Mind in the Media: How Accurate is the Amnesia Depiction in Apple TV+’s Surface?

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Mind in the Media
 is an ongoing series discussing mental health and psychology topics in popular movies and television.

Spoiler alert! This article contains major spoilers for the first season of the Apple TV+ series Surface.

Sophie (Gugu Mbatha-Raw), the main character in Apple TV+’s psychological thriller Surface, is pursuing an extremely personal mystery.

After falling from a boat and suffering a terrible injury that left her without any memory of her past, Sophie is trying to figure out who she was and whether her fall was really a suicide attempt like her husband James (Oliver Jackson-Cohen) and therapist Hannah (Marianne Jean-Baptiste) insist.

When the series starts, it’s been approximately five months since Sophie’s accident. Although her wounds have healed, her amnesia remains, and she’s becoming increasingly more desperate to remember. Sophie’s desire to recall who she was and why she jumped—or perhaps was pushed—from that boat, propel the story of Surface.

But how accurate is the show’s depiction of amnesia? And is there any legitimacy to the concern that if Sophie learns too much about her past, she could attempt suicide again? We spoke to experts to understand what would happen if Sophie’s fall happened in real life.

What Kind of Amnesia Does Sophie Have?

There have been more than a few movies and TV shows, from The Bourne Identity to Regarding Henry, built on the premise that a character has completely lost their past memories after suffering from an injury. According to licensed clinical psychologist Nicole Peniston at Thriveworks in Edison, NJ this would be classified as retrograde amnesia, or the loss of autobiographical—or personal—memories made prior to the onset of amnesia.

Although the kind of amnesia Sophie’s suffering from is never identified in Surface, the clinical report Sophie accesses about her accident in the show’s first episode says she sustained a suspected brain injury and her husband and therapist indicate that they attribute her memory loss to this injury, indicating that they believe she has retrograde amnesia.

However, Peniston suggests that Sophie might instead be suffering from dissociative, or psychogenic, amnesia, a kind of amnesia that occurs in response to emotional overload, not an injury.

Surface continually provides clues about Sophie’s mysterious past, including the fact that Sophie is not the character’s real name and that she was very good at conning people to get what she wanted. Therefore, Peniston observes that if Sophie became caught up in a scheme that led to significant stress or trauma, Sophie’s memory loss might be the result of dissociative amnesia.

Is Surface’s Depiction of Amnesia Realistic?

While it’s possible to identify the kinds of amnesia Sophie may be suffering from, if Surface is understood as a portrayal of a character with retrograde amnesia, it’s not especially realistic.

Neuropsychologist Laurence Miller, PhD, of Boca Raton, FL, notes that the show’s depiction of memory loss following a brain injury “is exactly the opposite of what happens in a true traumatic brain injury.” In reality, Miller says, although Sophie would likely suffer from a brief period of retrograde amnesia for events that happened immediately prior to her injury, her bigger memory issues would come in the form of anterograde amnesia, which would prevent her from forming new memories following her injury.

Based on this, it makes sense that Sophie doesn’t remember events right before she fell from the boat. Miller explains that before memories are stored in long-term memory, they have to be consolidated, a process that takes a few seconds to approximately 15 to 20 minutes. However, suppose the consolidation process is disrupted due to an accident like Sophie’s. In that case, memories won’t be stored, leading to a loss of the memories of events that occurred just before the injury happened.

Laurence Miller, PhD

[Sophie’s resulting situation] would require a brain injury so severe that other aspects of brain function would be involved. You’d be unable to think, your language would be disrupted, you’d barely be able to walk and function.

— Laurence Miller, PhD

Furthermore, Miller says that the longer the period of unconsciousness following a brain injury, the further into the past people will be unable to remember. In Sophie’s case however, the show establishes that she remembers being in the water immediately after falling from the boat and the paramedics rescuing her.

That suggests she wasn’t unconscious for a very long time and, therefore, she wouldn’t have retrograde amnesia that went back especially far in her life either. So while she might not remember making the decision to jump from the boat or falling afterward, she would likely remember almost everything else from the rest of her life.

Miller observes that the disruption to the memory consolidation process caused by Sophie’s brain injury is why, in reality, someone with a similar injury would also have anterograde amnesia.

If the injury impairs the parts of the brain that consolidate memories, that would lead to an inability to format memories in a way that would enable them to be stored in long-term memory.

As a result, Sophie wouldn’t be able to investigate the mystery of her past because she wouldn’t be able to remember anything she discovered.

However, according to Miller, Sophie would likely recover from this inability to make new memories, at least to some degree, although it could take anywhere from a few hours to a few months, depending on the severity of her injury.

Hollywood vs. Reality

Experts agree that Surface’s depiction of memory loss is pretty inaccurate. In the case of a real-life traumatic brain injury, Sophie would not be able to make or store new memories, which would have hindered her search for truth following her accident.

Additionally, given the course of events stated in the plot and her alleged retrograde amnesia, Sophie should have been able to remember previous events and elements of her life.

That being said, it’s possible Sophie’s true diagnosis is dissociative amnesia, given the mysterious nature of the injury she sustain and the trauma she suffered.

Both Miller and Peniston concur that one of the most unrealistic parts of Surface is the frequent runs Sophie takes.

According to the show, in addition to a brain injury, Sophie sustained multiple fractures and other physical injuries. Peniston points out that it’s highly unlikely that Sophie would be physically capable of taking daily runs just five months later. “There can be balance issues after a head injury, there can be motor planning issues, like not being able to plan the movements to run, so there’s a lot of things [about Sophie’s physical condition] that aren’t making sense.”

Similarly, Miller explains that while retrograde amnesia that totally wipes out someone’s autobiographical memories is possible, it’s exceedingly rare and “would require a brain injury so severe that other aspects of brain function would be involved. You’d be unable to think, your language would be disrupted, you’d barely be able to walk and function.”

Since Sophie’s physically able to take daily runs and isn’t neurologically compromised outside of her memory loss, the show’s insistence that Sophie has lost all her past memories but has recovered otherwise is entirely inaccurate.

From a neurological standpoint, then, Sophie’s memory loss may fit more comfortably with a diagnosis of dissociative amnesia, as Peniston noted.

That’s because just like Sophie, “in dissociative amnesia the person does actually act as if they have lost their identity,” Miller describes, “and in most cases, the person is neurologically intact, and in many cases there isn’t even any accident to explain it, so it happens spontaneously. And it’s usually attributed to a person due to severe conflict, sometimes severe trauma.”

Consequently, although Surface has only hinted at any severe conflict or trauma that Sophie may have suffered, dissociative amnesia seems to do a better job realistically accounting for her condition.

Would Sophie Continue to Be Suicidal After Losing Her Memories?

The possibility that Sophie attempted suicide—and that she will try again—hangs over Surface, and although the show eventually reveals the truth of what Sophie was really doing when she jumped from the boat, her husband’s and therapist’s worries about the possibility that she could attempt suicide a second time are well founded.

Laurence Miller, PhD

The best predictor of future behavior is past behavior. If somebody had a tendency towards suicidality prior to the injury, then generally that’s going to persist.

— Laurence Miller, PhD

“The best predictor of future behavior is past behavior,” observes Miller. “If somebody had a tendency towards suicidality prior to the injury, then generally that’s going to persist. One of the ironies is [suicide attempts]… can leave the person with fairly serious brain injury. So now you’ve got somebody who was suicidal to begin with, and now they’re impaired.” That might increase someone’s depression further, increasing the likelihood that they’d attempt suicide again.

Peniston agrees, noting that Sophie’s husband and therapist aren’t necessarily helping either, suggesting that by trying to get her to embrace her life now and dismiss her concerns about her memory loss, they “might be almost priming her for [suicidal] behavior.” However, Peniston also points out that in the story of the show, the impetus for Sophie’s initial suicide attempt and any future attempts would be different because while the first attempt was likely due to depression or other mental health challenges, any future attempts might be based on her bereavement over her amnesia.

Ultimately, Surface has taken a certain amount of dramatic license with its amnesia-based plot that’s prevented it from shedding light on the realities of the condition. If the series is renewed for Season 2, perhaps it will provide both more information about who Sophie really was before her amnesia as well as a more realistic explanation for her memory loss.

Read the full article here

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