Book Review: “Patient H.M.”

By Neuroskeptic | July 2, 2016 5:14 am

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?

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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.

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  • http://nonsignificance.blogspot.com non_sig

    I’m wondering how it can be (ethically right/allowed that it is) up to her alone to decide what can be published and even what to destroy… And if all relevent material has already been published, then why not destroy the rest right away (or after a specific period of time)? (To protect H.M. from the possible publication of things that may be irrelevant and personal to him.)

  • https://plus.google.com/u/0/101046916407340625977/posts Rolf Degen

    What a deeply disturbing story. Here is what Corkin herself revealed about the conservator in question in her book PERMANENT
    PRESENT TENSE:

    In 1974, when Henry was forty-eight, he and his mother moved in with Lillian Herrick, whose first husband was related to Henry on his mother’s side of the family… Mrs. Herrick’s son, Mr. M. [meaning, Tom Mooney], described her as “prim, proper, and very English.”… Mrs. Herrick had become the custodian of the Molaisons’ mementos, collected on vacations and from family events, and she passed them on to me. In 1991, the Probate Court in Windsor Locks, Connecticut appointed her son, Mr. M., to be Henry’s conservator, meaning that he was responsible for protecting Henry’s interests and supervising his personal affairs.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      Thanks. Here’s some more detail from Dittrich’s book:

      Herrick was “not Henry’s conservator” legally but she co-signed the research consent forms from 1974 to 1980. From 1980 when Henry moved into a care home, until 1992, “the only person who signed Henry’s consent forms was Henry himself.”

      Eventually, Tom Mooney “the son of Henry’s old landlady Lillian Herrick” applied to be H.M.’s conservator. On the application form he “claimed that he himself was Henry’s cousin” and “in paperwork filed with the court, Mooney was referred to alternately as Henry’s cousin and his nephew”.

      But Dittrich says “if Mooney and Henry shared blood ties, they were thin ones, undetectable even by following Henry’s family tree for several generations”.

      At the time, Dittrich writes, Henry had three surviving first cousins “all more closely related to Henry than Mooney” yet “none of these cousins had been contacted”. In a legal document, Mooney referred to himself as “Henry G. Molaison’s closest living next-of-kin” and it appears that this was how MIT authorities understood his role.

    • Dwayne Godwin

      I’ve posted an update of a document given to me by Suzanne Corkin back in 2013. It’s a link update at the end of my revew of Corkin’s book ( http://blog.brainfacts.org/2013/05/patient-zero-what-we-learned-from-h-m/#.V30-0fkrJGE ), for anyone interested in how she interpreted and implements the informed consent process.

      • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

        Many thanks for this update.

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  • http://www.mazepath.com/uncleal/qz4.htm Uncle Al

    Psychiatry/psychology is the “shut ’em up or shut ’em down” of social inconvenience – institutional, chemical, surgical, and physical abuse. Orthopedic surgeons are often carpenters whose plates, screws, beams, and sockets can cause remarkable harm (and for hip joints, cobalt poisoning via microgalling Vitallium alloy). Mental carpenters often precipitate organic mutilation (e.g., tardive dyskinesia), and merrily go beyond to “therapeutic” damage and destruction of mentailty.

    Compare the self-assured tweedy East Indian chappie toward the beginning of One Flew over the Cuckoo’s Nest (1975) to Project MKUltra and Guantánamo Bay Muslim Detention Camp – babies playing with razor blades. YouTube v=nqPD_g5X7gk, 1:20ff “just their way of having a bit of fun, the swine.”

  • Dwayne Godwin

    Brenda Milner is alive (97!) and might be able to weigh in on the question of the documentation. I work in epilepsy and once asked Corkin via email whether there were surviving EEG records from H.M. – she said no.

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      Corkin published a paper last year arguing that H.M. suffered from idiopathic generalized epilepsy (IGE). Dittrich doesn’t go into any detail about the epilepsy, except he notes that Scoville failed to find any seizure focus intraoperatively (but went ahead anyway!)

  • Tiziana Metitieri

    Can you tell something about Brenda Milner? How is she depicted by Dittrich? Thanks!

    • http://blogs.discovermagazine.com/neuroskeptic/ Neuroskeptic

      She is portrayed positively, she doesn’t have a big role in the book but Dittrich acknowledges the scientific importance of her work with H.M.

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  • David Schnyer
  • Neuroscientist

    Here’s a recent review that offers more context. What Dittrich doesn’t say in his book is that he evidently bears personal animus toward Suzanne Corkin, presumably because she applied her same practice of carefully guarding access to H.M. and his data to Dittrich as she did to everyone else. Much of what he writes in his book is either naive speculation or outright wrong. See this review, which is by a neuropsychologist who knew Corkin personally and (unlike Dittrich) actually met and studied H.M.: https://www.psychologytoday.com/blog/trouble-in-mind/201608/tale-science-ethics-intrigue-and-human-flaws

  • neuroscientist31

    I don’t think there is anything unsettling about care of HM being passed on to the only person who spent time with the family while HM’s mother was still alive. Suzanne Corkin knew this family through HM’s mother, and therefore it made sense that they would arrange for his care. It also makes sense that Tom Mooney trusted Corkin, and therefore signed her consent forms, since she cared very much about HM, his well-being, and his privacy. The closer cousins Dietrich tracks down didn’t come forward to request to care for HM, was Corkin really obligated to track them down, when the family didn’t present them, and the legal system didn’t find them?

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Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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