Wednesday, July 1, 2009

Memory and the single writer-- guest post by Doctor Tedd Roberts


*Doctor Tedd Roberts has agreed to let me do these every now and then. He would also like our readers to come up with questions. He has plans of writing a guide on the brain for writers in the future, and would like to know what our unique questions are. :) So, go ahead, comment and be unique.*


Science for the Mad Genius Writer
By Tedd Roberts


"Mrs. Smith?"

"Yes Doctor?"

"Your husband suffered a terrible head injury. He's in a coma."

"Oh, Doctor, will he be all right?"

"We'll only know once he wakes up."



"Ashley? It's me, Melissa!"

"Where am I? Who are you? What happened? Who am I?"

"Oh, no!"



It's a familiar theme, amnesia as a plot device. Overused, trite, cliché, yes; but also terribly *mis*-used.

Hi, the bloggers of the Mad Genius Club have asked me to contribute a series on the science behind science fiction/fantasy. I don't claim to be a Mad Genius, nor am I necessarily a Mad Scientist – a bit upset at times, but not truly Mad! Bwahahahaha! (I think we can safely save that label for Dr. Freer.) However, I am a writer, and I have over 70 "stories" in print, although they are all scientific articles in professional journals. My field is neuroscience, the physiology and pharmacology (mechanics and chemicals) of the brain, and I am currently employed as a faculty member at a medical school.



What? Oh, yeah. This is Ratley, an intelligent lab rat. Actually that's LabRat, they insist on the capitals. Ratley and his friends will help me with these blogs.

So, on to today's topic: SF/F clichés regarding the brain with particular emphasis on amnesia.

Amnesia is little understood by the lay public. The most common experience of amnesia is the soap-opera scene with which this column opened. But what is amnesia, and how does it *really* happen?

OK, classroom time.



What? I said, class…



OK, if you insist,*you* tell them.

[Ahem. OK, y'all, I got the stuffy Doc out of the way. As the Doc said, I'm Ratley, and I've *experienced* amnesia in the lab. Let me tell ya, it ain't no picnic. Amnesia means "without memory," and there's two typical types – retrograde amnesia, meaning a loss of memory from the past. The other kind is called anterograde amnesia and it means loss of memory "forward" into the future. I've had 'em both, and they result when a part of the brain that processes memory ain't workin'. ]

Excuse me, Ratley?



Are you going to explain what you mean by "future" memory? Shouldn't you tell them that anterograde amnesia is a lack of ability to make *new* memories?



I will, thanks.

In fact, anterograde amnesia is the most common form of amnesia, even though the retrograde form (poor Ashley, above) is better known. Imagine, trying to remember a phone number but never quite managing it; reading the same newspaper over and over again, never recalling the previous read; or never being able to remember where you'd left your keys, your car, your kids, your wife…

How can this be, how can it happen? Well, let's start by looking at how amnesia happens.

Take Ratley for instance.



Not literally, calm down, please! I'm just giving an example!

When Ratley said he had experienced amnesia, he means that in the lab, scientists use a chemical to temporarily put part of the brain to sleep, causing amnesia – which type depends on the brain area affected. In humans, amnesia usually results from damage to the brain. Oh, but not just any damage! It has to be specific type of damage and specific areas of the brain. Damage can be a traumatic head injury: Ashley's tragic soap-opera car crash, or the angsty teen's headfirst dive into an empty swimming pool. Damage to specific brain areas can also occur due to epilepsy, stroke, tumor, hemorrhage, infection (meningitis or encephalitis) or drug interactions.



Yes, Ratley, just like Ratface. See folks, Ratface did a bit too much LDS in the 60's. He's harmless – really – but not all there.

And what are those brain areas? Well, in scientist language, they are the pre-frontal and frontal cortex (for retrograde amnesia); hippocampus, medial temporal lobe and diencephalon (for anterograde amnesia). Traumatic injury, tumor and stroke can affect any of these areas; infection and hemorrhage are most likely to involve the frontal and prefrontal cortex, while epilepsy and drugs are most likely to affect the hippocampus, temporal lobe and diencephalon.



Yes, I know. Go ahead. Ratley wants to show you how to tell the brain areas apart.

[ Oh, sorry about that. Okay, humans. You've got those big hands with nice opposable thumbs. So, unhand that mouse and keyboard! Now, place your index fingers on your temples, yes, the soft areas at the side of the forehead. Feel that? It is the most direct access to your brain except from the inside. From your fingers to the center of your forehead is frontal cortex. If you draw a line between your forefingers across the top of your head – that's the prefrontal cortex. Move your fingers straight back until they are directly in front of your ears – that's the medial temporal lobe and hippocampus. Move the fingers below and behind the ears – straight in from there at the center, bottom of the brain is the brain stem, also known as the diencephalon.

[What about the other areas, the top of the head, the back, the base of the skull? You humans just *love* to make movies where the bad guy hits the hero on the top or back of the skull with the butt of a gun – he (or she) loses consciousness and wakes up in the hospital with amnesia. Silly humans. Listen to the rat, now: it's not gonna happen that way.

[Next exercise, put your thumbs directly in front of your ears and lace your other fingers over the top of your head. That's the sensory and motor areas – controlling all sense of touch, position and pain, and moving the various muscles of the body. From there to the back of the skull is visual area, responsible not only for sight, but also interpreting what you see. Run your fingers down from top, center of your head, to the very back the skull. Feel that slight dimple? That bony area right below it protects the cerebellum, responsible for coordinating all of the muscles involved in any movement. ]

Thanks, Ratley!

So, in our story brave Ashley foils the terrorist, gets cold-cocked at the base of his skull for his troubles, and wakes up with amnesia, right? Well, no. He might wake up with some coordination problems, blurred vision or possibly "agnosia" a specific type of amnesia for words or faces, but not full scale retrograde amnesia.

What about that mysterious alien parasite that "wraps itself around the cerebral cortex" and takes over its host, leaving total amnesia in its path?



No, Ratley, I know what you're going to say, but I'm *not* talking about Ratfink!

Leaving aside the fact that there is no *room* for such a parasite without sacrificing so much brain tissue that the host is clearly impaired in more than just memory, the description is not specific enough to suggest any particular type of amnesia. No, the more likely result will be pressure on the other parts of the brain causing the hapless host to stop thinking and breathing well before any amnesia could set in.

On the other hand, just about any surgery on the brain carries risk of damage to neighboring area. Anterograde amnesia is a common side effect, although retrograde amnesia is rarer. In fact, to get total retrograde amnesia requires trauma – massive infection, crushing injury to the central-to-frontal part of the skull, concussive blast injury. Anything less is unlikely to give total amnesia. Oh, sure, falling off a horse and hitting your head on a curb will likely cause a bit of amnesia – certainly for the 10 minutes or so immediately preceding the injury – but not the total "Who am I?" kind. Typically the amnesia lasts as long as the brain swelling that accompanies the concussion (about 24-48 hours) but usually only extends to memories from a few hours to a few months prior to the accident.

So, how *do* you incorporate brain damage and/or amnesia into a plot? Ratley?

[First, keep it simple. If the big dumb hero takes a glancing blow to the head, he's not gonna have total amnesia and lead a complete second life for 20 years. Keep it simple, and keep it short. Give the big dummy amnesia for the day leading up to the accident, and only lasting a few days to a week. However, you *can* leave the actual events of the accident permanently forgotten.

[Second, avoid the obvious. Instead of giving the dude full amnesia, consider an alternative.

[Doc?]

Right, Ratley. Alternatives to amnesia might be: (1) agnosia– inability to remember faces or the names of common objects, (2) aphasia - the inability to speak certain words or names (we also call this the "tip of the tongue" phenomenon), or (3) neglect – an apparent inability to consciously notice objects that occur in particular places in our field of vision.

Back to you, Ratley.

[Thanks, Doc.

[Third, remember that total retrograde amnesia is *rare*. Instead of amnesia, give your character vision, hearing or coordination problems. There's a bunchaton of other stuff that happens after head injury.

[Fourth, keep in mind the differences in those different types of amnesia: give a human anterograde amnesia and they may not remember that they had the exact same conversation 15 minutes ago, but they can still remember the name of their 10th grade crush. Likewise, retrograde amnesia still leaves the ability to make new memories.

[Ah, excuse me a sec…

[HEY RATFACE! The cheese is over THERE!

[Ah, sorry about that, maybe Doc needs to finish this while I go help Ratface.]

So, folks, Ratley's final point is to keep the perspective. Amnesia typically means loss of memory for facts. Skills such as reading, riding a bike, speaking a foreign language, complex logic puzzles – those memories are processed and stored in a different manner and not subject to the same injuries as amnesia. Just like Ratface can't remember where he left the cheese just now, he still remembers how to run mazes and get under Ratley's fur.

Finally, don't be too stuck on the rules (or clichés). Try something new, or figure out a way to let your protagonist function with just a partial injury. If you want help, don't hesitate to contact an expert –



- Or a LabRat! In fact, many scientists would be flattered to help out an author.

Until next time, be kind to your brain; for now, it's the only one you have!

14 comments:

Anton Gully said...

First, keep it simple. If the big dumb hero takes a glancing blow to the head, he's not gonna have total amnesia and lead a complete second life for 20 years.

... unless that would be funny and entertaining...

Teddy said...

Humor and plot are a different matter. If the goal is to be funny, and amnesia gets you to that goal, great!

However, Romance novels are particularly guilty of using total amnesia as drama. Frankly, there are *many* more interesting things that can be done with head injury than amnesia.

It's about empathizing with a character. While the public is familiar with total amnesia in theory, they are highly unlikely to have experienced it. On the other hand, it is more likely that they have first or second-hand experience of the consequences of stroke, tumor, epilepsy, paralysis, post-surgical side effects, making it easier for them to empathize with the character.

Anton Gully said...

BTW anterograde amnesia is what the character had in Memento, yes?

DO Romance novels USE retrograde memory loss as a plot device these days? I know it was pretty common a few decades ago - but I'm not up to date with my romance reading.

I'd go out on a limb here and say that the only people using the stereotypical memory loss plot device are doing it for laughs.

It's a bit like saying everything was a dream and then I woke up.

Anton Gully said...

Actually, now I think about it I do *remember* watching a TV show fairly recently that used retrograde memory loss, actually two of them. Dirty Sexy Money and, I'm pretty sure, Ugly Betty. Not that I watched either of them, but the miad likes to have them on while she's dusting the silverware.

warpcordova said...

I love head injuries in fiction. There's making life difficult but not impossible for your hero, then there's the Total Recall moment when the hero discovers tha tHE'S the bad guy...

Head injuries, in fiction, are you friend...

matapam said...

Amnesia can be fun, but now we have no excuse for hitting the hero on the wrong part of the head to produce the type of amnesia we want.

Some of the short term effects could be nice and challenging, in a crucial witness to a crime.

Thanks, Doc. Have some virtual pecans for the LabRats.

Rowena Cory Daniells said...

Doc Ted, I find the Fugue State really interesting. I read of a case about a soldier in WW1, where he had to deliver messages across battlefields on a bicycle (not sure why). Anyway, it constantly put him in danger. One day, he 'woke up' to find himself riding his bicycle at a seaside town in Britany with no idea how he got there.

The theory was that his mind had said, OK, this is going to get you killed. Time to step in and save you from yourself.

He wasn't a deserter, not that they understood this at the time. He had entered a fugue state.

Here's the link for it.
http://en.wikipedia.org/wiki/Fugue_state

So,if you needed someone to have a conveniently timed amnesia that wasn't related to a hit on the head, you could use this fugue state.

Anton Gully said...

I thought of another example of anterograde amnesia in fiction, I think.

Gene Wolfe's character Latro, from "The Soldier of the Mist" and the sequel, though for some reason I never got around to reading that. He wakes up each morning with no knowledge of the day before.

Teddy said...

This latter example is actually yet a third type of amnesia. In between the short-term (10 minutes) and the long term (10 years) is an intermediate form that must be rewritten several times before it becomes a permanent memory. The technical term is consolidation, and for the most part it happens during sleep.

Thank you all for the comments, and it does tie in to my theme which was to *vary* the type of amnesia and understand enough of the science to select the *right* consequence of injury.

By the way, those long line breaks were *supposed* to be Ratley squeaking [squeak], but I used angle brackets and I guess the formatter decided they were really text! Ah, well.

Kate said...

Matapam,

For some reason I managed to not see the words "part of" and spent rather a long time wondering how the heck you could give a guy amnesia by hitting the wrong head.

Mind you, that might be even funnier, plot-wise, if the aliens have an actual brain there. Er. Let's not go there...

Fugue state is an interesting one. I think it also covers some automatic behavior, where you do something routine and have absolutely no memory of it - as I recall epilepsy can cause this. I know for a fact that narcolepsy does because I've done it. It's quite unnerving having those gaps in your memory - especially when your awareness kicks back in 15 miles down the highway, at peak hour, and the last thing you remember is walking out of your workplace.

Rowena Cory Daniells said...

Kate said: I think it also covers some automatic behavior, where you do something routine and have absolutely no memory of it


Kate, that kind of thing happens to me all the time. I thought it was because what was going on in my head was more interesting than real life. grin

Not so funny when I got home and couldn't remember if I'd locked my shop and had to go back to check. I had. But still. Very odd.

Francis said...

The only time I've experienced major memory loss was when I was run over by a Mercedes Benz - or to be more accurate when a Merc tripped me over and I head butted the windscreen.

1) I don't recall the impact or the previous c.5 minutes.
2) I don't recall the subsequent half hour.
3) I have intermittent recollection of the next few hours some of which may be false memories induced by being interviewed in the exact same police room a day or two later and having recordings of some of what I sad played back to me.

Fictionally the description in Paksenarrion where she gets a concussion on the wall of a town and then isn't with it for a day or so absolutely rang true.

The absentmindedness when you do smoething on autopilot like driving, locking the door etc. is different I think - and you really really need to read this (tragic) article: http://www.washingtonpost.com/wp-dyn/content/article/2009/02/27/AR2009022701549.html

Sarah A. Hoyt said...

When I fell in the bathroom and hit whatever it was I hit (frankly, probably the sink) and got concussion I truly woke up going "who am I?" though it was actually "what am I?" That lasted a few seconds. However to this day I have no idea where I was or what I was doing when I fell. I mean, where I was in the bathroom. Because the last I remember, it would be impossible to hit my head on the sink, or to end up on the floor folded the way I was, with my legs UP the wall. (This still puzzles me.) I estimate I lost a couple of minutes.

The effects were the inability to put words together and apparently -- long term -- the ability to draw. (uh!) My doctor said that considering the concussion I got (My glass prescription went up one diopeter) was the equivalent of hitting the windshield in a crash at sixty miles per hour, there would be some new connections forming over the years and I might or might not notice the changes in how my brain works. Other than the art, the only thing I've noticed is a tendency to LESS depression. For two weeks or so, though it was very hard to write and if you own a hc of Draw One In the Dark, you'll notice the first three chapters mix four different English language dialects. I've used all of them at different times, but never scrambled them like that. OTOH I got fugues for about three months. I'd find myself out, in the car, and have no idea where I'd been or why. From what I can guess, nothing exciting. Mostly routine stuff. And Doc, what about Agatha Christie's disappearance/amnesia?

Teddy said...

Well, aside from the fact that Agatha Christie's amnesia was caused by Doctor Who... [grin!]

What most of the recent posts have described are clear characteristics of concussion affecting the "consolidation" of memory. Head injury frequently results in a loss of memory for a few minutes, hours or a day before and after the event because swelling and pressure affect blood flow, and the memory processing and consolidating areas of the brain do not act efficiently. Thus memory is lost/never permanently stored.

Fugue state is indeed very interesting, and Agatha Christie's situation was probably fugue of some sort. Some have been known to be triggered by psychological or physical stress (like the WW1 soldier). Others like Kate and Rowena describe may have some similarity to absence epilepsy where the "executive function" (frontal cortex) is electrically isolated from the rest of the brain. All of the motor programs that result in automatic behavior are present and operating, but the conscious awareness of the them is absent. Again - this can be attributed to lack of consolidation or even anterograde amnesia - after all - once a person "wakes up" from fugue, they really don't know if they were aware during the automatic behavior and perhaps just never stored the memory of those events!

This entire discussion is actually very good because it shows that people are thinking of the various ways to incorporate variability in head injury and amnesia without resorting to cliche!