email page print pageAll Topic Reviews
"Are You There Alone?""How Come Boys Get to Keep Their Noses?""My Madness Saved Me"10% Happier365 Days49 Up56 UpA Beautiful MindA Beautiful MindA Beautiful MindA Book of ReasonsA Can of MadnessA Child's Life and Other StoriesA Dangerous LiaisonA Fight to BeA First-Rate MadnessA Good Enough DaughterA Heartbreaking Work of Staggering GeniusA Lethal InheritanceA Lethal InheritanceA Life ShakenA Life Worth LivingA Little PregnantA Message from JakieA Million Little PiecesA Numerate LifeA Pocket History of Sex in the Twentieth CenturyA Slant of SunA Special EducationA Tribe ApartAbout FaceAddicted Like MeADHD & MeAEIOUAgainst Medical AdviceAgents in My BrainAileen - Life and Death of a Serial KillerAlgernon, Charlie and IAll Out!All Seasons PassAlphavilleAlways Too Much And Never EnoughAlzheimer'sAn Anthropologist on MarsAn EducationAn Unquiet MindAngela's AshesAngelheadAnna Freud: A BiographyAnnie's GhostsAnother Bullshit Night in Suck CityAnthology of a Crazy LadyApples and OrangesApproaching NeverlandAre You There, Vodka? It's Me, ChelseaAs I Live and BreatheAs Nature Made HimAt Home in the Heart of AppalachiaAt the End of WordsAvalancheBad BoyBad GirlBeautiful BodiesBeautiful BoyBeautiful WreckBecause We Are BadBecoming AnnaBecoming MyselfBen Behind His VoicesBequest and BetrayalBereftBertrand RussellBlackoutBlanketsBloodlettingBodies in Motion and at RestBoneBorn on a Blue DayBoyBoy AloneBoyleBrain on FireBreaking ApartBreaking the SilenceBrokenBulimics on BulimiaBuzzCamus and SartreCharles DarwinChasing the HighCheeverCherryCity of OneCluesClumsyComfortComplications Compulsive ActsConfessions of a Cereal EaterConfessions of a Former ChildConfessions of a Grieving ChristianConfessions of the Other MotherConfidingConquering the Beast WithinContesting ChildhoodCrackedCrazyCry Depression, Celebrate RecoveryDamned to EternityDancing at the Shame PromDante's CureDaughter of the Queen of ShebaDavid Sedaris Live at Carnegie HallDays With My FatherDefeating the VoicesDementia Caregivers Share Their StoriesDepression and NarrativeDescartesDetourDevil in the DetailsDiagnosis: SchizophreniaDirty DetailsDirty SecretDivided MindsDivine MadnessDon't Get Too ComfortableDown Came the RainDress Your Family in Corduroy and DenimDrinkingDriving My FatherDrunkardDryEarly Embraces IIIEarly ExposuresEinsteinEinstein and OppenheimerElectroboyElegy for IrisElijah's CupElliott Smith and the Big NothingElsewhereEnough About YouEpilepticEvery Girl Tells a StoryEverything In Its PlaceExamined LivesExiting NirvanaFaces of Huntington'sFamily BoundFast GirlFearless ConfessionsFind MeFinding Iris ChangFirst Person Accounts of Mental Illness and RecoveryFirst Person PluralFixing My GazeFlanneryFolie a DeuxFor the Love of ItFortress of My YouthFrank Ramsey (1903-1930)Franz KafkaFraudFree RefillsFreudFreudFreudFriedrich NietzscheFrom Joy Division to New OrderFumblingFun HomeFuriously HappyGalileo Get Me Out of HereGetting OffGirl in Need of a TourniquetGirl Walking BackwardsGirl, InterruptedGirl, InterruptedGirls on the VergeGoing BlindGoing Through Hell Without Help From AboveGraysonGrowing Up JungGuttedHalf a Brain Is EnoughHardcore from the HeartHead CasesHeal & ForgiveHeal & Forgive IIHeavier than HeavenHeinz KohutHeinz KohutHello from Heaven!Hello to All ThatHer HusbandHer Last DeathHigh PriceHole in My LifeHolidays On IceHolidays on IceHope's BoyHouse of Happy EndingsHouse of Happy EndingsHow I Stayed Alive When My Brain Was Trying to Kill MeHow to Lose Friends & Alienate PeopleHow to Make Love Like a Porn Starhow to stop timeHumeHunger Makes Me a Modern GirlHurry Down SunshineI Am Dynamite!I Am I Am I AmI Feel Bad About My NeckI Never Promised You a Rose GardenI Remain in DarknessI'd Rather Eat ChocolateI'd Rather LaughIf I Die Before I WakeImagining RobertIn Search of FatimaIn the Realms of the UnrealIn the Wake of SuicideInside TherapyInternInvisible No MoreIt Happened to NancyIt Takes a Worried ManJack Cole and Plastic ManJean-Paul SartreJohn Stuart MillJourneys with the Black DogJust CheckingKafkaKantLa SierraLab GirlLast Flight OutLearning to FallLet Me Make It GoodLife As We Know ItLife InterruptedLife ReimaginedLimboLincoln's MelancholyListening in the Silence, Seeing in the DarkLittle PeopleLive For Your Listening PleasureLive Through ThisLiving in the Shadow of the Freud FamilyLiving With SchizophreniaLiving with SchizophreniaLockeLonelyLong ShotLook Me in the EyeLooking for The StrangerLoose GirlLosing Mum and PupLosing My MindLove Is a Mix TapeLove SickLove Times ThreeLove Works Like ThisLove You, Mean ItLuckyLudwig WittgensteinLyingMad HouseMad PrideMadame ProustMadnessMagical ThinkingMalignant SadnessManicMarcel ProustMarcus AureliusMary BarnesMaverick MindMaybe You Should Talk to SomeoneMe Talk Pretty One DayMeaningMelanie KleinMemoirMemoirs of an Addicted BrainMemoirs of My Nervous IllnessMen-ipulationMisconceptionsMiss American PieMockingbird YearsMomma and the Meaning of LifeMommies Who DrinkMonkey MindMore, Now, AgainMortificationMy Age of AnxietyMy Body PoliticMy Brain Tumour AdventuresMy DepressionMy Father's HeartMy First Cousin Once RemovedMy Flesh and BloodMy Horizontal LifeMy Life Among the Serial KillersMy Sister LifeMy Stroke of InsightName All the AnimalsNeural MisfireNever EnoughNietzscheNietzsche: The Man and His PhilosophyNinety DaysNo Apparent DistressNo Hurry to Get HomeNo Impact ManNo More ShavesNo One Cares About Crazy PeopleNolaNotebooks 1951-1959NothingOdd Girl Speaks OutOedipus WreckedOf Spirits & MadnessOn Being RapedOn the Edge of DarknessOn the MoveOne Hour in ParisOne Hundred DaysOphelia SpeaksPagan TimePassing for NormalPeople Who Eat DarknessPerfect ChaosPerfect ExamplePermanent Present TensePersepolisPlanet of the BlindPlaying with FirePlease Don't Kill the FreshmanPoisoned LovePollockPOPismPortraits of Huntington'sPoster ChildProzac DiaryPsychiatrist on the RoadPsychosis in the FamilyPuppy Chow Is Better Than ProzacQuitting the Nairobi TrioRaising BlazeReasons to Stay AliveRebuiltRecovered, Not CuredRelative StrangerRescuing JeffreyRestricted AccessRevengeRewind, Replay, RepeatRichard RortyRiding the Bus With My SisterRobert Lowell, Setting the River on FireRoom For JRosemaryRough MagicRunning After AntelopeRunning with ScissorsRXScattershotSchizophreniaSchopenhauerSecond OpinionsSectionedSeeing EzraSeeing the CrabServing the ServantSet the Boy FreeSex & Single GirlsSex ObjectShakespeareShe Bets Her LifeShe Got Up Off the CouchShut the DoorSickenedSilencing the VoicesSimone de BeauvoirSinging in the FireSkin GameSlackjawSlut!SmashedSome Assembly RequiredSome Kind of GeniusSometimes Amazing Things HappenSometimes Madness Is WisdomSongs from the Black ChairSongs of the Gorilla NationSoren KierkegaardSpeak to MeSpeaking Our Minds: Revised EditionSpecial SiblingsSpentStandbyStick FigureStill LivesStretchSunset StorySurviving OpheliaSwing LowTales from Both Sides of the BrainTales of PsychotherapyTalk to HerTell Me Everything You Don't RememberTellingTelling Tales About DementiaThe Accidental BillionairesThe AddictThe Anatomy of HopeThe Anti-Romantic ChildThe Art of MisdiagnosisThe Bastard on the Couch CDThe BeastThe Bell JarThe Best Seat in the HouseThe Big FixThe Body SilentThe Boy on the Green BicycleThe Boy Who Loved Too MuchThe Boy Who Loved WindowsThe Bright HourThe Buddha & The BorderlineThe Burn JournalsThe Camera My Mother Gave MeThe Cancer Monologue ProjectThe Center Cannot HoldThe Chelsea WhistleThe Churkendoose AnthologyThe Day the Voices StoppedThe Devil WithinThe DisappearanceThe Discomfort ZoneThe Doctor Is InThe Eden ExpressThe Family GeneThe Family SilverThe Farm Colonies: Caring for New York City's Mentally Ill In Long Island's State HospitalsThe Fasting GirlThe First Man-Made ManThe First TimeThe Geography of BlissThe Glass CastleThe Good DoctorsThe Hillside Diary and Other WritingsThe Incantations of Daniel JohnstonThe Infidel and the ProfessorThe Last AsylumThe Last Good FreudianThe Last Time I Wore a DressThe Liars' ClubThe Lives and Loves of Daisy and Violet HiltonThe Lives They Left BehindThe LobotomistThe Long GoodbyeThe Looked After Kid: Memoirs from a Children's HomeThe Loony-Bin TripThe Madness of Our LivesThe Making of a PhilosopherThe Making of Friedrich NietzscheThe Man Who Couldn't EatThe Man Who Shocked the WorldThe Man Who Tasted ShapesThe Marvelous Hairy GirlsThe Maximum Security Book ClubThe Me in the MirrorThe Memory PalaceThe Mercy PapersThe Mistress's DaughterThe Mother of Black HollywoodThe Naked Bird WatcherThe Naked Lady Who Stood on Her HeadThe Neuroscientist Who Lost Her MindThe Night of the GunThe Noonday DemonThe Notebook GirlsThe NursesThe Only Girl in the CarThe Only Girl in the WorldThe Orchid ThiefThe Other HollywoodThe OutsiderThe Philosopher's Autobiography The Philosophical Breakfast ClubThe Philosophical IThe Pits and the PendulumThe Pornographer's GriefThe Private Memoirs and Confessions of a Justified Sinner The Professor and the MadmanThe Psychopath TestThe Quiet RoomThe Quiet RoomThe RecoveringThe Red DevilThe Rescue of Belle and SundanceThe Ride TogetherThe Rules of the TunnelThe Secret of LifeThe Shaking Woman or A History of My NervesThe Shared HeartThe Shiniest JewelThe Siren's DanceThe Statistical Life of MeThe Story of My FatherThe Strange Case of Hellish NellThe Summer of a DormouseThe SurrenderThe Talking CureThe Thought that CountsThe Three of UsThe Undoing ProjectThe Vagina MonologuesThe Velveteen FatherThe Winter of Our DisconnectThe Woman Who Walked into the SeaThe Years of Silence are PastThe Yellow HouseThe Yipping TigerThick As ThievesThinThis Close to HappyThomas S. SzaszTiger, TigerTits, Ass, and Real EstateTo Redeem One Person Is to Redeem the WorldTo Walk on EggshellsTransforming MadnessTrue CompassTruth & BeautyTruth Comes in BlowsTuesdays with MorrieTweakTwitch and ShoutUltimate JudgementUndercurrentsUnholy GhostUnlikelyVoices of AlcoholismVoices Of Alzheimer'sVoices of CaregivingVoices of RecoveryVoluntary MadnessWaiting for DaisyWar FareWashing My Life AwayWastedWaveWe're Going to Need More WineWe're Not MonstersWeather Reports from the Autism FrontWeekends at BellevueWhat Did I Do Last Night?What Goes UpWhat I Learned in Medical SchoolWhat's Normal?When a Crocodile Eats the SunWhen Breath Becomes AirWhen Do I Get My Shoelaces Back?.....When It Gets DarkWhen the Piano StopsWhen You Are Engulfed in FlamesWhere Did It All Go Right?Where is the Mango Princess?Where the Roots Reach for WaterWhile the City SleptWhile They SleptWho Was Jacques Derrida?Why I Left, Why I StayedWhy I'm Like ThisWildWill's ChoiceWinnicottWinnieWish I Could Be ThereWith Their EyesWomen Living with Self-InjuryWomen, Body, IllnessWrestling with the AngelYou All Grow Up and Leave MeYou Must Be DreamingYour Voice in My HeadZeldaZor
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.