Cognitive aspects of fugue state

A young man who disappeared for 20 days

A professor working in an arts college requested an appointment for psychiatric consultation for his son. Over the phone he gave me a brief account of the situation which entailed a psychiatric consultation. His son, a final year medical student disappeared suddenly and reappeared after twenty days. His son could not remember what he was doing all these twenty days. The professor wanted to know what was wrong with his son. I asked him to come to my office with his fugitive son for psychiatric examination. The professor came to my office in an agitated state of mind. He wanted to know what happened to his son during the three weeks while he was in anonymity. Many “unwanted” thoughts haunted him. He wanted to know whether his son was involved in any criminal offence committed by gangsters during the days of memory loss.

The young man could recollect that he was traveling to Bangalore city in an air conditioned coach of the superfast express train alone, on an invitation from a friend who was working in an IT company in the city. The medical student intended to spend two or three days with his friend in the Bangalore city. As the train approached the metropolis the young man suddenly lost memory. He remembered that when he regained memory he was working as a dish washer in a hotel in the suburban area of Bangalore city. He could not narrate how got the job and how many days he was working there. He says he could not meet his friend who assured him to come to the railway station to pick him up. He recollected that he became very upset because the friend didn’t turn up to receive him as assured. Suddenly he lost memory. He tried to regain it but failed. The professor verified the story of dishwashing at the hotel. The proprietor of the hotel vouchsafed the story true. He felt sympathy for the young man who was found in a pitiable condition without food and shelter. So he gave him shelter and food; that was all, according to the hotelier. The friend who invited him to the city told me over phone that he was a little late to arrive at the railway station as promised because of the traffic jam. But when he arrived at the station the train had left and there was no trace of his guest.  He tried to contact him over the mobile phone but the reply was ‘out of reach’.

Agatha Christie disappeared

Agatha Christie, the world renowned crime story writer disappeared on 3 December 1926 and reappeared eleven days later in a hotel in Harrogate, apparently with no memory of the events which happened during that time span. Vanessa Thorpe, the arts correspondent of the Guardian and Observer writes: “For 11 days the country buzzed with conjectures about the disappearance…. Christie was eventually discovered, but in circumstances that raised more questions than they answered. Alone, and using an assumed name, she had been living in a spa hotel in Harrogate since the day after her disappearance, even though news of her case had reached as far as the front page of the New York Times…. Norman, a former doctor, believes the novelist was in a fugue state, or, more technically, a psychogenic trance.”

Fugue state is caused by loss of memory

The son of the professor, who was brought for psychiatric examination, evidently suffered from a condition called dissociative fugue. According to Jason Brandt, Director of Medical psychology, John Hopkins Hospital (USA) fugue state is a memory disorder characterized by complete memory loss that is caused by psychological stress and that cannot be attributed to a known neurological cause.

Neuro-cognitive aspects of fugue state

There are two types of memory loss—global and situation-specific. Global amnesia, also known as fugue state, refers to a sudden loss of personal identity that lasts a few hours to days, and is typically preceded by severe stress and/or depressed mood. Fugue state is very rare, and usually resolves over time, often spontaneously. In most cases, patients lose their autobiographical memory and personal identity even though they are able to learn new information and perform everyday functions normally.

There are three types of memory—sensory, short-term, and long-term memory. Sensory memory lasts up to hundreds of milliseconds; short-term memory lasts from seconds to minutes; while anything else longer than short-term memory is considered to be a long-term memory. Information obtained from the sensory organs is processed in four stages - encoding, consolidating, storage, and retrieval. During encoding, the limbic system is responsible for filtering information obtained from the sensory organs. According to the type of information being processed in a given instance, the duration of consolidating stage varies drastically. The majority of consolidated information gets stored in the cerebral cortical networks where the limbic system record episodic-autobiographical events. These stored memories can be obtained by triggering the uncinate fascicle that interconnects the regions of the junction of temporal and frontal lobes of brain.

Emotions and memory

Emotion seems to play an important role in memory processing. Functional imaging of brains of normal persons reveals that the amygdala in the right brain and the ventral prefrontal regions are activated when they were retrieving autobiographical information and events.

Researchers have found that emotional memories can be suppressed in individuals via the prefrontal cortex in two stages - an initial suppression of the sensory aspects of the memory, followed by a suppression of the emotional aspect. Psychogenic amnesia is characterized by the loss of the ability to retrieve stored memory without any apparent neurological damage.

Psychogenic amnesia is a common plot device in many films and books and other media. Examples include Shakespeare’s King Lear who experienced amnesia and madness following a betrayal by his daughters