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Permanent Present TenseReview - Permanent Present Tense
The Unforgettable Life of the Amnesic Patient, H. M.
by Suzanne Corkin
Basic Books, 2013
Review by Elisabeth Herschbach
Jan 14th 2014 (Volume 18, Issue 3)

In 1953, Henry Molaison was a polite, mild-mannered 27-year-old who loved Big Band music, watched The Roy Rogers Show, collected hunting rifles and pistols, and worked an assembly-line job at the Underwood Typewriter Company in Hartford, Connecticut, where he lived with his parents in an ordinary middle-class home. Since the age of ten, however, Henry had been suffering from progressively more severe epileptic seizures that, despite heavy doses of medication, were making it increasingly difficult for him to live a normal life. Under the recommendation of his doctor, a proponent of the psychosurgery movement then in vogue, Henry agreed to undergo an experimental procedure involving the excision of targeted sections of his temporal lobes--in other words, a lobotomy. The operation, which suctioned out chunks of tissue from both sides of his brain, including the front half of the hippocampus and surrounding areas of the cortex, did in fact succeed in reducing the frequency and severity of Henry's seizures. Yet it soon became apparent that there was a devastating cost. Recovering in the hospital after the operation, Henry was unable to recognize the nurses and doctors who came to his room every day. He repeated conversations as if they had never occurred. He couldn't remember the way to the bathroom. Though he had retained most of his memories from before the operation, he had permanently lost the ability to form new memories.

Henry's loss, however, "became science's gain," as Suzanne Corkin puts it in Permanent Present Tense, a chronicle of the 46 years she spent studying him in her MIT neuroscience lab. Corkin first met Henry when she was a graduate student in 1962 and quickly realized his "limitless worth as a research participant." Until his death in 2008 at the age of 82, Henry--or "the amnesic patient H.M.," as he was referred to in the scientific literature--lived as a perpetual research subject, undergoing thousands of hours of psychological tests designed to assess his capacities and repeated brain scans to map the precise boundaries of the damaged areas of his brain, with the goal of linking specific cognitive functions to specific brain structures and mechanisms.

Henry could acquire new procedural knowledge and learn new motor skills, such as how to use a walker or how to complete a mirror-tracing task. His attention span and short-term memory were normal, and he could hold a conversation, read the newspaper, play bingo, watch TV, and--his favorite activity--complete crossword puzzles. But, lacking the ability to translate short-term memories into long-term memories or unconscious learning into explicit, conscious knowledge, Henry remained bound by the limits of his working memory, unable to store and retrieve memories of the post-1953 world. He watched the nightly news, but when the television was switched off, could no longer remember the Watergate scandal. He read the same magazines and completed the same jigsaw puzzles over and over again without realizing that he had already done so. While his intelligence was normal, he was unable to learn the meanings of new words not in his preoperative vocabulary. And while he did develop a sense of familiarity for Corkin over the decades, he remained unable to identify who she was, instead typically mistaking her for a friend from high school.

The crucial insight researchers gained from Henry's case is that memory is not a single process linked to a single area of the brain or to a discrete set of neural circuits, but a complex collection of many different processes and capacities that depend on a wide range of brain mechanisms and structures. "Our brains," as Corkin puts it in one of the many vivid analogies that enliven what might otherwise be dry and technical material, "are like hotels with eclectic arrays of guests--homes to different kinds of memory, each of which occupies its own suite of rooms." Familiarity and recollection, for example, are distinct abilities, depending on independent retrieval processes. Similarly, declarative memories--consciously recalled facts and knowledge, based on explicit learning--are formed in areas of the brain different from the ones that enable the implicit, unconscious learning mechanisms engaged in forming nondeclarative memories, the kind of memory involved in learning motor skills.

Though his inability to retain new events and facts meant that he would never be able to grasp his own importance to science, over the 55 years after his fateful operation, Henry became the world's most famous case of anterograde amnesia, studied by over 100 different researchers and cited in just about every psychology and neuroscience textbook. His case revolutionized the science of memory, "answer[ing] more questions about memory than the entire previous century of previous research," as Corkin writes.

Permanent Present Tense is a compelling account of these advances, with clear and engaging explanations of the research and theory inspired by Henry's case. Given the sheer span of Corkin's career, the book is also a fascinating record of the evolution of the field of neuroscience, showing how the increasingly sophisticated brain imagery techniques that became available over the almost five decades of her work with Henry enabled researchers to gain increasingly nuanced information about the neurophysiological underpinnings of memory.

Corkin is less adept, however, with the human side of the story than with the science. Over the course of her long relationship with Henry, it became her mission, Corkin says, "to make sure that he is not remembered by brief, anonymous descriptions in textbooks." Thus, Permanent Present Tense is intended to be not just a survey of the science of memory but also a tribute to Henry himself, a gentle, patient, good-humored man who bore his predicament with remarkable grace. "Henry Molaison was much more than a collection of test scores and brain images," Corkin writes. "There was a man behind the initials, and a life behind the data." But in her exhaustive cataloguing of clinical tests and technical results we are sometimes left with the uncomfortable sense that, for Corkin, there was no clear distinction between Henry as the subject of a human life and Henry as the object of science--the prized research patient who was a "boon to [her] lab's reputation."

This is especially true in the final chapter on "Henry's Legacy," in which Corkin narrates, in tones alternating between breathless excitement and clinical detachment, the elaborate proceedings undertaken upon Henry's death to scan, harvest, and autopsy the "most famous brain the world." Although Corkin developed a genuine fondness for Henry over the decades, she makes it clear that her interest in him was always primarily intellectual and her relationship to him that of an unbiased researcher. That's understandable, but all the same it is difficult not to cringe when Corkin, once listed on Henry's hospital chart as his "only interested relative, friend, or contact," writes sentences like this: "Seeing Henry's precious brain in the safety of the metal bowl was one of the most memorable and satisfying moments of my life."

The primary point of contact for Henry since the 1970s, Corkin tightly controlled other researchers' access to Henry during his lifetime to ensure that he wouldn't "become a sideshow attraction." But, a year after Henry's death, as his frozen brain is sliced up for future microscopic examination, it's a full-on spectacle in the lab and the atmosphere seems positively festive. Visitors flock in and out to gawk; the conference room is "decked out with treats," including "delicious Italian cake," and the entire process--53 hours of painstaking dissection, as the brain is shaved into 2,401 slices, each as thin as a single strand of human hair--is live-streamed on the Web. The narrative here is a strange blend of chatty details (the tasty treats, the name dropping of important luminaries) mixed with clinically dispassionate descriptions of the procedure, told with gratuitous exactness, and the occasional macabre metaphor (the microtome likened to an "exceedingly precise meat slicer"). The effect is a little chilling. Corkin describes the postmortem research on Henry as a "beautiful finale to his enduring contributions," but another image comes to mind: Henry as science's sacrificial lamb, under the carving knife one last time.

The tremendous value of what researchers learned and are continuing to learn from Henry is indisputable, and Corkin emphasizes that Henry himself often expressed satisfaction at the thought that research into his case would help others. Nonetheless, it is hard not to feel some moral queasiness about Henry's status as a permanent medical experiment, and about the way the value of his life was reduced to the importance of his brain for science. Though Corkin consistently refers to Henry as a research "participant," given his inability to integrate past and future experiences into a coherent, long-term view of his own life, the sense in which he could be said to have been a genuine participant in the perpetual rounds of tests to which he was subjected is questionable. How little meaning the term has, in fact, becomes clear when Corkin describes even the dead Henry as "remain[ing] a precious research participant." Despite his impaired memory, Henry occasionally showed a startling awareness of his condition, often expressed with his characteristic humor. Summing up his testing experiences to a lab member one day, Henry put it this way: "It's a funny thing--you just live and learn. I live and you learn."

After the devastating consequences became apparent, Henry's surgeon, William Beecher Scoville, described the operation as a "tragic mistake" that he "deeply regretted." But in a brief epilogue in which she discusses the ethics of experimental medical procedures, Corkin points out that even with the benefit of hindsight we owe Scoville some charity in judging his decision to perform what he acknowledged as a "frankly experimental operation." At the time, lobotomy was considered a legitimate medical procedure; Henry's epilepsy was not responding to medication, and, given the severity of his seizures, it is unlikely that he would have lived as long a life had they continued at their preoperative frequency and intensity. "Scoville arguably saved Henry's life, even if he took his memory," Corkin writes.

An earlier chapter on the history of lobotomy explaining the broader medical context of the day, however, tells what can only be called a story of recklessness. Some 40,000 patients were lobotomized in the United States in the 1940s and 1950s, "often with flimsy justifications and little evaluation and documentation of the therapeutic benefit and side effects." Proponents of psychosurgery, with a vested interest in securing their own reputation, reported their own results, often exaggerating their successes and downplaying the negative outcomes, and there was little external oversight or independent verification of their claims. And doctors embraced the procedure not based on evidence but because they had few other practical alternatives. "The history of lobotomy," as Corkin puts it, "is marked by optimism and a lack of skepticism on the part of both the surgeons and families of the recipients."

Today our standards for medical testing are much more rigorous and our regulation of new treatments is much stricter. But in an era when a majority of clinical trials are funded by the pharmaceutical industry and an increasing proportion of continuing medical education courses in the U.S. are financed by drug companies, there are still reasons to worry about the way that vested interests and a lack of skepticism can cloud medical judgment. Henry Molaison taught researchers many lessons about the nature of the brain and the mechanics of memory. But his story also holds another lesson for us, perhaps still waiting to be learned--the importance of caution and humility in medical science.

© 2013 Elisabeth Herschbach

Elisabeth Herschbach has a PhD in Philosophy from the University of Pennsylvania and teaches in Rhode Island.


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