Les Aliénés voyageurs: how fugue became a medical entity

Abstract

Dissociative fugue was first treated as a distinct psychiatric illness in Bordeaux in 1887, and was taken up by Charcot as automatisme ambulatoire in 1888. Charcot held that fugue episodes were caused by latent epilepsy; his opponents maintained an hysterical origin. The diagnosis flourished in France for more than a decade but, like the superordinate diagnosis of hysteria, had faded by 1910, although it was exported to Italy, Germany and Russia (but not the anglophone world). It was closely associated with vagrancy as a social problem, and military doctors tried to define the illness in order to protect deserters from punishment. Fugue was a companion to multiple personality, especially in respect of gender - most multiples were women, most fugueurs were men. Dissociative fugue provides a cameo illustration of how a psychiatric entity comes into being and then disappears.