‘In 1953 Dr William Beecher Scoville removed the hippocampii from Henry Molaison’s brain and left us with this artefact — which sort of makes archaeologists of us all — this artefact, Patient H.M.’
On 28th August, Analogue came together with leading figures from the neuroscience world to discuss the man behind the brain. Among the panelists were two neuroscientists who met Henry in his lifetime: Professor Richard Morris from the Centre for Cognitive and Neural Systems at the University of Edinburgh and Dr Jacopo Annese, the man who dissected HM’s brain in 2009, who joined us live from The Brain Observatory in San Diego.
It was a rare and exciting opportunity to ask experts at the cutting edge of their field more about HM’s story, to find out what we are learning from exploring the 2401 slices, and to explore what impact it might hold for our understanding of memory and the brain.
The University of California – San Diego has done all that I’ve trying to accomplish here on the blog. Meet “Project H.M” – a site and study based entirely on Patient H.M..
The Brain Observatory is dedicated to the study of the architecture of the human brain. We have optimized multiple complementary imaging modalities to illustrate the detailed structural design of the brain.
Jun 6 2013
Henry Molaison after his high school graduation.
In 1953 Henry Molaison, a sufferer of severe epilepsy, underwent experimental brain surgery that saved his life and robbed him of it at the same time. While the removal of bits of Henry’s brain (the hippocampi and parts of both amygdala) cured his condition, it also left him with a sort of amnesia, the likes of which neuroscience had never seen: every 30 seconds his memory was completely erased. Molaison became the first sacrificial martyr in the study of human memory. Although as a subject he was responsible for 60 years of breakthroughs in neuroscience, as a person he was reduced to clawing at facts that swirled around his conscious. After his father passed away, he carried a note in his pocket that read “Dad’s dead.”
Dr. Suzanne Corkin met Henry in 1962 when she was only a medical school graduate. Having become his lead investigator in 1982, she spent the next 46 years of her life working with him. I gave Dr. Corkin a call to try to understand what not being able to remember a parent’s death must feel like.
VICE: Hi Dr. Corkin. In your book, Permanent Present Tense, you make a beautiful analogy which to me sums up Henry’s condition sublimely. You write that “information collects in the hotel lobby of Henry’s brain but can’t check into any of the rooms.” Could you expand on this for me?
Dr. Suzanne Corkin: This is what inspired the title of my book, and that means basically that he was always living in the moment. He couldn’t tell you what he had done earlier that day, or the day before, or the month before. Once you distracted him, he couldn’t remember what he’d just been talking to you about.
I’m gonna try an analogy myself. It sounds like the closest experience we would have to Henry’s condition would be walking into a room and immediately forgetting our reason for doing so. Was this a constant frustration for Henry?
Well, he got used to that. He lived in very familiar surroundings after his operation. He lived with his parents and spent a lot of time in that house. So he got used to walking from one room to another without really knowing why. Presumably if he had to go to the bathroom he knew why he walked to the bathroom. He didn’t know where things were kept. He helped with yard work and he didn’t know where the tools were commonly kept.
Did he often watch the same films over and over?
Oh sure, he could read the same magazines over and over too.
What about music, were there any particular melodies that got stuck in his mind?
There was. I actually tested this formally. I made up a test where I went to the library and found the top ten tunes on the Hit Parade every year from 1926 (that’s when he was born) and recorded them. When I played them to him, and he recognized some of them… it wasn’t a complete failure. The controls did more but you’ve got to remember that he didn’t have much of a social life as a teenager because of his epilepsy.
Did he ever guess?
He wasn’t a confabulator but on occasion he did guess. When I asked him whom we had fought in the Gulf War, for example, he said, Mexico and Cuba. Obviously he had the wrong Gulf but he was able to fall back on his intellect. He made intelligent guesses, he didn’t make things up.
Did he ever lie?
Not that I know of. He had cataract surgery though, and after that he didn’t wear glasses any more. One time we asked him where his glasses were and he said, “Oh, somebody must have stole them.” It wasn’t a lie, because he didn’t know. All he knew was he wore glasses, so if his glasses weren’t there, he had to give an explanation for that.
How did he remain aware that his parents had passed away?
He didn’t. I think it just took him a long time of not seeing them to understand that they were gone.
The hippocampus—the part of Henry’s brain that was excised in surgery, and ultimately caused his amnesia.
What was Henry’s relationship like with the other sex?
Well, he was certainly always very polite, to the point of being chivalrous. I have several pictures of him with a woman named Maude, from I think it’s 1946. One is of the two of them standing together on the beach and they have their arms around each other. The other picture was of Maude in a pinup-like pose and on the back it reads, “To Henry, Love Maude.”
I also have letters from two friends of his who were in the service during WWII. They talked a lot about dames, babes, going out, getting married, and all of those kinds of things. So it was part of his conversation, but I don’t honestly know the extent to which these are true.
Did he ever mention girls after the operation?
No. We asked him about girlfriends, and he never mentioned Maude, which is very interesting.
There’s a spiritual aphorism that many religions aspire to, and it’s about forgetting the past and not worrying about the future. They preach that living in the present can bring an enlightened sense of peace. Do you think Henry unwittingly achieved this?
I don’t know that I can go out on a limb far enough to say he was having “zen” moments. A lot of people describe him as a very gentle person. I think he was that way preoperatively too. His father was also the “spoke-when-spoken-to” kind of person, so it’s hard to figure out how much of it is just genetic personality and how much was caused by him having his amygdalas removed, which used to be done to prisoners to tame them.
When he came to the clinical research center, he would have meals and we would test him, but sometimes he would have downtime when there was nothing special for him to do. The nurses put his chair out in the hall and he would sit there so that the people going by could say, “Hi, Henry.” He enjoyed this little extra stimulation. He was perfectly happy to sit there in the now, not asking, “What am I going to do next?” “When is dinner?” “May I have a glass of water?” He just sat there and enjoyed the scenery, the traffic of people walking by him in this little research center. It’s hard to determine whether that was to do with the memory, it was multifactorial. He was a happy person, he was not depressed.
How did Henry perceive you?
About 20 years after the first day we met, he started saying that he recognized me.
What did Henry provide to the field of study in human memory?
His dedication to research brought about an epiphany in the science of memory. First of all, he was living proof that you could be an intelligent person and still have a horrible memory. His IQ was consistently above average. This tells us that memory is processed by specialized brain circuits—that memory is compartmentalized.
The second thing Henry showed, was the ability to store new memories is localized to a specific part of the brain and this is the inner part of the temporal lobes. Before Henry, we didn’t understand that the hippocampus and the surrounding cortex are essential for the establishment of long-term memory. His third contribution was the discovery that there are different kinds of memory with different addresses in the brain. We know now that there are several different kinds of memory that are preserved in amnesia.
Didn’t they leave a small part of the hippocampi, where the flickers of memory function as a ghost of his memory?
No, the telephone lines going in were cut. The area of the brain that supplies information to the hippocampus was virtually all removed, there was only tiny little scraps left behind. For all practical purposes, on a day-to-day basis, he remembered nothing. Every now and then, there’d be these little scraps that came out and we’d fall off our chairs in surprise and excitement, but day after day this guy didn’t remember anything.
Memory forms a narrative of a person’s past, an identity. Did Henry lose that after the surgery?
That’s a complicated question. As you know, scholars ranging from philosophers to neuroscientists have argued that an individual who lacks the capacity to remember also lacks an identity.
So did Henry Molaison have a sense of self? The answer is yes, he did. It was just less complete than yours or mine. Our notion of self is that it’s a composite of memories from the past and the present, and our plans for the future. And when we look at Henry’s access to these time periods, we find it was patchy. So, he has rich representation covering the period of his birth, which was from 1926 right up to when he had his operation in 1953, he could tell us what he did for fun like roller-skating, banjo-playing, and target practice.
However the qualities of these preoperative memories were severely compromised in that he didn’t have any episodic autobiographical memories. He couldn’t remember anything that happened at a specific time or place as a unique episode.
Years after his operation he had selective insights and fragments of information, so he did have a sense of his identity. He knew that he had an operation and he also had the feeling that the procedure had only been tried on a few people before him, and that during the operation something went wrong. He knew this and was able to articulate it, but above all else he knew that he had a terrible memory. An interesting corollary of this was that he couldn’t record any new information, so his body image was outdated. He described himself as thin but heavy, and he was unaware he had grey hair.
Could he configure an image of the future?
No, he couldn’t construct an agenda. One of his constant little things were these little monologues. One of them was about how he wanted to be a brain surgeon.
But he believed he couldn’t, because he wore glasses. He thought they’d be dirty so he couldn’t see properly, or the nurse would wipe his brow and dislodge his glasses, or blood would spurt up in his glasses. If this happened, and his vision was impaired, he might make a mistake and harm someone. He would talk about the kind of things he might do to them, he had a real conscience and he didn’t want to do anything like that to someone else. The interesting thing was that he didn’t have a plan B. He actually had no plans. When I asked him what he’d do tomorrow, he said whatever’s beneficial, full stop. He couldn’t create a future and he was never able to chase his dreams because he didn’t have any.
In the mid-twentieth century, the lobotomy was such a popular “cure” for mental illness that Freeman’s colleague António Egas Moniz was awarded the 1949 Nobel Prize for Medicine for his role in perfecting the operation. While Moniz was treating patients in Europe, Freeman started using an ice pick-shaped instrument in America to perform up to 25 lobotomies a day, without anaesthesia, while reporters looked on. Freeman’s crazy antics didn’t scare off potential patients, though: John F. Kennedy’s sister Rosemary got a lobotomy from Freeman, which left her a vegetable for the rest of her life. And she was one of many people whose “cure” was more like zombification than freedom from mental anguish.
How did the lobotomy ever become accepted medical practice? And why are people still getting them today, under the less-disturbing name “lobectomy”?
Invention of the lobotomy
Moniz and Freeman are usually credited with inventing the lobotomy in the 1930s, though in truth their work was based on many other people’s research going back to the mid-nineteenth century. They had read about the work of a European doctor named Gottlieb Burckhardt, who in the 1880s performed some of the first psychosurgeries on patients’ frontal lobes as well as other parts of their brains. Though Burckhardt was derided by his colleagues, some of whom thought his work was barbarous, Moniz and Freeman were intrigued by the idea that the frontal lobe could be somehow separated from the rest of the brain. This would leave incurably schizophrenic patients relieved of their emotional distress, they believed. In experiments with dogs, they determined that cutting nerves between the brain and its frontal lobe – the so-called “seat of reason” – left the animals quiet.
And so Moniz, later followed by Freeman, began experimenting on patients. His first surgery, on a mentally ill woman, involved drilling two holes in her skull and pumping alcohol into her frontal cortex. Later surgeries involved “coring” several regions in the frontal cortex with hollow needles – literally sucking out parts of the brain to sever neural connections. All these surgeries were done blind, which is to say they rarely opened up a person’s skull to see where they were cutting. Moniz just drilled into the skull and guesstimated where he should core or cut.
They published articles about their work in prestigious scientific journals, reporting that patients who had been horrific burdens on their families, violent or suicidal, were calmed down immeasurably by the surgery. In a 1942 presentation at the New York Academy of Medicine, Freeman and his research partner James Watts reported that after lobotomy, patients did sometimes become “indolent” or “outspoken.” They were like “children,” and loving families could simply dismiss their lack of social graces because now they were so much happier.
Moniz, in a 1937 article on the procedure, describes curing a woman from Lisbon whose husband took her to the Congo, where she was unhappy and became “incapable of running her household.” So her husband forced her to go back to Lisbon alone, against her wishes, and she gradually became deeply upset because she was always “expecting horrible events” and believed people were out to kill her. In retrospect, it seems clear why she might have felt that way, but Moniz reports that after a frontal lobotomy she was cured, “though possibly a little reticent.” Though many of Moniz and Freeman’s patients became essentially catatonic, while others were unaffected, enough seemed “cured” that the lobotomy became standard practice in mental institutions in the 1940s and early 50s.
The icepick cure
Freeman apparently found Moniz’s techniques a bit stodgy, and he began experimenting with an outpatient procedure, where he would drive an icepick into his patients’ brains near the top of their eye sockets. Once the pick was inside the brain, he would literally wiggle it around, cutting through the white and gray matter. It was not a precision surgery. Using a hammer and his pick, he boasted that he could do a lobotomy in 10 minutes and didn’t even need anaesthesia (though usually he gave the patient shock treatment first, so they were unaware of what was happening). The icepick method was too much for Watts, who distanced himself from his former partner.
But Freeman became a big hit in America, where he toured hospitals performing the procedure and training psychologists to do it too. He even prescribed it for headaches. So many people wrote about Freeman’s work – he was a showman who invited press coverage – that he managed to popularize the surgery further. Of course, the lobotomy always had its critics. Doctors, as well as the families of patients, protested that the surgery did nothing more than turn people into vegetables. Sure, they might be easier to take care of, but were they really being helped? Or just snuffed out?
In 2005 NPR did an interesting profile of a man who was given a lobotomy by Freeman in the 1950s, because his stepmother felt that he was “savage” and refused to go to bed. The man was traumatized by the experience, but seemed to have suffered no ill effects – though of course, it’s impossible to know who he might have become if nobody had driven an icepick into his brain.
Rise of the lobectomy
These days, lobotomies are no longer performed on the mentally ill. The rise of drugs like thorazine make it easier to chemically lobotomize patients – no more messy ice picks. Though many doctors protest that these anti-psychotic drugs are just as bad as lobotomies once were, the justification for their use continues for the same reasons lobotomies were embraced 70 years ago. The patients often seem happier and more calm. Plus, they are less trouble to their families and caretakers.
A lobotomy-like procedure called the lobectomy, however, is on the rise. That’s because it’s actually an excellent way to treat extreme cases of epilepsy as well as other seizure disorders. Over time, epileptic seizures can cause irreparable brain damage, so it’s often considered better to remove the anterior temporal lobe of the brain so that seizures simply can’t happen. This is what lobectomies usually are, and ten years ago an article in the New England Journal of Medicine reported a that a randomized, controlled trial of epilepsy patients getting the surgery revealed that indeed it is probably the best treatment we have in these difficult cases.
Unlike Freeman’s “go in through the eyes” technique, these surgeries are performed in a very precise way. They may leave patients with a slightly different personality, but they are able to return to normal life. They are also far more likely to survive without suffering from brain-damaging seizures.
And so, from a terrifying medical practice we’ve gotten at least one good form of therapy. And a reminder that one generation’s Nobel Prize-winning cure is another generation’s worst nightmare.
Additional reporting by Robert Gonzalez
Memento chronicles two separate stories of Leonard, an ex-insurance investigator who can no longer build new memories, as he attempts to find the murderer of his wife, which is the last thing he remembers. One story line moves forward in time while the other tells the story backwards revealing more each time. The condition is loosely based on Patient H.M.
You can watch the whole movie free online here without having to download anything.