Brain Damage

McFadden’s experience as a practicing physician specializing in brain injury lends authenticity to Brain Damage. The novel’s dedication, “For my patients” (3), signals the link between her clinical work and fiction. The narrative provides a detailed depiction of recovery from a traumatic brain injury (TBI), a condition resulting from a violent jolt to the head that disrupts normal brain function. According to the Centers for Disease Control and Prevention (CDC), “a person with a moderate or severe TBI may need ongoing care to help with their recovery” (Centers for Disease Control and Prevention, Traumatic Brain Injury and Concussion, About Moderate and Severe TBI, 16 May 2024). TBIs often result in long-term complications that affect thinking, motor skills, sensation, and emotional functioning, all of which Charly experiences.

A common complication is hemispatial neglect, a neuropsychological condition common after injury to the brain. Patients who have this condition lose awareness of the area opposite the side of the injured brain hemisphere, and “it has proven to be a challenging condition to understand, and to treat” (Parton, A., Malhotra, P., and Husain, M. “Hemispatial Neglect.” Journal of Neurology, Neurosurgery, and Psychiatry, 2004. 75(1):13-21). Charly’s brain injury is in the right hemisphere, so she has left-side neglect. Her experience mirrors clinical examples with striking precision: She neglects food on the left of her tray, misreads “occupational therapist” as “rapist” because she sees only the right half of her world and initially lacks awareness of her left arm. This medical accuracy, stemming from McFadden’s professional background, transforms Charly’s unreliable narration from a convenient trope into a realistic exploration of how physical brain trauma can shatter a person’s reality, memory, and identity, grounding the novel’s psychological suspense in verifiable medical science.

Within this medical framework, Brain Damage uses conventions of the psychological thriller genre to explore the fragility of memory and identity. A central trope of the genre is the unreliable narrator. Some narrators intentionally mislead; in other cases, like Charly’s, a character’s perception of events is compromised. Charly’s unreliability stems directly from a severe TBI, which fragments her memory and distorts her sensory input. Hemispatial neglect causes her to miss half of her world, rendering her vulnerable to manipulation and unable to trust her mind. In other psychological thrillers, narrators lack reliability for different reasons; for example, in A. J. Finn’s The Woman in the Window, agoraphobia and substance use undermine the protagonist’s credibility.

Brain Damage builds a pervasive sense of paranoia, another genre hallmark that is believable within the context of Charly’s experience recovering from a TBI. While she’s in a rehab facility, surrounded by people with unclear motives, she struggles to distinguish friend from foe. Her husband, Clark, exploits her cognitive deficits, creating a plot driven by psychological manipulation rather than overt action. Charly’s recurring dream, in which a voice whispers, “You deserve this” (82), externalizes her internal battle to reconstruct memories while contending with the fear that she can’t trust herself or anyone around her. This conveys the psychological horror of her condition.