Further Remarks on Fugue and Orality

In a previous publication1 the thesis was proposed that fugue states may be sleep equivalents associated with particularly intense oral regressions. This hypothesis was suggested by the psychiatric treatment, lasting one year, of a schizophrenic adolescent boy who had been experiencing fugue reactions and somnambulistic states accompanied by intense oral preoccupations. In these dissociated states he behaved as if he were a predatory animal. He would howl, growl, snort, and move about on all fours as if he were stalking prey, and on one occasion he actually bit the leg of a chair. Acute attacks of uncontrollable anxiety always ushered in the fugue states, which were probably regressive phenomena through which oral sadistic drives, constantly striving for expression, were discharged. In his waking state this patient harbored an unfixed delusion that he was a werewolf, a particularly oral-sadistic creature.

During the therapy, oral fantasies were overwhelmingly prominent. Active aggressive-sadistic fantasies of biting, eating, and devouring, and passive masochistic fantasies of being eaten constantly presented themselves. The most prominent theme in the projective psychological data was the passive wish to be eaten.

The coexistence of this active and passive oral preoccupation with fugue reactions was strikingly reminiscent of Lewin's oral triad—the wish to eat, to be eaten, and to go to sleep. The basic thesis of my paper was that the fugue reactions were orally regressive phenomena and related to the oral triad as equivalents of sleep.

This hypothesis has received additional support in rather dramatic fashion from the symptoms described by a middle-aged business executive seeking psychiatric consultation because of 'black-out spells'. He was the only child of lovingly devoted and somewhat overly protective parents. In childhood his quick temper and touchiness led to frequent battles with child friends. He stated,