The Most Extraordinary Amnesia
People who suffer dissociative fugue can't remember who they are. Some even start life over with new identities. Are these flights of abandon unusual responses to stress or brazen acts of malingering?
By March 7, 2018 - last reviewed on April 17, 2018published
The urge to flee was instant and overwhelming. As soon as she saw her husband's face, Suzy* popped up from the table and turned to leave. She commanded herself to stop, even saying the word aloud: Stop! But as she blew through the restaurant door and out into the night, she could already feel that she was not herself.
It had been such a lovely September day. Suzy had gone sailing off the California coast with her husband, her son, and her son's friend, then settled in for dinner at the local yacht club. Halfway through the meal, the conversation took a dark turn. Suzy's father—a fraught subject for her—came up. "He was a violent alcoholic," she says, "who perpetrated every act he could against [our family], including trying to kill our mom in front of us." Her mother divorced him when Suzy was 6, but he continued to stalk them, haunting her childhood. She considered the subject private and was furious with her son for mentioning him in front of his friend. "Something snaps in my brain," she says. "I rev up emotionally, and the revving is zero to 100." It's an instant break.
Suzy suffers from a controversial disorder called "dissociative fugue," also known as "psychogenic fugue," a subtype of dissociative amnesia. All dissociative disorders fragment people's identities to some degree, and dissociative amnesias can cause memory loss for traumatic experiences as well.
But two main symptoms distinguish a fugue from other dissociative disorders. First, fugues disrupt or even erase people's sense of self and personal identity. "In those times," Suzy says, "I'm not who I am now." Second, people feel an overpowering urge to flee their lives (fugue means "flight"). Suzy, now in her mid-50s, experienced her first fugue at 17 when she fled her home and "came to" in a cul-de-sac she didn't recognize. Her doctor, baffled, put her on epilepsy medication, but episodes kept happening: She would suddenly find herself at the beach or in a park, having no idea how she'd gotten there. The trigger was usually a social confrontation.
Suzy doesn't walk much in daily life, but on that recent fall evening at the yacht club, she set out on a trek of several miles in her boat shoes. People with dissociative fugue can recover varying degrees of memory. For Suzy, large parts of the evening and following day remain blank, but she remembers feeling drawn to the beach, and she considered sleeping there under the stars—until a man in a nearby boat called out and spooked her. So she walked on. "Nothing looked familiar. I couldn't identify anything around me, yet it's someplace I'd been a thousand times." She finally saw a hotel and checked in. She didn't get any sleep that night. "The next day, I was even more sideways. I remember people having breakfast at the hotel, but it never dawned on me to eat. I didn't eat throughout the day, I just wandered."
Her phone showed that her son texted her repeatedly, roughly 15 times, asking where she was. In her right mind, she cherishes her relationship with her son, but at that moment, it was as if "the relationship was drowning in a lake, and I was walking on the shore, oblivious." In the grip of a fugue, she adds, "I do not know who I am. I'm not a mom, I'm not any of that. I honestly think I could become homeless and not think about it. I could just walk around and be completely happy."
No one knows how common dissociative fugues are. Colin Ross, a psychiatrist and expert in psychological trauma who specializes in dissociative disorders, says that among the thousands of patients he's treated, he counts only a handful of genuine fugue cases.
Psychologists do know that fugues appear in cultures worldwide and that they usually strike people in their 20s or 30s, although symptoms can arise in children as young as 8. Many victims "come back" to themselves within days or weeks, although some fugues last for years, even decades. And while there are victims who never leave town, others flee to entirely different countries—in cars, in boats, on bicycles, on trains. Some have crossed oceans.
But while the flights from home can be dramatic, the most psychologically disturbing aspect of fugues is how they erase a person's identity. Consider Joan, an Oklahoma woman whom Ross treated. One morning in September 2001, Joan, then in her early 30s, woke up in a hotel room in Albuquerque with no idea how she'd gotten there. Even scarier, she didn't remember her name or anything about her past, and when she opened her purse to look for clues about herself, she found only useless items, like M&Ms and lotion.
Anxious, she took a bus downtown, hoping to find something—anything—that looked familiar. She failed, and finally went to the police, still clueless about who she was.
The police eventually traced Joan to Tulsa, 10 hours away, but when her family came to get her, they seemed like strangers to her. She was especially distraught not to recognize the scent of her newborn son. Joan had no memory of fleeing Tulsa, and Ross had to rely on her mother to piece together what had happened. It became clear that Joan was suffering from extreme stress. She had three children, two of them under 3 years old, and the 4-month-old in particular, being unplanned, had caused serious financial strain. Joan's husband couldn't hold down a job and had recently been admitted to the hospital for psychotic thoughts, including a desire to smother the baby. He then tried to kill himself.
Joan had also recently tried to end her life, leaving her car running in a closed garage. She stopped herself, but things didn't get easier. In a case study on Joan, Ross wrote, "She felt she had three choices to get out of the bind: Her husband had to die, she had to die, or she had to leave the situation. None of these were acceptable." The only solution was for Joan to become not-Joan—to lose her identity, so it wasn't really "her" fleeing.
On the morning she left, Joan had been up all night with a severe headache and had started crying. She didn't want to show up at work like that, so on the drive in she skipped her exit on the highway, as if to buy time. Then she skipped another exit, and another, and just kept driving. After checking into a hotel in Albuquerque, she bought new clothes and a toothbrush at a Walmart, then tossed her phone and ID in the trash. Her identity dissolved completely after that, as did many memories. When a policeman mentioned the 9/11 terrorist attacks—which had just taken place—Joan had no idea what he was talking about.
Like Joan, most fugue victims experience severe stress before their break, usually a result of violence (war, domestic abuse, sexual assault) or financial troubles (bankruptcy, job loss). This stress seems to explain the biological basis of fugues. Stress can flood the brain with hormones called glucocorticoids, resulting in what's called a "neurotoxicity cascade." This cascade overwhelms certain structures in the brain that have a high number of glucocorticoid receptors—including the hippocampus, which is crucial for storing and retrieving memories. When the hippocampus gets overwhelmed, memory can go on the blink.
Other brain structures are probably implicated as well. Memory doesn't reside in a single spot in the brain; many different parts work together to produce memories. But these cascades can disrupt the crosstalk between different regions, disabling these memory networks. Some fugue victims never recover the personal memories they've lost, leaving years unaccounted for.
In addition, many fugue victims suffered trauma when young, which can make their brains more susceptible to stress as adults. This can set up a vicious cycle in which a stressful incident—like discussion of Suzy's father—dredges up old memories. These memories, in turn, bring up old anxieties, which produce even more stress, and then the mind spirals beyond control. Some psychologists, in fact, view fugues as a defense mechanism, a mental "circuit breaker" that protects people from stress by shutting down memory networks.
Still, many psychologists don't believe that fugues exist. "Because fugue is a syndrome that can be used for nefarious purposes, there's always been some skepticism," says Kai MacDonald, an assistant professor of psychiatry at the University of California at San Diego School of Medicine who has written sympathetically about the condition. That is, people could easily fake a fugue to duck responsibility or evade criminal charges. (Fugues sometimes even drive people to commit nonviolent crimes, like forgery or theft, since they may have no other means to support themselves during the spells.) Fugues are also so rare that most doctors either don't know that they exist or don't think to check for them.
Bernice Marcopulos, at the University of Virginia, wrote a case study about a supposed fugue victim at a hospital. Marcopulos noticed that the woman paused whenever someone asked an autobiographical question, whereas she answered other questions readily. She did not appear to be malingering, but digging by hospital staff revealed that she was wanted for a crime in another state. When confronted, she confessed to feigning the condition.
Marcopulos won't rule out the idea that genuine fugue cases exist, but she's skeptical: "It seems odd that memories that have presumably been well encoded over many years—personal memories that you had access to and were in your brain—should suddenly be absent or inaccessible." What's more, victims can readily lay down new memories after the fugue subsides, which doesn't normally happen with amnesiac disorders. In all, Marcopulos says, "[fugues] just don't fit with a lot of memory disorders we've studied."
However rare and controversial, psychologists who've treated fugues maintain that they exist and that they can provide real insight into human behavior. Based on how fugues affect some types of memory more than others, they may illuminate how the brain classifies memory.
In 2008, a 23-year-old New York schoolteacher named Hannah Upp was found floating face down in the Hudson River off Staten Island. Only the quick actions of a ferryboat captain, who spotted her hair bobbing in the water, saved her. When first pulled to safety, Upp had no idea who she was or why she'd been swimming. After coming back to herself, she was confused about why her family seemed so happy to see her in the hospital—until they explained she'd been missing for three weeks.
Security cameras helped police track Upp's movements during her fugue. Remarkably, she'd successfully purchased coffee at Starbucks, showered at her gym, and logged onto her email account at an Apple store. But if Upp couldn't remember something as basic as her name, how could she remember the mechanics of ordering coffee or typing in her email password?
In addition to autobiographical memories, psychologists recognize semantic memories, which involve facts about the world and how it works (Starbucks sells coffee), and procedural or muscle memories, which involve physical actions (logging into email). These types of memories can overlap, but each relies on distinct brain structures: Muscle memories lean heavily on the cerebellum, for instance, while personal and semantic memories are centered in the right and left hemispheres, respectively.
Fugues disrupt semantic and muscle memories on occasion: One victim forgot how to use her cell phone, while another forgot how to speak his native German language. But many other amnesiac disorders can disrupt these types of memories. What makes fugues unusual is that autobiographical memories evaporate—memories that, as one psychologist writes, "are a more-or-less routine part of conscious awareness: who I am, what I did, where I went, to whom I spoke, what was said, what I thought and felt at the time." It's difficult to dislodge such deeply rooted memories, but fugues do it. Victims forget their pets and their clothing, their names and the smells of their loved ones. Some can't even recognize photos of themselves.
These distinctions shed light on Upp's odyssey. Although she'd forgotten herself, she could still order coffee and do other routine tasks because the fugue had left her semantic and muscle memories intact. She could enter passwords, for instance, without really thinking about what she was typing—similar to how we sign our names automatically. Yet the actual messages in her inbox meant nothing to her, even the ones begging to know where she was. Because they can perform routine tasks, people in fugue states usually don't seem odd or unusual during everyday social encounters, which prevents strangers from intervening.
Such "passing for normal" can go to extreme lengths. Probably the most famous fugue victim in history was Ansel Bourne, a carpenter and itinerant preacher who disappeared from Rhode Island in January 1887. (He was reportedly the inspiration for Jason Bourne of the book and movie franchise.) Two weeks later, Bourne popped up in Norristown, Pennsylvania, calling himself "A.J. Brown." Brown rented a room there and set up a dry-goods shop, selling trinkets, candy, and toys. He kept this up for six weeks while his family searched for him, and no one in Norristown ever imagined that he'd had a serious break with reality.
But that outer shell can be deceptive: During a fugue, people are vacant inside. While wandering around in such a zombie-like state, Suzy says, "I'm sure I look normal to everyone, but I'm not really thinking like everyone else. My thoughts go offline. I'm doing normal things, but they're not normal."
There's no standard treatment for fugues. Therapists have tried hypnosis, electroconvulsive therapy, and drugs like sodium amytal (a "truth serum") without much success. In rare cases, drugs like ketamine and propofol can actually induce fugues. So can hyperglycemia from diabetes. Some patients don't need treatment at all. Bourne came back to himself when a loud bang frightened him one morning in bed. The man who forgot how to speak German suddenly snapped back when he read his mother's name.
The capricious nature of fugues can be torture for victims' families. "They all want to know, 'Will it happen again?'" says Ross. "I can't tell them for sure." In response, some families have embraced radical treatments. One fugue victim in New Zealand, a Vietnam War veteran, kept disappearing into nearby coastal forests that reminded him of Southeast Asia. Like Bourne turning into Brown, he'd then take on another persona, that of a friend killed in combat, as if the war were still taking place. The man's wife had no idea what to do, nor did local police, who'd spent a total of 93 days over six years searching for him.
His wife finally came up with a solution while watching a nature documentary: She fitted him with a GPS transponder, similar to those biologists use to track migratory animals. It was the size of a matchbook, was waterproof, and fit snugly into a chain he'd worn around his neck for decades. The receiver stayed at the couple's home, and whenever he disappeared after that, the police could pin down his coordinates in minutes. This not only reduced the search time, it eliminated much of the stress surrounding his disappearances—a relief that actually made future fugues less likely. Through therapy he also learned to recognize stressful triggers that set him off, like the sound of helicopters and the smell of foods he associated with Vietnam.
Unfortunately, not all fugue cases end so happily. After Hannah Upp was pulled from the Hudson River, she moved to Maryland, where she disappeared again in 2013. Police located her that time, but then she took a job as a teacher at a Montessori school on the island of St. Thomas in the Caribbean. Shortly after Hurricane Irma swept through last summer, Upp went swimming one morning and did not return. A construction crew later found her clothes and keys abandoned on the beach. No one knows what happened, but given her history, it seems likely that the stress and devastation of the storm set off another fugue. Friends have since plastered St. Thomas with posters of Upp—both to alert others and possibly to jog her own memory, in case she recognizes herself. So far, they've had no response.
Luckily, Suzy's fugue resolved itself. She walked 10 to 15 more miles the following day, ducking into stores for coffee and a new cellphone charger. Eventually she "burned off all the energy" of her revved-up emotions, and she slowly began to recognize her surroundings. Her feet had bloody blisters by then (she hadn't noticed the pain during the fugue), but she proceeded to limp home and fall asleep.
Her problems weren't over, however. "Even in my family, people don't believe me [about the fugues], and I kind of get that," she admits. "If it didn't happen to me, and somebody told me about it, I would think they were crazy and that they weren't telling the truth."
But as psychologists become more familiar with the disorder, and as more case reports emerge, that stigma will likely disappear. And psychologists who've treated fugue maintain that it can provide a fascinating window into certain aspects of human behavior. "The main conclusion I draw," Ross says, "is that the mind has an amazing ability to do things. If you decide that you're sick of the stupid life you're living and that you're going to take off and go to another place and completely forget your past, it's hard to do that. So what is it about some people's minds that can make that happen? It's an amazing capacity."
MacDonald focuses less on how the minds of fugue victims differ from most people's and more on how they're similar. In some ways, he says, fugues are simply extensions of temporary, everyday amnesia: "They're like sleepwalking, like alcoholic blackouts, or like daydreaming. You and I have short fugues when we drive and miss our exit home. We're checked out, but still driving and wouldn't even remember a guy in a gorilla suit on the side of the road." So perhaps we all have a latent capacity for fugues buried inside us.
If we're honest with ourselves, many of us have fantasized about doing exactly what Joan did—skipping our exit one day, abandoning our old lives, and starting over somewhere else. Perhaps what's so disturbing about fugues, then, isn't how strange they seem, but how tempting. If nothing else, this rare disorder provides a glimpse of how our identity and sense of self arise inside the brain—and just how fragile the brain can be.
* Name changed
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