Patient H.M. (18 page)

As for the “memory mechanisms” that Penfield proposed, Lashley was unconvinced. “Dr. Penfield's observations on stimulating the temporal lobe raise many problems,” Lashley said, “but I do not believe that they justify the conclusion that memories are stored specifically in that region.” He admitted that he had “no clear alternative to offer in explanation of Dr. Penfield's data” but added that whatever that data proved or didn't prove, it would be hubristic to give it too much credence. The functions of the temporal region were still, he said, “completely obscure,” noting that when he, Lashley, had destroyed the visual processing areas in animals, it did “not abolish visual memories” and that when he likewise destroyed the tactile areas, it did “not abolish tactile memories.” Finally, Lashley wasn't even convinced that the so-called memories Penfield described provoking were memories at all. Despite the fact that “Dr. Penfield considers that he is stimulating specific memory pathways,” Lashley said, we still had no idea “what cerebral processes arouse memories.”

The transcript of the meeting does not record whether Penfield at this point removed his glasses. He did, however, respond.

“Dr. Lashley,” he said, “pointed out, as I feared that he would, that in his opinion there are no specific memory traces. That is in keeping with his observations in the early days in Minneapolis, when he worked with rats. It is in keeping with his demonstration of the replaceability of areas of brain, functional areas of brain, one by the other. Yet if there are no recording patterns in the cortex, how is it that an electrical stimulus can cause the patient to reexperience an earlier experience?”

Then he added a jab of his own.

“I would point out,” he said, “that the replaceability seems to be somewhat less as one rises in the evolutionary scale.”

In other words, Lashley might be an expert on the minds of rats, but Penfield's expertise came about through his work with an entirely different category of animal.

At the end of the day, and the end of the conference, Penfield had presented some intriguing case studies, but he lacked the necessary evidence to support a real theory of how memory worked. Even if it was assumed that the brain contained a sort of tape recorder—or, for that matter, a telegraph, computer, or hydraulic pump—that allowed us to preserve our experiences, Penfield's operations hadn't given any idea as to its location. Just because stimulating a certain part of the brain cued up a particular recording didn't say much about where that recording originated or how it was made. To use another metaphor Lashley would disapprove of, when you tune a radio to a particular station and hear a particular song coming out of it, it doesn't tell you where the radio station is located physically, or the studio where the song was originally recorded.

Was there a seat of memory in the brain?

Karl Lashley would say no, but Wilder Penfield felt otherwise. The brains of rats might exhibit equipotentiality, each part equally important and capable when it came to memory, but Penfield's experiences had led him to a less democratic view. He was already famous for mapping out in great detail how various parts of the brain were dedicated to different actions and sensations. Why should the brain exhibit any less specialization when it came to something as fundamental as memory?

Penfield was a devout Christian. He had faith in the existence of a higher being, though of course he had no proof.

He also believed in the seat of memory.

He had no proof of that, either.

When Anwyn and I got back home from Sifnos, I did some research on Mnemosyne, the goddess of memory. I wanted to see if her story was any more fleshed out in books geared toward adults than it was in the version presented for kids in
D'Aulaires' Book of Greek Myths
. The answer, it turned out, was no, not really. Despite her obvious importance—Mnemosyne is credited with not just the creation of memory but the creation of language itself—her biography is always paper-thin, a collection of isolated fragments. She had long hair, she slept with Zeus, she gave birth to the Muses, she wore a golden robe. That's about all there is.

This doesn't mean people didn't write about her and reify her. They did.

Here was Homer, describing how Hermes viewed her:

“First among the gods he honored Mnemosyne, mother of the Muses.”

Here was Hesiod, describing her love life:

“For nine nights did wise Zeus lie with her, entering her holy bed remote from the immortals. And when a year was passed and the seasons came round as the months waned, and many days were accomplished, she bore nine daughters, all of one mind, whose hearts are set upon song and their spirit free from care, a little way from the topmost peak of snowy Olympus.”

Here was Pindar paying tribute in one of his odes, making the point that no glory endures if nobody remembers it:

“Even high strength, lacking song, goes down into the great darkness. There are means to but one glass that mirrors deeds of splendor; by the shining waters of Mnemosyne is found recompense for strain in poetry that rings far.”

But Mnemosyne's own story, her trials and tribulations, whatever they were, has been forgotten. The Greek pantheon of gods and goddesses is so vast that some characters are bound to be more fleshed out than others, but it struck me as unjust somehow that the story of the mother of all stories would get such short shrift.

Plato, in one of his Socratic dialogues, chronicled an interesting conversation that the Greek mathematician Theaetetus had with Socrates in 369
B.C.E.
As far as I can tell, this conversation contains the earliest known attempt at a scientific explanation for how memory works. It straddles both worlds, though: Socrates's concept of memory doesn't entirely let go of Mnemosyne. Instead he steps tentatively into the realm of secular reason while keeping one foot in the old mythos. He also uses yet another metaphor for the inner workings of the mind that no doubt would have gotten under the skin of Karl Lashley.

Socrates: Please assume, then, for the sake of argument, that there is in our souls a block of wax, in one case larger, in another smaller, in one case the wax is purer, in another more impure and harder, in some cases softer, and in some of proper quality.

Theaetetus: I assume all that.

Socrates: Let us, then, say that this is the gift of Mnemosyne, the mother of the Muses, and that whenever we wish to remember anything we see or hear or think of in our own minds, we hold this wax under the perceptions and thoughts and imprint them upon it, just as we make impressions from seal rings; and whatever is imprinted we remember and know as long as its image lasts, but whatever is rubbed out or cannot be imprinted we forget and do not know.

The world evolved in countless ways during the 2,320 years between the end of that conversation and the end of Wilder Penfield's presentation to the American Neurological Association.

Our understanding of memory, however, had advanced very little.

M
y mother remembers that during the years immediately following the war, my grandmother would continue to go away sometimes, for days or weeks or months. The children never understood these absences. One day their mother would be home, the next she'd be gone, and a nanny would move into the house until my grandmother returned. My mother remembers that by 1950 the absences were fewer, and my grandmother seemed more stable, less agitated, less upset. She even became a girl-scout troop leader. She would host my mother—just entering her teens—and the other scouts, teaching them sewing and jewelry making, two skills that she might have honed during her time at the Institute of Living, in the little arts and crafts colony near Pomander Walk.

My grandfather pushed my mother's brothers, hard. He had their IQs tested, and then told them whose was higher. He yelled, he bullied. My mother remembers thinking that the reason he didn't put equivalent pressure on her—she was never a good student, and he never seemed to care—was that she was a girl, and he didn't believe that a girl's grades mattered much. She remembers being grateful for this. Her older brother, Barrett, responded well to the pressure. He excelled. Her younger brother, Peter, did not. Peter had a difficult time, growing up. He moved from school to school. He acted out.

My mother remembers that the best days, for the family as a whole, were the ski trips. When my grandmother was not away on one of her unexplained absences, and my grandfather was not at work; when nobody was fighting; when, early on a Sunday morning, they would squeeze into their ski clothes and their ski boots, then squeeze into a car and head off to a mountain: to Stowe, Bromley, Otis, Mohawk, or Mad River Glen. Often, on the way to the slopes, my grandfather would suddenly pull into the lot of some small church in some small town. My grandmother was not religious, and held her nonbelief as a point of pride until the day she died, but she would march into the church along with the rest of them. My mother remembers wondering what the men and women in the pews thought of her strange, complicated family as they entered those sacred spaces and clomped up the aisles in their ski boots.

On August 31, 1950, orderlies at Connecticut State Hospital led a woman with the initials D.M. from her ward to room 2200, where my grandfather was waiting. She was twenty-eight years old and had been at the asylum for ten years. She had been diagnosed as a “homosexual schizhophrenic, actively hallucinating.” She lay down on the operating table. The records don't indicate whether she was sufficiently cooperative to undergo surgery under local anesthesia or whether a general anesthetic was required to subdue her. In either event, my grandfather proceeded to slice a wide arc across the top of her head, roll her forehead down, and use his custom trephine to drill his usual two holes in the front of her skull. After using a scalpel to slice an opening in her arachnoid mater membrane, he inserted his flat brain spatula into one of the holes and levered up her frontal lobes. He squinted through the magnifying lenses of his loupes, peering inside. He oriented himself, taking visual notes of the various cerebral landmarks as his eyes traced a path past the frontal lobes and toward the structures beyond. He spotted the “slight bulge” of the uncus, approximately three centimeters past the tips of the temporal lobe, opposite an area known as the dural ridge.

Although the day's operation would be a landmark one, my grandfather's first, tentative steps into the mysterious landscape of the “hippocampal zone” had actually taken place more than a year earlier. That was when, in collaboration with an electrophysiologist colleague named W. T. Liberson, he administered electric shocks to the uncuses of eight “sufficiently cooperative” lobotomy patients. The uncus is a hook-shaped, dime-size tangle of neurons that is either the farthest-forward portion of the hippocampus or its own independent structure, depending on which neuroanatomist you ask. Research with monkeys had hinted that removing the uncus might pacify agitated primates, but regardless, like with the rest of the medial temporal lobes, the purpose of the uncus was unknown.

“Striking effects were exhibited,” my grandfather later wrote of his electrical experiments. Specifically, “in all but one patient complete and prolonged apnea was recorded after stimulation.” In other words, they stopped breathing. Although the apnea often “considerably outlasted the duration of the stimulation,” all the patients eventually began breathing again, though one required artificial respiration to do so and another remained in a state of only “periodic respiration” for at least an hour. Many of the patients experienced seizures, and several fell into prolonged states of unconsciousness.

The function of the uncus, however, remained an open question, and my grandfather eventually decided that he'd need more than electricity to find the answers.

So on that late August day in 1950, instead of inserting one of his electrodes and giving D.M.'s uncus a jolt, my grandfather picked up his suction catheter and its attached “electrosurgical coagulating wire.” He fed the tool into her head, moving it carefully under the spatula, trying not to touch or damage anything he shouldn't. Three centimeters past the tip of the temporal lobe, he reached the uncus. He activated the tool. The suction catheter came to life and began vacuuming out D.M.'s uncus while the wire cauterized any veins that the vacuuming caused to burst. If D.M. was in fact under local anesthetic, she would then notice that the musty smell of her bone dust had been joined by a richer, more pungent smell as portions of her neural tissue were burnt away.

She did not stop breathing. This may have been something of a surprise, given his previous experiments. D.M.'s ability to continue breathing as he destroyed her uncus was, as my grandfather later pointed out, “in marked contrast to the profound physiologic changes resulting from electrical stimulation.” Once he was satisfied that he'd removed the entire uncus, a quantity of brain matter measuring approximately three centimeters long, two centimeters high, and one and a half centimeters wide, he removed the vacuum and proceeded to the other hole.

Immediately after her uncotomy, which is what my grandfather named the procedure, D.M. appeared to be more stuporous than patients who'd undergone his orbital undercutting lobotomy. The orderlies wheeled her away, and my grandfather changed out of his scrubs and drove back to Hartford. Initial reports on her condition weren't particularly encouraging, as she exhibited little psychiatric improvement, but they weren't particularly discouraging, either, since she didn't appear to have been compromised at any essential physiological level. She continued to breathe, for example. So ten weeks later, on November 16, 1950, my grandfather returned to room 2200 and performed four more uncotomies on four more women.

First was patient I.S., a forty-eight-year-old paranoid schizophrenic with a history of suicide attempts. During this operation, my grandfather's hand slipped and his electrocautery device accidentally caused “severe damage” to an untargeted part of I.S.'s midbrain. This damage provoked a “violent jerk on the operating table,” and his patient immediately fell unconscious. He proceeded with the uncotomy and noted that I.S.'s limbs continued to spasm unpredictably throughout the procedure.

Then there was patient E.M., a twenty-seven-year-old schizophrenic who'd been hospitalized for four years. She'd recently shown “temporary improvement” after shock therapy but was still “lacking in initiative and activity” and displayed “impaired judgment.” E.M. was cooperative, which allowed my grandfather to perform the surgery under local anesthesia. This time, his hand didn't slip.

The third patient, B.P., was twenty-five years old and had been hospitalized for two and a half years for, among other things, “religious delusions,” “excessive masturbation,” and “homosexual trends.” She vomited while my grandfather suctioned away her uncus, but the operation went smoothly otherwise.

His final operation of the day was on M.D., an “occasionally mute” and “actively hallucinating” twenty-five-year-old woman. She also vomited.

In attempting to assess the subsequent psychiatric effects of these uncotomies, my grandfather borrowed the protocols of the Connecticut Cooperative Lobotomy Committee. For each patient, at some indeterminate time following the operation, he tallied the opinions of five people, each of whom was asked to rate the patient's improvement on a scale from negative one to plus four. These five people were the asylum's ward physician, charge nurse, supervisor, ward attendant, and my grandfather himself. Occasionally a relative of the patient would be allowed to contribute to the scoring as well. A score of negative one indicated that the patient had become worse, while a positive score would indicate varying degrees of improvement. The highest score, positive four, was reserved for patients who'd been able to leave the institution altogether.

What he found was that, in general, lesioning the uncus didn't appear to have much negative or beneficial effect. Instead, four of the five patients he'd operated on showed little to no change whatsoever in their conditions, and received scores of zero, zero, zero, and one. The exception was Patient I.S., the woman who had received extensive accidental damage to some of her deep midbrain structures when my grandfather's electrocautery slipped. During the eight hours immediately following operation, I.S. remained in a stupor, her legs and arms periodically spasming. Her spasticity cleared up after a week, though she remained “vegetative and withdrawn” for two weeks. Then, after a month, she suddenly began to show marked improvement. After five months, she had improved to such a degree that she was able to leave the asylum and return home. This gave her a rating of four plus.

My grandfather continued his experiments, pushing deeper into uncharted territories of the human brain. On the morning of Thursday, December 14, 1950, he performed his first complete medial temporal lobotomy. This was “a far more extensive resection” than the uncotomy, which had served as a prelude to this more drastic procedure. The setup was similar, however: He drilled open his patient's skull using the same trephines, levered up her frontal lobes using the same flat brain spatula, and vacuumed and burned his patient's gray matter using the same suction catheter and custom electrocautery tip. Only this time, after destroying the uncus, he kept on going, suctioning out her amygdala and most of her hippocampus. Although the messy mechanics of burning and suctioning made it impossible to preserve what he'd removed for later histological inspection, he was able to weigh most of it and found that he'd removed twelve and a half grams of brain tissue out of each lobe, for a total of twenty-five grams. Twenty-five grams is approximately what two tablespoons of water weigh. The question he was trying to answer, however, was more qualitative than quantitative.

That is, what did those twenty-five grams of brain, with their millions of neurons and billions of synaptic connections, do?

He once explained the line of reasoning that had led him to target the medial temporal lobes, pointing out that anatomical studies seemed to indicate a “close functional relationship” between the medial temporal lobes and the frontal lobes. So, his reasoning went, why not follow those connections back from the frontal lobes to the medial temporal lobes to see if the latter were the root cause of madness? He brought up Paul Bucy's work on the mescaline-dosed macaques who appeared “tamer” after having their temporal lobes removed, and explained that those “previously reported alterations in the behavior of experimental animals following temporal lobe surgery were primarily responsible” for his decision to see what effects similar surgeries might produce in man. Or, more accurately, in woman. My grandfather, like most lobotomists, performed a disproportionate number of psychosurgeries on women. This discrepancy never received a satisfactory explanation, but it seems worth pointing out that the known clinical effects of lobotomy—including tractability, passivity, and docility—overlapped nicely with what many men of the time considered to be ideal feminine traits.

That same Thursday, as soon as my grandfather finished his first medial temporal lobotomy, he proceeded to perform three more.

The first was V.M., a “destructive, assaultive, noisy” twenty-eight-year-old woman who'd been “hospitalized since 1946, unimproved on shock therapy” and whose aggressive tendencies often required “packs and seclusion.” (“Packs” was asylum shorthand for ice packs, a form of tranquilizing therapy in which patients were bound tightly in soaking wet, ice-cold bedsheets.) Immediately after the operation V.M. vomited, then became restless and hunched over. She “wished to be left alone,” my grandfather wrote, before adding that the final result of the operation was to make her “more childish” and “more active with self-mutilation.” She rated a zero to one plus.

There was E.S., a thirty-eight-year-old “mental defective with psychosis,” who also had epilepsy and whom my grandfather described as follows: “Impulsive, assaultive, resistive, mutters, huddles in fetal position in a chair.” She also vomited right after the operation and had seven major seizures during the first month of recovery. In the year that followed, however, those seizures steadily improved in “number and severity.” Her behavior improved somewhat, and by the end of 1951 she no longer required seclusion all of the time and was “slightly less assaultive.” Final rating: one plus.

There was G.M., fifty-eight years old, who despite “temporary improvement on shock” remained largely “deteriorated, untidy, assaultive, impulsive.” After her medial temporal lobes were removed, she experienced an “emotional regression with baby talk” but was otherwise “cheerful” and “no longer assaultive.” She did, however, appear aged and was “still actively hallucinating.” One plus.