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Representation of Amnesia and Head Injury in Before I Go to Sleep

 The movie starts with a close up of Christine Lucas’s bloodshot eye, a woman who wakes up every morning and doesn't recognise her own bedroom, the guy in the bed next to her, or even her own 40-year-old face. This is because she has atypical psychogenic amnesia, which means she has struggled to remember anything that has transpired in the 13 years after her catastrophic head trauma. She can remember the events of a day until she falls asleep, but the slate is wiped clean again after a night.

Therefore, through this blog, I aim to analyse the representation of Christine’s condition in the movie and its related aspects like treatment and memory retrieval and their accuracy as per psychological standard practices. 

The guy in the bed discloses that he is her husband Ben, and that she suffered an accident that caused her amnesia, with a tired patience that implies he's recounted the scenario many times before. When Ben leaves for work, Christine's phone rings, and a guy who introduces himself as Dr. Nasch tells her that he's a neuropsychologist who's been assisting her with her memory issue. He tells her where to look in her closet for a camera on which she's been keeping a video journal for the last two weeks, causing a lengthy flashback to show all she's learnt so far.

Psychogenic amnesia (also known as 'functional amnesia') is a memory and learning deficit. It's linked to decreased recall of previously acquired memories, including autobiographical and semantic information, and can occasionally hinder learning new material, just like organic amnesia. It is caused by a multitude of reasons. From extreme levels of stress to PTSD or in Christine’s case, because of a traumatic head injury (Saeeduddin Ahmed, Rex Bierley, Java, 2000).

In some cases, amnesia can be treated and lost memories can be retrieved. Over the years, psychologists have made tremendous progress in treating symptoms of memory loss due  to amnesia, these include cognitive behavioural therapy, psychotherapy, clinical hypnosis and medication (Hayes, Wilson, Gifford, Follette & Strosahl, 1996). Avoidant coping strategies, which involve active suppression of memories associated with negative self-evaluations and negatively perceived emotions in an attempt to regulate aversive internal experiences, are thought to be important in the development and maintenance of psychogenic amnesia (Stanilou, Markowitsch, & Brand, 2010). The function of adverse experience avoidance and suppression has been reported in numerous cases of psychogenic amnesia, both historically and in more recent accounts.

The goal of treatments like CBT or ACT (Acceptance and Commitment Therapy) is to cultivate acceptance by diminishing experiential avoidance, which can help to address and improve the psychopathological factors that caused psychogenic amnesia (Cassel & Humphreys, 2015). The basic principle on which most of the therapeutic approaches work is  to  make the client comfortable and relaxed and allow free association of their thoughts. This is done so in hopes that the information the client comes up with acts as a retrieval cue for older memories, and since their mental state is relaxed, there would be no conscious or unconscious barriers to the retrieval. The goal of treatment is to cultivate acceptance by diminishing experiential avoidance, which can help to address and improve the psychopathological factors that caused psychogenic amnesia (Sharma, Guirguis, Nelson & McMahon, 2015).

In the movie, fourteen years pass by, neither Ben nor Christine made any attempts to seek treatment for the lost memories, there were no follow up checks made with the doctor overseeing her case and surprisingly; no medication for a chronic condition that has handicapped Christine’s lifestyle. As commonly seen in psychogenic amnesia patients, Christine isn’t all that motivated to retrieve her lost memories; primarily because she is unable to link one day’s information to the next. (Dudukovic, N., & Kuhl, B.). Ben’s life also seemingly takes a hit, but he doesn’t seem to be interested in her treatment either. He is rather content with having to repeat the same story to her everyday. Later in the movie it is revealed that the memory retrieval cues that he provided to Christine were untrue. He manipulated the events he narrated to her in such a manner that they were not even close to reality, thus even after hearing the same thing everyday, she couldn’t find her lost memories. Additionally, she was forbidden to visit places from her past and meet people she knew before the accident, because it might be upsetting for her, as per Ben.  But in actuality Ben knew that meeting people from her past would help her regain the lost memories, which he did not want. 

Each day Ben left for work, Dr Nash would call Christine and help her navigate the hidden camera in her closet, in which she journalled the events of the day, before she went to sleep and forgot everything. It is through these journals and her secret meeting with Dr. Nash that she was able to remember her best friend Claire. Upon interrogating  Ben about her friend and whether she tried to contact her or not, he told her that Claire moved to another country and hasn’t reached out either. Dejected but unsure if Ben’s being honest, she tries to look for her the next day, after she recovers the events of the previous day through the camera journal. She is pleasantly surprised to know that Claire is still in the country and was more than eager to meet her. She is also able to recall having a son because of these past memories and stretch marks around her belly confirm make her even more resolute about having given birth. She lashes out on Ben, who then lies to her and tells her that they lost their son to leukaemia years ago. She is further able to recall certain parts of her past, but because of her fragile emotional condition she isn’t able to attend to them properly. The bittersweet meeting with Claire leads to some important revelations. Claire tells Christine that she was having an affair with someone before the accident and that it adversely affected her marriage with Ben. A little confused, but Christine does realise that they, in fact did separate from each other, but her memories and the facts that Ben told her were clashing with each other.

 In the memories she retrieved about her marriage, her son Adam was still alive and the reason she couldn’t remember that was because she thought he was dead, because of Ben. She later records herself saying that she shouldn’t trust Ben, because she realises that his lies are the reason for her dissonance and which is why she’s having so much trouble remembering her past. In her subsequent sessions with Dr. Nash, as he narrates the events of Christine’s attack and she faintly remembers the name Mark. But Dr. Nash’s name was also Mark so she grew apprehensive and discontinued their sessions. Still unsure of Ben’s real intentions, she probes him for answers. To placate her worries and doubts, Ben tells her to get  ready for a night away; unaware that Christine’s memories were starting to come, he books the same hotel that she was attacked in.  

Upon entering the lobby of the hotel, Christine felt a surge of memories hitting her, flashbacks of signing the guest book prompt her to check it for her entry from all those years ago. She eventually finds her entry along with a man named Mark. Perturbed with this information, she runs out and ends up walking around the hotel. When she reaches the parking lot, the spatial familiarity of the place helps retrieve the exact memories of the night and she realises Ben isn't her husband, he is Mark, the guy she was having an affair with. He was the one who attacked her so violently that led to years of inability to remember things. After a violent rush of events, the police are called and her emergency contacts, Claire and her actual husband Ben were also contacted. She is then put under the care of Dr. Nash, and is finally united with her son and estranged husband. 

Although a thrilling production, certain aspects of the recall were represented inaccurately. For example, as Sharma and at al. discussed in their paper, even after therapy the retrieval cues don’t enable a complete recall and the contents retrieved are often hazy. Thus establishing fact from fiction becomes extremely difficult. Further, the client-therapist relationship has shoddy dynamics and is unethical because Nash ultimately develops feelings for Christine. Even during treatment sessions, there is little focus on the cause of this amnesia; the doctor seldom checks the brain scans and depends solely on therapeutic approaches. In reality, it is nearly impossible to use therapy in isolation for such a severe case of amnesia, because of the partial success of psychotherapy. 

Bibliography



Cassel, A., & Humphreys, K. (2015). Psychological therapy for psychogenic amnesia: Successful treatment in a single case study. Neuropsychological Rehabilitation, 26(3), 374-391. doi: 10.1080/09602011.2015.1033431


Dudukovic, N., & Kuhl, B. Forgetting and Amnesia.       https://nobaproject.com/modules/forgetting-and-amnesia 


Hayes, S., Wilson, K., Gifford, E., Follette, V., & Strosahl, K. (1996). Experiential avoidance and behavioural disorders: A functional dimensional approach to diagnosis and treatment. Journal Of Consulting And Clinical Psychology, 64(6), 1152-1168. doi: 10.1037/0022-006x.64.6.1152


Saeeduddin Ahmed, Rex Bierley, Java. (2000). Post-traumatic amnesia after closed head injury: a review of the literature and some suggestions for further research. Brain Injury, 14(9), 765-780. doi: 10.1080/026990500421886


Sharma, P., Guirguis, M., Nelson, J., & McMahon, T. (2015). A Case of Dissociative Amnesia With Dissociative Fugue and Treatment With Psychotherapy. The Primary Care Companion For CNS Disorders. doi: 10.4088/pcc.14l01763


Stanilou, A., & Markowitsch, H. J. (2014). Dissociative amnesia. The Lancet Psychiatry, 1, 226–241. doi: 10.1016/S2215-0366(14)70279-2


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