Patient H.M.: A Story of Memory, Madness, and Family Secrets480
Patient H.M.: A Story of Memory, Madness, and Family Secrets480
Winner of the PEN/E.O. Wilson Literary Science Writing Award • Los Angeles Times Book Prize Winner
NAMED ONE OF THE BEST BOOKS OF THE YEAR BY
The Washington Post • New York Post • NPR • The Economist • New York • Wired • Kirkus Reviews • BookPage
In 1953, a twenty-seven-year-old factory worker named Henry Molaison—who suffered from severe epilepsy—received a radical new version of the then-common lobotomy, targeting the most mysterious structures in the brain. The operation failed to eliminate Henry’s seizures, but it did have an unintended effect: Henry was left profoundly amnesic, unable to create long-term memories. Over the next sixty years, Patient H.M., as Henry was known, became the most studied individual in the history of neuroscience, a human guinea pig who would teach us much of what we know about memory today.
Patient H.M. is, at times, a deeply personal journey. Dittrich’s grandfather was the brilliant, morally complex surgeon who operated on Molaison—and thousands of other patients. The author’s investigation into the dark roots of modern memory science ultimately forces him to confront unsettling secrets in his own family history, and to reveal the tragedy that fueled his grandfather’s relentless experimentation—experimentation that would revolutionize our understanding of ourselves.
Dittrich uses the case of Patient H.M. as a starting point for a kaleidoscopic journey, one that moves from the first recorded brain surgeries in ancient Egypt to the cutting-edge laboratories of MIT. He takes readers inside the old asylums and operating theaters where psychosurgeons, as they called themselves, conducted their human experiments, and behind the scenes of a bitter custody battle over the ownership of the most important brain in the world.
Patient H.M. combines the best of biography, memoir, and science journalism to create a haunting, endlessly fascinating story, one that reveals the wondrous and devastating things that can happen when hubris, ambition, and human imperfection collide.
“An exciting, artful blend of family and medical history.”—The New York Times
*Kirkus Reviews (starred review)
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About the Author
Read an Excerpt
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.
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
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
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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