Patient H.M. (19 page)

As with the uncotomies, the preliminary results of the medial temporal lobotomies were inconclusive. Before he could evaluate the operation's therapeutic promise or begin to answer the larger question of what the medial temporal lobes did, there was more to be done. Like most experimentalists, my grandfather believed that the more research subjects you worked with, the better. An N of one does not count for much. Luckily for my grandfather, he suffered no shortage of material. The lobotomy continued to rise in popularity—just the year before, in December 1949, Egas Moniz had received the Nobel Prize in medicine for his invention—and asylum superintendents around the world were still giving neurosurgeons unlimited access to their patients. By the 1950s, a dizzying variety of approaches to the procedure had been developed, each targeting different parts of the brain: topectomy, gyrectomy, cingulotomy, capsulotomy. The Nobel committee had endowed psychosurgery with a patina of nobility, demonstrating that future breakthroughs in the field might pay great professional, therapeutic, and scientific dividends. For ambitious tinkerers like my grandfather, the lure was irresistible.

In the weeks following his first four medial temporal lobotomies, he performed ten more:

The case of Patient A.Z. was interesting.

She'd been institutionalized for the past eight years at Connecticut State Hospital. She was thirty years old, and although prior to surgery she'd been “temporarily helped by extensive shock therapy,” she was nevertheless classified as “tense,” “assaultive,” “tidy,” and “impulsive.” She was also, my grandfather said, “preoccupied with sex thoughts” and “sex threats,” which he classified as paranoid delusions. He operated on her on November 19, 1950. She was cooperative and under local anesthetic during the operation. She remained conscious throughout until, while my grandfather was in the process of suctioning out portions of her right hippocampal cortex, he “inadvertently went through the arachnoid and injured by suction a portion of the right peduncle, geniculate or hypothalamic region.” A.Z.'s immediate response was to fall into a deep coma. She remained in the coma for seventy-two hours, incontinent, spasming periodically. Then she slowly came to, remaining in something of a stupor for a week but was eventually able to walk without support and regain control of her bladder.

She emerged from the coma with what my grandfather described as “complete remission in her delusions, anxiety, and paranoid trends.” This “immediate and marked” result, he said, had “delighted” her family.

The case of A.Z., like the earlier case of I.S.—in which surgical slipups led to unexpected benefits—reminded my grandfather of a story he was told while at one of the asylums, about a female patient who'd been tied down in a bath for twenty-four hours. The bath had a broken thermostat, and the water was far hotter than intended. This resulted in the patient developing “extreme hyperthermia,” “beyond the limits of the thermometer.” Presumably, according to my grandfather, such prolonged overheating would damage some of the same parts of the brain that he had accidentally lesioned in I.S. and A.Z. So it seemed to him significant that the hyperthermic woman also “underwent a remarkable remission of all psychotic trends.”

He wondered whether “the unexpected benefit accruing from deep central damage,” as exhibited in these three “fortunate misfortunes,” indicated that “the primary mechanisms of mental disease” might lie in regions even deeper within the brain than his own aggressive procedures were targeting.

But those were questions for another time. For now, in contemplating the case of A.Z., my grandfather thought that one more thing might be a significant factor in her “excellent results.” Not only did she seem to have experienced a dramatic remission, but she also exhibited a “retrograde amnesia for her entire psychosis (of three years' duration).”

She hadn't just recovered from her illness. She didn't even remember it.

My mother had no idea what my grandfather was doing in the asylums back in those days. He worked a lot and talked about it very little. His career, in her mind, remains vague and indistinct. What she remembers is his presence. She remembers the times when he was home.

He was a good father, that's what she remembers.

A busy one, of course. On a typical workday, he came home late after dinner, past eight or nine
P.M
. He would retreat to his study for an hour or two, where he'd sit surrounded by his collection of neurosurgical bric-a-brac—ancient blades, old books, a bleached and anonymous skull—and use a Dictaphone to keep up with his correspondence. My mother knew not to bother him while he was in his study. She did other things instead, getting ready for bed. She read, or listened to
The Shadow
or
The Lone Ranger
on the radio, or gossiped on a tin can telephone with a girl who lived across the street. Just before my mother went to sleep, though, my grandfather would always go to her room and say good night. Often, she remembers, he told her a story, one he made up on the spot. It was a serial, a continuing saga about three animals: a deer, a bear, and a talking monkey. They'd go on new adventures every night. She doesn't remember the details of these adventures. I've asked her if she remembers the monkey's name. She doesn't. But the details don't matter. What matters is that these stories came from her father. What matters is that he took the time, late at night, exhausted from whatever he'd done that day, to sit with her and tell her stories. What matters is that even now, more than a half century later, those acts of storytelling glow warm and golden in her memory. Afterward, he'd tell her to say her prayers, then he'd leave, shutting the door softly behind him. She was never sure where he went, but she imagines him going back to his study to continue with his work, whatever that work was, while she drifted off to sleep, the latest escapades of the deer and the bear and the monkey tumbling in her head.

A person can be many different things to many different people.

He was good to her.

MIT
N
EUROPSYCHOLOGY
L
ABORATORY,
F
EBRUARY 1986

By 1953, it was obvious that the drugs hadn't helped. Henry was on massive doses of powerful, brain-dampening epilepsy medications—Dilantin, five times a day; Mesantoin, three times a day; phenobarbital, twice a day; Tridione, three times a day—and they hadn't helped, or at least they hadn't helped enough. Henry was still seizing several times a day, sometimes falling to the ground, sometimes just falling silent. Those second type of seizures, the petit mal ones, were often described as “absences.” When he was in their grip he became, briefly, a human husk, his lungs working and his heart beating but his mind on pause. The truth was, though, that even when he wasn't seizing, Henry was never entirely present, in the sense that his epilepsy had caused him to withdraw from the richer life that might otherwise have been his.

He was a smart, strong twenty-seven-year-old man, but he existed within borders as circumscribed as a child's. Weekday mornings he'd catch a ride downtown to the Underwood factory, on Capitol Avenue, where he'd sit on the line and help assemble the typewriters, a blue-collar worker making white-collar tools. In the afternoon he'd catch a ride back home to his parents' house in East Hartford. He was unable to drive a car, of course, just as he was unable to go off to war, or to college, or to any of the other places that his old friends had gone. Instead he just stayed home, where his parents could take care of and watch over him. He would spend evenings listening to the radio. He liked the big bands—Benny Goodman, Duke Ellington—and he liked some of the new rock and roll—the jive music, as he called it—that tinned through the speakers. He liked dance music but he never danced. He read magazines, soaked up Hollywood gossip, learned about scandals and successes of the sort he knew he would never experience. On a good weekend he would take a rifle a short walk into some nearby woods, heft the stock to his shoulder, sight down the barrel at a target, pull the trigger, and feel the kick. On a bad weekend he wouldn't do much of anything at all.

In 1953, Henry's past was still clear to him. It was his future that was growing dark. If things continued as they were, if his seizures continued to increase in frequency and severity, it wasn't hard to imagine that he would soon become too big a burden for his aging parents. If he became unable to work, unable to contribute, Gustave and Elizabeth might have to let him go. They might have to send him someplace like the nearby Mansfield Training School, an institution founded in 1930 through the merger of two older institutions, the Connecticut Training School for the Feebleminded and the Connecticut Colony for Epileptics. There the strictures that bound his life would be cinched even tighter. Like many of the other residents, he might be put to work in the onsite factory, making bricks. Or he might just sit in one of the crowded wards, becoming more and more absent, continuing his slow slide toward an uncertain fate.

Unless.

In a large banquet hall at the Hollywood Beach Hotel, in Hollywood, Florida, on the afternoon of April 23, 1953, my grandfather stepped to a podium to give a speech to the Harvey Cushing Society, America's preeminent association of brain surgeons. It was the closing address of that year's neurophysiological symposium. A little earlier, John Fulton had given the symposium's opening remarks, during which he'd made a joke about Becky, the chimpanzee from his laboratory who had inspired Egas Moniz to begin lobotomizing humans seventeen years before. “Was this the face that lopped ten thousand lobes?” Fulton asked, referencing a photo of Becky's wrinkled features. Then Fulton made a now familiar entreaty, urging the many psychosurgeons in the crowd “to study their patients with the same thoroughness with which chimpanzees are studied, for you have a much finer opportunity to gain insight into some of the basic problems of frontal lobe function than we who are limited to gaining information from inarticulate beasts.”

Paul MacLean, another Yale researcher, spoke after Fulton. MacLean was considered the world's leading authority on the limbic region in animals, and his speech opened with a literary flourish: “Today, with the annual celebration of Shakespeare's birthday, it may be expected that the occasion will arouse renewed discussion among those interested in English literature as to whether Shakespeare or Bacon wrote the plays. This points up for contrast an equally bewildering problem that faces those whose major concern is with the functions of the brain. In the brain, the authors of function—the structures themselves—are easily identified. But what do these authors write? That is the question. This is no better illustrated than by our lack of knowledge regarding the functions of parts of the limbic system that will concern us here, particularly that sizable author known alternatively as the hippocampus or Ammon's horn.”

MacLean then gave a comprehensive survey of how very little was known about the true functions of the hippocampus, before ending with a complaint and a Fulton-esque challenge: “Animal experimentation can contribute next to nothing about the ‘subjective' functions of the hippocampal formation,” he said. “To corrupt a statement by Wiener, psyche is information, not matter or energy. The animal cannot communicate how he feels. Here is the rub for the physiologist. Realizing that Aladdin's lamp is not for him, he obviously looks, as he has long been accustomed, to the neurosurgeon!”

The stage was set for my grandfather.

My grandfather looked up from the podium and out over the group of surgeons and scientists. Many giants of his field were there: Bill Sweet, Leo Davidoff, Gilbert Horrax. As for my grandfather, he was forty-seven years old, no longer the ambitious young striver he'd once been. He was now a peer, or more than a peer, of many of the people here, a teacher as much as a student. The neurosurgical residency programs at Yale and the University of Connecticut had recently merged, and he had become the co-director, training the next generation from his old alma mater, teaching them the brutal subtleties of his craft, instructing them in the use of the numerous techniques and tools that he'd invented and that many of the men in that ballroom had begun to use in their own practices. He had become, in the eyes of the neurosurgical community, something of a giant in his own right.

“For the past four years in Hartford,” my grandfather began, “we have been embarked on a study of the limbic lobe in man.”

Coming as it did immediately after MacLean had outlined both the enduring mysteries of the limbic lobe and the difficulty of solving those mysteries through animal research, my grandfather's announcement was bound to cause a stir. Hearing it, the attendees may have hoped that he was about to announce a breakthrough, a revelation of some sort.

If so, he dashed those hopes right away.

After describing the operations through which he'd conducted his study—the uncotomies, in which he lesioned just a part of the limbic region; the medial temporal lobotomies, in which he lesioned almost all of it—my grandfather gave a gloomy general assessment of his results. “I speak with all humility,” he said, “of the small bits of passing data we have accumulated in carrying out these operations on some two hundred thirty patients.”

He had reason to be humble. The cuts he'd made in the brains of hundreds of human beings truly hadn't contributed much useful knowledge. He dutifully recounted some of the more interesting phenomena he'd encountered over the course of his experiments, such as the fact that “vomiting and temporary loss of consciousness occurred commonly during manipulation of the uncal region, but following resection they disappeared,” and mentioned that one of his psychotic patients had suffered postoperative memory problems, but he didn't pretend that these scattered tidbits did much to illuminate the larger questions of what the limbic lobe—or medial temporal lobe or hippocampal region or whatever you wanted to call it—actually
did.

One explanation for my grandfather's unimpressive results had been best articulated more than a decade before, in one of those letters between Paul Bucy and John Fulton, the one in which Bucy complained that psychosurgery-based research was hobbled by the fact that one never “starts with a normal organism.” This was certainly the case for my grandfather's limbic lobe investigation, in which his subjects had all been “long-standing, seriously deteriorated” asylum residents. If it was true that it was difficult to understand how the human mind worked by operating on animals, it was also true that attempting to understand how the normal human brain worked by lesioning the deeply abnormal ones belonging to hopeless psychotics was challenging at best, a fool's errand at worst.

And when it came to
treating
mental illness—which after all was what these procedures were designed to do—my grandfather's medial temporal lobotomies had proved equally useless. They'd produced, he told the audience, only “meager” psychiatric improvement, and “no marked physiologic or behavioral changes.”

An observer listening to my grandfather describe the therapeutic and scientific failures of his limbic lobe studies that day might reasonably conclude that these studies had hit a dead end and should be abandoned. Instead my grandfather told the audience that although his project had so far failed to provide much useful information about the mechanics of the mind, he hoped that “continuing limbic lobe studies may bring us one blind step nearer to the location of these deeper mechanisms.” And at the end of his talk he hinted that he'd already begun thinking of a way to expand his studies, a strategy that would also avoid the scientific pitfalls that were inevitable when you worked with asylum-sourced research subjects. He described how some of his psychotic patients had also been epileptic, and how his operations had seemed to provide them relief from their seizures. Now, he said, “an interesting query comes to mind—could
bilateral
resection of such known epileptogenic areas as the uncus raise the threshold for all fits, as do pharmaceutical anticonvulsants?” Or, to put it another way: What would happen if, rather than performing his limbic lobotomies only on the mentally ill, he began performing them on perfectly sane people who suffered only from epilepsy?