"Patient H.M." by Luke Dittrich is a fascinating exploration of one of the most important case studies in the history of neuroscience. The book delves into the life of Henry Molaison, known for decades only as Patient H.M., whose unique brain condition revolutionized our understanding of memory and the human brain.
In 1953, Henry Molaison underwent an experimental brain surgery to cure his severe epilepsy. The procedure, performed by Dr. William Scoville, involved the removal of significant portions of Molaison's brain, including his hippocampus. While the surgery succeeded in reducing his seizures, it left him with a profound and permanent amnesia. Unable to form new long-term memories, Henry became a subject of intense scientific study for the rest of his life.
Dittrich's book takes readers on a journey through the history of brain science, the era of lobotomies, and the ethical questions surrounding human experimentation. It's a tale of scientific discovery, personal tragedy, and the relentless pursuit of knowledge about the most complex organ in the human body.
The Fascination with the Brain
Ancient Insights
Humans have long been fascinated by the brain and its functions. This curiosity dates back to ancient times, with some of the earliest known attempts to understand the brain coming from ancient Egypt. Archaeologists have discovered a 3,600-year-old Egyptian scroll that provides instructions for treating brain injuries. The scroll advises keeping brain wounds clean and protected, suggesting an early understanding of the brain's importance and fragility.
Hippocrates and the Brain
The Greek physician Hippocrates, often called the father of modern medicine, made significant contributions to our understanding of the brain. Born in 460 BC, Hippocrates challenged many medical assumptions of his time. One of his most important theories was that epilepsy was not caused by divine intervention, as was commonly believed, but was instead a result of brain impairment. This marked a crucial step in recognizing the brain's role in controlling bodily functions and mental states.
Early Brain Surgery
Evidence suggests that forms of brain surgery may have been attempted as far back as 7,000 years ago. In Ensisheim, France, archaeologists have unearthed prehistoric skulls with small holes that appear to be surgical in nature. While the exact purpose of these procedures remains unclear, they indicate an early willingness to intervene directly with the brain.
The Birth of Modern Brain Surgery
The modern era of brain surgery began in the late 19th century. In 1888, Swiss psychiatrist Gottlieb Burckhardt performed what is considered one of the first psychosurgeries. He removed 18 grams of brain matter from a patient in an attempt to cure her "madness." This radical approach shocked his peers and was widely condemned at the time.
However, the idea of surgically altering the brain to treat mental illness didn't disappear. In 1935, Portuguese neuroanatomist Egas Moniz performed the first leucotomy, a procedure that involved cutting white nerve fibers in the brain. Moniz was inspired by the work of Yale physiologist John Fulton, who had observed that damaging the frontal lobes of chimpanzees made them calmer and more manageable.
Moniz's procedure, which involved drilling holes in the patient's skull and cutting brain matter from the frontal lobe, was presented as a potential treatment for severe depression. This marked the beginning of a new era in psychiatry and surgery, setting the stage for the lobotomy craze that would follow.
The Era of Experimental Therapies
Mental Asylums and Desperate Measures
In the late 1930s and early 1940s, mental asylums were often overcrowded and understaffed. Patients with various mental illnesses were housed together, often in chaotic and distressing conditions. The primary goal of physicians during this time was to find ways to calm their patients and make them more "fit for society."
This desperation led to the development of various experimental therapies, many of which would be considered inhumane by today's standards. These treatments were often carried out behind closed doors, away from public scrutiny.
Pyretherapy
One such treatment was pyretherapy, which involved subjecting patients to extremely high temperatures. The patient would be placed inside a metal tube, and their body temperature would be raised to as high as 106 degrees Fahrenheit, well above the normal body temperature of 98.6 degrees. This treatment could last for a week or more, with the belief that it would "burn out" the mental illness.
Insulin Coma Therapy
If pyretherapy didn't produce the desired results, doctors might move on to insulin coma therapy. This involved injecting patients with massive doses of insulin, causing their blood sugar levels to plummet and inducing a coma. The theory behind this treatment was that the shock to the system might somehow reset the brain and alleviate mental illness symptoms.
The Introduction of the Lobotomy
It was in this environment of desperate experimentation that American neurologist Dr. Walter Freeman introduced the lobotomy to the United States in 1939. The word "lobotomy" comes from the Greek words for "cutting of the lobes," which accurately describes the procedure.
Dr. Freeman's technique involved drilling two holes in the side of a patient's skull and using these openings to slice into the frontal lobes of the brain. Remarkably, patients were often conscious during the procedure, allowing Freeman to ask questions as he worked. He would stop cutting when the patient's responses reached what he considered to be the right level of confusion and disorientation.
Freeman believed that the lobotomy could cure a wide range of mental disorders. He performed the procedure on patients ranging from seven to 72 years old. While some of his patients were severely mentally ill, others had what we might today consider relatively minor issues, such as obsessive behaviors.
Despite occasional patient deaths and concerning side effects like emotional numbness or catatonia, lobotomies quickly gained popularity as a treatment for mental illness. The apparent benefits seemed to outweigh the risks in the eyes of many medical professionals at the time.
The Rise of Psychosurgery
A New Understanding of the Brain
The rise of lobotomies coincided with a shift in how scientists understood the brain's function. Prior to the mid-1800s, the prevailing view was that the brain operated as a "perfect democracy," with each section contributing equally to all functions such as speech, memory, and cognition.
This view began to change in 1861 when French physician Dr. Pierre Broca performed an autopsy on a patient known as "Monsieur Tan." This patient could only repeat the word "tan" over and over. Broca discovered a small lesion on the left hemisphere of the patient's inferior frontal lobe and deduced that this must be the brain's speech area.
This discovery led to a new understanding of the brain as a collection of specialized regions, each responsible for different functions. This concept aligned well with the practice of lobotomy, as it suggested that targeting specific areas of the brain could address specific mental health issues.
Dr. William Beecher Scoville
One of the key figures in the development of psychosurgery was Dr. William Beecher Scoville, nicknamed "Wild Bill" for his daring surgical approaches. In 1939, Scoville founded the neurological department at Hartford Hospital, where he became known for taking on high-risk surgeries that other doctors wouldn't attempt.
Scoville had a personal stake in understanding and treating mental illness, as his wife suffered from mental health issues and was institutionalized in 1944. This personal connection likely fueled his interest in developing new surgical techniques to treat mental disorders.
The Justification of Lobotomies
As knowledge of the brain grew, the practice of lobotomy became more justifiable in the eyes of many medical professionals. While it may seem barbaric by today's standards, it's important to understand the context in which these procedures were developed and performed.
Throughout medical history, there have been instances where seemingly inhumane experiments led to important advancements. For example, in 1796, British physician Dr. Edward Jenner discovered the smallpox vaccine by testing it on an 8-year-old boy he had intentionally infected with the disease. While ethically questionable by modern standards, this experiment led to the eradication of a deadly disease.
Similarly, the development of modern gynecology involved cruel experiments on enslaved women by J. Marion Sims in the 1840s. While his methods were undoubtedly unethical, the surgical techniques he developed have saved countless lives.
In the context of overcrowded asylums in the 1940s, lobotomies seemed to offer a practical solution to a growing problem. President Truman signed the National Health Act of 1946, providing federal funds to address the issue of overcrowded mental health facilities. Two years later, William Scoville introduced a new, supposedly more humane lobotomy technique that used suction to remove connecting fibers in the brain rather than cutting through brain tissue.
This technique appeared to be a perfect solution: a quick, surgically precise procedure that could treat troubled patients and allow them to return home, thus relieving the pressure on overcrowded asylums. As a result, psychosurgeons like Dr. Scoville were given considerable freedom to treat patients as they saw fit.
Advances in Understanding the Brain
Dr. Wilder Penfield's Discoveries
In the early 1950s, as the lobotomy craze was in full swing, other neurosurgeons were making important discoveries about the brain's functions. In Canada, Dr. Wilder Penfield developed an innovative technique for treating epilepsy.
Penfield's method involved electrically stimulating different areas of a patient's brain during surgery. If a patient experienced uncontrolled movement in their left arm during seizures, Penfield would locate the area of the brain controlling the left arm and perform his operation there. This process allowed him to create detailed maps of the human brain, showing which areas were responsible for different functions.
During one of these procedures, Penfield made an unexpected discovery. When he stimulated a region in a patient's right medial temporal lobe (located behind the temples, near the middle of the brain at the base of the cortex), the patient reported hearing a familiar song being played on a piano. Intrigued, Penfield tried this on another patient, who reported seeing a mental image of a dog walking down a country road.
Penfield realized he had stumbled upon an area of the brain involved in memory. He believed he might be on the verge of discovering the brain's memory center, a finding that would have significant implications for neuroscience.
Dr. William Scoville's Epilepsy Treatment
Meanwhile, Dr. William Scoville was making his own discoveries in the treatment of epilepsy. In 1950, he began removing entire medial temporal lobes from epileptic patients. This procedure proved to be an effective cure for the symptoms of epilepsy, although it didn't address any underlying mental illnesses.
Scoville was eager to test this procedure on a patient who was epileptic but otherwise mentally sound. This would allow him to better understand the effects of the surgery without the complicating factor of pre-existing mental illness.
The Case of Henry Molaison
Henry's Background
On August 25, 1953, a 27-year-old man named Henry Molaison arrived at Hartford Hospital for a lobotomy procedure to be performed by Dr. William Scoville. Henry had been suffering from severe epileptic seizures since the age of eight. Despite being intelligent and capable, his condition had severely impacted his life.
Henry's seizures had worsened over time. By the age of 15, they often resulted in complete blackouts, from which he would awaken disoriented and confused. His condition was so severe that he was not allowed to collect his high school diploma on stage due to fears he might have a seizure during the ceremony.
The Decision for Surgery
When Henry and his family met Dr. Scoville in March 1953, they were desperate for a solution. Henry had been taking massive doses of epilepsy medications, none of which had been effective. The lobotomy procedure, despite its risks, seemed like their last hope.
Before the surgery, Dr. Scoville examined Henry's brain scans, hoping to locate the source of his seizures. However, the scans revealed nothing unusual. Based on his past experience, Scoville believed the problem lay in Henry's medial temporal lobes, but he couldn't determine whether it was in the right or left hemisphere.
The Fateful Surgery
Faced with this uncertainty, Dr. Scoville had three options: call off the procedure, choose either the left or right hemisphere and hope for the best, or operate on both hemispheres. True to his nickname "Wild Bill," Scoville chose the third, most aggressive option. He removed both hemispheres of Henry's medial temporal lobes.
This decision would have profound consequences. While it did cure Henry's seizures, it also left him with severe amnesia. Henry Molaison ceased to exist as he had been, and "Patient H.M." was born – a man who would become the most studied individual in the history of medicine.
The Aftermath of Henry's Surgery
Severe Amnesia
The immediate effect of Henry's surgery was a cure for his seizures. However, it soon became apparent that the procedure had caused severe and permanent damage to his ability to form new memories.
Dr. Scoville quickly realized the significance of Henry's case and invited Dr. Brenda Milner, a psychologist from Cambridge University, to study him. Dr. Milner found that despite his profound amnesia, Henry had an above-average IQ. His condition was more severe than any she had encountered before – he couldn't retain new information for more than a few minutes.
Living in the Present
Henry's condition meant he was essentially living entirely in the present. He would forget having met people moments after being introduced, including Dr. Milner herself, who had to reintroduce herself each time they met. This led to practical challenges in daily life – for instance, Henry might eat two dinners because he'd forgotten he had already eaten.
Interestingly, Henry retained some memories from before the operation, such as his name, hometown, and having met Dr. Scoville. However, he couldn't form new long-term memories after the surgery. Henry described his experience as dream-like, with each moment feeling disconnected from all others.
Locating the Memory Center
Henry's unique condition provided Scoville and Milner with an unprecedented opportunity to study the brain's memory functions. By comparing Henry's case with other patients who had undergone similar procedures, they were able to narrow down the area responsible for memory formation.
Their research led them to identify the hippocampus as the brain's memory center. The hippocampus is a ridge of brain matter shaped like a seahorse, with one half in each hemisphere of the medial temporal lobes. They found that the extent of memory loss in patients correlated with the amount of hippocampal tissue removed during surgery.
In 1957, Scoville and Milner published their groundbreaking discovery, establishing the hippocampus as the brain's memory center. This finding was a major milestone in neuroscience and marked the beginning of modern memory research.
Insights into Different Types of Memory
Procedural vs. Declarative Memory
Dr. Brenda Milner developed a series of tests and activities for Henry to better understand his condition. One of the most famous was the mirror-drawing test, where Henry was asked to trace a double-edged five-pointed star while looking at it in a mirror.
Surprisingly, Henry showed improvement in this task over multiple attempts, even though he couldn't remember having done the task before. This revelation suggested the existence of two distinct types of memory:
Conscious or declarative memory: This is the type of memory Henry had lost – the ability to intentionally recall facts and past experiences.
Subconscious or procedural memory: This type of memory allowed Henry to improve at tasks through repetition, even without conscious recollection of having done them before.
This discovery was groundbreaking, providing evidence for multiple memory systems in the brain. Today, we understand declarative memory as the conscious recollection of facts and events, while procedural memory involves unconscious learning of skills and habits.
Semantic vs. Episodic Memory
Later research by Dr. Suzanne Corkin, who joined Milner's laboratory in 1961, revealed another fascinating aspect of Henry's condition. She discovered that Henry lacked episodic memory but retained some semantic memory.
Semantic memory refers to general knowledge and facts about the world, while episodic memory involves the ability to recall specific personal experiences and events. Henry could remember certain facts (semantic memory) but couldn't put them into a personal context or recall how he learned them (episodic memory).
For example, Henry could remember that he had once fallen in love, but he couldn't recall any details about when, where, or with whom this happened. This distinction between semantic and episodic memory has become a fundamental concept in memory research.
The Legacy of Patient H.M.
A Lifelong Subject of Study
Henry Molaison, known to the scientific world as Patient H.M., remained a subject of intense study until his death in 2008. For over five decades, he contributed immensely to our understanding of memory and brain function.
In the late 1970s, Dr. Suzanne Corkin became Henry's custodian, protecting his identity and carefully screening those who wanted to study him. This arrangement continued until Henry's death from respiratory failure on December 2, 2008, at the age of 82.
Posthumous Fame
Ironically, Henry's fame only increased after his death. His full name was finally revealed to the public, along with more details about his life and his brain. The preservation and study of Henry's brain became a subject of great scientific interest and some controversy.
The Dissection of Henry's Brain
After Henry's death, his brain was carefully removed and preserved. It was then shipped to the Brain Observatory at the University of California in San Diego, where it came under the care of neuroanatomist Jacopo Annese.
Dr. Annese conducted a meticulous dissection of Henry's brain, which was broadcast live over the internet. This process involved extracting over 2,400 slices of brain tissue, with the goal of creating a detailed, three-dimensional, zoomable map of Henry's brain.
During this process, Dr. Annese made an unexpected discovery: a previously unknown lesion in Henry's frontal lobe. This finding suggested that earlier researchers may not have fully understood the extent of Henry's brain damage, potentially complicating the interpretation of some previous studies.
Legal Disputes and Final Resting Place
The custody of Henry's brain became a subject of legal dispute between Dr. Annese and Dr. Corkin. While Dr. Annese wished to continue his research, there were also plans for the brain to be studied at MIT. Eventually, Dr. Corkin won her case, and Henry's brain, along with its thousands of preserved slices, was transferred to the MIND Institute of the University of California, Davis, where it remains today.
The End of the Lobotomy Era
Decline of the Procedure
The lobotomy fell out of favor in the 1970s, coinciding with the deaths of its main proponents. Walter Freeman, who had popularized the procedure in the United States, died in 1972. William Scoville, who had performed Henry's fateful surgery, passed away in a car accident in 1984.
Several factors contributed to the decline of lobotomies:
The development of effective psychiatric medications, particularly antipsychotics, which provided alternative treatments for severe mental illnesses.
Increased awareness of the procedure's risks and side effects, including personality changes and cognitive impairments.
Growing ethical concerns about the use of invasive, irreversible procedures to treat mental illness.
Improved understanding of brain function, partly due to studies of patients like Henry Molaison, which highlighted the complexity of the brain and the potential for unintended consequences from crude surgical interventions.
Lessons Learned
The era of lobotomies, while now viewed as a dark chapter in medical history, provided valuable lessons and insights:
- The importance of ethical considerations in medical research and treatment.
- The need for rigorous scientific study before widely adopting new medical procedures.
- The complexity of the human brain and the potential for unintended consequences when manipulating its structure.
- The value of long-term follow-up studies to understand the full impact of medical interventions.
Conclusion
The story of Patient H.M. and the era of lobotomies represents a complex chapter in the history of neuroscience and psychiatry. It's a tale that encompasses both the relentless pursuit of scientific knowledge and the ethical dilemmas that can arise in that pursuit.
Henry Molaison's tragic loss of memory led to groundbreaking discoveries about how the brain works, particularly in relation to memory formation and storage. His case highlighted the existence of different types of memory – declarative and procedural, semantic and episodic – and pinpointed the crucial role of the hippocampus in forming new memories.
The lobotomy era, while now rightfully criticized for its crude and often harmful approach, was born out of a genuine desire to help those suffering from severe mental illnesses at a time when few effective treatments were available. It serves as a stark reminder of the potential consequences of medical interventions that outpace our understanding of the systems they aim to treat.
Today, the field of neuroscience continues to build on the knowledge gained from studying Patient H.M. and others like him. Advanced imaging techniques, more targeted surgical interventions, and a deeper understanding of brain chemistry have revolutionized our approach to treating neurological and psychiatric disorders.
The legacy of Patient H.M. extends far beyond the field of neuroscience. It raises important questions about medical ethics, the nature of identity, and what it means to live without the ability to form new memories. Henry's willingness to participate in decades of studies, despite not being able to remember doing so, has left an indelible mark on our understanding of the human brain and mind.
As we continue to explore the frontiers of neuroscience, the story of Patient H.M. serves as both a cautionary tale and an inspiration. It reminds us of the potential costs of scientific progress, but also of the remarkable insights that can emerge from even the most challenging circumstances. Henry Molaison's involuntary sacrifice has enriched our understanding of ourselves in ways that continue to unfold, ensuring that while he could not form new memories, he has become an unforgettable part of scientific history.