Fugue with Awareness of Loss of Personal Identity

Three types of fugue have been previously described: fugue with awareness of loss of personal identity, fugue with change of personal identity, and fugue with retrograde amnesia (1), (2). The first presents some interesting and puzzling features, the psychological meaning of which has not been completely elucidated. In this paper two cases of fugue with awareness of loss of personal identity will be presented along with pertinent observations made on five additional cases. This material sheds some new light on the more obscure aspects of this type of fugue and confirms certain earlier observations.

In seven cases of fugue with awareness of loss of personal identity so far observed, as well as in those reported in the literature, the fugue developed in two stages. Rapaport was the first to make this observation (3). In the first stage the previously 'normal' subject suddenly enters an altered state of consciousness during which he may be impelled by unconscious forces to perform complicated activities, sometimes involving travel over long distances. This stage varies in duration from fifteen minutes to days, weeks or even longer. From this, the patient suddenly enters the second stage in which, spontaneously or through the force of circumstances, he becomes aware that he does not know his name nor have any memory of his past life.

Typically, in the second, the subject has no memory for the first stage, but in several instances there was a spotty memory for it. Usually the patient remembers accurately the second stage while it is in progress, and the events of this stage may constitute the sum total of his memories. On emerging from it, either spontaneously or as the result of treatment, the patient regains his awareness of personal identity and the memory of