Dissociative Amnesia (Psychogenic Fugue) and a Literary Masterpiece

June 5, 2013

To understand the psychodynamics of the dissociative fugue, Dr Michael Sperber analyzes some of the characters in a collection of interrelated vignettes set in small town America.

In the midst of dictating a letter, Sherwood Anderson (1876-1941), then president of the Anderson Manufacturing Company, stopped speaking and began to stare down at his feet. His astonished secretary inquired, “Are you feeling ill?” Anderson continued to look down and spoke cryptically, “My feet are cold, wet, and heavy from long wading in a river. Now I shall go walk on dry land.”1 He is reassuring in a note he wrote to his wife, Cornelia: “There is a bridge over a river with cross ties before it. When I come to that I’ll be alright. I’ll write all day in the sun and the wind will blow through my hair . . .”

[[{"type":"media","view_mode":"media_crop","fid":"13852","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_417958282755","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"623","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 125px; width: 100px; margin: 5px;","title":" ","typeof":"foaf:Image"}}]]That day, November 27, 1912, was pivotal in his life. When he closed the door to his company, he walked for 4 days along the railroad tracks, 30 miles from Elyria to Cleveland, Ohio. He wound up at a pharmacy, disoriented and disheveled, and he was taken to the psychiatric ward of a hospital.

After discharge, Anderson relocated to Chicago where he joined a literary group, sent for his wife and 3 children, divorced her in 1914, immediately married someone else, and began to write Winesburg, Ohio: A Group of Tales of Ohio Small-Town Life.2 The book, published in 1919, would be proclaimed a masterpiece. The flourishing writer’s group-the Chicago Literary Renaissance-along with Theodore Dreiser, Vachel Lindsay, Edgar Lee Masters, and Carl Sandburg, depicted the contemporary urban environment, decrying the loss of traditional rural values in an increasingly industrialized and materialistic American society. They noted the failure of the romantic promise that hard work would automatically bring material and spiritual rewards.

Anderson later described the events that led to his hospitalization as “escaping from his materialistic existence.” A psychiatrist in the Cleveland hospital where he was a patient might have diagnosed what DSM-5 currently terms dissociative amnesia.3

Dissociative amnesia (DSM-5 300.12) (subtype dissociative fugue) and Journey of the Traumatized Hero
Although it is conjectural for a psychiatrist to make a diagnosis in absentia, presumably Sherwood Anderson appears to have had a condition DSM-5 terms “dissociative amnesia, subtype dissociative fugue.”3 This condition is characterized by a marked but reversible impairment of recall of important personal information, too extensive to be explained by ordinary forgetfulness.4

There is a connection between the events of Anderson’s life and an archetypal human odyssey I coin the “Journey of the Traumatized Hero.”

In this journey, the first step is “trauma,” and PTSD follows, with symptoms of re-experiencing trauma in flashbacks, nightmares, or fearful daydreams; avoidance symptoms (eg, psychic numbing, emotional anesthesia with trouble remembering the precipitating event); and hyperarousal symptoms (eg, being easily startled, feeling tense, jittery, or “on edge”). The journey is an internal-not geographic-process, but physical relocation (as in Anderson's fugue) may occur. If successful, the hero becomes resilient, a boon is acquired, and egocentricity ends.

[[{"type":"media","view_mode":"media_crop","fid":"13872","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5825060054294","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"626","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 183px; width: 200px; border-width: 0px; border-style: solid; margin: 5px;","title":" ","typeof":"foaf:Image"}}]]Anderson’s inability to move beyond the abyss led to a psychiatric impasse (Figure). In Chicago he was able to shift from participant-observer to the role of a creative participant and transform the misery of the first 3 decades of his life into literature.

Dissociative amnesias reported
•On December 3, 1926, Agatha Christie, disappeared, only to reappear 11 days later with no memory of the events during that time. On the day of her disappearance, Agatha’s husband, Archie, revealed that he was in love with another woman and wanted a divorce. The couple quarreled, and Archie left their house in Sunningdale, Berkshire, to spend the weekend with his mistress at Godalming, Surrey. Around 9:45 in the evening, without warning, Agatha drove away from the house, having first gone upstairs to kiss her sleeping daughter, Rosalind.

Her abandoned Morris Cowley was later found down a slope at Newlands Corner near Guildford. There was no sign of her, and the only clue was a letter for her secretary saying that she was going to Yorkshire. Her disappearance caused an outcry from the public, many of whom were admirers of Agatha Christie’s novels. Despite a massive manhunt, there were no results at all. Eleven days after her disappearance, Christie was identified as a guest at the Swan Hydropathic Hotel in Harrogate, where she was registered as “Mrs Teresa Neele” from Cape Town.

Christie gave no explanation for her disappearance. Doctors diagnosed amnesia or a fugue state brought about by depression, exacerbated by her mother’s death earlier that year, and the discovery of her husband’s infidelity. Others speculated Christie was trying to make the police think her husband killed her as revenge for his affair.

•Jody Roberts, a reporter for the Tacoma News Tribune, went missing in 1985 and was found 12 years later in Sitka, Alaska, living under the name of “Jane Dee Williams.” While there were some initial suspicions that she had been faking amnesia, some experts have come to believe that she genuinely suffered a protracted fugue state.

•David Fitzpatrick entered a fugue state on December 4, 2005, and he is still working on regaining his entire life’s memories.

•Hannah Upp, a teacher from New York, disappeared missing on August 28, 2008, and was rescued from the New York Harbor on September 16 with no recollection of the time in between. The episode was diagnosed as dissociative fugue.

•Jeff Ingram appeared in Denver in 2006 with no memory of his name or where he was from. After appearing on national television to appeal for help, his fiancée Penny called Denver police and identified him. The episode was diagnosed as a dissociative fugue. Jeff has experienced 3 incidents of amnesia: in 1994, 2006, and 2007.

An internal journey
To understand the psychodynamics of the dissociative fugue, one may analyze some of the characters in Winesburg, Ohio. It is a collection of interrelated vignettes set in small town America, loosely connected by the narrator, journalist George Willard, Anderson’s alter ego. It is a remarkable literary venture. “America should read this book on her knees,” Hart Crane5 wrote. “It constitutes an important chapter in the Bible of her consciousness.” Through George, Anderson gave voice to those who had entrusted him with the story of their lives.

The book begins with an elderly writer who hires a carpenter to rebuild his bed so that it is level with his window and he can see the trees across the way in the morning. After work is completed, the writer lies in the bed and reflects about death. As sleep approaches, in a hypnogogic hallucination, all the people he has ever met pass slowly before his eyes, seen by him as “grotesques”-some amusing, some terribly sad, and some horrifying. Immediately after this experience, he climbs out of bed and writes down everything that he saw in a book, which he calls “The Book of the Grotesque.” The old man conjectures that the world is full of different truths, all of them beautiful, but when a person seizes on and tries to live by one truth alone, that person’s life becomes distorted. He writes obsessively for hundreds and hundreds of pages, but in the end, he never publishes the book.

[[{"type":"media","view_mode":"media_crop","fid":"13895","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_326113584348","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"642","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 141px; width: 100px; margin: 5px;","title":" ","typeof":"foaf:Image"}}]]The “grotesques” live in a mental jail, detached from others, in a town where communication is impossible. They are, however, able to communicate with the perceptive newspaper reporter of the Winesburg Eagle, George Willard, to whom they tell their stories, hoping he will find meaning in them and perhaps give expression to it in his writing. Dr Parcival hopes that George Willard “will write the book I may never get written,” and for Enoch Robinson, Willard represents “the youthful sadness, young man’s sadness, the sadness of a growing boy in a village at the year’s end [which may open] the lips of the old man.”2

This is problematic for George, who does not know how to interact with or understand them. He is an outsider, and on the continuum between “observer” and “participant,” an observer. As he matures, he becomes more engaged with others in town. Literary critic Irving Howe5 notes that George does not meet the needs of the inhabitants of Winesburg nor they his.

What the grotesques really need is each other, but their estrangement is so extreme they cannot establish direct ties-they can only hope for connection through George Willard. The burden this places on the boy is more than he can bear. He listens to them attentively, he is sympathetic to their complaints, but finally he is too absorbed in his own dreams. The grotesques turn to him because he seems “different”-younger, more open, not yet hardened-but it is precisely this “difference” that keeps him from responding as warmly as they want. It is hardly the boy’s fault; it is simply in the nature of things. For George Willard, the grotesques form a moment in his education; for the grotesques, their encounters with George Willard come to seem like a stamp of hopelessness.5

Ultimately, Sherwood Anderson’s dissociative fugue was a gradual shift in psychological stance from observer to participant-observer to creative participant. In Winesburg, Ohio, Anderson became a creative participant, finally giving voice to the grotesques whom the elderly writer describes in the prologue: “Some [who] were amusing, some almost beautiful, and one, a woman all drawn out of shape, hurt the old man by her grotesqueness. When she passed he made a noise like a small dog whimpering . . . All of the men and women the writer had ever known.”2

Conclusion
Dissociative amnesia, subtype psychogenic fugue, is characterized by reversible amnesia for personal identity.4 The state is usually short-lived (ranging from hours to days but can last months or longer); usually involves unplanned travel or wandering; and is sometimes accompanied by the establishment of a new identity. Fugues are usually precipitated by a stressful episode. Upon recovery, amnesia of the original stressor may occur (dissociative amnesia).

When he had his breakdown, Anderson entered what Campbell6 calls an “abyss”-a psychogenic fugue or other dissociative process that involves the disintegration of the ego and a breakthrough expansion of consciousness. During Anderson’s lifetime, he had 4 wives, 3 children, 2 careers, and 1 masterpiece, Winesburg, Ohio. In a dissociative fugue Anderson's unconscious mind closed a trap door and he ventured on the journey of the traumatized hero. His words come to mind:

All men lead their lives behind a wall of misunderstanding they have themselves built, and most men die in silence and unnoticed behind the walls. Now and then a man, cut off from his fellows by the peculiarities of his nature, becomes absorbed in doing something that is personal, useful and beautiful. Word of his activities is carried over the walls.2

As the dust settles over the literature of past century, Sherwood Anderson, “cut off from his fellows by the peculiarities of his nature”5 (dissociative amnesia), creates a literary masterpiece out of the adversities of his life.

References 1. Rideout WB. Sherwood Anderson: A Writer in America, Volume 1. Madison, Wisc: University of Wisconsin Press; 2006.
2. Anderson, S. Winesburg, Ohio. New York: B.W. Huebsch; 1919.
3. Grohol JM. DSM-5 Changes: Dissociative Disorders. Psych Central. pro.psychcentral.com/2013/dsm-5-changes-dissociative-disorders/004410.html. Accessed June 5, 2013.
4. Spiegel D, Lewis-Fernández R, Lanius R, et al. Dissociative disorders in DSM-5. Annu Rev Clin Psychol. 2013;9:299-326.
5. Howe I. Sherwood Anderson. New York: William Sloane Associates;1951.
6. Campbell J. The Hero With a Thousand Faces. New York: Princeton University Press, 1949.