie (1944) the patient in a true fugue suddenly leaves his previous activity and goes on a journey which has no apparent relation to what he has just been doing, and for which he has complete amnesia afterwards. William McDougall (1926) states: “Fugue is the name given to those instances in which a person suddenly disappears from his accustomed haunts and re-appears at some distant place, astonished and puzzled to find himself there, and unable to give any account of himself in the period between his disappearance and his re-appearance.” In a footnote McDougall adds: “This word is sometimes used in a wider sense to include wandering of a seemingly aimless kind for which the subject (generally a psychopath) can assign no adequate reason or motive, but of which, nevertheless, he can give some description.” In our cases the criteria for a fugue have been sudden onset of wandering with clouding of consciousness and a more or less complete amnesia for the event.Over the past 3 years we have collected 37 cases, either from the hospital records or from cases personally seen by us. Interesting features have emerged which, as far as we can ascertain, have not previously been described. A control group matched for sex, age and clinical diagnosis has been studied to exclude fortuitous associations. In the 37 cases of fugue under review, 31 are men and only 6 women. This incidence in favour of males is in accordance with the findings of other workers who have dealt with mixed groups, but differs from Stengel (1941), who picked his cases mainly from the female wards of Bristol Mental Hospital.