Neurophysiologie Clinique/Clinical Neurophysiology (2008) 38, 171—176

D i s p o n i b l e e n l i g n e s u r w w w . s c i e n c e d i r e c t . c o m

j o u r n a l h o m e p a g e : h t t p : / / f r a n c e . e l s e v i e r . c o m / d i r e c t / n e u c l i

ORIGINAL ARTICLE/ARTICLE ORIGINAL

Autobiographic memory: Phenomenological aspects,
personal semantic knowledge, generic events
and characters (one case of pure retrograde memory
recovery)

Mémoire autobiographique : aspects
phénoménologiques, connaissances personnelles
sémantiques, souvenirs génériques et traits de
caractère (un cas de récupération d’amnésie
rétrograde pure)

C. Thomas Antérion

a

,

∗

, L. Mazzola

b

, B. Laurent

b

a

Unité de neuropsychologie CM2R, CHU Bellevue, 42055 Saint-Étienne cedex 05, France

b

Service de neurologie, CHU Bellevue, 42055 Saint-Étienne cedex 02, France

Received 12 February 2008; accepted 17 February 2008
Available online 20 March 2008

KEYWORDS

Pure retrograde

amnesia;
Functional amnesia;
Episodic memory;
Long-term memory;
Lifetime period;
Autonoetic
consciousness;
Recovery

Summary

Tulving et al. [Brain Cogn 8 (1988) 3—20] proposed an operational distinction con-

cerning memory between a semantic component consisting of general information about the
individual’s past and an episodic component, containing memories of specific events that can
be situated in space and time. After a mild head trauma and in the context of professional
troubles, patient FF displayed a pure retrograde amnesia concerning both his biographical
identity and semantic memories. The patient could no longer access his memories. However,
these did not seem completely lost since his answers to tests concerning historical events were
better than random, his answers to a television quiz were automatic, he showed temporal
transfer phenomena (ecmnesia) and since he retrieved the entirety of his memories within
nine months. The patient FF illustrates the loss of retrograde autobiographic memory and the
recovery of episodic memories, which requires three elements: a sense of subjective time, an

∗

Corresponding author.

E-mail address:

[e-mail]

(C. Thomas Antérion).

0987-7053/$ – see front matter © 2008 Elsevier Masson SAS. All rights reserved.
doi:

10.1016/j.neucli.2008.02.006

172

C. Thomas Antérion et al.

autonoetic awareness (the ability to be aware of subjective time) and a ‘‘self’’ that can travel
in subjective time.
© 2008 Elsevier Masson SAS. All rights reserved.

MOTS CLÉS

Amnésie rétrograde

pure ;
Amnésie
fonctionnelle ;
Mémoire épisodique ;
Mémoire à long
terme ;
Périodes de vie ;
Conscience
autonoétique ;
Récupération

Résumé

Tulving et al. [Brain Cogn 8 (1988) 3—20] ont proposé de distinguer la mémoire

sémantique, constituée d’informations générales ayant trait au passé d’un sujet et la mémoire
épisodique, faite d’événements précis situés dans leur contexte spatiotemporel de survenue.
Après un traumatisme crânien léger et dans le contexte de troubles professionnels, le patient
FF présenta une amnésie rétrograde pure concernant à la fois ses souvenirs biographiques
intimes et sa mémoire sémantique. Le patient n’avait plus accès à aucun souvenir personnel,
mais n’avait pas perdu ceux-ci. Premièrement, il répondait à des questionnaires concernant
des événements publics ou des célébrités mieux que le hasard ; deuxièmement, il répondait
automatiquement aux questions d’un jeu télévisé ; troisièmement, il vécut des phénomènes
de translations dans le temps (ecmnésie) et quatrièmement, surtout, il finit par récupérer
l’ensemble de ses souvenirs en neuf mois. Le patient FF nous renseigne sur la perte de la
mémoire autobiographique et sa récupération qui nécessite trois élements : le sentiment du
temps subjectif, un niveau de conscience autonoétique et un « soi » capable de voyager dans
ce temps subjectif, de contrôler la plausibilité des événements rappelés et de les situer dans
leur contexte d’origine.
© 2008 Elsevier Masson SAS. All rights reserved.

Introduction

The study of autobiographic memory presents conceptual
ambiguities.

Autobiographic memory is often considered only as an

episodic memory. It actually consists of a collection of
information as well as memories particular to an individ-
ual, which the individual has accumulated since his birth
and which allow him to construct a feeling of identity and
continuity

[29]

. The episodic component of autobiographic

memory includes phenomenological aspects of memory,
capacity of mental travelling in time and ability to relive
in the mind a past event with an autonoetic consciousness

[35]

.

Tulving et al.

[36]

proposed an operational distinc-

tion between a semantic component consisting of general
information about the individual’s past (workplace, names
of colleagues or friends) and an episodic component,
containing memories of specific events that can be sit-
uated in space and time (‘‘the day I saw in my town,
this actor playing this story’’). Many studies revealed
that subjects can answer questions about events of
their lives by using memories of generic autobiographic
events that were often repeated (‘‘walking in the garden
every Sunday’’)

[20]

. Recently, Tulving

[37]

showed that

personal semantic-memory retrievals concern general infor-
mation in lifetime periods, general events and character.
Conway

[3]

proposed a recent model with a construc-

tive account of autobiographic memory from knowledge
at three different levels of specificity: lifetime peri-
ods, general events and sensory/perceptual event-specific
knowledge.

Recall requires self-working memory: frontal lobe func-

tioning is involved in these effortful processes, which are
required to recollect episodic memory and for autonoetic
awareness. By contrast, some authors suggested that there
would be a transition from episodic memory to semantic
memory with time interval and repetition of similar events

[20]

.

Autobiographic memory is individuated knowledge,

which is based on self-experience and may be shared with
others. Both personal and social (and cultural) dimensions
are functionally and structurally related

[27]

. There are two

main bases for the distinction between episodic memory and
other types of declarative memory: firstly, episodic mem-
ory is temporally situated as an event in a specific point
in the past and concerns individual self’s experience

[34]

.

Secondly, episodic memory is characterised by autonoesis,
that is, re-experience of the past, as opposed to semantic
memory, which is characterized by noesis, that is, factual
memory with no accompanying sense of self-experience in
a specific past. ‘‘Autobiographic memory is clearly a form
of episodic memory in this sense, although not all everyday
episodic memories are retained in the set of « self stories »’’

[27]

.

Neuropsychological assessment

Autobiographic memories are explored with cue-word meth-
ods

[4]

, where the subject is asked to provide the first

specific memory that comes into mind for each cue-word
(river, dog

. . .). Some studies only examined personal-

semantic knowledge (childhood friends, schools, streets

. . .).

The method of the semi-structured autobiographic ques-
tionnaire

[16]

was developed to address the demands of

neuropsychological assessment. The Autobiographical Mem-
ory Interview (AMI) is divided into a schedule involving the
recall of personal-semantic information (names of teach-
ers, employers, doctors

. . .) and another one involving the

recall of autobiographic incidents, which are considered
episodic (but which may also be generic

. . .) from three dis-

tinct age periods: infancy to adolescence, young adulthood
(18—30 years) and recent past (last year). The Episodic and
Semantic Remote Memory Autobiographical Memory Inter-
view (TEMPau)

[29]

evaluates the recall of autobiographic

incidents (during a travel, with family

. . .) from four distinct

age periods and from last year. In this test, the episodic
character of recall is controlled.

Autobiographic memory

173

Anatomical correlates of isolated
autobiographic retrograde amnesia

No single lesion has accounted for the spectrum of isolated
retrograde amnesia syndromes. Medial temporal and dien-
cephalic structures are more associated with anterograde
amnesia

[26]

. Most cases of isolated retrograde amnesia

are not characterized by damage in these regions. Most
cases of isolated retrograde amnesia are secondary to her-
pes encephalitis

[2,6,27]

, head trauma

[15,31,33,38]

or

operated suprasellar meningioma

[39]

, which suggests that

multifocal lesions are necessary. Critical localizations of
focal lesions have included the anterior temporal lobes,
frontal lobes and posterior regions. The anterior tempo-
ral region is considered an ‘‘integrative’’ cortex, which is
involved in the cataloguing of multimodal memory traces.
Many patients with retrograde amnesia for episodic autobi-
ographic information have anterior temporal damage that
is right-lateralized or bilateral with more damage on the
right

[19,28]

. The presence of frontal damage is consistent

with the involvement of the frontal lobes in the performance
on memory tasks of remote memory that require strategic
processing of contextual information

[19]

. The presence of

anterior temporal pathology in most of these cases, how-
ever, suggests that frontal pathology is not sufficient to
cause isolated retrograde amnesia. Several researchers have
suggested an association between retrograde amnesia and
damage to posterior regions, including inferior temporal,
parietal, and occipital regions

[28]

.

Preserved anterograde memory and isolated
retrograde amnesia

Focal retrograde amnesia has been described in a certain
number of pathologies associated with documented brain
lesions in morphological imagery

[27]

. It has been also

reported in neurological episodes, mild enough not to cause
any visible lesions in morphological examinations

[13,30]

. It

may appear in a defined stressed environment, which ques-
tions the organic versus psychogenic character of the defect.
In this case, retrograde amnesia usually concerns identity
and autobiographic components.

Some authors

[23]

reported on metabolic alterations,

particularly in bilateral hippocampus and right-temporal
regions, despite a normal morphological imagery. These
observations suggest that functional neuronal alterations
would give rise to a blockade of the access to stored memo-
ries. However, it does not allow one to know whether or not
one psychological mechanism only could cause such func-
tional alterations. In order not to presume of an organic,
psychogenic or mixed origin, De Renzi et al.

[7,8]

suggested

the term of functional amnesia. The mechanisms of func-
tional amnesia remain obscure and it is impossible to say
whether they are univocal. Some authors, like Markowitsch

[23]

, think that the mere fact of wanting to differentiate

possible psychological and organic mechanisms implies that
this amnesia is artificial.

Lastly, amnesia can be compared to a repressive psy-

chic mechanism aimed to protect the patient. Few cognitive
models can account for this repression. The psychoanalyt-

ical model of Freud and his students can, indeed, define
amnesia as a means of unconscious defence, but cannot
identify the mechanisms of this conflict, in either term of
cognitive mechanisms or involved neural structures

[10]

.

Moreover, it is an apparent paradox that processes oper-
ating successfully on retrieval of newly learned information
cannot be used to retrieve information predating the injury.
‘‘It is unlikely that nature would evolve separate systems for
long-term retrieval that are differentially affected by neuro-
logical disease: one that operates on postinjury information
and another on preinjury information’’

[19]

. This does not

give any explanation to why these patterns of focal retro-
grade amnesia remain rare or why their evolution varies so
much

[12,14]

.

The patient FF illustrates the loss of retrograde autobio-

graphic memory and the recovery of episodic memories.

Case report: patient FF

FF, a 41-year old married man with two daughters (aged 10
and 14) and three stepdaughters (aged 33, 30, and 28) devel-
oped an acute isolated retrograde amnesia. He was working
as a history teacher and school headmaster. Whilst he was
talking on the phone, alone in his office, the patient fell
off his chair on 14th March 2002. He was found lying on the
floor, regained consciousness and amnesia was immediately
diagnosed. The neurological examination was normal. The
patient immediately displayed an amnesia concerning his
identity, that is, ignoring his name, address, profession and
social status. However, he did recognize his wife as soon
as he saw her and remembered that he had children the
day after. His identity amnesia disappeared after eight days,
unveiling an isolated retrograde amnesia. EEG, brain scan-
ner, MRI and angiography were normal. A PL carried out on
arrival in emergency room displayed a cell-free proteino-
rachy at 1.07 g and was never rechecked. It was noted that
the episodic amnesia occurred in a context of enormous pro-
fessional stress, which the patient found harder and harder
to cope with.

The patient had his first neuropsychological examina-

tion on 20th March 2002. He could memorize all the events
that had occurred since the hospitalization. He was sponta-
neously nervous and fully aware of his situation that worried
him a lot. The patient felt as if he had forgotten his entire
life. The check-up also included the memory of public events
and famous people. The patient had to perform the tests
by giving forced answers, which were better than random.
The patient was very cooperative and found it strange that
he remembered ‘‘nothing’’. He talked several times about
familiarity feelings as he remembered his relatives or lis-
tened to music. He surprised them by counting in euros very
easily (this currency had been in circulation for hardly three
months) and could not understand why they needed to con-
vert the sums into French Francs. His relatives reported that
he no longer smoked when he used to be a heavy smoker!
The patient remembered many of his dreams during his stay
at hospital and tried to analyze them spontaneously. He
remembered people or pictures, which he identified giving a
description of them or looking at photos. He recalled scenes
like for instance, an operating theatre where he was dressed
in green, a scene that was identified by his wife as being the

174

C. Thomas Antérion et al.

birth of their second daughters. The recollection of these
dreams immediately after waking up was less intensive after
one month. The patient had his story told by someone else
and read as many documents as possible. During his stay at
hospital, he watched a television game and surprised him-
self by giving answers he did not remember. Moreover, he
perfectly defined that a ‘‘palimpsestus’’ was a parchment
on which one erases a text to write a new story! This fact
reassured and comforted him in the idea that he ‘‘had not
forgotten everything’’.

An empirical neuropsychological treatment focused on

the retrieval of memories was then suggested: the sessions
were one-hour long and took place every 15 days. Memories
did not come back to him regularly, but rather periodically
and all in one lot. Most of the time and without know-
ing why, the subject remembered something that triggered
other memories. Such phenomenon that the patient named
‘‘flash’’ often happened while waking up or as he was read-
ing documents, but very rarely when a relative told him
something. The precipitant was often contextual, a memory
generating another memory to the spatiotemporal context
or to the close content: remembering a birthday gener-
ated the memory of another party night with the same
friends or the memory of a day out in the mountains, which
generated the memory of another day out in a different
mountain. Memories were retrieved chronologically. He was
always sure that what he remembered really happened.
When he remembered particular events, he explained that
they were first very clear, but faded away the following days.
For instance, he was able to remember a picnic with his
family and describe precisely what his wife wore that day,
which she did not remember herself (but which, on second
thoughts, was coherent with the time of the scene), as many
details he could no longer remember the following days.

Lastly, he displayed astonishing phenomena of ecmnesia.

First of all, as he was wandering into town, he could not find
his way, since the town map had been entirely changed for
several years. He described buildings that had been demol-
ished for 10 or 12 years. Lastly, as he was a schoolteacher, he
pictured himself chairing a year meeting (which in fact dated
back to 1990) and gave the names of all the teachers and
of many pupils attending that day. Within two months, the
patient had retrieved the first 20 years of his life. In the five
following months, he progressively retrieved his memories,
but kept a total amnesia concerning the last 12 years of his
life. The retrieval of these last memories took 15 days, nine
months after disorders started. The patient did not recall
what had happened on the day of the episode, but remem-
bered painful events within the same period. The patient
who was systematically examined every 12 months was doing
well, had resumed his work and all personal activities.

Discussion

The pure retrograde amnesia of patient FF comes within
the hazy scope of functional amnesias. FF displayed ret-
rograde amnesia after a short lasting loss of consciousness
and a minor brain trauma. The fact that FF forgot the whole
of his biography means that he forgot people, places and
conversations. As this information is distributed in various
cortical regions, one can assume that some convergence

areas play a critical part in the recollection and recon-
struction of biographical memories

[11,22]

. FF kept all his

procedural abilities, but had lost the habit of smoking, which
has already been reported by Lucchelli et al., 1995

[21]

in

the case of patient GR.

The period of retrograde amnesia in the context of

functional amnesias lasts invariably from two to 40 years

[1,18,24,30]

. It was total in the case of FF. However, he

retrieved the events from his childhood within the first
15 days, but maintained amnesia of 25 years during three
months and of 12 years during six months. FF retrieved the
personal events according to lifetime periods, as suggested
by Conway

[3]

. FF had a certain ability to initiate search

strategies, to check whether recalls were plausible and to
have an autonoetic consciousness. FF behaved as if he could
no longer have direct access to his memories, but was still
able to rebuild traces

[25]

. FF relearned historical events

and found that he could sometimes picture himself teaching
them. The semantic memory stirred an episodic situation,
which in its turn was enriched with other episodic mem-
ories that had occurred within the same period: general
events and sensory/perceptual event-specific knowledge.
FF noticed that the image of the memory was extremely
clear and bright. The re-experience of the past is accom-
panying the sense of self-experience in a specific past

[37]

.

Lastly, the patient experienced very intense reminiscences
phenomena with a transposition in time. These phenomena
have been reported in the amnesic ictus where the retro-
grade disorder can be accompanied by an updating of past
or recent events and relived as a present situation (redupli-
cation paramnesia). In this manner and after a mild brain
trauma, a baseball player was still able to play using a game
code that was totally incomprehensible to his new team
mates

[9]

or a rugby player was persuaded that he was play-

ing a match that had actually taken place eight days before

[17]

. It is not surprising that a retrograde amnesia should

trigger a transposition in the past if one admits that bio-
graphical memories are classified in a strict temporal order
just like in a diary.

Functional amnesias are known to regress within a few

days or months. Few details concerning the modalities of
recovery are reported in literature. Recoveries on a drip
of sodium amytal have been described

[1]

. Patient PN

[32]

retrieved his memories whilst he was watching a funeral cer-
emony on television, a similar event to the one preceding
the amnesia. Patient GR

[21]

suddenly recovered towards

the end of an anaesthesia, which at first triggered the rem-
iniscence of an anterior operation and later the memory of
all past events. Patient MM

[21]

recovered one month after

the initial amnesia: whilst he was playing tennis, he remem-
bered an old match and retrieved all of his memories. Some
of the patients named in literature, however, never recov-
ered

[5,24]

. FF suddenly retrieved the last 12 years of his

life after nine months of medical follow-up and this, in three
or four days, close to the case of GR

[21]

.

Pure retrograde amnesia corresponds to a gap in memory

access, which can reappear spontaneously or with precipi-
tants, totally or truncated and in a variable period of time.
Amongst the many interpretations, one can talk about a
contextual incompatibility between the encoding and recol-
lecting situations, which explains that recollection is easier
if done in the same thymical or biological conditions than

Autobiographic memory

175

learning. Another interpretation could be a loss of ability
of working self to access to past events and/or a frontal
control, which blocks mnesic traces in a new emotional
and biological context after alterations linked to stress or
trauma. In keeping with this, patient AMN

[24]

remembered,

during psychotherapy, a car in flames when he was four. This
is all the more interesting that his amnesia started when
he found a fire at home and he displayed flow alterations
in functional imagery. The authors dared to assume that
the fire revived an amnesic trace and led to a blockade
of the system. Patient FF illustrates the loss of retrograde
autobiographic memory and the recovery of episodic mem-
ories, which requires three elements: a sense of subjective
time, autonoetic awareness and a ‘‘self’’ that can travel
in subjective time. A common assumption for patients with
retrograde amnesia of psychogenic origin is that their mem-
ories are not lost, but just repressed or blocked

[23]

. FF

has strong similarities to previously described patients with
‘‘functional amnesia’’, an ability to acquire new informa-
tion, which persisted at long-term and minor-head injury
as a trigger for his amnesia. One may speculate that the
temporary-graded amnesia recovery might be attributable
to less firmly consolidated memory traces. His retrieval of
information was accompanied by the subjective phenom-
enal experience that characterises episodic memory. The
(re) learning of information was similarly described for sev-
eral previous cases with retrograde functional and organic
amnesia. Remembered painful events could explain his sud-
den environmentally triggered behavioural change. The way
emotional centres interact with cognitive centres has not
yet been completely clarified, but it is conceivable that a
sudden, abnormal excitation of the former can result in the
inhibition of the latter, through a mechanism that is cur-
rently better understood in physiological than psychological
terms.

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