Review of: Patient H.M. by Luke Dittrich (Random House), August 2016
Patient H.M. - real name Henry Gustav Molaison (1926-2008) - is probably the most famous neurological case study in history. The outlines of his story are familiar to every neuroscience student: H.M. was an epileptic man who underwent a radical surgery intended to cure his disorder in 1953. A surgeon removed his medial temporal lobes on both sides of his brain, including brain structures called the hippocampi. After the surgery, H.M. had 'anterograde amnesia' - he couldn't form any new long term memories. He would forget people, events and places within minutes. This led scientists to conclude that the hippocampus is essential for memory. So much for the brief sketch. But who was Henry Molaison, and why did he have the drastic surgery that he did? How did he feel about becoming a guinea pig for science? Was he the victim of unethical treatment?
Luke Dittrich's new book "Patient H.M." offers a fascinating and disturbing look at Molaison's life. I can wholeheartedly recommend buying the book when it comes out, but in this review I'll focus on three especially interesting things that Dittrich reveals. On H.M.'s surgery Dittrich is the grandson of William Beecher "Bill" Scoville (1906-1984), the neurosurgeon who operated on H.M., but he's anything but a partisan for his grandfather. On the contrary, Dittrich reveals that Scoville was a maverick psychosurgeon who aggressively promoted (and carried out) the use of brain surgery to treat mental illness. He was the second most prolific lobotomizer in America, after the notorious Walter Freeman. Sensationally, Dittrich even reveals that Scoville may well have personally lobotomized his own wife (Dittrich's grandmother), who suffered from schizophrenia. Scoville was always experimenting with new psychosurgical techniques, using his patients as test subjects. He invented (amongst many others) the bilateral medial temporal ablation as a psychosurgical operation: H.M. was not the first patient who received the surgery - although for reasons unknown, he was the one who suffered the most amnesia - but he was the first epileptic; all of the preceding patients were psychiatric cases. We're led to the inevitable conclusion that H.M. did not undergo "epilepsy surgery" in any normal sense. Surgery is indeed used to treat epilepsy if there is a epileptogenic focus, a spot of diseased brain tissue which triggers the seizures. But no such focus was found in H.M.; Scoville himself looked for one and failed to find any. In other words, H.M. was an epileptic who underwent experimental psychosurgery with no clear medical rationale. On H.M.'s emotions The conventional view of Molaison post-surgery is that he was remarkably placid, happy and contended, maybe as a side-effect of his surgery or possibly just because he was a laid-back person all along. Dittrich reveals, however, that while H.M. was certainly a passive person most of the time, he certainly did not exist in a permanent state of Zen-like calm. At points in his life post-surgery, he threatened suicide. He was physically aggressive on rare occasions. In his later life, he was tormented by tinnitus, a side-effect of one his anti-seizure medications (the operation had failed to cure his epilepsy) and at one point he asked to be given a gun so he could kill himself. On the ethics of Patient H.M. Post-surgery, H.M. was unable to live anything like a normal life. He passed into the custody of his parents and, after they died, a care home, but Dittrich implies that the de facto overseers of Henry Molaison's life were the researchers who studied him, most notably the recently deceased psychologist Suzanne Corkin (1937-2016). Corkin, incidentally, was a childhood friend of Dittrich's mother (Scoville's daughter). After his parents died, a disabled man such as H.M. should have had a court-appointed conservator, someone to represent his interests. However, for many years, H.M. had no conservator. Amongst other things, this meant that H.M. himself was the one providing sole consent for all of the psychological testing he underwent during this time. Dittrich questions whether H.M. was able to provide meaningful consent. Eventually, Corkin arranged for a man called Tom Mooney to be appointed H.M.'s conservator. Mooney described himself as H.M.'s cousin, but Dittrich reveals that, scandalously, there's no evidence that Mooney was related to H.M. A number of H.M.'s real first cousins were alive at the time, but they weren't involved in his care. Mooney, meanwhile, gave blanket consent to all of the testing that Corkin proposed. There's something undeniably unsettling about this arrangement. Indeed, Corkin comes across rather badly in Dittrich's book. There is no suggestion that she was cruel in her treatment of H.M., but she was possessive, guarding his identity and acting as a strict gatekeeper for other researchers hoping to work with him. She banned all video and audio recording of Molaison. The most negative moment in Dittrich's portrayal of Corkin comes at the end of the book where Dittrich asks her what will happen to the unpublished notes and results from her decades spent testing H.M. Corkin said that after her death, all of the files would be shredded. Dittrich expressed his surprise, saying that future researchers would be disappointed were this to happen, but Corkin replied that all of the good material had already been published and what remained would be misleading if it were shared. Update 10th August 2016: Since this post was published, a New York Times article appeared containing extracts from "Patient H.M.", focussed on the work of Sue Corkin. Many neuroscientists are critical of this piece and dispute Dietrich's portrayal of her. Over 200 researchers have signed a letter of support for Corkin. James DiCarlo, head of the Department of Brain and Cognitive Science (where Corkin worked), released a statement contesting three points in Dietrich's piece. Dietrich has just released his own statement in response.