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4 January, 2016

A fugue state is a dissociative episode which is somewhat like multiple personality disorder.  The person who experiences these episodes “loses time” while engaging in complex behaviors for which they have no recall.  It is a little like sleep walking except for the complexity of the behaviors and the waking state in which they occur.

The following facts have been altered to protect the confidentiality of the woman whose symptoms are described, but are essentially true:

A young woman was brought by her boyfriend to the clinic where I worked 35 years ago.  Some days before, she had appeared at a large, state psychiatric hospital, carrying a suitcase but unable to tell them who she was or where she was from.  She had eventually come out of her fugue state and was able to tell staff who she was.

She was seen with her boyfriend as a walk-in client to determine if treatment at the clinic was warranted.  During the interview, it was learned that she had been telling her boyfriend, with who she lived, that she worked during the day.  The fact was that she had spent her days reading romance novels.  In the wake of the hospitalization incident, her boyfriend discovered a number of unusual things.  Among them was the discovery that she apparently went shopping often to buy undergarments and lingerie, and that she had concealed the items among, and in, cookware.  It was expectable that she had no recollection of the behaviors.  However it was, clinically, fascinating that she was able to cook and “not see” the items.  (In the current day and age, one might question why the boyfriend apparently never did, or assisted in, any cooking.)

Further individual evaluation, not surprisingly, revealed she had been a victim of childhood sexual abuse.

It appeared that she had been having the fugue episodes perhaps daily for some time.  I was not able to see her myself as an ongoing client and was given to understand that she dropped out of treatment after only a few visits.  Those facts made it difficult to rule out multiple personality disorder* but, at least on brief evaluation, she appeared to lack some of the characteristics of that disorder.


* Unfortunately, the existence of multiple personality disorder has become controversial, with many clinicians doubting that it exists.  It is perhaps no coincidence that the decreases in funding for mental health clinics fit in, time-wise, with that controversy.  The result was a switch from analytic, insight-oriented therapies to brief therapy models, both in the training of and practices of clinicians such as clinical social workers and marriage and family counselors.

There has been for some decades a large scale demise of long-term therapy in favor of what the famous psychoanalyst Robert Langs, somewhat contemptuously, called “feel-good therapy”.  It does not make sense to strike out in a search for gold, and after six or eight, one hour weekly efforts, pronounce that none is to be found.

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