doi:10.1093/brain/awp100
Brain 2009: 132; 2609–2616
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BRAIN
A JOURNAL OF NEUROLOGY
OCCASIONAL PAPER
‘The quicksand of forgetfulness’: semantic
dementia in One Hundred Years of Solitude
Katya Rascovsky, Matthew E. Growdon, Isela R. Pardo, Scott Grossman and Bruce L. Miller
Memory and Aging Center, UCSF Department of Neurology, San Francisco, CA, USA
Correspondence to: Katya Rascovsky,
UCSF Memory and Aging Center,
350 Parnassus Ave., Suite 905,
San Francisco, CA
94143-1207, USA
E-mail: [email protected]
This multidisciplinary article compares the pattern of memory loss described in Gabriel Garcı́a Márquez’s One Hundred Years of
Solitude to that exhibited by patients with semantic dementia (SD). In his renowned novel, Garcı́a Márquez depicts the plight of
Macondo, a town struck by the dreaded insomnia plague. The most devastating symptom of the plague is not the impossibility
of sleep, but rather the loss of ‘the name and notion of things’. In an effort to combat this insidious loss of knowledge, the
protagonist, José Arcadio Buendı́a, ‘marked everything with its name: table, chair, clock, door, wall, bed, pan’. ‘Studying the
infinite possibilities of a loss of memory, he realized that the day might come when things would be recognized by their
inscriptions but that no one would remember their use’. The cognitive impairments experienced by Macondo’s inhabitants are
remarkably similar to those observed in SD, a clinical syndrome characterized by a progressive breakdown of conceptual
knowledge (semantic memory) in the context of relatively preserved day-to-day (episodic) memory. First recognized in 1975,
it is now considered one of the main variants of frontotemporal lobar degeneration. Writing within the realm of magical realism
and investigating the power of language as a form of communication, Garcı́a Márquez provides beautiful descriptions of the loss
of ‘the name and notion of things’ typical of the syndrome. He further speculates on ways to cope with this dissolution of
meaning, ranging from ‘the spell of an imaginary reality’ to José Arcadio’s ‘memory machine’, strategies that resonate with
attempts by semantic dementia patients to cope with their disease. Remarkably, Garcı́a Márquez created a striking literary
depiction of collective semantic dementia before the syndrome was recognized in neurology. The novel also provides an
inspiring and human account of one town’s fight against ‘the quicksand of forgetfulness’.
Keywords: semantic dementia; Gabriel Garcı́a Márquez; One Hundred Years of Solitude; magical realism; neurology and
literature
‘La vida no es la que uno vivió, sino la que uno recuerda y cómo
la recuerda para contarla.’
Introduction
‘Life is not what one lived, but what one remembers and how one
remembers it in order to recount it.’
The insomnia plague
Gabriel Garcı́a Márquez
The mythical town of Macondo has been stricken with the
dreaded insomnia plague. Despite precautions, the illness spread
Received January 27, 2009. Revised March 16, 2009. Accepted March 22, 2009. Advance Access publication May 15, 2009
ß The Author (2009). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
For Permissions, please email: [email protected]
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| Brain 2009: 132; 2609–2616
through Úrsula Iguarán’s lovingly prepared candy animals:
‘Children and adults sucked with delight on the delicious green
roosters of insomnia, the exquisite pink fish of insomnia, and the
tender yellow ponies of insomnia, so that dawn on Monday,
found the whole town awake’ (Garcı́a Márquez, 1970). Initially,
Macondo’s inhabitants were not alarmed: ‘If we don’t sleep again,
so much the better’, José Arcadio Buendı́a said in good humour,
‘That way we can get more out of life’. Unfortunately, the most
fearsome part of the sickness was not the impossibility of sleeping,
but ‘its inexorable evolution toward a more critical manifestation:
a loss of memory’.
Loss of ‘the name and notion of things‘
The first and most devastating aspect of this memory loss was the
loss of ‘the name and notion of things’. Aureliano Buendı́a was the
first to notice this troubling symptom:
One day he was looking for the small anvil that he used for
laminating metals and he could not remember its name. His
father told him: ‘Stake’. Aureliano wrote the name on a piece
of paper that he pasted to the small anvil: stake. In that way he
was sure of not forgetting it in the future. It did not occur to
him that this was the first manifestation of a loss of memory,
because the object had a difficult name to remember. But a few
days later he discovered that he had trouble remembering
almost every object in the laboratory. Then he marked them
with their respective names so that all he had to do was read
the inscription in order to identify them. When his father told
him about his alarm at having forgotten even the most impressive happenings of his childhood, Aureliano explained his
method to him and José Arcadio Buendı́a put it into practice
all through the house and later on imposed it on the whole
village. With an inked brush he marked everything with its
name: table, chair, clock, door, wall, bed, pan. He went to
the corral and marked the animals and plants: cow, goat, pig,
hen, cassava, caladium, banana. Little by little, studying the
infinite possibilities of a loss of memory, he realized that the
day might come when things would be recognized by their
inscriptions but that no one would remember their use.
Semantic dementia
The cognitive impairments experienced by Macondo’s inhabitants
are remarkably similar to those observed in semantic dementia
(SD). Semantic dementia is a clinical syndrome characterized by
a breakdown of conceptual knowledge (semantic memory) in the
context of relatively preserved day-to-day (episodic) memory.
History
Although initially described by Pick (1892), SD is first recognized
in the neurological literature following an article by Warrington
in 1975 (Warrington, 1975). She described 3 patients with
progressive anomia accompanied by a loss of word and
picture comprehension. These deficits were apparent in the
absence of phonological or syntactic impairments of language,
K. Rascovsky et al.
perceptual/visuospatial abilities or day-to-day memory. Drawing
on Tulving’s newly proposed distinction between memory for
experienced events (episodic memory) and knowledge about the
world (semantic memory) (Tulving, 1972), she argued that these
patients exhibited a selective breakdown in semantic memory.
Shortly afterward, Mesulam (1982) described a number of cases
characterized by a ‘slowly progressive aphasia without generalized
dementia’ and coined the term Primary Progressive Aphasia
(Mesulam, 1982). On autopsy, the majority of these patients
showed non-Alzheimer’s pathology. It quickly became evident
that there were at least two main subtypes of progressive aphasia:
fluent and non-fluent. On the one hand, the non-fluent variety
was characterized by effortful, hesitant speech with agrammatism
and phonemic paraphasias, but relatively preserved comprehension (Grossman, 2002). On the other hand, it became clear that
the impairments of patients with ‘fluent’ aphasia went beyond
the domain of language, and in fact mirrored those described
by Warrington a few years earlier. This prompted Snowden
(Snowden et al., 1989) to re-name the syndrome ‘semantic
dementia’, as this name encapsulated the essence of a deficit in
representational knowledge. In 1992, Hodges and colleagues
described five similar cases and proposed criteria for the diagnosis
of SD (Hodges et al., 1992). Semantic dementia is now recognized
as the temporal variant within the frontotemporal lobar degeneration (FTLD) spectrum (Neary et al., 1998).
Description
Patients with SD often present to medical attention with empty
circumlocutory speech, prominent anomia and frequent semantic
paraphasias. They tend to replace specific words with general
terms (e.g. ‘thing’ for chair) or prototype members of the same
category (e.g. ‘dog’ for ‘rhinoceros’). They also have difficulty
understanding the meaning of words and will often express their
lack of familiarity with questions such as ‘cow? What is a cow?’
Nevertheless, their speech output is fluent, grammatically correct
and free of phonological errors.
The core semantic deficit in SD can be formally demonstrated
using a variety of tests. Semantic dementia patients exhibit severe
deficits in picture-naming, word-picture matching and tests of
associative semantic knowledge (e.g. Pyramids and Palm Trees
Test, Camel and Cactus Test) (Hodges et al., 1992; Howard and
Patterson, 1992; Bozeat et al., 2000; Ikeda et al., 2006; Rogers
et al., 2006; Hodges and Patterson, 2007). This failure to recognize or name objects is not due to perceptual deficits, as can be
seen in Fig. 1. Although SD patients are able to copy drawings
accurately and with great attention to detail, they are unable to
assign the correct name to each figure. Figure 2 best exemplifies
the dissolution of semantic knowledge in the disorder. When SD
patients are spontaneously asked to draw various animals, they
produce drawings that converge on a prototypical four-legged
creature, and they fail to include the salient features that would
distinguish these animals.
The deterioration of representational knowledge typical of SD
can be seen in all modalities. Thus, patients may have difficulty
with naming from verbal descriptions (Hodges et al., 1992a), identifying odours (Luzzi et al., 2007), non-verbal sounds (e.g. ringing
Semantic dementia in Garcı́a Márquez
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Figure 1 Animal copies by patient B.F. (shown on right) demonstrate retention of visuoperceptual ability in SD patients. Confrontation
naming tests highlight their semantic deficits. When asked to name these animals, B.F. called the cow a ‘dog’ and the elephant a ‘cow’.
Reference drawings by Katharine Woodman-Maynard.
of a telephone) (Bozeat et al., 2000) and selecting appropriate
colours for familiar black and white drawings (e.g. choosing
yellow for a banana) (Breedin et al., 1994). Most patients exhibit
deficits naming and later recognizing familiar faces (Hodges and
Graham, 1998; Snowden et al., 2004; Thompson et al., 2004),
and some have difficulties with actual object use (Hodges et al.,
2000; Bozeat et al., 2002).
In stark opposition to their profound semantic memory
deficits, SD patients reportedly have preserved memory for
day-to-day events. Caregivers report that patients can remember
prospective appointments, keep track of the preceding days and
weeks and, in general, continue to function adequately in their
daily activities. Semantic dementia patients also show preserved
performance on tests of visual recall and recognition (EdwardsLee et al., 1997; Graham et al., 2000; Hodges and Graham,
2001; Scahill et al., 2005). Other cognitive skills such as
visuoperceptual and spatial ability, non-verbal problem solving,
and working memory can be strikingly spared, even at relatively
late stages of the disease (for a review, see Hodges et al., 1992;
Hodges and Patterson, 1996; Hodges et al., 1998; Hodges
et al., 1999; Snowden, 1999; Perry and Hodges, 2000;
Hodges and Patterson, 2007).
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K. Rascovsky et al.
Davies et al., 2005; Shi et al., 2005; Knibb et al., 2006; Alladi
et al., 2007; Snowden et al., 2007; Davies et al., 2008). Most SD
patients exhibit ubiquitin-positive tau-negative inclusions, while a
minority of patients show either Pick’s Disease or Alzheimer’s
Disease. Atrophy always predominates in the temporopolar and
perirhinal cortices with relative sparing of adjacent temporal
regions (Davies et al., 2008).
Semantic dementia in One Hundred
Years of Solitude
Figure 2 Drawings by patient G.W. elucidate semantic deficits
in spontaneous recall. The figures converge on a prototypical
four-legged creature with a rounded abdomen. Distinguishing
features are absent: the fish lacks fins, the first bird lacks wings
and the elephant lacks a trunk.
Anatomy
Semantic dementia is now recognized as the temporal variant
within the FTLD spectrum (Neary et al., 1998). Quantitative
MRI imaging studies of patients with SD have revealed focal atrophy of the temporopolar and perirhinal cortices, as well as the
anterior fusiform gyri (Galton et al., 2001b; Chan et al., 2002;
Rosen et al., 2002; Davies et al., 2004; Gorno-Tempini et al.,
2004). The structural integrity of these areas has been shown to
correlate with performance in semantic memory tasks (Galton
et al., 2001b; Davies et al., 2004; Williams et al., 2005). As the
disease progresses, atrophy may also be evident in anterior medial
temporal lobe structures (Chan et al., 2001; Galton et al., 2001a)
as well as ventromedial frontal regions (Mummery et al., 2000).
Pathology
There have been few SD cases with pathology reported in
the literature (Rossor et al., 2000; Hodges et al., 2004;
Coined by German art critic Franz Roh in 1925, the phrase magical
realism originally captured a post-expressionist style of realist
painting that cast common objects in a new light so as to reveal
their original mysticism masked by familiarity. Through later decades, the term evolved to describe a writing style rich in fantastical
elements that blend into the backdrop of an otherwise ordinary
reality. In his essay Magical Realism in Spanish American
Literature, Luis Leal writes, ‘In magical realism key events have
no logical or psychological explanation. The magical realist does
not try to copy the surrounding reality (as the Realists did) or to
wound it (as the Surrealists did) but to seize the mystery that
breathes behind things. . . . In magical realism ‘the mystery does
not descend to the represented world, but rather hides and
palpitates behind it’ (Leal, 1995).
Although increasingly recognized as an international movement,
magical realism has undeniable roots in Latin American literature.
Garcı́a Márquez’s One Hundred Years of Solitude is often cited as
one of the earliest and finest examples of modern magical realism.
Throughout the novel, the lines between objective reality and
dreams are consistently blurred, as seen in the character of
Mauricio Babilonia, a mechanic who is forever surrounded by
yellow butterflies. Similarly, Remedios the Beauty, too beautiful
and innocent for the lustful appetite of Macondo’s men, one
day rises into the heavens while folding laundry. In the realm
of magical realism, the world as imagined by Garcı́a Márquez
is not defined by traditional rationalism, but rather by alternate
realities that co-exist almost seamlessly in the lives of Macondo’s
residents.
Garcı́a Márquez’s masterful use of magical realism is on full
display in his depiction of the memory loss epidemic that ravages
Macondo. While his conception of the plague is undoubtedly
fantastical, Garcı́a Márquez, the magical realist, depicts the catastrophe as if it were an everyday reality. He probes the mystery
that ‘hides and palpitates’ behind mundane concepts, such as the
names of everyday objects. This process leads him to a terrifying
vision—of a world in which people are unable to communicate the
names of things, or to understand their use—that bears a striking
resemblance to the clinical syndrome of SD.
Semantic loss
Writing in the style of magical realism, Garcı́a Márquez provides
beautiful descriptions of the loss of ‘the name and notion of
things’ experienced by Macondo’s villagers. This is best
Semantic dementia in Garcı́a Márquez
exemplified by the strategy devised by José Arcadio to combat the
effects of memory loss:
The sign that he hung on the neck of the cow was an exemplary proof of the way in which the inhabitants of Macondo
were prepared to fight against loss of memory: This is the cow.
She must be milked every morning so that she will produce
milk, and the milk must be boiled in order to be mixed with
coffee to make coffee and milk.
José Arcadio realizes that memory loss extends beyond the mere
loss of names; rather than simply hanging a sign that reads ‘this is
a cow’ on its neck, he elaborates on the animal’s importance in
the production of milk and, by extension, coffee. The sign encapsulates not just the name of the cow, but its purpose, or its
semantic connection with other objects. In the same way, patients
with SD struggle not only with naming objects, as shown in Fig. 1,
but also with recalling how an object must be used, or how it
might interact with other objects.
Brain 2009: 132; 2609–2616
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Many SD patients catalogue their retained vocabulary in an
attempt to keep track of object names and concepts; this activity
bears a striking resemblance to the strategy described in One
Hundred Years of Solitude. In Fig. 3, one SD patient imposes
order on a seemingly disconnected string of vocabulary words
by linking specific words to the larger semantic categories that
group them together and shed light on their purpose.
Autobiographical memory
Semantic dementia also affects remote autobiographical episodic
memory in a rather unusual way. Using the Autobiographical
Memory Interview, Graham and Hodges (1997) found that,
although SD patients were successful in producing autobiographical memories for the most recent time-period, they were significantly impaired at retrieving episodes from childhood and early
adulthood, thereby reversing the pattern of retrograde amnesia
exhibited by classic amnestic and Alzheimer’s disease patients.
Figure 3 Word list by patient L.H. reflects her attempt to preserve vocabulary. She writes specific words followed by parenthetical
descriptions of the category into which those words fit, e.g. ‘cucumber (food)’ and ‘Cincinnati (city)’. She also groups words by
category, e.g. ‘blanket, pillow case, sheet, bed’. These strategies help the patient not only to remember the names of objects but also
to recall how these words can be grouped into larger semantic categories and therefore used in relation to each other.
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K. Rascovsky et al.
This sequence of progressive memory loss, starting with distant
memories, resembles that of Macondo’s inhabitants: ‘. . . when the
sick person became used to his state of vigil, the recollection of his
childhood began to be erased from his memory, then the name
and notion of things, and finally the identity of people and even
the awareness of his own being, until he sank into a kind of idiocy
that had no past’.
A town copes with loss of meaning
Garcı́a Márquez speculates on strategies a small community might
use to cope with the dissolution of meaning. This description
serves as a testament to the immense challenges posed by a
progressive loss of semantic knowledge and, more importantly,
to the unwavering and human need to maintain hope during
difficult times.
Initially, Macondo’s inhabitants cope with their memory loss
practically. They apply José Arcadio’s labelling method to ensure
that everything’s name and function is known:
At the beginning of the road in to the swamp they put up a sign
that said MACONDO and another larger one on the main street
that said GOD EXISTS. In all the houses keys to memorizing
objects and feelings had been written.
Eventually, despair led some villagers to abandon the method:
The system demanded so much vigilance and moral strength
that many succumbed to the spell of an imaginary reality, one
invented by themselves, which was less practical for them but
more comforting. Pilar Ternera was the one who contributed
most to popularize that mystification when she conceived the
trick of reading the past in cards as she read the future before.
By means of that recourse the insomniacs began to live in a
world built on the uncertain alternatives of the cards, where a
father was remembered faintly as the dark man who had arrived
at the beginning of April and a mother was remembered only as
a dark woman who wore a gold ring on her left hand, and
where a birth date was reduced to the last Tuesday on which
a lark sang in the laurel tree.
While some of Macondo’s inhabitants resign themselves to their
fate, some are not content to fade into oblivion. José Arcadio
combats the insomnia plague by building an encyclopedic
‘memory machine’—a blueprint for villagers to make sense of a
world that has lost its meaning:
The artifact was based on the possibility of reviewing every
morning, from beginning to end, the totality of knowledge
acquired during one’s life. He conceived of it as a spinning
dictionary that a person placed on the axis could operate by
means of a lever, so that in very few hours there would pass
before his eyes the notions most necessary for life.
The ‘memory machine’, which attempts to capture words, definitions and ‘notions’ essential to life, is Garcı́a Márquez’s most
fantastical solution to memory loss, but remarkably is the most
Figure 4 Patient R.B. lists in a yearly planner his residences
across a 32-year period, reflecting his attempt to retain basic
autobiographical information and to carry a physical reminder
of his identity on his person at all times. The mention of
Bethlehem indicates the importance of religion in his life,
showing again how the pocketbook planner is crucial to his
self-identification.
similar to the coping mechanisms used by SD patients as they
deal with progressive semantic loss. The excerpts in Figs. 4
and 5, taken from a pocket planner, paint the picture of a man
fighting the gradual loss of valuable memories (his home and
friends), who creates a portable ‘memory machine’ to keep details
of his life accessible. The patient’s journal, kept close at all times,
acts as a physical manifestation of his remote past to partially
alleviate the strain of losing his identity. The desperation of José
Arcadio, who pens almost fourteen thousand entries for his
machine, further resonates with the SD patient from Fig. 3, who
methodically stores the totality of her vocabulary on sheets of
paper. By committing words and knowledge to paper, diaries, or
even a ‘spinning dictionary’, patients with SD and Garcı́a
Márquez’s fictional characters share the desire to imbue their
fading semantic knowledge with permanence.
Discussion
In One Hundred Years of Solitude, Garcı́a Márquez created a
literary depiction of collective semantic dementia before the syndrome was recognized in neurology. The memory plague section
of the novel also provides an inspiring and human account of one
town’s fight against ‘the quicksand of forgetfulness’.
Semantic dementia in Garcı́a Márquez
Brain 2009: 132; 2609–2616
| 2615
process and a fantastical plague. As such, Garcı́a Márquez
achieves a masterful portrayal of SD not just in his description of
the plague’s ravaging effects on semantic knowledge, but even
more vividly in his account of the affected people’s ability to maintain hope through various coping strategies—to preserve their
fragile self-identity in the pages of word lists and pocketbook
diaries.
Caveat
Any manuscript that attempts to uncover deeper meaning in One
Hundred Years of Solitude must end with a caveat. As Garcı́a
Márquez himself points out: ‘In general, [critics], with the investiture of pontiffs, don’t realize that a novel like One Hundred Years
of Solitude completely lacks seriousness and is full of signals to
close friends, signs that only they can decipher; so they assume
the responsibility of decoding all the riddles in the book, running
the risk of saying a lot of stupid things’ (Garcı́a Márquez and
Apuleyo Mendoza, 1982). Whatever his intention, it is clear that
Garcı́a Márquez offers his readers insights into the nature of
knowledge and the scope of semantic memory. That his depiction
of Macondo’s dreaded insomnia plague resonates so well
with clinical accounts of SD is a testament to Garcı́a Márquez’s
perceptiveness and to the value of studying cognition in neurodegenerative disease.
Figure 5 Patient R.B. devotes another page from his pocketbook planner to familiar names. The page is not thematic, as
entries alternate between using location, occupation and
directions as descriptive factors. The inconsistency of details
highlights the fragmented memory of once intact interpersonal
relationships.
Why does Garcı́a Márquez envision a world in which people
lose their ability to communicate the names of everyday things?
He gives some insight into his use of magical realism in the
opening lines of the novel, in which he describes the village of
Macondo in its earliest days: ‘the world was so recent that many
things lacked names, and in order to indicate them it was necessary to point’. With this description, Garcı́a Márquez implies that
the ability to assign a name to an everyday object is a defining
human achievement that has developed over time. In this light,
the insomnia plague forces Macondo villagers into a primitive state
by robbing them of their ability to remember ‘the name and
notion of things’.
Remarkably, Garcı́a Márquez’s probing investigation of the
power of words and everyday names leads him to a striking
literary enactment of the clinical syndrome of SD and the
problems faced by SD patients. His fictional characters, just like
the SD patients discussed here, are acutely aware of the ‘infinite
possibilities of a loss of memory’. Both patients and characters
attempt to preserve semantic meaning in more permanent forms
that are free from the devastating effects of a neurodegenerative
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