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

This biography and scientific history book is unique, for several reasons. First, the author is the grandson of Henry Beecher Scoville, the neurosurgeon who pioneered frontal lobotomies and also bilateral temporal lobe ablations. Frontal lobotomies, or leukotomies, were relatively new, although Scoville was not the first to perform them, and he operated on literally hundreds of psychiatric patients. Scoville’s wife, the author’s grandmother, suffered from mental illness, making the subject vividly important to the author. Patient H.M., on the other hand, had epilepsy secondary to a head injury. Scoville had performed bilateral medial temporal lobectomies on psychiatric patients, but the resulting memory syndrome had not been clear in these debilitated patients. This is why H.M., previously normal except for epilepsy, was so important to the delineation of the amnesia caused by temporal lobe ablations. Scoville was a pioneering neurosurgeon, but one who by his own admission favored action over thought, and who frequently tackled controversial problems. His exploits in driving sportscars and motorcycles, once nearly dying of a ruptured spleen before submitting to surgery himself, exemplified his daring. “Wild Bill,” as his colleagues called him, operated on hundreds of psychiatric patients before there was clear evidence of benefits or risks. He was willing to perform bilateral temporal ablations for epilepsy, whereas more cautious pioneering neurosurgeons, notably Wilder Penfield of Montreal, would try only unilateral operations. The second major focus of the book is the patient, H.M., and his memory loss following the bilateral temporal lobe ablation performed by Scoville. He suffered nearly complete anterograde amnesia, in the presence of intact immediate or “working” memory, and preservation of much long-term memory for events prior to the surgery. Most neurologists consider “short-term” memory to be the storage of memories over minutes to hours, but for some neuropsychologists, “short-term memory” was the immediate stage, which was the stage preserved in H.M. Neuropsychologists tested H.M. because he was such a perfect “experiment of nature” regarding the memory system. They included Brenda Milner, a neuropsychologist who worked with Penfield at the Montreal Neurological Institute, and later Suzanne Corkin, a neuropsychologist at the Massachusetts Institute of Technology. H.M. was the subject of hundreds of research studies, tested over literally thousands of hours, for minimal or no pay, such that he was definitely the most studied patient in history. By coincidence, Corkin was also the best friend of the author’s mother, creating another entanglement for the author. Dittrich discusses the memory system and its phenomena, although this is perhaps less of a focus of the book than the biographical portraits. One aspect of H.M.’s memory deficit that I had not fully appreciated is that even his past memories, from well before the operation, were only factual, lacking the experiential aspects of a recalled event. It is also striking that, although neuropsychologists such as Milner and Corkin spent literally hundreds of hours with H.M. over decades, each time they met, the neuropsychologist was a new acquaintance for H.M. As mentioned to the author by Brenda Milner, her friendship with H.M. was therefore one-sided. Much as the author’s grandfather is presented in a very mixed fashion, Corkin is also a flawed character. She is dedicated to her work, but also protective of H.M. to the point of not allowing other investigators to study him unless they agreed to her total control of his participation. She kept all his personal information secret for decades, including his full name, Henry Molaison, and his photograph. Corkin also recruited an ally, not biologically related to H.M., to be his conservator, even though there were living cousins who could have been chosen. The final battle was over H.M.’s brain, initially given by Corkin to a neuropathologist at the University of California at San Diego, Jacopo Annese. When Annese discovered frontal lobe damage related to H.M.’s surgery, Corkin sought to block publication of his article, later agreeing to only a brief mention of the frontal injury, and only after long negotiations, with the three other reviewers voting very positively on the manuscript. Corkin also had M.I.T. attorneys threaten a lawsuit, resulting in the removal of the brain and all of Annese’s photographs and dissections from his custody. The very strong implication is that Corkin wanted to make sure that her breakthrough research on the effect of bilateral temporal lobectomy on memory was not tainted by the additional involvement of the frontal lobe. Two sudden developments characterize the end of the book, giving it a suspenseful ending (spoiler alert for those readers who want to be surprised). The first is the revelation that Henry Scoville may have performed a frontal undercutting operation on his own wife, the author’s grandmother. This was revealed to the author by the 93-year-old Karl Pribram, also a neurosurgeon and a prominent memory researcher, who made the claim when Dittrich interviewed him. No confirmatory evidence was discovered. The second revelation is the frontal damage also present in H.M.’s brain, a finding that might have important implications for the memory disorder that made H.M. so famous. I recommend this book both as entertaining reading and as a wideranging exploration of the history of neurosurgery and neuropsychology with regard to the memory system. This book has appeal both for the general public and for cognitive neurologists.