The Story Behind Psychology’s Most Famous Brain

Every introductory psychology student by now knows the legendary if somewhat mystifying tale of “Patient H.M.,” the man with no hippocampus and, therefore, no short-term memory. However, even those who think they know the case, a new book called “Patient H.M.,” by Luke Dittrich, will show you that your prior knowledge didn’t even come close.
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The book, published in August, falls into the tradition of great psychology books made even greater perhaps by the fact that they’re not written by psychologists. For example, Gina Perry’s Behind the Shock Machine was an astonishing expose of the Stanley Milgram obedience experiments. Jon Ronson, similarly, brought us into the world of the psychopath in The Psychopath Test. When great writers tackle great psychological topics, they provide the kind of perspective that those of us in the profession may take for granted. Perhaps we get too "journaled-out" to be able to recognize the humanity in the cases and studies that form the grist of our professional mills.

In the case of Patient H.M. (whose actual name was Henry Molaison), Luke Dittrich’s story has so many layers that I hardly know where to begin. The first was the revelation, published just prior to the release of the book (link is external), that the MIT neuroscientist, Suzanne Corkin, who handled Henry’s autopsied brain may have mishandled or misreported the evidence regarding the exact nature of his injury. The attention surrounding this controversial claim of the book, as headline-grabbing as it was, unfortunately overshadows the otherwise astonishingly insightful revelations about, as the book’s subtitle proclaims: “Memory, Madness, and Family Secrets.” It’s a fascinating story in its own right to anyone interested in the history of modern science’s attempts to understand the causes of mental illness along with the many botched attempts to treat it.

The core of the book revolves, not surprisingly, around memory. Henry suffered from a severe memory disorder, after all. But the memories revealed in this book extend to the “family secrets” that Dittrich describes in a frank and objective tone, despite the painful history from his own ancestry that they document. “Memories,” as Dittrich observes in the Preface, “make us. Everything we are is everything we were.” Henry was to lose his, not due to a head injury suffered as a young boy in a bicycle accident (which may have caused him to develop epilepsy) but at the hands of Dittrich’s grandfather, Dr. William Scoville, a neurosurgeon who excised much of Henry's limbic system. At the time, no one knew for certain what that part of the brain did, but thanks in part to Henry's case, we now know it to be crucial in the formation of memory. Scoville had became a prominent lobotomist in the heyday of this “therapeutic” procedure in the mid-20th century (a “modern neurosurgical attack on mental illness”) but in Henry's surgery (and others that were to follow) went far beyond the frontal lobe into the deeper parts of the brain, including the limbic system.

Here is where the family secrets, madness, and memory intersect in remarkable fashion. Dittrich’s family secrets included not just the fact that his grandfather gained fame for a procedure now considered barbaric, but that his grandmother, Emily, herself underwent this surgery after her own descent into mental illness, perhaps at the hands of Scoville himself. All of this took place at two mental hospitals near Hartford, Connecticut, including the state hospital and the Institute for Living. It was because of Henry’s geographic proximity to Hartford that his life path was to become inexorably tied to Dittrich’s grandfather.

Prior to the development of psychosurgery, people with psychological disorders (including Dittrich’s grandmother) were subjected to such treatments as “pyretotherapy” (being subject to intense heat), “hydrotherapy” (being submerged for hours at a time in water) and other forms of "therapy," none of which worked but all of which exacted a brutal toll on the patient’s body and mind. Practitioners of psychosurgery included the infamous Walter Freeman, who traveled around the countryside in his Lobotomobile, using icepicks to perform a “new and improved” lobotomy. Freeman believed that the brains of people with mental illness were better if they were relieved of some of their connections: “To do with a few swipes of a blade what years on an analyst’s couch, or in an asylum’s cell, failed to accomplish.” For his part, Dittrich’s grandfather developed his signature neurosurgical scalpel from a tool he came across while tinkering on his car in the garage.

The operation Dr. Scoville performed on Henry, intended to treat his epilepsy, represented a set of risky decisions that left Henry without “those mysterious structures” in both medial temporal lobes: “lacking a specific target in a specific hemisphere of Henry’s medial temporal lobes, my grandfather had decided to destroy both.” The results of the operation, which Dr. Scoville reported to The Journal of Neurosurgery became a “cornerstone of a skyscraper that is modern memory science… the birth announcement of Patient H.M.” but also the “obituary” of Henry Molaison. You might think that the operation would also be the first and last of its kind but, tragically, it was to be repeated on a variety of institutionalized individuals as well as on experiments with laboratory primates.

Not all psychiatrists of the day were advocates of psychosurgery, and “even the staunchest defenders … realized there was something inherently ghoulish about it.” However, those (including Scoville) who conducted the operation on thousands of mental patients, showed no concerns about “trampling blithely, arrogantly, even insanely through the delicate soil of other people’s brains.”

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Messy medical ethics permeate the retelling of Henry’s story. Dittrich shows us how, for example, the “research” conducted by neurosurgeons such as his grandfather failed to include control conditions, to ensure the basic human rights of the patients, or to put the health of patients above the cause of “science.” In one particularly chilling passage, Dittrich compares the work of American psychiatrists to the horrors that occurred in “research” on prisoners at Auschwitz, which he describes as the origins of the phrase “experiment successful, but the patient died.”

At the Institute for Living, rehabilitation from lobotomies included so-called “conversion therapy” to change an individual’s sexual orientation. Cringe-worthy moments abound in the reading of these stories, and I felt layers peeling back on what I thought I knew about the history of mental illness. The detail with which these episodes are revealed embellish what themselves are unpleasant facts about our profession, but they are details of which we all need to become aware. Asking a question that begs to be asked, Dittrich wonders whether the surgeons destroying the brains of their patients were as “mad as the inmates.”

There are many sidelights in this book for anyone interested in the history of psychology in general, including the fate of Phineas Gage (the New England railroad worker with a railroad pin driven through his brain), the stark and inhumane conditions to which state hospital patients were forced to live in the post-War II era, the use of trephining in ancient times, and many previously little-known events in the history of the neuroscience. We even hear about the visit of Charles Dickens to the Institute for Living (then called "the Hartford Retreat"). You become privy to the backstories of some of the most prominent figures in the field, learning about what motivated them via details of their personal lives and experiences. There are also fascinating coincidences permeating that pages of the story, including the fact that Scoville had a brother named Henry who died in a bicycling accident similar to the one that caused patient Henry’s head injury. Decades later, Scoville himself suffered a ruptured spleen in a motorcycle accident, and in 1984, died after his car was hit on the New Jersey Turnpike.

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The many secrets that Henry’s injured brain revealed about memory were due in large part to the painstaking tests performed by Canadian neuropsychologist (now 98 years old), Brenda Milner, as well as to the work of Corkin, who became the curator of Patient H.M. and the dozens of studies conducted on him for 5 decades. Most random of all the coincidences in the book is perhaps the fact that Suzanne Corkin was a childhood friend of Scoville’s daughter, Dittrich’s mother.

Dittrich became intrigued with Henry’s case in 2004 after deciding to pitch the idea to his Esquire editor. He knew he could gain access to the story since Corkin, as his mother’s long-time friend, was Henry's “gatekeeper.” Much of the ending of the book describes his, to put it mildly, difficult relationship with Corkin as he began his on and off search over the years to uncover what were then unknown details about Patient H.M. (including his name).

In his later years, Dittrich notes that Henry became “an aging rock star,” as “his best days were long past.” Milner’s early studies on him were to be the most important than those of the “legions of other scientists" who followed her. After he died, however, Henry’s brain could reveal its secrets in a way that even modern MRIs couldn’t provide.

In the aftermath of the brain’s dissection, conducted by UC San Diego’s Jacopo Annese, a dispute over ownership developed with Corkin, a bit of scientific warfare that has now come to light (at the least, a “violation of academic etiquette”). More significantly, though, new data based on the autopsy suggest that Henry's brain had a lesion in the frontal lobes, which would cast doubt on the validity of the claims by Corkin and others that it was the hippocampal lesion alone that caused the Henry's memory deficits (you can listen to Dittrich's interview with Corkin here (link is external)).

The details of this latest twist in the stories surrounding the documentation of Henry’s brain only continue to add to Dittrich’s fascinating tale. What they tell us is that science rarely occurs without involving the egos, biases, and desires of those who conduct it. Dittrich’s book itself has resulted in charges and countercharges in the press, not the least of which is a posthumous defense of Corkin (who died in May 2016) published on MIT’s website.

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Whatever the fate of these disputes, the path that led Henry’s brain to experience the accidental and intentional damage that destroyed his memory is a fascinating one. The book is indeed about memory, madness, and family secrets and, in that sense, about the paths that shape the core of the self, in each and every one of us.![Patient HM Geralt_0.jpg]