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 www.tanyagoodwin.com