On the Aetiology of the Fugue States

Abstract

The peculiar condition designated “fugue state,” of which the main symptom is compulsive wandering, has puzzled psychiatrists since it was first described. Nothing is known of the aetiology of this well-defined condition. Fugue states occur in epileptics, hysterics, and certain psychopaths. Bleuler has described their occurrence in schizophrenia, and they have been recorded in cases of general paralysis and of altered personality due to brain tumour. There are gradations between the typical fugue states and certain fugue-statelike conditions in psychopaths. Kraepelin recognized that it was impossible to distinguish between the states of compulsive wandering associated with various mental disorders. Janet tried to distinguish between hysterical and epileptic fugues by pointing out that short fugues are more likely to be epileptic than hysterical. Although to-day Kraepelin's view is generally accepted, the opinion is held that as a matter of course the mechanisms underlying an epileptic and a hysterical fugue are fundamentally different. Henderson and Gillespie, for instance, arguing against Kinnier Wilson, point out that in a hysterical fugue a search for personal emotional factors will reveal fully the cause of the fugue, while such factors usually play no part in epilepsy.

The intimate similarity of fugue states associated with different mental disorders suggests that there must be aetiological factors common to all. However, no attempt has been made hitherto to ascertain such factors. I have been engaged in investigations concerning this problem for more than eight years, and have published a preliminary report (Stengel, 1939) on some of the results.

Before entering into discussion of the problems involved, it is proposed to present reports on the individual cases observed, the number of which (25), considering the rarity of the condition, provides a large case material. The cases will be reported as briefly as possible, and special attention will be given only to the features which are important for the subject of this paper.