Patient H.M.: A Story of Memory, Madness, and Family Secrets

Patient H.M.: A Story of Memory, Madness, and Family Secrets

by Luke Dittrich

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Product Details

ISBN-13: 9780812982527
Publisher: Random House Publishing Group
Publication date: 05/02/2017
Edition description: Reprint
Pages: 480
Sales rank: 264,201
Product dimensions: 5.10(w) x 7.90(h) x 1.20(d)

About the Author

Luke Dittrich is a National Magazine Award–winning journalist, and a contributing editor at Esquire. This is his first book.


From the Hardcover edition.

Read an Excerpt

one

The Fall

In the northeast corner of Colt Park, in downtown Hartford, Connecticut, a ten-­foot-­tall bronze statue of the park’s namesake rose from a granite pedestal. Engraved tributes to Samuel Colt, inventor of the Colt .45, covered one side of the pedestal, but the boy trudging toward it wouldn’t have been able to read them even if he’d wanted to, since he wasn’t wearing his glasses. It was dinnertime, July 3, and it was probably 1933 or 1934, though the exact year would be one of the things that scientists would argue about in the decades to come. His family’s second-­floor walk-­up apartment was about a quarter mile away. He was seven or eight years old and already he’d moved at least five times. His father was an electrician, didn’t make much money, had to go wherever the work was. It must have been confusing sometimes for the boy, all these homes flashing by, all those fresh starts. He had blond hair and bright blue eyes and a sweet, uncertain smile.

A steep road skirted the northern edge of the park, and if the boy cut across it and down some backstreets, he could shave a little time off his walk home. The boy’s eyesight may have been bad, but there was nothing wrong with his ears. He didn’t hear any cars coming. He stepped off the sidewalk and started crossing the road.

The bicyclist, coasting down the hill, didn’t see Henry until it was too late.

•••

Hippocrates Asclepiades, a Greek physician born on the island of Cos in the fourth century b.c., is widely regarded as the father of modern medicine. Although his last name indicates a claimed family connection to Asclepius, the revered doctor-­god of Greek myth, Hippocrates became famous by advancing the revolutionary argument that the gods had no place in medicine. Healers of one sort or another have existed for as long as humans have, but Hippocrates was one of the first to reject the magic and spiritualism and religion that most who came before him relied on. Instead he attempted to localize the sources of our ailments in our physical environment and inside our bodies themselves.

That approach was well illustrated in an essay he wrote called “On the Sacred Disease.” The title was a little misleading, since Hippocrates preferred to call the disease in question by a different name: epilepsy, from the Greek epilambanein, which means “to seize.” And the disease of epilepsy, he wrote, was “no more divine than others; but it has its nature such as other diseases have, and a cause whence it originates.” He criticized the “conjurors, purificators, mountebanks, and charlatans” who used “divinity as a pretext and screen of their own inability to afford any assistance,” and he ridiculed them for blaming the gods for the various ways epilepsy manifested itself in their patients: “For, if they imitate a goat, or grind their teeth, or if their right side be convulsed, they say that the mother of the gods is the cause. But if they speak in a sharper and more intense tone, they resemble this state to a horse, and say that Poseidon is the cause. Or if any excrement be passed, which is often the case, owing to the violence of the disease, the appellation of Enodia is adhibited; or if it be passed in smaller and denser masses, like a bird’s, it is said to be from Apollo Nomius. But if foam be emitted by the mouth, and the patient kick with his feet, Ares then gets the blame.”

After rejecting all the sacred explanations, Hippocrates presented a startling explanation of his own: “The brain is the cause of this affection,” he wrote, “as it is of other very great diseases, and in what manner and from what cause it is formed, I will now plainly declare.”

The details of Hippocrates’s subsequent explanation of the aetiology of epilepsy, of course, haven’t stood the test of time. In his view, the brain was a pneumatic organ, alternately pulsing with phlegm and bile. It was delicately attuned to the winds, and the wrong wind blowing on the wrong person at the wrong time could wreak havoc. If the west wind buffeted a constitutionally phlegmatic child, for example, it might cause the child’s brain to temporarily “melt,” at which point epileptic fits would occur. Hippocrates’s prescription for such children would be to shield them from the west wind and expose them instead to the north wind, which would, presumably, recongeal their brains and set them right.

What’s important about Hippocrates isn’t that he figured out epilepsy’s origins or its treatment—­he did neither—­but that he began looking in the right place: not up to the heavens or Mount Olympus but into the even more mysterious terrain inside our skulls.

In the years since, many doctors grappling with the problem of epilepsy followed Hippocrates’s lead, venturing deeper and deeper into the brain, seeking a secular understanding of the “sacred disease.”

By the early 1930s, when a bicyclist knocked down a young boy on a street in Hartford, Connecticut, they’d begun to find some answers.

Let’s imagine ourselves inside Henry’s skull.

Let’s imagine the moment after the bicycle hit him and before he hit the ground, when he was neither standing nor lying down but was instead floating through the air.

His brain was floating, too. It was nestled in a warm pool of cerebrospinal fluid, while vivid sensations of every sort coursed through it. The pain from wherever the bicycle impacted him, the shards of scenery as he was knocked off his feet, the view of the fast-­approaching ground, the sound of his own involuntary gasp, the feel of his wavy hair ruffling as he fell through the air—­all of these sensations and more were relaying from the nerves in his retinas, his auditory canals, his skin, his vestibular balance system, and buffeting his brain, which processed them into the multidimensional stew we experience as in-­the-­moment consciousness.

Now let’s imagine the impact.

Henry landed on the left side of his head, hard enough to tear a deep inch-­long gash in his forehead just above his eyebrow. His brain then experienced what are known as torsional forces—­that is, forces that caused it to twist inside his skull, in this case from left to right. At the same time, it sloshed forward in its watery womb, pushing up against the thin membrane of the pia mater and the thicker membranes of the arachnoid and dura mater, its weight compressing them all until it crashed against the unyielding barrier of his skull. His brain deformed. It changed shape exactly like a rubber ball does when it hits a hard surface, and then rebounded. If it was moving fast enough, if the rebound was strong enough, it again compressed the various layers of insulation that usually kept it safe, this time on the opposite side of his skull. This second impact would have been somewhat less violent than the first. And if it rebounded again, to make a third transit, it would be moving even more slowly. Within a second, it stopped its bouncing. The force of the impact dissipated, and Henry’s brain was again floating serenely in its warm pool of cerebrospinal fluid.

But the damage was already done.

During that first concussive impact and its immediate aftermath, as Henry’s brain twisted and compressed and rebounded, various things happened. Some of these things were physical and easy to understand. Neurons and glial cells—­the stuff our brains are made of—­were torn and ruptured. Other things that happened inside Henry’s brain, in that violent moment, were chemical and electrical and harder to explain. For reasons that are still poorly understood, when a brain experiences a combination of torsional forces and blunt-­force impact, like Henry’s brain experienced, local clusters of neurons open up their floodgates in lockstep synchrony. Bursts of electricity surge down axons—­the slender filaments that stretch out from each neuron—­and trigger the release of neurotransmitters at their tips. These neurotransmitters bridge the synapses between the ends of the axons and the waiting dendrites of other nearby neurons, causing those neurons to trigger their own bursts of electricity. Eventually, the growing tsunami of neurotransmitters creates an overwhelming surge of brain activity. Whatever sensations and thoughts were inhabiting Henry’s brain prior to this moment—­the fear, the pain, the confusion—­were wiped out by this burst of activity. Which means that, much like a power surge knocks out a computer, it knocked Henry out.

For five minutes, nothing. Henry’s brain carried on with its usual autonomic, life-­regulating tasks, but wherever his consciousness resided was temporarily shut down.

Then, slowly, he came back online.

He opened his eyes. The world came flooding in again, the bustle and noise of downtown Hartford, the voices of a gathering crowd, the pain from the gash in his forehead, the sticky warmth of the blood flowing down his face: The steady march of experience and sensation resumed.

He was back, but he was not the same.

The next day was the Fourth of July, and Henry went to a picnic with his family. It was perfect weather for it: warm, no rain. His forehead had been stitched up, and there was a bandage above his left eye. People joked with him about it, asking if he’d been playing with firecrackers.

“You must have been up early and got at it,” somebody said.

Henry laughed.

He seemed fine.

He felt fine.

Soon, though, the seizures began.

While the exact origins of Henry’s epilepsy can never be known for sure, many scientists believe that it was related to his fall. It could have been the direct physical damage: When brain injuries heal, the scars left behind have a tendency to become epileptogenic, meaning they can generate epileptic seizures. There’s also a theory known as the kindling effect, which holds that the sort of short-­circuiting Henry’s brain underwent leaves a new circuit in its wake, a dangerously convulsive circuit, one that grows more active over time, kindling a fiercer and fiercer blaze.

The seizures were minor at first. Little instants of inattention. Dazed moments, small absences.

Still, the seed had been planted, and Henry’s transformation into Patient H.M., the most studied individual in the history of neuro­science, had begun.

That’s his real name: Henry.

I can even give it to you complete: Henry Gustave Molaison.

There was a time I couldn’t. It was a secret.

For almost six decades, the scientists who studied Henry kept his name hidden away. When they wrote about him they were always careful not to reveal too much, for fear that outsiders might find him, and they were successful. There wasn’t a single paper, out of the hundreds that chronicled in great detail the experiments performed on Henry during the fifty-­five years between his operation and his death, that contained anything but the vaguest biographical information about Henry himself.

If you happened to read a lot of these papers, you could have pieced together a fragmentary portrait: One might have mentioned that he had relatives in Louisiana. Another that he was born in 1926. A third that his father’s name was Gustave. A fourth that he was an only child.

And so on.

But most of his story, starting with that most basic fact of his name, was a tightly guarded mystery to the outside world.

•••

Henry Gustave Molaison was born in Manchester, Connecticut, on February 26, 1926.

Two twenty-­six, twenty-­six.

“ ’Least it’s easy enough to remember,” he often told the scientists with a laugh.

They prodded him for his birth date over and over, sometimes five, six, seven times during a single session, and though he never remembered the previous time they’d asked him, the correct answer always came tumbling out intact: two twenty-­six, twenty-­six.

Other questions had less consistent answers.

“Henry,” a scientist asked him one afternoon, about fifteen years after the experiments began, “could you once more describe a little your earliest memory, very early in your life, when you were very small, the very first thing?”

“Well, gee,” Henry said. “There is a jumble right there.”

He paused. He was sitting in a laboratory at the Massachusetts Institute of Technology, though he didn’t know that, and when the scientists had earlier asked where he thought he was, he guessed that he might be in Canada.

“Sort of,” he continued, “to pinpoint, put them right down in a . . .”

Henry paused again. He was smoking a cigarette.

“Find the one that comes before or after,” he said. He had a soft, gentle voice with a thick New England accent. You could almost hear the thoughts whirring inside as he reached back, deep into his childhood. That time, his earliest memory was of a place. A little blue house the Molaison family once lived in.

Another time, during the same session, responding to the same question, he described a person.

“I can think of my grandfather,” he said. “Walking with him. I was very, very small. I think of, uh, well, right off I thought of a tall man, but he isn’t, wasn’t, tall. Medium-­size. Not heavy-­built. I always think of him in a gray suit. . . . He looked entirely different than my father did, of course. . . . He was, uh, I think of about five-­eight.”

“Your father?” the scientist asked.

“Grand,” Henry corrected. “Grandfather. Because my father was almost exactly six foot, just had, oh, a quarter part of an inch or so to go, and he’d be six foot.”

“How tall are you?” the scientist asked.

“I think of six-­two right off.”

“Pretty tall,” the scientist said.

“Yes, I know I’m taller than my father,” Henry said.

“Is your father still alive?” the scientist asked.

Henry thought about the question for a few moments before answering. “There I have an argument with myself. Right off, I think that he is. And then I have the argument, of course, that I think that he has been called.”

“You’re not sure?” the scientist said.

“I’m not sure,” Henry said. “Can’t put my finger, well, definitely on it.” He paused again before continuing. “He is and he isn’t.”

The scientist made a note of this—­Henry’s father had died three years before—­and then asked once again for his earliest memory.

“Now, Henry, I want you to go back as far as you can, and I want you to try to tell me what you think is your very first, earliest childhood memory, the memory which you think comes before any other.”

“Well, I can go back to, uh, taking a sleigh ride for the first time. . . .”

He described being on Spruce Street, in Manchester, Connecticut, midwinter. He remembered the sleigh being pulled by a single horse. He thought the sleigh and horse belonged to the father of playmates of his, two brothers, Frankie and Jimmie. As he told the story, he picked up the pace, added more details, lost himself in the memory. The horse was on its way to a stable to be reshod. Frankie and Jimmie and Henry were nestled warmly in the back. Some other local kids, seeing them go by, threw snowballs, but the walls of the sleigh kept them safe.

Table of Contents

Prologue xi

Part I Origins

1 The Fall 3

2 Crumpled Lead and Rippled Copper 12

3 Dream Jobs 20

4 The Bridge 27

5 Arline 38

Part II Madness

6 Pomander Walk 51

7 Wafer, Fire, Electricity 63

8 Melius Anceps Remedium Quam Nullum 75

9 The Broken 89

10 Room 2200 98

11 Sunset Hill 105

12 Experiment Successful, but the Patient Died 110

13 Unlimited Access 122

14 Ecphory 134

15 The Vacuum and the Ice Pick 144

Part III The Hunt

16 It Was Brought into the Sea 159

17 Proust on the Operating Table 179

18 Fortunate Misfortunes 190

19 Henry Gustave Molaison (1926-1953) 201

Part IV Discovery

20 Where Angels Fear to Tread 219

21 Monkeys and Men 234

22 Interpreting the Stars 250

23 The Son-of-a-Bitch Center 259

24 "An M.I. T. Research Project Entitled 'The Amnesic Patient H.M.'" 267

Part V Secret Wars

25 Dewey Defeats Truman 293

26 A Sweet, Tractable Man 316

27 It Is Necessary to Go to Niagara to See Niagara Falls 322

28 Patient H.M. (1953-2008) 336

29 The Smell of Bone Dust 347

30 Every Day Is Alone in Itself 357

31 Postmortem 379

Epilogue 407

Acknoledgments 413

Endnotes 417

Index 439

Reading Group Guide

1. Do you think the psychosurgeons like Dittrich's grandfather thought they were doing good – applying their surgical expertise to alleviate suffering — or were they driven more by the thrill of experimentation and the hunger for knowledge? 

2. What is the difference between medical practice and medical research? Should there always be a strict line dividing the two?

3. If you were the parent of a child like H.M., debilitated by his epilepsy and seemingly beyond treatment, and you went to visit a doctor who said he could perform an experimental brain surgery that might make your child’s life better, what would you have done?

4. Do you think all of the post-operative research conducted of HM was ethical? Do you think he understood what was being done to him, and was capable of providing informed consent?

5. Should patients like H.M. be entitled to some form of reparations for the surgeries that were performed on them?

6. The author investigates his own grandmother's history of mental illness, and reveals to the reader some of the most secret and painful episodes of her life. Do you think he was right to do so, or was this a violation of his grandmother's privacy?

7. The majority of the people who were lobotomized in the psychosurgical era were women – women who weren’t docile enough, who were depressed, or who were "preoccupied with sex thoughts." Why do you think that is?

8. Many asylum superintendents used to give psychosurgeons unlimited access to their "psychiatric material," by which they meant the residents of their asylums. What made this particular population of patients so vulnerable to exploitation?

9. Are there things you think doctors are doing today that we will look back on in fifty years and say, “How did we possibly think that was a good, or ethical, thing to do?”

10. Conversely, have modern advances made it difficult to view the past in a clear light? Has Dittrich been fair to the men of his grandfather's generation, who were operating and experimenting without the benefit of all we know today? 

11. What do you think H.M. was aware of, day to day? Did you come away feeling like he lived in the moment and was more or less happy, or do you think he was aware that an essential part of his self had been lost? 

12. Did this book make you think differently about memory, and who and what we would be without it?

13. How would you describe the author’s grandfather, Dr. Scoville – his motivations, his morality, his sense of obligation to his patients? What do you think drove him? 

14. How would you describe the relationship between Dr. Suzanne Corkin and H.M.?

15. Are there heroes in this book? If so, who are they?

16. Many great advances in human understanding have been built on the back of troubling human experimentation. How do you reconcile the lifetime of hardship that H.M. endured with the body of knowledge he gave to the world?

17. Put yourself in the author’s shoes, for a moment. You come to understand that your grandfather's surgical experimentation created the most studied patient in the history of brain science. You also come to understand that your grandfather was, in moral and ethical terms, a deeply complex and flawed character. Could you have written about your family in this way?

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Patient H.M.: A Story of Memory, Madness, and Family Secrets 4.4 out of 5 based on 0 ratings. 8 reviews.
Anonymous More than 1 year ago
I have to admit, when I bought this book I had no idea what I was getting myself into. I suppose I thought it would be a biography of either Patient H.M. or the author's grandfather, Dr, Scoville (or perhaps a.mishmash of both). What I got however, is an interesting combination of biography, scientific investigation, ethical examination, and study related to the reliability of memory itself. The subject matter of this book spans decades and moves delicately between familial secrets, the changing course of psychosurgery (and its many players) and into the politics of intellectual capital. If you are in the least bit interested.in the topic, I can't recommend it enough!
SheTreadsSoftly More than 1 year ago
Patient H.M.: A Story of Memory, Madness, and Family Secrets by Luke Dittrich is a very highly recommended account of his grandfather, Dr. William Beecher Scoville, an early brain surgeon, and his most famous patient, Henry Molaison. If you were mesmerized by The Immortal Life of Henrietta Lacks by Rebecca Skloot, you won't want to miss Patient H.M.: A Story of Memory, Madness, and Family Secrets by Luke Dittrich. Investigative journalist Luke Dittrich covers not only the story of Henry Molaison, an epileptic man who is considered one of the most important neuroscience human research subjects; he also explores the history of neurosurgery and lobotomies, and his own family history. Along the way ethical questions are raised regarding the treatment of Henry, famously only known as Patient H.M. for years, and how proprietorial researchers are on sharing information. Henry and his family agreed to brain surgery in order to stop the debilitating epileptic seizures he was having. While it did stop the seizures, it also causes short term amnesia. Henry could no longer remember any new information or form any new long term memories. After this he became Patient H.M., one of the most studied individuals over a span of decades, but also one whose identity was closely guarded. Dittrich takes the facts of Patient H. M. and early neurosurgery and makes the story personal. His grandfather was a pioneer in the field and the one to perform the surgery on Henry, but Dittrich also tells of his mentally-ill grandmother, and a family secret. In Patient H.M. the author takes an extremely interesting piece of history and makes it even more compelling because of the personal connection Dittrich has to it, while describing the limbo Henry found himself in, with no ties to recent memories. The writing is very good and this nonfiction account reads like a novel. I was immersed in Dittrick's family history, as well as the story of Henry himself and the history of neurosurgery. The legal fights over Henry's body and the ending was, well, stunning. You have to read this book which is sure to be in the top nonfiction of the year. Disclosure: My advanced reading copy was courtesy of the publisher for review purposes.
rdgit More than 1 year ago
Patient HM Drowning in details This is not a book about Patient HM (Henry G. Molaison). It is a book about the history of brain surgery to cure epilepsy, lobotomies and the study of the brain. That, in itself, could make a good book but in this case, the author’s diligent research got in the way of telling the story. Just because the research was extensive, doesn’t mean the author had to use every detail he uncovered. I was very intrigued from the start as the story focused on Henry as a child who had a terrible accident that later, may have caused him to have frequent seizures. Henry underwent brain surgery by Dr. William Scoville, the author’s grandfather. Dr. Scoville removed portions of Henry’s brain based on a hunch that he knew the areas that were causing Henry’s seisures. I wanted to get to know Henry and also Dr. Scoville’s wife who spent time in an asylum for her mental issues. I never got to know these people. I don’t feel I ever knew Henry even though the book was supposedly about him. I never understood his personality and even though it was told he had a very high IQ, we were not told how Henry appeared to the world. There were extensive interviews where the reader could view his responses but I never felt I knew what he was like. At one point the author told part of the story of Dr. Scoville’s wife and I got the feeling he would at some point finish her story but frankly, I was so overwhelmed in all the details, the dates, the institutions, the people, the laboratories the universities, that at times I would skim many pages at a time, so I could have missed the continuing story of Mrs. Scoville. She was in an institution where Dr. Scoville often performed lobotomies and I wanted to know if he performed surgery on her. Another let down was that I wanted to understand how all the research on Henry Molaison throughout his life lead to a better understanding of the brain and and memory function. I’m sure that information is buried in the book somewhere. This could have been so much better.
MontzieW More than 1 year ago
Patient H.M. by Luke Dittrich is a book about the history of brain surgery in general but I was more hoping it was about the patient HM. The writing was excellent and the information of the history of the the various treatments used on people with "mental illness" was interesting and appalling at the same time but very little was about this particular patient really. There was a great deal about the authors family, other patients, POW's, etc. It was very interesting but just a little misleading in the title. I received this book from NetGalley for a honest review.
onemused More than 1 year ago
"Patient H.M." is a beautifully and lyrically written work of nonfiction about H.M., the history of medicine and neuroscience, the doctors who treated H.M. and the author's own life (the author is the grandson of the doctor who treated H.M.). All medical, science, and psychology students know the immortal patient H.M. whose experiences taught us so much about the brain and memory. As a doctoral student, I remember hearing about the death of H.M. and learning his identity in awe of this individual who had given so much to science despite his unfortunate circumstances. Later, as researchers began preserving and slicing his brain, we were able to view over webcam the careful process. This book is a necessary accompaniment to the textbook description of H.M. The respect for patient H.M. is enormous as we would not be where we are today without the knowledge he has kindly helped us to attain. Dittrich writes about H.M. in depth, discussing his past and his conversations with researchers, as well as information about the brain and history of what we know to compete the story. Indeed, I believe this book will become a staple for anyone who wishes to learn about memory and a necessary book in many college courses. The inclusion of stories about Dittrich and his grandfather flesh out the book to keep readers engaged and interested in all aspects of the story of H.M. including the doctors and scientists who worked with him. This book is written in an approachable and understandable way. I think even non-science majors will find it interesting and educational. It is a must for scientists and those in the medical field. Please note that I received this book from netgalley in exchange for my honest review.
SUEHAV More than 1 year ago
Loved it and was horrified by it.
Darcy714 More than 1 year ago
Patient H.M. is a fascinating work of nonfiction in which author Luke Dittrich delves into the history of brain science, particularly the various lobotomies being performed in the 1930’s and beyond. Dittrich’s grandfather, William Scoville was one of the most well-known advocates of the lobotomy performing countless ones himself on mental asylum patients with issues ranging from schizophrenia to mild depression. Dittrich centers the story on a particular patient, Patient H.M., otherwise known as Henry Molaison, who was not from the asylum but sought help for his epilepsy. Dittrich’s grandfather performed a lobotomy on Molaison in an effort to stop the seizures Molaison had suffered since a childhood bike accident. Unable to locate the area of the brain that the seizures originated from, Scoville performed a more invasive lobotomy. The results of which appear to have left Molaison with a severe form of amnesia, unable to make new memories after the surgery. Though the title is Patient H.M., the book delves heavily into the types of lobotomy being performed, the lack of choice that patients from asylum had and the other crazy procedures performed in an effort to “cure” them of their psychological issues. It is of note that Dr. Scoville’s own wife, Dittrich’s grandmother, was among those put in an asylum as she suffered delusions herself. The accounts of treatments like instances of putting patients into a diabetic or drug induced shock and then coma to reset their minds, is shocking and the lobotomies hardly seem a better option. Dittrich opens a page into a lesser known and rather horrifying chapter of medical science here in America and does so in a way that a layperson can understand and follow. My one issue with this book was that, at times, it jumped around in a way that didn’t work well with the subject matter. Usually there were attempted tie-ins to the subject and the tangents were well written, but it felt like Dittrich was stretching the connections of his tangent to the subject. For example, at one point he randomly decided to discuss his grandfather climbing the George Washington Bridge and then linked it to Dittrich himself climbing the The Great Pyramid in Egypt and his foray into writing. All fascinating stuff but not really relevant to the story at hand unless used as the Intro. Odd tangents aside though, this book is a well-researched and multi-faceted work of nonfiction with a remarkably readable and beautifully flowing writing style. It isn’t light reading, but it also doesn’t stray into dry scholarly prose. The result is an engaging and informative history of treatments used unnervingly recently for issues within the brain. An engrossing read. Disclaimer: I received a free ARC from the publisher in exchange for an honest review.
Anonymous More than 1 year ago
How are you?