A New Origin Story for H.M., One of Psychology’s Most Famous Case Studies

By
Patient H.M.

You’re familiar with Henry Molaison, even if you don’t recognize his name. You likely know him by his initials: He is H.M., an epileptic man who became a famous amnesiac patient after an unprecedented brain surgery done by the august neurosurgeon William Scoville. H.M.’s story is a mainstay in undgrad psychology courses, and it’s also inspired books and movies, not to mention hundreds of scientific studies — all of which makes one wonder, at first, why a new book on the subject is needed. “I’m certainly not the first person who has written about H.M., and I’m certainly not the last,” the journalist Luke Dittrich tells me, a few days before the publication of his first book, Patient H.M.: A Story of Memory, Madness, and Family Secrets. “But one of the things I’m trying to accomplish is to take back H.M.’s story, or at least give an alternate telling, that is wrested in a certain sense from the people who have already told it.” Dittrich offers a perspective on this famed case that no one else can: Scoville, the surgeon who created Patient H.M., was his grandfather.

A quick overview of H.M.’s story, in case it’s been a while since you took Psych 101: In the 1950s, H.M. was a young man living with his parents in modest circumstances in Connecticut; he had such severe epilepsy that he could live only the most stripped-down existence, barely able to function at the most menial of jobs. In 1953, Scoville suggested the unprecedented step of removing a good deal of H.M.’s temporal lobes — the area of the brain just behind the ears that contains what’s known as the limbic system, often thought to be fundamental to the brain’s ability to manufacture emotion — including most of his hippocampus and part of his amygdala. H.M. and his parents said yes.

They said yes, but they didn’t know — no one knew — that the regions of the brain Scoville intended to remove were, in fact, integral to the brain’s ability to form new memories. After his surgery, H.M. was reborn in Hartford, Connecticut, as the ultimate amnesiac, unable to remember events from more than a few minutes before. He was reduced to short-term memory, lost in a maze of the present tense. His amnesia was considered “pure” — that is, manufactured with the precision of the surgeon’s scalpel, with his intellect left undimmed (indeed, possibly even slightly improved). Over the next 50 years, his case would fuel hundreds of studies by researchers eager to solve the mystery of how memory works in the brain. The fascination went beyond science: H.M.’s story has inspired books and movies, all depicting the man whose profound amnesia left him suspended in his own distorted chronology, uncertain of whether his own father was alive or dead, who was the president of the United States, or even his own age. (His estimates could be off by decades.) Until the end of H.M.’s life, Dr. Scoville would loom as the ultimate authority figure. “Henry,” a nurse at his assisted-living home might say, “Dr. Scoville insists that you take your meds right now.” The tactic was effective even long after Scoville’s death.

At 43, Scoville’s grandson is a seasoned magazine writer, for Esquire and other publications, yet it took him more than five years to complete his sprawling book. Dittrich’s account raises entirely new questions about the way in which the research on H.M. was conducted — and about the conclusions that have long been incorporated into our understanding of memory. In a café in Washington, D.C., where we meet for lunch, Dittrich — tall, lanky, and recovering from his first NPR interview — is quick to say that he had reservations about digging into this chapter of his family history. Indeed, his is, in some sense, a strange legacy to claim. His grandfather performed the second-highest number of lobotomies in American history. Yet one thing Dittrich’s book does so effectively is to lay out the context which enabled “psychosurgery” to become acceptable, even mainstream.

It started in Switzerland. In 1892, the psychiatrist Dr. Gottlieb Burckhardt longed to find a physical cure for mental illness and, over the next seven years, operated on six patients, cutting out parts of their brains almost at random. “Two of them died, two became epileptic, and one committed suicide,” Dittrich notes. The European medical Establishment rejected Burckhardt’s project with disgust, but by the 1930s, a surgical cure for mental illness was again attempted, this time by the Portugese neuroanatomist Egas Moniz, who targeted, specifically, the brain’s frontal lobes. At the same time, experiments done on monkeys and chimpanzees in the United States — most notably by John Fulton at Yale — revealed that cutting through swathes of frontal-lobe brain matter led to docile, placid creatures, lending a kind of scientific underpinning to the human experimentation. In a breathtakingly short amount of time, the American public embraced psychosurgery as a treatment for the mentally ill. Dittrich writes that the American press embraced the new procedure, and articles appeared bearing such headlines as “Wizardry of Surgery Restores Sanity to Fifty Raving Maniacs.”

Author Luke Dittrich.

In the following years, as the lobotomy became more and more widespread, some neurosurgeons hewed to the most conservative applications of the procedure — surgeons like Wilder Penfield, at McGill, who limited his cuts only to the most established parameters — while others, like Dittrich’s grandfather, felt a great deal less inhibited. When it came to the brain, still so little understood, men like Scoville considered themselves explorers, pioneers, charging forth into uncharted territory with a very real desire to plant their flags, even at steep human costs. Scoville in particular had been an ardent believer in psychosurgery from his early days of practicing it. “I am more impressed with psychosurgery every year,” he said, in 1970, after decades of performing the surgeries. “I wonder why more people don’t have it done.” Such was his faith that he continued to perform them into his 70s, long after they had fallen out of favor. Dittrich remembers his grandfather as charismatic and larger than life, the mythic family figure, with a passion for sports cars and reckless driving. But he remains a kind of cipher, a figure of deep moral ambiguity, even after Dittrich’s long attempt to understand.

One of the revelations of Dittrich’s book is personal: His grandmother, Emily Scoville, a.k.a. Bambam, was admitted in 1944 to the ominously named Institute of Living in Hartford, Connecticut, after having a nervous breakdown as a young wife and mother. At the asylum, she was subjected to the harsh treatments of the day — for example, having her body temperature grossly manipulated in icy baths, or, on other days, in scalding heat, for hours on end. Neither hydrotherapy nor pyretotherapy seemed to help her very much. Her husband was affiliated with the Institute of Living, listed as “consulting staff.” He would write to a friend that all of his work in the years to follow, honing his surgical skills on the brains of the mentally unwell, was for “E’s sake.” “If it hadn’t been for my grandmother’s mental illness, there’s an argument to be made that Patient H.M. would never have happened,” Dittrich tells me.

The surprises in Dittrich’s narrative do not end with his family; Dittrich’s reporting casts a new, rather harsh light on H.M.’s treatment as a research subject — and throws into question some of the scientific findings that we’ve long understood to be solid. Indeed, the lessons that have emerged from H.M.’s plight have, more than any other single source, informed our understanding of memory. For instance, it is because of H.M. that we know that different kinds of memories are stored in different areas of the brain. Procedural memories, like how to ride a bike, drive a car, or turn a combination lock (to the right, to the left, to the right, just so) — skills we’ve internalized so deeply we no longer give them full conscious attention — are laid out in the brain separately from episodic memories, those mini movies we play in our head when we recall the specific moments of our life, like a kiss or a fight or yesterday’s dinner. H.M. was able to form new procedural memories, growing increasingly masterful on certain tricky tasks, like tracing a star while looking only at its reflection in a mirror. (Who knew, but this is famously difficult to do.) H.M. quickly improved on the star-mirror task, even without remembering ever having done it before. But he could never again form new episodic memories — and, the research suggests, he essentially lost the episodic memories that came before his surgery, too, retaining only the facts of his life, without its lived richness. He could remember where a birthday party had taken place, but not the party itself.

Patient H.M.

It was Suzanne Corkin, a neuropsychologist at MIT, who conducted much of this research. Decades’ worth of it. H.M. spent most of his post-surgical life traveling between his assisted-living home in Bickford, Connecticut, and Corkin’s lab at MIT, where he was scrutinized by an ever-changing cast of grad students and researchers, given an endless battery of tests and tasks. In his reporting process, Dittrich ran up against the same phenomenon that many others have also encountered: Corkin controlled access to H.M. as if to a diamond mine. Far from practicing openness and transparency, the supposed values of science, she established herself as a Cerberus figure, ferociously guarding the patient who had made her famous. When Dittrich attempted to meet H.M., for instance, Corkin refused him access. When he wanted to include a photograph of H.M. in his book, he found that Corkin had assumed control of all of that material as well — and she demanded $850 from Dittrich for use of the photo. (He declined.) When Dittrich was finally able to interview Corkin herself, she told him rather nonchalantly that she had shredded much of the original data gathered from decades of H.M. research. “The papers exist, so you don’t need the data,” he recalls her explaining.

Yet some of the original data that Dittrich did manage to turn up contradicts the story that Corkin liked to tell. For example, Dittrich discovered psychological questionnaires that had been given to H.M. in the 1980s. Filling out the Beck Depression Inventory in 1982, H.M. circled such statements as: “I feel that the future is hopeless and that things cannot improve.” And: “I feel that I am a complete failure as a person.” Yet, as Dittrich writes, Corkin herself said that H.M.’s test results showed “no evidence of anxiety” or depression. Indeed, Corkin liked to describe H.M. as being a kind of walking, talking example of Buddhist enlightenment, a man unafflicted by the burden of his past, unable to be anything but present in the moment. “I think there’s something almost like the medieval priesthood, like, only we can read the Bible and tell you what it means,” Dittrich tells me, reflecting on Corkin’s behavior. “I think she felt she was the ultimate interpreter of H.M. and throwing his data out into the world for just anybody to look at would be troubling to her. Ultimately, it allows her to control his narrative — forever.”

When H.M. died, in 2008, his brain was whisked away to be dissected and immortalized in digital form by the neuroanatomist Jacopo Annese, at the University of California, San Diego. Dittrich recounts a deeply unbecoming chapter that ensued, involving a protracted power struggle and legal threats from Corkin and MIT, and ultimately resulting in Annese’s forfeiting the brain — as well as his job. Yet one of the discoveries that Annese made while in possession of H.M.’s brain was a lesion in the frontal lobe that had never been mentioned or documented before. Indeed, one of the great claims of H.M.’s case was that his frontal lobes — the brain’s chief executive, so to speak — were intact, and that Scoville’s surgical cuts had been limited to the temporal lobes, allowing researchers to correlate specific aspects of memory to those specific temporal structures in the brain. It’s not at all clear exactly what the presence of a frontal-lobe lesion might complicate about the story of H.M. Dittrich himself makes no claims to understand the potential rethinking such a lesion might require. “For me, the frontal lesion adds another dimension to Henry’s story,” Dittrich says. “It raises the sort of questions that make the destruction of the raw data in his case so tragic.” For her part, Corkin, upon learning of the discovery of the lesion, argued that it must have been made posthumously, during the dissection process.

Corkin, who died a few months ago, never read Dittrich’s account of the case that defined her professional life. It is an astonishing version of a story that began long before H.M.’s fateful surgery, in 1953, one that has been told and retold countless times since, new details continuing to surface, new implications to consider, new contradictions to reconcile. No doubt, there are still more to come.