Abstract
Before I Go to Sleep is a film that embarks on the idea of Anterograde Amnesia and its effect on the life of Christine. To understand just how Anterograde Amnesia effects Christine one must first explore all the topics that are encompassed in this condition including the different types of Amnesia, Retrograde and Anterograde, and the different types of onsets, psychogenic and organic, that can exist. It is also important to dive into the various cases out there that can give a fuller picture of what the condition entails. Looking at the cases of H.M., N.A, R.B., and Angie one is able to relate the real-life examples of Anterograde Amnesia to the Hollywood-like productions of movies like Memento and Before I Go to Sleep. It is easy to see that although Before I Go to Sleep is a fictional story it is a pretty realistic depiction of Anterograde Amnesia and all that it entails.
Keywords: Before I Go to Sleep, Anterograde Amnesia, Retrograde Amnesia
Introduction
Amnesia encompasses characteristics of severe learning and memory impairment that can affect the encoding of new memories or the retrieval of old memories. We can see this in various people who have become subjects of case studies to understand their conditions. Some of the few case study subjects include the famous Henry Molaison also known as H.M., N.A, and even R.B.. Although amnesia affects each patient differently, they do share some similar characteristics in that they all suffer from some form of Anterograde Amnesia with varying degrees of Retrograde Amnesia (Siegert and Warrington, 1996). The effects of amnesia can also be seen in various films throughout history and even in present times, but they do not always get it right. Amnesia has been depicted in many Hollywood Blockbuster films like Memento, Bourne Identity, 50 First Dates, and so on. One movie in particular, Before I Go To Sleep, is a more recent film that depicts a 40-year-old woman suffering from Anterograde Amnesia in which she tries to piece together the pieces of her life. In the case of Christine Lucas, the main character of the film, Anterograde Amnesia is the central focus.
Memory Phenomenon
The first thing to remember in understanding amnesia is that it is important to explore the different aspects encompassed in this topic. Amnesia can either be categorized as having an anterograde nature or a retrograde nature (Siegert and Warrington, 1996). The onset of the condition can even be categorized as either psychogenic or organic (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). No matter what the case may be, amnesia seems to affect each patient in varying ways. Anterograde Amnesia with varying degrees of Retrograde Amnesia, in the organic onset sense, tends to be the most common case out there (Siegert and Warrington, 1996). Now, although there may be little evidence of psychogenic anterograde amnesia, psychogenic retrograde amnesia, or organic retrograde amnesia with preserved anterograde amnesia that is not to say that it does not occur.
With this in mind, it is important to dive into the differences between Anterograde Amnesia and Retrograde Amnesia. It has been accepted that the more severe one is, the more severe the other, although some say that Anterograde Amnesia and Retrograde Amnesia can be dissociable (Siegert and Warrington, 1996). Anterograde Amnesia mainly refers to the idea that any event that occurs after a brain injury or an illness will not be remembered (Siegert and Warrington, 1996). When talking about Anterograde Amnesia it is common to see that the primary deficiencies seem to be caused by a dysfunction in the initial stages of memory formation (Whiting and Hamm, 2008). Anterograde Amnesia is also commonly seen with varying degrees of Retrograde Amnesia and is rarely seen with completely preserved Retrograde Amnesia (Siegert and Warrington, 1996). Retrograde Amnesia, on the other hand, refers to the idea that any event that occurred before the onset of the brain injury or illness is not remembered (Siegert and Warrington, 1996). The dysfunction in Retrograde Amnesia seems to revolve around retrieval failure (Whiting and Hamm, 2008). Here it is seen that, although both Anterograde and Retrograde Amnesia revolve around problems with memory processes like encoding, storage, and retrieval, they do have their differences (Siegert and Warrington, 1996). It is no question that memory is one of the victims of amnesia.
Moving forward, it is also important to recognize the difference between the two types of onsets when it comes to amnesia. This includes the psychogenic onset and the organic onset. Amnesia with a psychogenic onset refers to the idea that amnesia is a type of memory disorder that stems from a nonorganic origin, meaning that there is no physical evidence of brain damage that could indicate a cause of the amnesia (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In this sense, psychogenic amnesia can either be situation specific or global (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). When psychogenic amnesia is situation specific, it refers to the idea that memory is not remembered when it comes to a specific incident or part of an incident which, in turn, can result in post-traumatic stress disorder (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). When psychogenic amnesia is global, it refers to the idea that there is a sudden loss of autobiographical memories that can go back many years and may even result in personal identity loss (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In this it is quite easy to see that psychogenic amnesia seems to produce a widespread of cognitive deficits unlike organic amnesia which is typically restricted to memory function (Kumar, Rao, Sunny, and Gangadhar, 2007). Amnesia with an organic onset, on the other hand, does show signs of cerebral sufferance, meaning that there is clear physical evidence that shows that the condition can be linked to damage of the cortical areas of the brain (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). Even though many cases of amnesia can be quite debilitating, it is not to say that people cannot overcome their condition and lead a successful life like Angie, a 50-year-old woman with profound anterograde amnesia (Duff, Wszalek, Tranel, and Cohen, 2008). Whereas, it could have a completely opposite effect in which the person suffering from some sort of amnesia could be lead to a life of crime and violence, like depicted in the movie Memento.
Adding on to the last point, there is one article that points to the fact that psychogenic and organic amnesia can be compared on 4 different levels. These levels include clinical, neuroradiological, neuropsychological and psychopathological features (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). When taking a look at the clinical aspect it can be seen that in organic amnesia the memory disorder seems to preserve personal identity, basic semantic knowledge and procedural skills, while psychogenic amnesia includes the loss of personal identity and very basic semantic and procedural abilities (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In the neuroradiological sense, organic amnesia seems to have a physical cause that is consistent with cerebral damage affecting cortical and/or subcortical areas known to be important in memory, while in psychogenic amnesia damage to the cerebral areas important in memory does not have a clinical or neuroradiological basis (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). Looking at the neuropsychological aspect it is easy to see that in organic amnesia there is documented impairment in declarative episodic memory with preservation of other memory functions and general intelligence, while in psychogenic amnesia declarative episodic memory is affected along with general intellectual dysfunction (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). In the psychopathological sense, organic amnesia shows no predisposing psychiatric conditions before the onset of the condition, while in psychogenic amnesia a psychopathological condition is existent before the onset of the condition (Serra, Fadda, Buccione, Caltagirone, and Carlesimo, 2007). Although psychogenic and organic amnesia are on opposite sides of the same spectrum it is easy to see that they revolve around the same concepts.
Regardless of what type of amnesia a patient may have it all has to start somewhere. The cause of amnesia seems to have a wide range and is unique to each patient. It can range from a traumatic event in psychogenic amnesia to traumatic brain injury in organic amnesia. In one article it was outlined that amnesia could be caused by various circumstances including aneurysms, anoxia, cerebrovascular accidents, herpes simplex encephalitis, and even Wernicke-Korasakoff syndrome in the case of organic amnesia (Duff, Wszalek, Tranel, and Cohen, 2008). Another article even mentions how amnesia in various patients have been caused by fencing accidents, bilateral lesions, car accidents, and even lesions of other cortical areas (Siegert and Warrington, 1996). It has also been documented that psychological trauma can trigger the onset of amnesia in a psychogenic sense. In this case the fear of not being able to pay a friend back on an agreed date lead to the loss of memory for a 38-year-old man in which he was unable to remember any event after that date (Kumar, Rao, Sunny, and Gangadhar, 2007). It was later found that he had no evidence of brain injury, but showed psychological stress immediately before his problems revealed itself (Kumar, Rao, Sunny, and Gangadhar, 2007). Moving forward into various case studies and the depiction of Anterograde Amnesia in Before I Go To Sleep, it is important to understand all of the topics encompassed in amnesia that has been discussed.
Case Studies
The most compelling evidence that can be found on the effects of Anterograde Amnesia on someone’s life is the actually cases studies of individuals living with the condition. Through the case study of H.M. psychologists were able to determine important key brain structures that seemed to play a role in memory (Draaisma, 2013). In the case studies of N.A., R.B., and T.W. the world was able to see just how each physical accident lead to Anterograde Amnesia with differing degrees of Retrograde Amnesia (Siegert and Warrington, 1996). For Angie, Anterograde Amnesia did not stop her from achieving her goals, but did present her with a few challenges here and there. Leonard, on the other hand, was not as lucky as Angie and seemed to explore a more criminal path as a result of his amnesia. Although, these individuals differ in how the condition developed and what has happened to them since the condition, it is easy to see that they their lives, in some way, has been changed because of their condition.
The first case study that is important to mention is the case of Henry Molaison who is also known as the famous H.M. (Draaisma, 2013). In 1953, H.M.’s life changed forever when he underwent a surgery to treat his epilepsy which lead to major memory loss (Draaisma, 2013). During this surgery subcortical parts were removed from both hemispheres of the brain (Siegert and Warrington, 1996). The study on H.M. brought to light many discoveries when it came to the brain. Throughout this case it was discovered that the amygdala and the hippocampus were important brain structures when it came to memory processes (Draaisma, 2013). This study also provided the world with proof that there was a distinction between short-term and long-term memory where short-term memory stores information for what is being worked on now while long-term memory is focused on the storage and retrieval of stored information (Draaisma, 2013). One important aspect to take away from this study is the idea that while declarative memory is affected by amnesia, implicit memory is preserved (Draaisma, 2013). It is easy to see this demonstrated in the fact that although H.M. did not consciously remember tracing a star-shape while looking in the mirror, over time H.M. improved in this task (Draaisma, 2013). In the past it was thought that, in addition to his Anterograde Amnesia, he suffered from Retrograde Amnesia for about a two or three-year period before the onset of his condition (Siegert and Warrington, 1996). Now, through recent research it has been revealed that the two to three-year period may extend as far back as eight years (Siegert and Warrington, 1996). The life of Henry Molaison did not only provide the world with important information about the brain, but his case study showed us just how amnesia can affect someone’s life.
In the case of N.A., a fencing accident lead to physical damages in the brain resulting in Anterograde Amnesia, in which they had poor recall for any event or famous face since the time of their accident when compared to control subjects (Siegert and Warrington, 1996). Although they had Anterograde amnesia they scored better than all control subjects when it came to identifying famous faces from before their accident (Siegert and Warrington, 1996). This showed that memory in the retrograde sense seemed to be preserved for the most part.
Moving forward to the case of R.B., it is seen that a bilateral lesion to the hippocampus due to an ischaemic episode resulted in characteristics of Anterograde Amnesia with little to no signs of Retrograde Amnesia and preserved intellectual abilities (Siegert and Warrington, 1996). In general, R.B. scored as well or better than most of the controls and only showed Retrograde Amnesia for the few years before the onset of his condition (Siegert and Warrington, 1996). This case showed that not every case of amnesia is the same in that each patient suffers from a varying degree of the condition.
The next important case to highlight is the case of T.W. who is a twenty-six-year-old university student who was admitted into National Hospital Queen Square on December of 1994 after being transferred from a hospital in France following a car accident (Siegert and Warrington, 1996). As a result of the accident T.W. suffered from head injuries, meningitis, fractures of the humerus, ventricular dilations on the left side of his brain and frontal lobe lesions (Siegert and Warrington, 1996). It is easy to picture that with damage like this to the brain there had to be some sort of cognitive dysfunction as a result. Sure enough, T.W. showed evidence of generalized cognitive decline, including signs of frontal lobe damage which lead to his severe case of Anterograde Amnesia along with various cognitive impairments and relatively well preserved Retrograde Amnesia (Siegert and Warrington, 1996). Now, this case along with the previously mentioned cases showed that the lives of these patients has changed forever, however it is not to say that people with Anterograde Amnesia cannot lead a successful life or even a life of crime. These cases in particular seemed to fall into the middle-ground in which the condition seemed to affect their lives, but in contrast they are not leading a successful life, like Angie, or a life of crime, like Leonard.
Although learning about H.M., N.A., R.B., and T.W. is important in understanding amnesia, it is also important to look at the extreme cases in which one can see how a patient with amnesia can live a successful life or how another patient is led to to live a life of crime because of amnesia. In seeing how amnesia can lead to a life of crime many people look to the movie Memento for answers. In this film, it is easy to see how Leonard’s life takes a turn for the worst in which his condition prevents him from creating new memories, and because of this he uses Polaroids and notes to know what is going on in his life (Todd, Todd, and Nolan, 2000). Although he keeps these Polaroids and notes with him he still has trouble knowing who he can trust (Todd, Todd, and Nolan, 2000). It is not until later in the movie when the audience realizes that he has been manipulated by an undercover detective to get rid of all the problem individuals in the world, but what drives this easy manipulation is the fact that Leonard is looking to kill the guy that raped and killed his wife (Todd, Todd, and Nolan, 2000). There is not much literature on this type of extreme when it comes to amnesia, but as seen in the film cases do exist. It is because their memory is not all there that they can easily be manipulated by others without knowing it and in turn can be led to a life of crime.
In contrast, it is also important to explore the extreme in which amnesia can exist in a patient with a quite successful life despite all the challenges she is faced with. Angie, at the age of 29, experienced an allergic reaction to a vaccine while driving and hit a utility pole resulting in a close head injury (Duff, Wszalek, Tranel, and Cohen, 2008). From the close head injury, Angie developed severe anterograde amnesia and right-sided hemiparesis of the upper and lower extremities (Duff, Wszalek, Tranel, and Cohen, 2008). Angie’s parents were embarrassed of her condition so they removed her from the hospital, denied her treatment, rented her an apartment, and provided her with an untrained dog (Duff, Wszalek, Tranel, and Cohen, 2008). This forced Angie to rely on a network of dedicated friends to help her in her day-to-day life (Duff, Wszalek, Tranel, and Cohen, 2008). A year after the injury, her condition began to deteriorate and she lost contact with all those dedicated friends she used to have (Duff, Wszalek, Tranel, and Cohen, 2008). After about 14 years Angie was able to pull herself up and accomplish a great deal of success including moving to a new town, graduate school studies, working as a project manager, getting married, helping raise three stepchildren, and establishing and maintaining several close friendships (Duff, Wszalek, Tranel, and Cohen, 2008). Although Angie faced several challenges including her parent’s embarrassment, she was able to prove everyone wrong and make her life successful.
Movie Analysis
Now, after diving in to the various topics concerning Anterograde Amnesia and looking at various case studies, it is time to explore how Anterograde Amnesia was depicted in the movie Before I Go to Sleep by director Rowan Joffé. The movie starts off with Christine, a 40-year-old woman who suffers from Anterograde Amnesia, waking up next to a man she does not recognize (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). She heads to the bathroom to collect herself and find out what is going on (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). When walking into the bathroom she sees a wall filled with photographs of her past and sticky notes explaining them (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Walking back into the bedroom she finds Ben who explains her condition to her and how she has ended up where she is today (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Throughout this movie, viewers tend to question the integrity of Ben, especially since he does not seem exhausted about explaining her condition to her everyday like someone in that situation would. The audience begins to sense that Ben is manipulating Christine, and this idea is ultimately strengthened throughout the movie. When Ben explains how she got her condition, he explains how she was in an accident where she suffered brain injuries (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Those brain injuries allow her to store information for the day, but when she goes to sleep all the memories of the day are gone and she goes back to only remembering things from when she was 20-years-old (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). This suggests that Christine is suffering from Anterograde Amnesia with some degree of Retrograde Amnesia since she is unable to remember events from years before her accident. In the movie, Christine meets Dr. Nasch who says that he might be able to help her with her condition (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Dr. Nasch is a neuropsychologist studying atypical psychogenic amnesia and believes that if Christine keeps a video diary it will help in improving her condition (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Within that first meeting with Dr. Nasch, Christine realizes that she cannot trust everything Ben says because he lied to her about her accident (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Christine begins to regain some memories through her dreams and pictures she finds in the house (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). When questioning Ben about Claire and her son, he tells her that Claire left because she could not handle Christine’s condition and that her son died when he was 8-years-old (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). It is not until a little later in the movie that she realizes that everything he told her was a lie and that he is not the real Ben, but the guy she was seeing when married to the real Ben (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). This Ben then takes Christine back to where it all started, back to the scene of the accident (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Here Ben, who we find out is really Mike, tells Christine that he is tired of being Ben and erases the videos on her camera so she cannot remember what she has learned that past few days (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). This reveals to the audience that Mike was her initial attacker and has since manipulated and tricked her into being with him. He tells her that the only way she is leaving is if she leaves with him and loves him like he wants (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). She eventually escapes from him and Mike is caught by the police (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). She is taken to a hospital-like facility that aids in her recovery (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). In the closing scene of the movie Christine is visited by the real Ben and her son Adam and begins to regain her memory of her time with Adam(Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Although the movie had a happy ending for Christine, it is not always this way for someone with Anterograde Amnesia.
Comparison of the Movie and Real-Life
Despite the happy ending the movie gave Christine, the depiction of Anterograde Amnesia was pretty realistic. Realistic in that, along with suffering from Anterograde Amnesia, Christine also suffered from Retrograde Amnesia (Lerner, Marshall, Gill, O’Toole, Scott, and Joffé, 2014). Which is the the most common pattern of memory loss, Anterograde Amnesia with varying degrees of Retrograde Amnesia (Siegert and Warrington, 1996). Another realistic depiction seen in the movie is the idea that keeping a video diary can help improve memory. The main evidence for this could be seen in the case study of Angie. To turn her life into a success after her life was deteriorating, Angie broke large tasks into smaller more manageable ones and developed a set of reliable routines that over time became a reflex (Duff, Wszalek, Tranel, and Cohen, 2008). The idea that these routines will become a reflex overtime relies on the idea that procedural memory, in the face of Anterograde Amnesia, is preserved (Duff, Wszalek, Tranel, and Cohen, 2008). The last thing that is important to touch upon that the movie got right is the idea of regaining memories from before her accident. It is generally thought that if she was not able to remember those events now she would not be able to remember them later. Although this is the belief of many people, research has shown that if memories have gone through the stages of consolidation then they would be held in storage and available for retrieval later on (Whiting and Hamm, 2008). Meaning that it would be possible for Christine to remember past events from before her accident since those memories already went through the process of consolidation. Although the movie is a fictional case of Anterograde Amnesia it is quite accurate in depicting Anterograde Amnesia and its effects on someone’s life.
Conclusion
Overall, Anterograde Amnesia is a condition that is quite unique to each individual living with it. Although they may differ in the severity, the onset, the causes, and the effects of their condition they all seem to show similar characteristics. The most compelling evidence we have on the effects of Anterograde Amnesia is the research and case studies on individuals like H.M., N.A., R.B., T.W., and Angie, in which the world is able to see just how Anterograde and Retrograde Amnesia can change a life. It is also seen that movies, although not always accurate, can raise awareness to these types of conditions and show people just what it is like living with this condition. Through movies like Memento and Before I Go to Sleep, viewers get to experience the condition from the point of view of the individual with amnesia. The brain is such a complex and intricate organ that questions still linger about what exactly each part does, but through research and case studies the world becomes more knowledgeable in its effects.
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