An Unusual Case of Fugue and Orality

Alex, a Puerto Rican boy of Caucasian type, was fifteen years of age when he was admitted to the hospital for observation and treatment after being suspended from school with a diagnosis of schizophrenia. He seriously entertained thoughts that he was a werewolf although he was not fully convinced of this. His behavior in school had been bizarre. He had on occasion inserted wax monster teeth in his mouth and had imitated a werewolf by making clawlike gesticulations with his fingers while howling, snorting, and growling like a wolf. On a few occasions he had stealthily crept up on unsuspecting pupils and tried to choke them. At these times teachers had observed a faraway, glazed appearance in his eyes, and there seemed to be a disturbance in consciousness. It was described by observers as delirium. These attacks of wolflike behavior could be aborted by a firm command by his teacher, such as, 'Snap out of it, Alex!'. During lucid periods he was generally quiet, introspective, and depressed. At other times, however, he was silly, made incessant jokes, asked irrelevant questions, talked expansively, and was disturbing in the classroom.

Since the age of ten he had experienced terrifying nightmares in color, the most vivid of which had been dreams of a werewolf attacking him. These nightmares were intensely lifelike. Alex would actually feel the pain and see the blood spurting from wounds in his neck after the wolf's attack. He would awaken in terror, often to find that he had bitten his fingers and sometimes his toes during the dream. He also dreamt of dinosaurs attacking him. (In waking life he was interested in paleontology, archeology, and ancient history.) His mother revealed the fact, of which he had no recollection, that for a few years, beginning