Remembering Henry Molaison, the Man Who Kept Forgetting

IRA FLATOW: This is Science Friday. I’m Ira Flatow.

For decades, Henry Molaison was known to the world only as patient HM, the man who could not form new memories. And 1953, in an experimental surgery aimed at curing is epilepsy, doctors removed, among other things, his hippocampus. It left him in a persistent amnesiatic state. Neuroscientists conducted study after study on this human lab animal to determine the extent of the damage. And he became one of the most famous cases in the field for his contributions to our understanding of memory. Here’s Molaison being interviewed by late neuroscientist Suzanne Corkin.

SUZANNE CORKIN: Do you know what you did yesterday?

HENRY MOLAISON: No, I don’t.

SUZANNE CORKIN: How about this morning?

HENRY MOLAISON: I don’t even remember that.

SUZANNE CORKIN: Could you tell me what you had for lunch today?

HENRY MOLAISON: I don’t know to tell you the truth.

IRA FLATOW: Molaison died in 2008 and his brain was sliced thin and digitized by a team at UC San Diego to be further studied in death. But soon after, journalist Luke Dittrich was examining the details of HM’s life as a patient, research subject, and man. And how his story fit into the area of lobotomies and other highly experimental human brain surgeries. He shares his findings in the new book Patient HM. A Story of Memory, Madness and Family Secrets. He’s here to talk to us today. Luke Dittrich welcome to Science Friday.

LUKE DITTRICH: Thanks so much for having me.

IRA FLATOW: You’re welcome and we have excerpt of your book. An excerpt of the book is on our website at sciencefriday.com/hm. Besides the title Memory and Madness. I’m intrigued by the family secrets in your book. It’s a reference to your own family’s connection to this story right? Your grandfather was the surgeon who removed the critical parts of his brain?

LUKE DITTRICH: That’s correct, my grandfather was the surgeon who transformed Henry Molaison into patient HM.

IRA FLATOW: And tell us about your grandmother here.

LUKE DITTRICH: Right, so, my grandmother. So when I began working on this book it quickly became clear that there was this entire sort of chunk of my family history that I was entirely unaware of that also had strange sort of implications for memory science.

So my grandmother was mentally ill. And she was institutionalized in the 1940s. This is my grandfather’s wife. And my grandfather became, in part as a result of her mental illness, he became a very sort of passionate practitioner of an advocate for psycho surgery. Which is what we usually think of as the lobotomy, that is sort of a surgical treatment for mental illness. The belief that you can treat all sorts of mental illnesses by removing different parts of the brain. And he became a really zealous advocate and proselytizer for psycho surgery.

But this kind of zealous passion for psycho surgery was driven, in large part, by a very personal and kind of secret desire to discover a fix for mental illness so that he could fix his own wife who was mentally ill.

And what I discovered, over the course of my research, was that it’s really impossible to understand the case of patient HM without understanding this long period, this sort of campaign of psycho surgical experimentation that my grandfather, and a number of other leading neurosurgeons and researchers of the day, participated in. HM, even though he was not strictly speaking sort of a cycle surgical patient because he didn’t have a psychiatric disorder, he grew out of that whole period. And was in many ways a culmination of it

IRA FLATOW: Was he really a human guinea pig, the kind of surgery they did on him and other people?

LUKE DITTRICH: Well it’s these were the it was an era when the modern notions of informed consent really didn’t exist. I found, in various archives, for example, John Fulton, who was a prominent scientist at Yale University, was encouraging a researcher to go spend time with my grandfather as my grandfather was performing a series of lobotomies in a particular asylum. And he said um, he said Doctor Scoville, who’s my grandfather, he said Doctor Scoville has been given unlimited access to the psychiatric material of this institution and I highly recommend you go see what he’s up to.

And that word, psychiatric material, I had to read it twice before I realized that they were talking about human beings. That sort of attitude, this sort of blurring of the lines between medical research and medical practice, was prevalent at the time. I mean I open my book with a quote from another neurosurgeon slash scientists to sort of straddled this divide, a man named Paul Bucy who did a lot of work with animals, with monkeys, but then began performing lobotomies. And he said man is certainly no poorer as an experimental animal merely because he can talk.

IRA FLATOW: Times have changed I hope.

LUKE DITTRICH: Yes they have.

IRA FLATOW: Tell me how– you talk about this in graphic detail in your book and it’s almost like reading science fiction about the way they’re carving up people’s brains who are still alive. Tell us how a lobotomy was performed in those days.

LUKE DITTRICH: Well there were a number– it was sort of this evolving procedure. It began, it originally was directly inspired again– Yale comes up often in the book because Yale was ground zero for the lobotomy. The lobotomy was inspired by chimpanzee research that was done at Yale, where they lesioned the frontal lobes and then found that chimps who had had their frontal lobes lesioned, when faced with difficult experiments or tasks afterwards couldn’t perform those tasks as well as they could have had before. But they no longer got as upset when they failed to execute the test properly. They exhibited less so-called experimental neurosis.

And so a man, a Portuguese neurologist named Egaz Moniz saw that work that had been done in chimpanzees and wondered whether human beings with lesioned frontal lobes would also exhibit less neurosis, would be less anxious, less worried by any problems they might have. And he began performing the first lobotomies in the 1930s, late 1930s.

Very quickly it lept the Atlantic Ocean and a man named Walter Freeman began performing sort of a variation of Egaz Moniz’ lobotomy. Then people like my grandfather began refining the procedure. He developed what he considered to be a much less blunting version of the lobotomy than the standard one. It was called an orbital undercutting procedure. And what he would do is he would drill two silver dollar sized holes right above the eyebrows in a person’s skull. And he would actually drill those using trephines that were basically modified auto mechanic tools.

He would drill these disks of bone out then lever up the frontal lobes and do some very precise cuts underneath, rather than the more I don’t know more brutal operation some would say that Walter Freeman was performing at the time. Walter Freeman eventually developed what he considered to be the quickest, easiest version of the lobotomy which was the so-called ice pick lobotomy. Where he would just insert what started out as a literal ice pick and then he refined it somewhat. But right above the eyeballs, tap it through the orbital bones, which are very thin. Inserted a certain distance into the frontal lobes and then just swish it back and forth.

He considered it to be almost an outpatient procedure. He thought that he could teach any, I think he said any reasonably competent psychiatrist could learn this procedure in an afternoon.

IRA FLATOW: Wow, the imagery. Did anybody actually learn anything? Did it help the patients? I mean what was the outcome of all of this?

LUKE DITTRICH: You know it’s a very good question and it’s a very hard question to answer. For awhile, and I again I was constantly struck by how this was not a fringe procedure, this was embraced at first. And it was pushed, not just by the doctors and the researchers themselves, but by the mass media. I mean the New York Times was running articles about the lobotomy and talking about how suddenly there was this– it was easy, it was as easy to remove madness as it was to pluck a diseased tooth.

So there was a lot of general mainstream excitement about this thing. But in terms of the effects, those effects became clearer over the years and even though they were hard to quantify there was a famous lobotomist who took it on his own to try to figure out what it was he was doing to these patients. And he said you know it’s very hard to figure out quantifiably what we’re taking from these people that we’re lobotomizing. But if I had to give it a word I’d say soul. We’re removing their souls.

IRA FLATOW: Wow, and HM was sort of the central figure here? How many operations did he Have

LUKE DITTRICH: OK so HM only had one operation. And his operation, even though it wasn’t strictly speaking a psycho surgical procedure, it originated in research that my grandfather began in asylums. So it actually was identical to a procedure that he had spearheaded in the asylums first, and then decided to see whether it could be modified or adapted as a treatment for epilepsy.

And so my grandfather performed one operation on him, but it was one very dramatic, and from HM’s perspective, a catastrophic operation from the world of– from the scientific perspective and illuminating and revelatory operation.

He removed, as you mentioned– I mean he again he levered up his frontal lobes. He used that same trephine approach, levered up his frontal lobes. Got deeper into this region known as the medial temporal lobes and removed most of his hippocampus, his amygdala, his uncula, his entorhinal cortex. And from that point forward, from that moment forward, HM lived the rest of his life in basically 30 second increments. The present would just slide off of him constantly.

IRA FLATOW: And the point was to try to cure him of epilepsy all of this?

LUKE DITTRICH: That was the point. I mean that was– my grandfather hoped that this operation would alleviate his seizures. HM did suffer from devastating epilepsy. At the same time, yes sorry.

IRA FLATOW: So he wasn’t a threat, he wasn’t trying to harm people. He just had epilepsy and that was the point. To remove all of that stuff for just–

LUKE DITTRICH: Right but at the time nobody knew exactly what of that stuff did. Which is– I mean that doesn’t excuse it because you would think then maybe it’s best not to remove it. And in a sense there was this once again this strange straddling of the divide between medical practice and medical research. My grandfather didn’t know what these structures did. He had been performing very similar operations on psychotic patients in the back wards of asylums.

But their minds were so kind of muddied by mental illness that the actual effect of the operation was very difficult to glean. And there was a huge amount of interest in determining what these structures did at the time among the broader scientific community. There was almost– I mean there was a real drive to figure it out. And patient HM, in that case, was this extremely useful individual in the sense that he had a mind that was normal. He was more, apart from his epilepsy, he was psychologically sound.

And so if was immediately apparent what he lost. Whereas it hadn’t been so immediately apparent in the disturbed asylum patients.

IRA FLATOW: I’m Ira Flatow. This is Science Friday from PRI, Public Radio International. Talking with Luke Dittrich, author of HM: A Story of Memory, Madness, and Family Secrets. It’s as chilling a story as any, going to the movies or reading a Stephen King novel would be about these patients. And so why is HM singled out and reached such fame that he did amongst everybody else. And it was kept secret. He was kept secret was he not?

LUKE DITTRICH: Right, well the results were not kept secret. Countless papers were written about him. But yes his identity was kept secret. He was this constellation of data and information floating behind this anonymizing set of initials, HM. So his real name, Henry Molaison, wasn’t revealed until the day after he died. In a front page obituary in the New York Times.

But what was so– I mean there were numerous things that were important about him and that made him this epic, famous figure. And a lot of the revelations that came out of the study of HM came fairly early on. There’s a brilliant neuropsychologist at McGill University who’s still active there as a researcher and a professor, and I don’t want to get her age wrong, but she’s in her 90s, mid 90s I believe. Brenda Milner.

And she had been– there were a lot of operations going on at McGill where they would remove from one hemisphere of the brain these same structures. But they wouldn’t go bilaterally like my grandfather did. But they would remove one half of the hippocampus, amygdala, entorhinal cortex. And they found in a couple of those cases that post operatively these patients also suffered from amnesia.

And so she had a hunch that what was going on, even though she didn’t have the type of neuro-imaging technology that we have today, she had this hunch. She and the neurosurgeon Wilder Penfield, who was actually performing operations, that those structures must somehow be required to create new long term memories. But they didn’t know because they couldn’t see the other side of the brain at that point.

And so they thought the other side of the brain in those individuals must have already been damaged and compromised, which effectively made them bilateral operations. But when she heard about the amnesia, it was basically my grandfather ran into the neurosurgeon at a conference and they got to talking, and they were talking about these somewhat similar operations they’ve been for performing.

And my grandfather mentioned patient HM to the neurosurgeon and then he mentioned it to Brenda Milner. And she immediately wanted to go down to Hartford, Connecticut, which is where HM lived, which is where Henry Molaison lived, in order to study him. And so she took that first trip in I think 1955. And then she and my grandfather collaborated on a paper about him, centered on him, that really is the cornerstone for the skyscraper that is modern memory science.

And it had a very simple conclusion. And that conclusion– but it was simple but also revolutionary. It was that Henry clearly could no longer create new long term memories. They knew more or less, with more or less precision and specificity exactly what had been taken from his brain. And so those structures must be required to create new long term memories.

And that was a revelation

IRA FLATOW: OK there’s so much more to talk about read about. Get the book yourself. It’s Luke Dittrick’s book HM: A Story of Memory, Madness, and Family Secrets. A fascinating read and a personal story in there too Luke. Thank you for taking time to be with us today.

LUKE DITTRICH: Thank you so much for having me.

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