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To: Jim Collier Fugue The word fugue is derived from the Latin fugere (to flee). It is used to describe both a form of musical composition and a psychological disorder. Musical usage predates the psychiatric by nearly three centuries. Chronology would suggest that the term was adopted by medical practitioners as a musical metaphor. Psychiatric usage, however, relates closely to fugue's cognates and etymological origins; musical usage does not. In other words, while the musical usage came first, the psychological usage most closely resembles the word's origins. Did fugue enter the realm of psychiatric terminology primarily because the word's root meaning aptly describes the psychological condition's most outstanding characteristic-the propensity to travel? The term's more familiar musical usage is bound to predispose most who discover it in a psychiatric context to assume a connection between the two usages. Whether the word's musical overtones exert significant influence on perception and treatment of the condition is a question to consider. Etymology The term fugue originates in the Latin fuga (act of fleeing) which comes from fugere (to flee). The stem of fugere is related to the Lithuanian búgstu (to be frightened), and the Indo-European base *bheug-, which means an approximation of "to bend one's course away from a place." Cognates include refugee (one who flees in search of refuge), fugitive (running away; fleeting), centrifugal (moving away from the center), refuge (protection or shelter from danger or hardship) and subterfuge (a deceptive stratagem)- one escapee, many escapes. Definitions of Fugue In Music. A multi-toned musical composition that uses contrapuntal devices (two or more independent but harmonically related melodic parts sounding together) to develop one or more short themes (subjects), each of which is announced singly at the beginning. For examples, visit: http://mapage.noos.fr/dardelf/musique/Bach.html and click on Fugue from Toccata BWV 915 In Psychiatry. A pathological response to trauma characterized by dissociative amnesia and travel to some unconsciously desired locality. Rational behavior persists during the episode, which can last as long as several months. On recovery, there is no memory of events that took place during the fugue state, unless these are brought to consciousness through hypnosis or psychoanalysis. The Musical Fugue-History and Description of the Form The words of Christopher Morley, written in 1597, provide the earliest known citation of the term fugue: "We call that a Fuge, when one part beginneth and the other singeth the same, for some number of notes (which the first did sing)" (OED) Morley's description implies a departure from the term's original implications. There appears to be no record of how this happened. Early fifteenth- and sixteenth-century fugues, however, were more like games of follow-the-leader than flights away from threat or toward protection. They were also comparatively short. By Bach's time, the form lengthened and became more complex. (Altschuler, 24) The fugue is composed of an introductory exposition, an ending coda (musical passage), and a middle section usually longer than the other two parts put together. In the exposition, melodic material is introduced. Each voice alone takes its turn (runs an entry) with the theme (subject). Once the initial introductions are over, other voices play in opposition to the theme (provide countermaterial or a countersubject). The fugue's middle section is an alternation between entries of the subject and seemingly independent "episodes"- that is, anything other than the subject. The coda, with no set structural requirements, begins at the completion of the last entry and brings the fugue to a close. (Altschuler, 24-25) This largely predetermined structure supports myriad possibilities for improvised and composed invention. An extremely important point about fugue is that it is a discussion among equals: there is never a solo voice and accompaniment voices, no voices going oom-pah-pah or beating out chords while a prima donna voice takes a solo: all of the voices of fugal texture have statements of relatively equal interest to make; they are independent. In Gödel, Escher, Bach, Douglas Hofstadter compares the fugue to the less flexible form of the canon, saying, "it allows for more emotional and artistic expression. . . . Each of the voices enters in turn, singing the theme, often to the accompaniment of the coutersubject in some other voice, with the remaining voices doing whatever fanciful things entered the composer's mind." (9) At its best, a fugue is constructed as a drama, a gradual build-up of texture, complexity, and power, carefully controlled never to lose the listener's interest, and introducing various textures, themes and countersubjects gradually such that when "all the stops are pulled" at the end, all of these ideas will be brought together in a final exposition at a maximal display of complexity, emotional power, and the composer's technique. When the fugue has ended, the listener should feel that the conversation has come to a grand, complete, termination, all questions having been answered and all issues having been settled
Expanded Definition, page 2 The Psychiatric Fugue-History and Description The Oxford English Dictionary cites psychiatry's first use of the term fugue- today called dissociative fugue (DF)- in C. R. Corson's 1901 translation of Janet's Mental State Hystericals: "Those long flights (fugere), . . . those strange excursions, accomplished automatically, of which the patient has not the least recollection." Symptoms of dissociative amnesia (DA), a pathological disorder that includes DF, were first observed and described in classical European accounts of demonic possession and exorcism. By the middle of the nineteenth century, practitioners included occurrences of DF in recordings of case histories. In 1890, the American psychologist William James (1842-1910) reported in detail the case of Rev. Ansel Bourne of Greene, Rhode Island. Bourne's case came to be regarded as the model description of fugue in the early part of this century. Pierre Janet (1859-1947), a contemporary of James whose contribution to the study of dissociative disorders has been rediscovered and newly appreciated in recent decades, hypothesized that fugue, like other forms of DA, was based on a disconnection of complex groups of mental functions (memory, feelings, thoughts, ideas) from the "overall executive control of the [patient's] total personality." (Lowenstein, 314) A study by Abeles and Schilder in 1935 first postulated that DA and DF develop in extremely stressful psycosocial environments where suicide or conscious flight have been rejected as options for escape (Lowenstein, 315). War-related studies of DA and DF confirm these findings. Only in recent decades, however, have systematic studies been conducted on the relationship between trauma, especially childhood trauma, and dissociative disorders, including DF. Possible Relationships Between the Two Uses of Fugue Who first chose the term fugue to describe a "stressed-out" sufferer's tendency to travel? Someone who knew his Latin? Did he consciously peg this running-away behavior as a flight from something unbearable? This is not what early psychological literature suggests. William James describes Ansel Bourne's flight to another town and change of identity as an "escapade" (Hilgard, 23). How did he perceive Bourne's actions? A flight of fancy? A lark? A fanciful episode? Did he see it at a concoction of musical countermaterial set against the background of the man's real life? Was this what mid-nineteenth-century practitioners had in mind when they adopted the term fugue? Or did the term originate as a musical metaphor devised by someone who appreciated the parallels? The interplay of multiple parts within the framework of a musical composition or one life? A separate self introducing a new subject into the themes of daily existence, devising an independent episode. Was dissociative fugue seen as a creation-much like its musical counterpart-a construction, an invention? Turn-of-the-century interest in fugue-amnesia was bound to be layered with romantic overtones--the burden of late-Victorian sensibility and a growing fascination with Freudian psychology, persisting well into mid-century. Witness such films as Alfred Hitchcock's Spellbound and the 1945 Love Letters. There was good entertainment value in stories of amnesiac soldiers returning from World War II. But these stories are more about arrival than flight--the mysterious appearance in a new location, the inventions of a new identity. Few scrutinize the trauma that triggered the condition. (In a recent article for Psychological Reports, Dr. Philip M. Coons of Indiana University School of Medicine characterized DF as "the least studied dissociative disorder.") Limitations of Psychiatric Usage Fugue as a descriptive metaphor for DF may be useful to the observer of the phenomenon, the "audience." But does it serve the needs of DF sufferers? In musical composition, even in improvisation, invention is a product of conscious intention; invented themes are generally designed to relate to one another harmonically. The invented life of someone in a fugue state, however, ostensibly bears no relationship to the life that has been left behind, no chasing after some remembered theme. The inventiveness that typifies sufferers of DF is achieved without consciousness. Therefore, to label DF in terms of a musical entertainment--something consciously created to please an audience--is misleading. Dissassociative fugues are not created to entertain an external audience; they are the result of an internal struggle. The terminology we use to describe DF predisposes neither speaker nor listener/reader/audience to focus on questions relating to illness, cause and cure. Perhaps we would do well to devise a new term, one that focuses less on description of DF's "special effects" and more on its underlying causes. References and Works Cited Altschuler, Eric Lewin. BACHanalia: The Essential Guide to Bach's Well-Tempered Clavier. NY: Little, Brown & Co., 1994. The Barnhart Concise Dictionary of Etymology. Edited by Robert K. Barnhart. NY: Harper Collins, 1995. Cardeña, Etzel, and David Spiegel. "Diagnostic Issues, Criteria, and Comorbidity of Dissociative Disorders." Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives. Edited by Larry K. Michelson and William J. Ray. NY: Plenum, 1998. A Comprehensive Etymological Dictionary of the English Language. Edited by Ernest Klein. NY: Elsevier, 1971. Coombs, Philip M. "Psychogenic or Dissociative Fugue: A Clinical Investigation of Five Cases." Psychological Reports. June 1999: 881-886. Elson, Louis C. Elson's Pocket Music Dictionary. Bryn Mawr, PA: Oliver Ditson Co., 1909. An Etymological Dictionary of the English Language. Edited by Walter W. Skeat. Oxford: Clarendon, 1909. Hilgard, Ernest R. Divided Consciousness: Multiple Controls in Human Thought and Action. NY: John Wiley & Sons, 1986. Hofstadter, Douglas R. Gödel, Escher, Bach: An Eternal Golden Braid. NY: Vintage, 1979. Lowenstein, Richard J. "Dissociative Amnesia and Dissociative Fugue." Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives. Edited by Larry K. Michelson and William J. Ray. NY: Plenum, 1998. The Oxford English Dictionary. Oxford: Oxford University Press, 1989. Terr, Lenore. Unchained Memories: True Stories of Traumatic Memories, Lost and Found. NY: Basic Books, 1994.
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