The brain has been an organ of much fascination for centuries. So much so that research into the brain began to take a strange and somewhat darker route. There have been many fascinating surgeries in recent years where patients have been awake whilst neurosurgeons operate. However, in the past, the closest doctors got to this was the more sinister lobotomy. We’ve all heard about lobotomies, or seen some version of it in horror movies but did you ever hear about patient H.M?
Patient H.M was the most well-known lobotomy patient of our time. His case provided much information to the medical world and has inspired many areas of research. To truly understand his journey, we have to first understand lobotomies themselves.
In this book summary readers will discover:
- The history of studies of the brain
- The origins of the lobotomy
- What information lobotomies provided
- The story of Patient H.M
Key lesson one: The history of studies of the brain
Our brains control everything that we do, both consciously and unconsciously. Throughout history, many inquiring minds were intrigued by this complex organ. Some of the first to understand the importance of it was the Egyptians. A 3600-year-old scroll was found by archaeologists which contained advice on how to care for severe head injuries that left the brain exposed.
Even Hippocrates, the father of modern medicine, theorised that epilepsy was a problem that originated in the brain and not something that the Gods had inflicted. There has even been evidence in France that forms of brain surgery were attempted 7000 years ago. Skulls were found with what seems to be small surgical holes in them. Later on, in 1888, Gottlieb Burckhardt removed 18g of brain matter from a patient in an attempt to cure her madness. This was considered to be an atrocious act at the time, shocking many doctors.
It was not until 1935 that someone attempted this again. Egas Moniz performed the first leucotomy whereby he cut white nerve fibres in the brain. He was inspired by the work done by physiologist John Fulton who discovered that the chimpanzees he was working with became calmer after the frontal lobes of their brains were damaged. Moniz used leucotomy to treat severely depressed patients. He published the results obtained from this procedure in 1936. Moniz strongly believed that it was a possible way to treat people with mental illness. This inspired a whole new generation of brain explorers.
Key lesson two: The origins of lobotomy
In the 1930s mental asylums were the place of nightmares. We have all seen the movies depicting these asylums as being filled with screaming patients either in straight jackets or restrained in some way. Unfortunately, this is exactly what used to occur. So, doctors set their aims on trying to figure out how to calm these patients down.
Their methods were anything but therapeutic. First came pyretherapy, whereby a patient was placed in a metal casing and was heated until their body temperature reached 106 degrees Fahrenheit. They did this to the patient for a week and if it did not work, they moved on to insulin coma therapy which is exactly as the name describes. The patient was given huge amounts of insulin which caused their sugar levels to plummet inducing a coma.
Mental asylums became these doctors experiment grounds and their patients were in no condition to complain or refuse therapy. This was when lobotomy was introduced by neurologist Dr Walter Freeman. It launched a new field of study called psychosurgery. Freeman kept his patients awake whilst he drilled two holes on the side of a patient’s skull to access the frontal lobe. Whilst cutting into the frontal lobe, Freeman spoke to his patients, asking them questions. He would stop when they reached a level of confusion and disorientation which he deemed appropriate. Freeman’s aim was simply to make the patients manageable but not completely incapacitated.
Freeman continued his practice of lobotomies of patients ranging in age from 7 to 72. He believed he could cure them of their ailments. Because of his relentless use of lobotomy, it spread to other facilities that wished to have more manageable patients. The procedure became popular despite the occasional death or some other unexpected side effect like emotional numbness.
Key lesson three: What information lobotomies provided
Since it was known that different areas of the brain controlled different actions, doctors sought to operate on the piece of the brain that was responsible for the problems they were seeing. Unfortunately, they did so without having all of the knowledge we now have about the different regions of the brain. So some opportunistic doctors saw lobotomy as a procedure they could use to find out more about the brain.
One of the doctors was Dr William Beecher Scoville, who later became well-known as ‘Wild Bill’. He began numerous risky brain surgeries at his newly founded neurological department at Hartford Hospital. He intended to find out more about the brain in hopes of curing his wife’s mental illness. In the 1940s, Scoville launched a new lobotomy technique, one that was considered to be more humane than the previous one. A specifically designed suction device was used to remove connecting fibres in the brain instead of cutting through it. It decreased the collateral damage that the previous technique inflicted on patients. This development came at a time when the United States was battling the high number of patients in mental asylums across the country. Therefore, the lobotomy was well-received as patients had the surgery and were sent home to recover. Psychosurgeons jumped at the opportunity to perform lobotomies as a solution to overcrowded asylums and were left to do as they please.
As the years passed, psychosurgeons developed even more techniques which led to more discoveries about the brain. One such discovery came from Dr Wilder Penfield. He was focused on surgeries regarding epilepsy. When a patient had a seizure, he observed which part of the body had uncontrolled movement. If it was the left arm, he operated on the part of the brain that controlled the left arm. He located these areas in the brain using electronic stimulation. Penfield’s notes eventually produced extremely informative maps of the brain. It was during this process that he narrowed down the area of the brain that was related to memory. All he had to do was pinpoint it.
At the same time, Scoville was making his important discoveries whilst also treating patients with epilepsy. He was curing epilepsy by removing the entire medial lobes of patients. This cured their epilepsy but it did not alleviate any underlying mental illness they also suffered. So Scoville sought to find a patient who suffered from epilepsy but who did not have any signs of mental illness.
Key lesson four: The story of Patient H.M
Scoville found the patient he was looking for. His name was Henry Molaison and he received a lobotomy from Scoville in 1953 at the age of 27. Henry had had epileptic seizures from the age of eight and was otherwise unaffected. His seizures became severe when he was a teenager resulting in complete blackouts. The seizures were so bad his school decided to bar him from collecting his high school diploma on stage in fear of him having a seizure.
Henry and his family decided that a lobotomy was his only option for a normal life. The medications he had been prescribed previously did not work. Scoville conducted brain scans before the lobotomy to locate any other issues in Henry’s brain but they came back with nothing out of the ordinary. This meant that Scoville did not know which lobe to operate on. He was left with three options. Deny Henry the surgery because he could not identify the problem area, continue with the surgery picking either the left or right lobe or take the risk and operate on both lobes. Scoville was not called Wild Bill for his cautious nature. For him, the obvious choice was to operate on both lobes and guarantee some sort of result. This decision made Henry Molaison Patient H.M.
After the surgery, Henry was cured of his epilepsy but his memory was also severely affected. Scoville saw an opportunity for a new study and teamed up with Brenda Milner, a psychologist. Together they studied Henry after his surgery. Milner found that Henry had an above-average IQ but he could not remember anything for very long. It took him two minutes to forget numbers that were given to him to be memorised. He even forgot that he was asked to do anything with the numbers at all. This meant that Henry had issues remembering if he had already eaten or when he met someone new, including Milner. There were a few memories from before the surgery that Henry kept like his hometown, his name and surprisingly, meeting Scoville. Henry was now living constantly in the present moment. Everything he experienced was new to him, disconnected from everything that had happened before because he could not remember it.
Scoville knew he had removed a part of the brain that was responsible for Henry’s memory, but he had to figure out which part. Scoville and Milner started investigating other patients at Hartford with memory issues in a bid to identify the exact region affected. Through this investigative work, they deduced that the hippocampus was the area of interest. When looking at Henry’s brain again they found that the amount of hippocampus removed related to the amount of memory lost. They published their findings in 1957 letting the world know that the hippocampus was the brain’s memory centre.
Milner and Scoville continued to study Henry long after this. They subjected him to various tests and made many discoveries. One of these was that memory can be conscious and subconscious. Now, this is referred to as declarative and procedural memory respectively. Even more interesting is that conscious or declarative memory is composed of semantic memory and episodic memory. Semantic memory helps us remember facts whereby episodic memory enables us to string those facts together. Henry was found to have no episodic memory whatsoever even though he had semantic memory.
Even though lobotomies died out when the doctors that pioneered it did, Henry remained a person of interest right up until he died in 2008. His identity was kept a secret, hence he was referred to as Patient H.M. His custodian, Dr Suzanne Corkin did not let just anyone interview or study him. She screened people before figure out who could interact with Henry. Only after Henry died did his name become known to the public. His brain was removed from his skull and taken to the Brain Observatory in San Diego to be further studied. Henry’s brain was dissected by neuroanatomist, Dr Jacopo Annese during a live broadcast. Henry’s brain was sliced into 2400 pieces revealing a previously unseen lesion in the frontal lobe. This suggested that all the other doctors and researchers who worked with Henry had missed this, not fully understanding Henry’s condition.
The key takeaway from Patient H.M is:
The brain has been an organ of fascination for centuries. With the development of lobotomy, a whole new generation of questionable doctors and researchers were born. Their methods were somewhat barbaric but they still managed to justify their work with the amount of information they managed to gain about the brain. Patient H.M was the patient who provided an interesting case study and revealed many interesting facts about human memory.
How can I implement the lessons learned in Patient H.M:
Don’t take your memory for granted! Today there are many techniques that you can employ to strengthen your memory especially as you get older. Many of them are quite enjoyable as they take the form of games. Go on and give them a try!
