9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page i PERMANENT PRESENT TENSE 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page ii 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page iii PERMANENT PRESENT TENSE The Unforgettable Life of the Amnesic Patient, H.M. SUZANNE CORKIN A Member of the Perseus Books Group New York 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/8/13 2:33 PM Page iv Copyright © 2013 by Suzanne Corkin Published by Basic Books, A Member of the Perseus Books Group All rights reserved. Printed in the United States of America. No part of this book may be reproduced in any manner whatsoever without written permission, except in the case of brief quotations embodied in critical articles and reviews. For information, address Basic Books, 250 West 57th Street, 15th Floor, New York, NY 10107-1307. Books published by Basic Books are available at special discounts for bulk purchases in the United States by corporations, institutions, and other organizations. For more information, please contact the Special Markets Department at the Perseus Books Group, 2300 Chestnut Street, Suite 200, Philadelphia, PA 19103, or call (800) 810-4145, ext. 5000, or e-mail [email protected]. Book Design by Cynthia Young Set in Adobe Garamond Pro Library of Congress Cataloging-in-Publication Data Corkin, Suzanne. Permanent present tense : the unforgettable life of the amnesic patient, H.M. / Suzanne Corkin. pages cm Includes bibliographical references and index. ISBN 978-0-465-03159-7 (hardback)—ISBN (invalid) 978-0-465-03349-2 (e-book) 1. H. M., 1926–2008. 2. Amnesiacs—Biography. 3. Epilepsy — Surgery — United States — History. I. Title. RC394.A5C58 2013 616.85'2320092—dc23 [B] 2013002391 First Edition 10 9 8 7 6 5 4 3 2 1 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page v In Memory of Henry Gustave Molaison February 26, 1926–December 2, 2008 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page vi 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page vii Contents List of Insert Figures ix Prologue: The Man Behind the Initials xi 1. Prelude to Tragedy 1 2. “A Frankly Experimental Operation” 19 3. Penfield and Milner 35 4. Thirty Seconds 51 5. Memories Are Made of This 77 6. “An Argument with Myself” 99 7. Encode, Store, Retrieve 115 8. Memory without Remembering I: Motor-skill Learning 151 9. Memory without Remembering II: Classical Conditioning, Perceptual Learning, and Priming 181 10. Henry’s Universe 201 11. Knowing Facts 237 12. Rising Fame and Declining Health 265 13. Henry’s Legacy 287 Epilogue 305 Acknowledgments 317 Notes 321 Index 351 vii 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page viii 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page ix List of Insert Figures 1. Four lobes of the cerebral cortex. Courtesy of André van der Kouwe, Jean Augustinack, and Evelina Busa. 2a. Medial temporal-lobe structures. Courtesy of André van der Kouwe, Jean Augustinack, and Evelina Busa. 2b. Hippocampus, entorhinal, and perirhinal cortices. Courtesy of André van der Kouwe, Jean Augustinack, and Evelina Busa. 3. Henry’s MRI. S. Corkin et al., “H.M.’s Medial Temporal Lobe Lesion: Findings from Magnetic Resonance Imaging,” Journal of Neuroscience 17 (1997): 3964–79. 4. Mooney Face-perception Test. B. Milner et al., “Further Analysis of the Hippocampal Amnesic Syndrome: 14-Year Follow-up Study of H.M,” Neuropsychologia 6 (1968): 215–34. 5a. Visual stepping-stone maze. B. Milner et al., “Further Analysis of the Hippocampal Amnesic Syndrome: 14-Year Follow-up Study of H.M,” Neuropsychologia 6 (1968): 215–34. 5b. Tactual stylus maze. 6. Route-finding task. 7. Limbic system. This image is a work of the United States Government (NIH) and is in the public domain falling under Image License B de- fined under the Image License section of the Disclaimer page. 8. The typical neuron. L. Heimer, The Human Brain and Spinal Cord: Functional Neuroanatomy and Dissection Guide (New York: Springer- Verlag, 1983). With kind permission of Springer Science+Business Media. ix 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/11/13 10:24 AM Page x LIST OF INSERT FIGURES 9. Mirror tracing task. 10. Rotary pursuit task. 11. Bimanual tracking task. 12. Coordinated tapping task. 13. Sequence-learning task. 14. Reaching task. 15. Basal ganglia. Image by John Henkel, FDA staff writer, via Wikimedia Commons. 16. Eyeblink conditioning task. Courtesy of Diana Woodruff-Pak. 17. Gollin Incomplete Figures Test. B. Milner et al., “Further Analysis of the Hippocampal Amnesic Syndrome: 14-Year Follow-up Study of H.M,” Neuropsychologia 6 (1968): 215–34. 18. Pattern priming. J. D. Gabrieli et al., “Intact Priming of Patterns De- spite Impaired Memory,” Neuropsychologia 28 (1990): 417–27. 19a. William Beecher Scoville. 19b. Brenda Milner. Photograph courtesy of Neuro Media Services 20. Five-year-old Henry. 21. Henry the animal lover. 22. Henry’s high school graduation photo, 1947. 23. Henry, 1958. 24. Henry with his parents. 25. Henry, 1975. 26. Henry ready for testing at MIT. Photograph by Jenni Ogden, 1986. 27. Henry at Bickford Health Care Center. 28. Henry’s drawing of the floor plan of his home. S. Corkin, “What’s New with the Amnesic Patient H.M.?” Nature Reviews Neuroscience 3 (2002): 153–160. 29. Henry’s spoon. x 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page xi Prologue The Man Behind the Initials Henry Molaison and I sat opposite each other, a microphone on the nar- row table between us. Parked next to him was his walker, and the white basket attached to the front held a book of crossword puzzles; he always kept one close by. Henry wore his usual attire—pants with an elastic waist, a sport shirt, white socks, and sensible black shoes. His large face, partly covered by thick glasses, wore a pleasant, attentive expression. “How are you feeling today?” I asked him. “I feel okay,” Henry replied. “That’s good. You look great.” “Well, thank you.” “I understand that you have a little trouble remembering things.” “Yes, I do. I do have—well, a lot of trouble remembering things, you know. And one thing I found out that I fool around with a lot is crossword puzzles. And, well, it helps me in a way.” Henry and I talked a bit about his crossword puzzles, a frequent topic of conversation. Then I asked, “How long have you had trouble remembering things?” “That, I don’t know myself. I can’t tell you because I don’t remember.” “Well, do you think it’s days or weeks? Months? Years?” “Well, see, I can’t put it in exactly on a day, week, or month, or year basis.” xi 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page xii PROLOGUE “But do you think it’s been more than a year that you’ve had this problem?” “I think it’s about that. One year or more. Because I believe I had an—this is just a thought that I’m having myself—that, well, I possibly have had an operation or something.” Our conversation took place in May 1992, nearly forty years after Henry’s capacity to form long-term memories disappeared as a result of a risky sur- gical intervention. In 1953, he underwent a bilateral medial temporal- lobe resection, an experimental brain operation intended to alleviate the severe epilepsy he had faced since childhood. Since his first seizure in 1936, his condition had grown worse, making it increasingly difficult for him to participate in normal activities. The operation did control his seizures, but with an unanticipated and devastating consequence—an ex- treme amnesia that robbed Henry of the ability to form new memories and, in doing so, determined the course of the rest of his life.1 Amnesia is the inability to establish lasting memories that are later available for conscious retrieval. The word’s origin is in the Greek amne- sia, meaning forgetfulness or loss of memory, but the deficit goes beyond forgetting. Amnesic patients such as Henry are stripped of their ability to turn their immediately present experiences into lasting memories. This condition, which may be permanent or temporary, typically stems from an insult to the brain, such as encephalitis, stroke, or head injury. Amnesia can also arise from a rare psychiatric disorder, psychogenic am- nesia, which has no identified neurological cause. In Henry’s case, the amnesia resulted from the surgical removal of pieces of his brain, and it was permanent. Henry was a young man of twenty-seven when he had the operation. Now sixty-six, he relied on a walker to prevent falls. But to him, only a short time had passed. In the decades after his operation, he lived in a permanent present tense: he could no longer remember the faces of people he met, places he visited, or moments he lived through. His expe- riences slipped out of his consciousness seconds after they happened. My conversations with Henry vanished from his mind immediately. xii 9780465031597-text_Basic: CORKIN: 6.125 x 9.25 3/6/13 3:11 PM Page xiii PROLOGUE “What do you do during a typical day?” “See, that’s tough—what I don’t . I don’t remember things.” “Do you know what you did yesterday?” “No, I don’t.” “How about this morning?” “I don’t even remember that.” “Could you tell me what you had for lunch today?” “I don’t know, tell you the truth.