Friday, May 11, 2012

Dissociative Fugue: Tanya Goodwin

I'm so pleased to have Dr. Goodwin back. She is a lot like me in that the rare and unusual fascinate her. I thoroughly enjoyed this post and I think it makes for a good character disease/developemnt.

Welcome back, Tanya!

In case you missed my last month’s guest post on necrotizing fasciitis, rare or unusual medical conditions fascinate me. Today’s weird condition is dissociative fugue, the basis of my debut novel, If Memory Serves, in which my protagonist, Dr. Tara Ross experiences this disorder.

The Merck Manual defines dissociative fugue as one or more episodes of amnesia resulting in the inability to recall one’s past and the loss of one’s identity accompanied by the formation of a new identity with sudden and unexpected travel from home; a traumatic nature that isn’t explained by normal forgetfulness.

The DSM IV (a diagnostic manual of psychiatric disorders) characterizes dissociative fugue by 1) sudden and unplanned travel from home 2) inability to recall past events or important information from the person’s life 3) confusion or loss of memory 4) significant distress or impairment.

Fugue is temporary and there isn’t a physical or organic cause (ie brain injury or stroke). Although it’s rare (2% of population), it can happen to those that are chronically stressed, often with a major inciting event noxious enough to catapult them into a fugue state. It’s the brain’s defense mechanism, and eventually resolves within days, weeks, or months, leaving them unaware of occurrences during their amnesic state. They are fully functional but may not recall their identity or parts of their identity. They are often called travelers since they wander or travel away from home. Their nomadic adventure generally occurs after a stressful event.

Physiologically, the hippocampus of the brain is bathed in cortisol, the stress hormone secreted by the adrenal glands, those glands that sit on top of the kidneys. Normally cortisol is ushered away from the brain by calming hormones that bind or pick up cortisol and send it to the kidneys for excretion. The chronic wearing of the nervous system leads to the decrease of important neuropeptides and neurotransmitters necessary for memory creation, processing, and storage. The brain is like a computer and if pressed with too many requests in too short of time freezes from the overload.

So what’s the treatment? Dissociative fugue is temporary and will eventually resolve, but psychotherapy and cognitive therapy can be very helpful. If the person is very anxious or clinically depressed, pharmacologic remedies are considered. And of course, other organic sources of memory loss should be ruled out by blood work and radiologic tests such as CAT scans.

Because the disorder is self-limiting, the prognosis is good. Attention to the underlying emotional issues decreases the likelihood that dissociative fugue may reoccur.

So how did I get interested in dissociative fugue? When I was an OB/GYN resident (doctor in training) I often left the hospital exhausted and stressed. One day, I couldn’t remember how I had made it home, waking up in my bed completely disorganized. It was a frightening experience, at least for a minute or two. That prompted me to think of dissociative fugue and what it must feel like to be totally lost.

Tanya Goodwin is an obstetrician/gynecologist and a novelist of romantic suspense with slice of medicine. She enjoys sprinkling unusual medical conditions in her writing. A character in one of her novels has the misfortune of contracting necrotizing fasciitis, and in her debut novel, If Memory Serves, due for release in November by Knight Romance Publishing, her main character, Dr. Tara Ross has dissociative fugue, a rare disorder as well. You can find out more about Tanya at


  1. What an interesting post! I often have forgetful periods like the personal story Tanya mentioned--usually in association with lack of sleep and stress. I remember one time in residency driving all the way home and parking the car, and then realizing while I was parking that I didn't remember ANY of the drive there. Which route did I take? How long did it take me to get home? It was really terrifying! What if I'd gotten in an accident? I didn't drive post-call for a long time after that happened. (Luckily I live in a city with public transportation!)

    I can't imagine waking up and not remembering things for such a lengthy period of time--and then constructing a new life that turns out to be false! How strange!

    1. Exactly. It's scary back in those days how I didn't injure myself or others. I read in one of my OB journals (publications) that sleep deprivation was equivalent to an illegal blood alcohol level. That was sobering!

  2. Tanya, Enjoyed the post, especially since a fugue state plays a role in one of my own medical mysteries (can't say which one--spoiler). Nice to meet (via cyberspace) another physician/novelist.
    Jordyn, thanks for the introduction.

  3. That's great, Richard. Looking forward to it!

  4. Wow! This is so interesting--and so amazing that stress can take such a huge toll on our bodies. All the more reason to decompress and relax as much as possible!

  5. Heather, So true. I'm a definite type A.

  6. Great post Tanya and I'm enjoying all these comments!

    When I worked night shift in the Pediatric ICU-- I remember driving home being so tired and getting home and thinking-- I don't really remember much of the drive.

    I do believe tired people can be as dangerous as those under the influence. So scary!!

  7. Thanks, Jordyn. It was my pleasure guest blogging today. Have a great weekend.

  8. I can relate to this on a small level. I have experienced this more than once, driving home and not remembering how I got home. Stress can play a big role in our lives, mentally and physically.

    Thanks for sharing this with us.

  9. I wonder how many missing people are experiencing this situation? I suppose they are among those stats of missing unidentified people. Not unidentified bodies.

    The characters in Milk Carton People are a group all of their own. Now, I am wondering if any legal thrillers have already taken this one to fictional court.

    I hope that the people driving home without incident are driving as safely as I use the cell under the influence of zolpidem. I no longer take my phone to bed. I do not remember the conversations or activities after this medication takes hold and I wonder if I am getting any sleep at all.

    Wow, I have given you a whole new topic for the blog!

    Sally Franklin Christie

  10. This is truly fascinating. As an educator, it interests me how stress affects learning. I think we live in a highly stressful world, and even "good events" can lead to stress. Thank you for sharing this. I'm looking forward to reading If Memory Serves. It's going to be a very suspenseful novel.
    Catherine Greenfeder

  11. I've read that fugue states can be triggered by Ambien, and other such sleeping medicines. I suspect that it isn't the Ambien alone, but a combination of the kinds of situations that would cause fugue, along with taking Ambien.