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Moments in time
Perspectives
Book Moments in time Henry Molaison was a young American man with severe epilepsy. Born in 1926 in Connecticut, his seizures made it hard to fit in at school, and then difficult to do a job. The large doses of anticonvulsant medication he took did not control his symptoms. His only hope for a better quality of life was for a medical breakthrough. Egas Moniz shared the 1949 Nobel Prize in Physiology or Medicine for developing the prefrontal leucotomy, and during the 1950s radical surgery on the brain was ascendant. The approach was mostly used for patients with severe psychiatric disorders, but American neurosurgeon William Scoville was also interested in its application in patients with epilepsy. In 1953, Scoville suggested an experimental operation to the then 27-yearold Molaison: a bilateral resection of parts of the medial temporal lobes, including both hippocampi. The operation was uneventful. Molaison’s seizures were reduced, but he also lost much of his ability to form new long-term memories. He was unable to remember what day it was, what he had eaten, or what was said to him mere minutes before. New memories formed tortuously slowly: for years he experienced fresh grief every time he heard of his father’s death. For the rest of his life Molaison experienced the world as a series of essentially unconnected and unremembered moments in time. It tests the imagination to contemplate such an existence. Molaison’s nearest fictional counterpart is the protagonist in Christopher Nolan’s film Memento who spends his days violently pursuing the people he believes responsible for the attack that renders his memory so impaired. Molaison, however, generally bore his predicament with more equanimity. He embraced medical science and allowed his devastated memory to be www.thelancet.com Vol 382 July 20, 2013
researched in detail. Neuroscientist Suzanne Corkin studied Molaison’s memory over five decades, and to understand him she reaches for a metaphor: he was trapped in the “permanent present tense”. But Molaison was more than just a curious case, he was also a man. Wishing to document the “life behind the data” she has written a unique biography-cumexploration of the science of memory.
“…Molaison the man often struggles to emerge from the shadow of Molaison the star research subject.” Molaison is important because our current understanding of the human brain and behaviour is built upon anomalous cases such as his. As his deficit was in the absence of psychiatric disorder, he became the gold standard for the study of amnesia and he influenced and inspired many new lines of research into human memory. He makes an enigmatic subject. Molaison was never able to gain more than a vague sense of the curiosity he engendered and remained anonymous whilst alive, despite increasing fame. People found him patient, accommodating, and endearing but his memory problems generally excluded him from the activities around which everyday lives revolve: his relationships were few; his employment simple and repetitive. By contrast, his brain remains more generous with its secrets. It continues to be studied and is practically a distinct character in proceedings. As Corkin relates, on the night of Molaison’s death, in 2008, it was scanned in situ and then removed from his cranium in a procedure that was planned for many years. It is now preserved as more than 2000 slices; a 3D reconstruction will be available to all via the internet.
By the 1970s psychosurgery moved to the fringes of medical practice; its rise had been characterised by unfounded optimism built on weak foundations. Scoville ultimately seems to have regretted his role in shaping Molaison’s life, but Corkin takes a generous view of the part he played: medicine advances because of the willingness of patients and doctors to take risks. What comes through in Corkin’s book is Molaison’s great generosity: he had enough understanding to bear a grudge, but didn’t. We know that it was his wish that if the procedure wasn’t to help him then at least it might help others. This sentiment became his unspoken mantra. Fortunately, in this, Molaison was not unique. It gives me hope that this is a notion I still encounter in my clinical practice. Molaison was spared the more anonymous incapacity endured by many others after psychosurgery only because his brain suffered unique and interesting damage. We can only guess if there was a life he would rather have lived. Corkin’s book generally resists such moments of reflection and although it often piques the interest, I found it did not satisfy either as biography or as popular science. Molaison had little ability to reflect on his experience and as the central subject, he is as much an absence as a presence. Instead, the book concentrates on accounts of the methods and outcome of his memory testing whilst the ethical and philosophical questions posed by his operation and status as a semiprofessional research subject pass mostly unremarked. Despite intention, Molaison the man often struggles to emerge from the shadow of Molaison the star research subject.
Permanent Present Tense: the Man with No Memory, and What he Taught the World Suzanne Corkin. Allen Lane/ Penguin, 2013. Pp 384. £20·00. ISBN 9781846142710
Stephen Ginn [email protected] http://frontierpsychiatrist.co.uk
197
Book Moments in time Henry Molaison was a young American man with severe epilepsy. Born in 1926 in Connecticut, his seizures made it hard to fit in at school, and then difficult to do a job. The large doses of anticonvulsant medication he took did not control his symptoms. His only hope for a better quality of life was for a medical breakthrough. Egas Moniz shared the 1949 Nobel Prize in Physiology or Medicine for developing the prefrontal leucotomy, and during the 1950s radical surgery on the brain was ascendant. The approach was mostly used for patients with severe psychiatric disorders, but American neurosurgeon William Scoville was also interested in its application in patients with epilepsy. In 1953, Scoville suggested an experimental operation to the then 27-yearold Molaison: a bilateral resection of parts of the medial temporal lobes, including both hippocampi. The operation was uneventful. Molaison’s seizures were reduced, but he also lost much of his ability to form new long-term memories. He was unable to remember what day it was, what he had eaten, or what was said to him mere minutes before. New memories formed tortuously slowly: for years he experienced fresh grief every time he heard of his father’s death. For the rest of his life Molaison experienced the world as a series of essentially unconnected and unremembered moments in time. It tests the imagination to contemplate such an existence. Molaison’s nearest fictional counterpart is the protagonist in Christopher Nolan’s film Memento who spends his days violently pursuing the people he believes responsible for the attack that renders his memory so impaired. Molaison, however, generally bore his predicament with more equanimity. He embraced medical science and allowed his devastated memory to be www.thelancet.com Vol 382 July 20, 2013
researched in detail. Neuroscientist Suzanne Corkin studied Molaison’s memory over five decades, and to understand him she reaches for a metaphor: he was trapped in the “permanent present tense”. But Molaison was more than just a curious case, he was also a man. Wishing to document the “life behind the data” she has written a unique biography-cumexploration of the science of memory.
“…Molaison the man often struggles to emerge from the shadow of Molaison the star research subject.” Molaison is important because our current understanding of the human brain and behaviour is built upon anomalous cases such as his. As his deficit was in the absence of psychiatric disorder, he became the gold standard for the study of amnesia and he influenced and inspired many new lines of research into human memory. He makes an enigmatic subject. Molaison was never able to gain more than a vague sense of the curiosity he engendered and remained anonymous whilst alive, despite increasing fame. People found him patient, accommodating, and endearing but his memory problems generally excluded him from the activities around which everyday lives revolve: his relationships were few; his employment simple and repetitive. By contrast, his brain remains more generous with its secrets. It continues to be studied and is practically a distinct character in proceedings. As Corkin relates, on the night of Molaison’s death, in 2008, it was scanned in situ and then removed from his cranium in a procedure that was planned for many years. It is now preserved as more than 2000 slices; a 3D reconstruction will be available to all via the internet.
By the 1970s psychosurgery moved to the fringes of medical practice; its rise had been characterised by unfounded optimism built on weak foundations. Scoville ultimately seems to have regretted his role in shaping Molaison’s life, but Corkin takes a generous view of the part he played: medicine advances because of the willingness of patients and doctors to take risks. What comes through in Corkin’s book is Molaison’s great generosity: he had enough understanding to bear a grudge, but didn’t. We know that it was his wish that if the procedure wasn’t to help him then at least it might help others. This sentiment became his unspoken mantra. Fortunately, in this, Molaison was not unique. It gives me hope that this is a notion I still encounter in my clinical practice. Molaison was spared the more anonymous incapacity endured by many others after psychosurgery only because his brain suffered unique and interesting damage. We can only guess if there was a life he would rather have lived. Corkin’s book generally resists such moments of reflection and although it often piques the interest, I found it did not satisfy either as biography or as popular science. Molaison had little ability to reflect on his experience and as the central subject, he is as much an absence as a presence. Instead, the book concentrates on accounts of the methods and outcome of his memory testing whilst the ethical and philosophical questions posed by his operation and status as a semiprofessional research subject pass mostly unremarked. Despite intention, Molaison the man often struggles to emerge from the shadow of Molaison the star research subject.
Permanent Present Tense: the Man with No Memory, and What he Taught the World Suzanne Corkin. Allen Lane/ Penguin, 2013. Pp 384. £20·00. ISBN 9781846142710
Stephen Ginn [email protected] http://frontierpsychiatrist.co.uk
197