Autobiographical memories are not stored in isolation but rather are organized into life chapters, higher-order knowledge structures that represent major themes conveying the arc of one's life. Neuropsychological studies have revealed that both episodic memory and some aspects of personal semantic memory are impaired in adults with medial temporal lobe (MTL) damage. However, whether such impairment compromises the retrieval and formation of life chapters is unknown. Therefore, we had 10 adults with MTL amnesia and 20 control participants narrate their life stories, and we extracted life chapters from these narratives using a novel scoring protocol. For the retrograde and anterograde time period separately, we evaluated the number of life chapters and assessed their quality, as indexed by measures of complexity and richness. Additionally, to investigate the idea that formation of life chapters occurs on a protracted time scale, we separated the amnesic participants into an early-life and a later-life onset subgroup. Results revealed that early-onset, but not later-onset, amnesic participants generated fewer retrograde life chapters than controls. The higher-order temporal relation among retrograde chapters, but not their thematic relation or the richness of individual life chapters, was impaired in both amnesic subgroups. The amnesic participants also generated fewer anterograde life chapters than controls, and the richness of their anterograde chapters was reduced in terms of content, but not self-reflection. Findings suggest that the organization of autobiographical content into life chapters is a protracted process that depends on the MTL, as does retrieval of higher order temporal relations among life chapters.