How to Write About Retrograde Amnesias: Amnesia Part 2

RETROGRADE AMNESIAS

Recently, I got the privilege to assist Denise Hunter with her latest book “Before We Were Us” (just released in September, it’s great – go read it!) where the heroine suffers a severe head injury and gets amnesia. Denise needed to use temporally-graded retrograde amnesia for this story.

The heroine forgets her current boyfriend (the hero had the ring to propose with that night), even forgets her dog, and still thinks she’s headed back to Boston for a new job!

Amnesia after a concussion/head injury or trauma has been used in many films, TV shows. and books. This includes a couple of my favorites, While You Were Sleeping, and The Bourne Identity.

The erasure of memories with amnesia is a handy device for writers and alien-hunters like the Men in Black. Most movies use amnesia wrong, like Fifty First Dates. It’s based on an unusual case, but the flaw comes at the end.

Drew Barrymore’s character would never recover her memory and be normal again.

A more recent film, Falling for Christmas, got amnesia right as well. Lindsay Lohan’s character is skiing (high impact sport), hits a tree, and gets a concussion. What this film got right that all others usually mess up — Lindsay’s character doesn’t have a change in basic personality. Your regular personality (happy-go-lucky, driven to succeed, etc.) doesn’t change with amnesia.

She’s an heiress, and let’s just say housework is not her thing and still isn’t!

Amnesia is a complex topic. Learn how to write about it correctly from a physician-author at Novel Malpractice.com. Share on X

First: How memory works!

It’s an oversimplification of the human brain, but helpful to think of it as a computer, and a memory as a file. The computer’s memory or a “cloud” stores files you save. These files can be accessed repeatedly and will not change unless altered and re-saved.

The vast processing capability of the human brain is the problem.

It contains eighty-six BILLION neurons.

An old theory was a single memory linked to a single neuron which like a computer bit, was either off or on. With all the new brain function scans, like PET, scientists have realized memories are encoded in patterns of neurons. And just like a key and lock, the correct pattern must fit before “boundary” neurons allow the memory to be accessed.

Neurons in the brain are either on or off, just like a computer bit, BUT recent science has demonstrated the human brain has spiral circuits linking all of this in a complex metadata system.

Diagram of a laptop computer and what it links to. Shows the networking.

SEO technology flat illustration with laptop and icons. eps10

Your laptop or desktop also has RAM, random access memory. Our brain does, too. It’s called short-term working memory. When someone gives you a series of words or numbers, and asks you to repeat them later, they’re assessing this function.

A new/recent memory stays in RAM until it’s moved to a higher level, that of permanence, in different parts of the brain. Those parts are called the hippocampus, the diencephalon, and the temporal lobes. Other parts including the frontal lobes and the posterior lobe at the back are involved. The temporal lobes are on the sides of the head, so blows there are common with falls, as are hitting the forehead or back of the head.

Memories are not stored in just one part of the brain, like once was thought. Multiple brain areas store parts of a single memory. It also turns out that some types of neurons “guard” access to your stored memories. Just like a key in a lock, you have to have the correct code to fire those neurons and “open” the memory vault.

Writers Know Emotion!

As writers, we understand how emotion works to link a reader to our characters. The same is true of memories in the brain. Traumatic memories can be “hard-wired” to the point they cause PTSD, post-traumatic stress disorder. Most researchers believe memories don’t “encode” until we are about age two or three.

Second: Definitions for How to Write About Retrograde Amnesias Part 2

When writing about retrograde amnesia, it’s helpful to understand the medical definitions because there are so many forms of retrograde amnesia.

A previous post, Writing about Transient Global Amnesia explains a rarer but distinct form of retrograde amnesia.

https://novelmalpractice.com/wp-admin/post.php?post=610&action=edit

Amnesia: Loss of memories, including experiences, facts, events and recognition of people.
Retrograde – Unable to retrieve memories formed before the event. Sometimes temporary but can be permanent or progressive.
Anterograde – Impossible to form new memories. Factoid: the reason someone who is drunk (blackout) can’t remember is because alcohol interferes with the formation of new (anterograde) memories.
Transient Global Amnesia: A distinct form of retrograde amnesia that only lasts a few hours to a day.
Post-traumatic Amnesia: A form of retrograde amnesia due to a stroke or head injury. It can cause difficulty with remembering identity, or orientation to time and place. If the patient awakens in the ER, they may not know who they are, what day it is or even the year, but they will still recognize being in a hospital.

Third: Forms of Retrograde Amnesia

Retrograde Amnesias are divided into:

Focal retrograde amnesia

Temporally-graded retrograde amnesia

Dissociative Amnesia

Post-traumatic amnesia

Transient Global Amnesia

WHAT CAUSES RETROGRADE AMNESIA?

ACUTE health issues:

Cardiac arrest
Strokes
ECT – electroconvulsive therapy
Brain infections — meningitis and encephalitis
Vitamin deficiencies – B12 deficiency and alcoholism can cause Wernicke-Korsakoff
Seizures
TBI – traumatic brain injury (includes all concussions)

CHRONIC health issues:

Progressive brain diseases like Alzheimer’s or other dementias
Brain tumor
Strokes, once the acute phase resolves

HOW ARE PATIENTS ASSESSED?

Physical examination with special attention to the neurological system. FYI: The first doctor seen will often be an ER doctor, then either an internal medicine specialist or a neurologist. Depending on the type of amnesia, a psychiatrist may be consulted.
Lab tests – looking for things such as blood sugar level, infection or inflammation indicators
Often, a lumbar puncture is performed to rule out infection – meningitis or encephalitis
Imaging – definitely if there’s trauma, plain Xrays looking for skull fractures or bone cancer are done. (multiple myeloma in particular) If no trauma or suspected bone cancer, then it’s on to the CT-scanner and/or an MRI.
CT-scans diagnose skull fractures as well – many ERs will skip plain skull Xrays if a CT is available.

WHAT’S THE TREATMENT FOR AMNESIA?

No treatment exists for the amnesia by itself, but treating underlying conditions may improve the memory loss.

Often, patients are enrolled in occupational therapy to relearn information and knowledge that was lost. Motor Skills like driving are typically left intact. Psychotherapy and counseling are used for coping mechanisms, as well as social support.

Temporally-graded Amnesia:

Most common form of retrograde amnesia
Affects more recent memories the most, distant (older) memories remain intact.
The amount of memory loss depends on the part of the brain affected
Some people can lose nearly all their adult memories.
Childhood memories generally retained.
Happens with damage to the brain sections that deal with memory and emotion (why stress plays a part)

With amnesia after a typical head injury or concussion, the victim can’t recall the trauma nor what they were doing right before. They don’t lose years of memory – but rarely, that can happen. Share on X

NOTE! Most closed head injuries – concussions – don’t result in severe amnesia.

In Before We Were Us, Denise used an adequate injury – a fall from a high loft with a severe concussion. It’s important for authors to use plausible head injuries. Just striking your head on a door jam in a vast majority of cases will not cause a severe concussion nor amnesia. Denise also allowed enough room in her plot line for the heroine to slowly recover her memories over time. It’s not an overnight process, and usually takes weeks to months. Even years, in some cases.

My mom suffered a severe ischemic stroke, with a full hemiplegia, while my father was in hospice. She already had significant vascular dementia. While her physical functioning was saved by an infusion of the clot buster drug, she lost almost half of her past memories.

Mom had both retrograde and anterograde amnesia, because she couldn’t recall our dad had died nor being at his funeral.

It took my brother six months of patient repeating the facts before her brain finally recorded Dad’s death.

Her retrograde memory mostly never returned. After some time, she developed some ability to lay down new memories as her brain healed, but it was limited compared to what she had before.

The other flaw used in amnesia is using a second head injury to suddenly recover their memory – that doesn’t happen. Share on X

Strange Things Do Occur:

One patient with a relatively minor closed head injury lost ten years of memory retrograde for three months, had anterograde loss for one day. This patient’s handwriting returned to that of ten years prior. (juvenile) Both autobiographical and event/famous faces memory was lost, and the person surprisingly once recovered still had trouble performing complex tasks.

Author Jo Massaro suffered amnesia after a severe auto accident in 2007. She was in a coma for five days, but all her scans and tests were normal. Nothing obvious explained her closed brain injury. It took Jo until 2013 to mostly recover her memory, but she still has deficits. Jo lost some memories permanently, including childhood ones.

She could not read nor write (not a good thing for an author!) and her daughter still helps her some. Interestingly — Jo became obsessed with playing the “Farmville” game; she played because it felt like her brain had shifted.

I wonder the game helped fix damaged pathways?

The brain can heal but it’s slow and not always complete.

RETROGRADE AMNESIAS

First: How memory works!

Writers Know Emotion!

Second: Definitions for How to Write About Retrograde Amnesias Part 2

Third: Forms of Retrograde Amnesia

WHAT CAUSES RETROGRADE AMNESIA?

HOW ARE PATIENTS ASSESSED?

WHAT’S THE TREATMENT FOR AMNESIA?

Temporally-graded Amnesia:

Strange Things Do Occur:

**Click here to go to Amazon to order a copy of Before We Were Us!**

Click here to check out Jo Massaro’s Books and her Ministry:

DEEPER DIVES

Writing About Transient Global Amnesia

Writing about Hospitalization

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