The Fugue is gradually driving you towards madness. If your temporary Willpower ever reaches 0, you automatically gain a derangement which can never be removed. You may remove other derangements you gain in other ways as usual. You may gain a maximum of three of these permanent derangements from losing your Willpower before being consumed by it. Should it happen a fourth time, you immediately lose yourself to the Fugue and become a character under the control of the Storyteller, walking in whatever direction the music takes you and killing anything you come across.