Editor’s note: This piece contains spoilers for Seasons 4 and 5 of Jane the Virgin.
When Michael returns from the dead with a bad case of amnesia on Jane the Virgin, Jane takes her long-lost husband to a neurologist for an examination. “There’s so much we don’t know about the brain,” the doctor tells them. There’s so much the new Michael doesn’t know either, including who he is, how he lost his memory, and where to find the space bar on a computer. Instead of the sweet, traumatized ex-cop Jane fans knew and mourned, he’s developed a totally different personality: “Jason” is a line-dancing, NCIS-watching Montana farmhand.
This transformation was orchestrated by the show’s crime lord Sin Rostro, who offhandedly explains how she used “electroshock therapy focused on the hippocampus and temporal lobe” to make Michael forget his past. (Straight out of a telenovela, right?) All because Michael might have noticed Sin Rostro’s mask slipping, exposing her disguise—or so she says. At the end of this season’s third episode, Michael’s memories return—so we’re sure to find out soon what really happened.
While Jane the Virgin breathes new life into the amnesia cliché, it’s still exactly that, a cliché, which got us wondering: Does this soap opera go-to have any basis in reality? Slate spoke to Dr. Roy Hamilton, a cognitive and behavioral neurologist at the University of Pennsylvania and a member of the American Neurological Association, to find out. This interview has been edited and condensed.
Marissa Martinelli: Amnesia is very common on soap operas. How common is it in real life?
Roy Hamilton: Depending on how you’re defining it, it is either very uncommon or very common.
What do you mean by that?
Memory loss acceleration—forgetting in ways that are very different than individuals with healthy memories tend to forget—that’s very common. I see patients in our memory disorders center for whom it’s the most common symptom associated with the most common neurodegenerative disease, Alzheimer’s disease. I think people are familiar with this heightened forgetfulness. Then there’s amnesia as portrayed in TV shows, this notion of some type of neurologic event that then erases your memory, erases your sense of your own identity, on the basis of some neuro injury. That’s largely fictitious.
A neuro injury. You mean like a bonk on the head, right?
Yeah. I’ve never seen Jane the Virgin, but when I was a kid, I used to watch old syndicated reruns of Gilligan’s Island. There’s one episode with the Skipper getting bonked on the head with a beam or something, and he doesn’t know who he is, he doesn’t know that Gilligan’s his little buddy, doesn’t recognize any other people on the island. It’s like somebody sucked out his personality and inserted a new one—or a fresh one with nothing written on it. That’s largely not a neurological thing, right? There’s no place I’m going to stick a pin in your brain or specifically damage it and cause you to have a total reset of your hard drive like that.
We do see patients who, on the basis of neurologic injury or neurologic disease, have lost personal information or loss of their old memories. But generally speaking, they aren’t walking and talking. If they’ve lost massive amounts of personal information and are still interacting normally otherwise, that’s actually in the family of psychiatric disorders.
Let’s say—hypothetically—that I’m a crime lord, and I need to erase someone’s memory of a specific event. Could I zap it out using electroconvulsive therapy?
Can I give you a very brief synopsis of the life span of a memory?
By all means.
If I were to tell you a piece of information—let’s say, I don’t know, I gave you my phone number—but I didn’t let you write it down, and I said, “Remember it, and call me back in half a minute,” you would just sit there and chances are you would recite it to yourself, right? But what if you’re sitting there holding onto it, and then something really shocking happens, totally unexpected? A lion enters the room.
That’s actually not a bad idea for a soap opera plotline. But continue.
You would attend to the lion, obviously, and you’d totally lose the information. You wouldn’t know it anymore. That’s something called your working memory. Something distracts you; it’s gone. You haven’t stored those memories into what’s called delayed recall. You haven’t fully formed them into a memory that you’re going to store. That kind of memory requires your frontal lobes to concentrate and focus on this information.
After you rehearse stuff a bunch of times—let’s say you call me every day for 30 days. You would just remember that number. The reason you’d remember is because you have functioning medial temporal lobes and hippocampus. These systems [in the brain] package and form these new memories in ways that allow you to represent them across a distraction. In other words, you could do all sorts of stuff in between. You don’t have to keep reciting the number. You can go eat your dinner and go to the gym, do your day job, and then call me back.
Makes sense so far.
Now, let’s say you did this every day for years. Let’s say that you call your parents all the time, that they’ve had the same number since you were a baby. You could lose your hippocampus—in fact, there are patients who, because of bad seizures, they’ve had their whole hippocampus taken out—and lose that intermediate ability that we were just talking about, the ability to form new memories across a delay. But the ones that you’ve had for a long time, those are still there. Because they have been consolidated. They have been re-represented in some more distributed way throughout the brain that makes them harder to erase.
Let’s get back to ECT and memory. Because ECT is predicated on generating seizure, that seizure is usually going to involve the medial temporal lobes. It is the case that you’ll have a period of amnesia, where the person has a hard time remembering the things that happened immediately before the ECT.
Wait, let’s go back to that hypothetical. You’re saying that ECT actually would be an effective way for me to erase this person’s memory, as long as it’s recent? Again, in this scenario, I’m a crime lord.
If you had perfect control over the situation and could mimic some very short period of time, make them seize by putting them through ECT or some other way of causing a temporary dysfunction in those regions of the brain—yes, it’s possible that they could lose the memories of whatever period of time, right up to that incident.
But what wouldn’t happen to them is, they wouldn’t lose all knowledge of who they were, because all of those memories are consolidated. It wouldn’t wipe their identity from them.
It wouldn’t turn a cat person into someone who hates cats? Where do a person’s tastes and preferences come into all this?
You can think of your preferences as acquired positive associations to certain stimuli you have been exposed to over a lifetime. Not to get all Clockwork Orange with you, but I’m sure that if—from the time you were a small child—every time you saw a cat you threw up violently, you wouldn’t like them.
Probably not. So, to be a cat person is basically to have a lifetime of pleasant memories about cats.
Even if you don’t remember them. Even if you can’t call them up, because you have emotional hardware, what is called the limbic system, that links in with memory systems. We like the things we like because there are connections, direct or indirect, that over time, accumulating them seems to give us a preference for what we have a preference for.
What about forgetting specific skills? Could you forget how to use a laptop?
It is possible to have neurologic conditions that affect your ability to perform certain procedural skills that you already learned. For example, if you have that very familiar phone number that you’ve dialed every day, you might not even explicitly be able to tell someone it as quickly as you could just go to a phone and dial it, right? You know where the positions [of the numbers] are.
There are conditions where people can have trouble either acquiring those skills or will note that some of the skills they had have degraded. They were great in their golf game, and somehow they lost that ability when they have disorders that also affect their motor system in other ways. Because the motor system represents some of that information, and I’m not talking about just the motor system for the strength of your muscles, but control systems. Patients with Parkinson’s disease and related disorders can have problems with this kind of procedural learning. But it’s not going to be this kind of thing where they’ll sit down, not have the skill, and not know that they ever had the skill.
The way it would be portrayed in the television show, the person will be like, “No, I never knew how to do this thing.” [In reality] they would sense some degradation of their own prior motor acquisition.
What would you do, as a behavioral neurologist, if someone came to you exhibiting the symptoms of a soap opera amnesiac?
I would evaluate them. I would get a history, a neurological examination. I would look at imaging of their brain, and I would also keep my eyes and ears open for the kinds of markers that might signify that their problem wasn’t necessarily due to a focal neurologic injury, but perhaps some more holistic effect on their neuropsychological state, some kind of emotional trauma or some type of history that gives insight into the possibility that what they’re suffering from might be one of these dissociative disorders. That would be one thing to keep in mind.
A common resolution for soap opera amnesiacs is that all their memories come flooding back if they hit their head again or, as on Jane the Virgin, if they experience something familiar that unlocks their memories.
I think that’s what happened to Skipper. He got hit again.
I’m going to go ahead and assume that you would not recommend hitting someone who is experiencing memory loss over the head in an attempt to bring back their memory.
[laughs] Yeah, no. That is completely contraindicated. That is not the current standard of care.
What about the other way, triggering the memories with familiar surroundings or events? Michael’s come back when some plaster falls on him, which is also what happened during his first kiss with Jane.
It’s hard for me to answer that question, because the way it’s set up is not realistic enough for me to say, “Well, yes, if you bring one of these total amnesiacs into a situation, that’s going to cause their memories to come flooding back.” Let me say, I think that’s the point where it might be useful to talk to a psychiatrist.
Is there any way to make soap opera depictions of amnesia more realistic, if that’s something a writer wanted to do?
If they want to make it based on known neurologic conditions, then I think common severe memory loss is its own interesting plotline. It is incredibly hard to put yourself in that mindset, the mindset of not being able to store new information. Contrast that with your amnesiac from television. That guy doesn’t remember anything about the past, right? Their remote past. It’s like, it’s just gone. Somebody erased the hard drive. But they can store all the new memories from the time they show up on the set. Moving forward, it’s not like every time, every episode, they’re like, “I don’t remember anything that happened 15 minutes ago.” Imagine what life is like with that as your new normal.
That sounds like Dory from Finding Nemo. Are you saying the talking fish is actually a more realistic depiction of memory loss?
The talking fish appears to be more realistic than this resurrected husband figure. There’s also Memento. Again, not totally accurate, but closer than the total amnesia case, at least from a neurologic perspective, and I don’t think anyone would accuse that of not being an interesting movie.
Are there any other pop culture pet peeves you have as a neurologist?
I do think that medical shows are rife with misportrayals in general. This is a total aside, but I did this research involving noninvasive brain stimulation called transcranial magnetic stimulation, and it’s a little bit out there. We use magnets to manipulate, target parts of the human brain to make people think, to make their cognitive functions operate differently for either brief or long periods of time, depending on when we’re doing it therapeutically. Anyway …
Don’t let that fall into the hands of a crime lord.
I know, I know. I suddenly sound like a comic book supervillain, but it was portrayed in an episode of House once, and it was so laughable. They put little LED lights underneath the coil, and they’re waving it around like it’s a magic wand. It was an exquisite combination of amusing and painful to watch.
Anything else to add about amnesia?
Just that I really appreciate this opportunity to get this off my chest.
Gilligan’s Island has been weighing on you.
Let me tell you, I loved that show when I was a kid, and it’s one of those things that got me thinking, “Wow, this brain thing is really interesting.” So in a way it kind of motivated me and got me interested in doing the thing I do now, only to find out years later, that’s not how it works at all.
Are you telling me that the amnesia episode of Gilligan’s Island inspired you to become a neurologist?
There are a number of other things that led to that, but I thought it was very cool that memories can be altered in such a way. Turns out, it’s not so. But in a way, Gilligan did. Yes.
