Writing tip-Catatonia vs Coma
Today’s tip (tiny rant) for fanfic writers:
Comas: Please use coma tropes wisely. Long-term comas are damaging to the human body. The chances of anyone becoming fully functional after a brain injury related coma become much slimmer after 4 MONTHS. Having someone wake up from a coma after YEARS is pretty unrealistic. Having them at all cognitively functional, much less *immediately,* is nigh impossible (unless magic/supernatural is involved). For this reason, the medical community strongly recommends “pulling the plug” on long term coma patients. It is thus VERY unlikely a family would be able to keep a coma patient alive more than a year (much less 4 or 6) without BUCKETS of money and power. Really, it’s a writing faux pas to do this-really breaks suspension of disbelief.
INSTEAD, consider CATATONIA.
If you want a character tragically out of the way for a long (indefinite) period of time, from which they CAN come back fully, try institutionalized for “catatonia”. This is a symptom caused by a very wide variety of things, including PTSD, brain injury, and severe illness. It has several forms, including a hyperactive one and one with repetitive motions. It can be ameliorated by treatment, but cured only by addressing the underlying cause. For PTSD, it is possible (but rare) for the brain to simply ‘heal’ and give you that sudden recovery you may be looking for. It is also medically proven that some people do perceive the outside world while catatonic. Lastly, some folks can have intermittent catatonia (usually triggered) with unpredictable and intermittent participation in the world.
So- writing tip for the day: for a more believable long term uncommunicative-must-be-institutionalized medical issue, go with CATATONIA rather than coma.
I now return you (and I) to our regular fanfic reading and writing activities.
I tend to get a tad ranty (at least internally) when I see amnesia portrayed in fics.
Amnesia due to some type of brain injury:
The vast majority (and I mean VAST majority) of cases of amnesia caused by some neurological event are characterized by the inability to make NEW memories. Old, well-laid down memories of who you are and who your family is and what you did a year ago are well-established and highly resilient in any type of neurological injury.
After some type of acquired brain injury, some of the more recent memories that weren’t quite fully laid down can be gone, but that’s only the case in SEVERE injuries (read: included a coma of a day or more) and the further in time you go back the less of a chance of losing that memory.
If you’ve ever interacted with someone with really dense amnesia due to a neurological event it is very much like talking to Dory from Finding Nemo. Their ability to pick up on context cues is intact. So after about 20 to 30 minutes of talking to them they’ve forgotten anything you told them when you first got together and the purpose for you coming to see them, but it’s almost like they’re watching a movie that started in the middle of the action and are picking up cues and kinda just going with it. It’s not until you ask them something specific about what you talked about earlier or the purpose of the conversation, or they start repeating themselves, that their lack of new recall becomes apparent. People with really dense amnesia don’t often know that they have amnesia – because they tend to live life in 20 to 30 minute increments.
BUT, amnesia is a phenomena related to CONSCIOUS memories and we have other memory systems that operate just fine during amnesia. Procedural memory tends to remain intact, so someone with amnesia can learn a new series of actions involved in a simple skill, as long as they’ve practiced it often enough. Other types of implicit/associative memory also tends to remain intact – leaving people with amnesia with a general sense of positive or negative feelings associated with specific people, situations, or activities depending on how many times positive or negative experiences have been associated with that particular trigger. If a dense amnesia goes on long enough, you can see changes in mood as massed experiences of confusion and feeling lost add up.
People with amnesia that isn’t as dense – they’re making new memories intermittently – are often very distressed. They’re going to most often remember things that had strong emotions associated with them – and that’s most often going to be painful emotional experiences like not being allowed to do things that they’re used to doing because they’re not safe to do them anymore. They’ve picked up on the fact that things are not quite right, but don’t have enough specific recall of new events to remember all those things people do around them to help them understand what is going on and to give them hope and purpose. This is common after severe anoxic brain injuries (e.g., near drownings, suicide attempts through hanging, cardiac arrest, status epilepticus, carbon monoxide poisoning). And let me tell you, it is an incredibly painful situation for everyone involved.
Amnesia involving loss of memories related to identity:
Loss of memory about who you are is a psychological phenomenon – not related to a physical injury – referred to as Dissociative Amnesia. It can be “localized” in the sense that only certain aspects of identity or periods of time are lost, “generalized” in the sense that broad swathes of things related to the person’s identity are lost, or a “fugue” which includes generalized loss of memories associated with identity, adopting a new identity, and often travel to a different location and starting a new life.
Memory Phenomena that have some interesting fic potential:
Capgras Syndrome: In which you recognize the familiar person or place in the abstract, but lack that jolt of emotional recognition. The brain then interprets that situation as: if they look like my mother, but don’t emotionally feel like my mother, therefore they must be an IMPOSTER – someone has replaced my mother. It is a disorder of our visual recognition system and can be related to brain injury or dementia. So, hearing the person’s voice over the phone doesn’t trigger the “IMPOSTER” response, only seeing the person. Here are also some tips for how to help manage the impact on day to day life. I’ve run into someone with this syndrome a couple of times. In my experience, as long as you aren’t directly confronting someone about the fact that they are wrong or challenging something that they want to do based on their misperception, they are surprising blase about the whole thing. As long as it isn’t creating a problem for them right here and now, they don’t tend to make a big deal about it. (As in: “Hey, how was your weekend?” “Fine. I was in a different hospital this weekend.” “You were? Where’d you go?” “I mean it looked just like this one and the nurses looked the same, but it was a different hospital, and then we came here.” Spoiler: they’ve been in the same hospital room for the past two weeks.)
Prosopagnosia (aka Face Blindness): in which you can’t recognize someone from their face. It can be due to an acquired injury or can be developmental in origin. I’ve met a few people with this condition, and they tell me that after a family member has been away for a few hours they don’t immediately recognize them when they come back. It takes a while for the voice and a few distinct physical features to reassure them that, yes, that is my mom or other familiar person. They are also completely thrown when someone alters a distinctive feature, like gets a haircut or shaves a beard. The people I’ve met with face blindness know that it’s a odd experience and it kind of weirds them out, but usually find ways to work around it.
Transient global amnesia: a form of Dissociative Amnesia often brought on by acute stress. “During an episode of transient global amnesia, your recall of recent events simply vanishes, so you can’t remember where you are or how you got there. In addition, you may not remember anything about what’s happening in the here and now. Consequently, you may keep repeating the same questions because you don’t remember the answers you’ve just been given. You may also draw a blank when asked to remember things that happened a day, a month or even a year ago.With transient global amnesia, you do remember who you are, and recognize the people you know well.” It tends to resolve over a day or so, and the ability to make new memories returns. A friend’s mother experienced this once after she had an emotional shock. Luckily, my friend was from work and she knew how to just keep answering her questions, re-orienting her to what was going on, not challenging her errors if she didn’t need to, and keeping her occupied. They were in the ER and every once in a while, her mother would pat her on the knee and say something along the lines of, “Honey, everything’s going to be okay, I’m sure the doctor will be along soon.” She’d pick up on the context cues of being in the hospital, the fact that she was there with her daughter, and fall into the role of mother reassuring what she thought was her sick child. This really reflects the fact that we interpret context cues in very personal ways in the absence of specific information about what’s going on.
Well. That went on longer than I thought when I first started out, so maybe, perhaps, a bit more than “a tad” ranty.
Hearseeno 