第1章
The Man Who Could Only Live in the Present
The story of Patient H.M. is perhaps neuroscience's most famous case study-a man who lived perpetually in the present moment after a radical brain surgery in 1953. When Luke Dittrich, grandson of the surgeon who performed this operation, began investigating the case, he uncovered a deeply personal connection to one of science's most important human subjects. The book became an instant sensation upon publication, with Oliver Sacks calling it "a book that will rank with the best of the medical narratives." Time magazine named it one of the best nonfiction books of the year, praising how it "illuminates the machinery of memory and explores the profound ethical dimensions of treating the mind by operating on the brain." Beyond its scientific significance, the book raises profound questions about identity, ethics, and what makes us human. What happens when someone can form no new memories? And what responsibilities do we have toward those whose suffering advances our knowledge?
第2章
A Fateful Accident and the Beginning of a Medical Mystery
In downtown Hartford's Colt Park, a young boy with blond hair and blue eyes took a shortcut home one day. Without his glasses, he failed to notice a bicyclist coasting downhill. The collision caused severe trauma to his brain, which twisted inside his skull, tearing neurons and triggering electrical surges that knocked him unconscious. Though he seemed fine the next day at a Fourth of July picnic, the injury left lasting damage. Soon, Henry Molaison began experiencing minor seizures-small absences and moments of inattention that would eventually worsen into full epileptic episodes.
This bicycle accident marked the beginning of Henry's transformation into "Patient H.M."-a man whose identity would remain secret for nearly six decades while becoming the most studied individual in neuroscience history. Born February 26, 1926, Henry would retain memories from before his later operation but would struggle with his father's death and other recent events, often responding inconsistently to scientists' questions about his past.
Henry's childhood was marked by financial hardship. His family struggled after the 1929 crash, living in partly furnished tenement apartments. As a teenager, he worked various jobs to help support his family-as a movie theater usher, department store stock boy, and junkyard worker. After dropping out of school when his family moved back to Hartford, he trained as a motor winder at Ace Electric Motors, but had to abandon this promising career when his epilepsy worsened.
His first grand mal seizure occurred on his fifteenth birthday while riding with his father, followed by increasingly frequent episodes that compromised his ability to work with precision. Though he eventually graduated from East Hartford High, his seizures were so frequent that he wasn't allowed to collect his diploma onstage, for fear he might have an attack and disrupt the ceremony. After high school, Henry worked on the assembly line at Underwood Typewriter factory, but his seizures continued to be problematic, causing him to freeze mid-task and back up the production line.
Henry's childhood memories revealed a poignant unrequited affection. Whenever asked about his schoolmates at St. Peter's Catholic School, he immediately mentioned a girl named Arline Hallissey, whose father was a police officer who later became chief of police. He recalled hoping she would be "shifted" into his classroom each year. Ironically, when the author contacted the now 87-year-old Arline Pierce (nee Hallissey), she had no recollection of Henry Molaison whatsoever, despite remembering other classmates who became priests.
第3章
The Rise of Psychosurgery and a Desperate Solution
The history of treating the brain spans millennia. Ancient skulls worldwide show evidence of trepanation-surgical holes made in the skull-dating back over ten thousand years. Peruvian Inca skulls typically had holes in the left frontoparietal area, likely treating battle wounds, while European skulls showed more varied placement. The Edwin Smith Papyrus, translated in 1930, revealed sophisticated medical knowledge from 3,600 years ago, with detailed descriptions of brain injuries and cautious treatments that followed the principle: "Abstain from doing harm."
This conservative approach to brain treatment persisted until the early 20th century, when more aggressive interventions began to emerge. In 1935, Portuguese neurologist Egas Moniz performed the first leucotomy-a procedure that involved severing connections in the brain's frontal lobes to treat mental illness. American neurologist Walter Freeman eagerly adopted and modified these techniques, replacing Moniz's wire-based leucotome with a scalpel and renaming the procedure "lobotomy."
By 1939, Freeman had become lobotomy's most fervent evangelist, traveling nationwide to demonstrate the procedure and preparing his revolutionary book "Psychosurgery," which argued that "an individual can think more clearly and more productively with less brain in actual operation." He had expanded his practice beyond severe mental illness to include people suffering in more subtle ways: the emotionally unstable housewife, the "premature spinster," the obsessive hand-washer, and even misbehaving children.
Dr. William Scoville, the author's grandfather, became America's second most prolific practitioner of psychosurgery after Freeman. At the Institute of Living in Hartford, Scoville performed numerous lobotomies, developing his own technique called "orbital undercutting" that he believed was more precise than Freeman's methods. Unlike the traditional lobotomy which he considered too mutilative, his technique focused specifically on severing neural fibers connecting the orbital portions of the frontal lobes to deeper brain structures, leaving the rest intact.
By 1953, twenty-seven-year-old Henry Molaison's epilepsy remained uncontrolled despite massive doses of medications. He suffered multiple daily seizures-grand mal episodes where he'd fall to the ground and petit mal "absences" where his mind would temporarily pause. His condition severely limited his life: though intelligent and strong, he lived with his aging parents, working at the Underwood typewriter factory by day and spending evenings listening to radio music. He couldn't drive, attend college, or live independently.
In March 1953, the Molaisons consulted with Dr. Scoville again. After assessing Henry's deteriorating condition, he offered them hope-perhaps describing his own bilateral procedures and explaining that the source of Henry's affliction likely lay in his medial temporal lobes. Despite the frightening prospect of brain surgery, the desperate family agreed.
第4章
The Operation That Changed Neuroscience Forever
On August 25, 1953, Henry underwent the operation that would forever change both his life and our understanding of memory. The week before, Henry underwent an EEG that failed to reveal an epileptic focus. Psychologist Liselotte Fischer administered psychological tests, noting Henry was "somewhat nervous" but cooperative. His IQ tested at 104, lower than his post-operative scores would be, possibly affected by the twelve petit mal seizures he experienced during testing after being taken off medications.
Dr. Scoville followed his usual procedure: injecting local anesthetic, cutting an arc across Henry's head, drilling two holes in the skull, and using a brain spatula to access deeper structures. Finding no visible abnormalities, he applied electrodes to Henry's medial temporal lobes while an electroencephalographer monitored for seizure activity. Once again, no epileptic focus was found.
At this critical juncture, Scoville faced a decision. A more cautious surgeon like Wilder Penfield would have ended the operation, stitched Henry up, and sent him home with medications. Alternatively, he could have operated on just one hemisphere, giving a 50% chance of improvement while minimizing functional losses.
Instead, he chose the riskiest option-suctioning out both hemispheres of Henry's medial temporal lobes, removing his amygdala, uncus, entorhinal cortex, and hippocampus entirely. This decision, while most dangerous for Henry, offered the greatest potential research value for the surgeon. After years of operating on mentally ill patients, Henry represented a "normal" subject who could provide new insights into these mysterious brain structures.
Six weeks later, Scoville submitted his Harvey Cushing Society presentation to the Journal of Neurosurgery with one crucial addition: his limbic lobe operations had "resulted in no marked physiologic or behavioral changes, with the one exception of a very grave, recent memory loss." This italicized clause transformed a modest paper into a cornerstone of modern memory science. It announced the birth of Patient H.M. and simultaneously marked the death of Henry Molaison as he had existed before.
第5章
Living Without Memory: The World of Patient H.M.
When psychologist Brenda Milner first tested Henry after his surgery, she discovered something astonishing. His memory quotient was only 67-the lowest she'd ever seen. Yet when she tested his IQ, he scored an impressive 118, well into the "superior intelligence" range. He excelled particularly at arithmetic, working out answers quickly in his head. Throughout testing, Henry remained focused and cooperative, never complaining or showing boredom.
The most striking demonstration of his condition came when Milner briefly left for coffee and returned. Henry greeted her with a friendly smile, having completely forgotten who she was despite having spent hours with her. This pattern would repeat throughout his life-he would meet researchers, have lengthy conversations with them, and minutes later greet them as complete strangers.
Henry's amnesia wasn't limited to people. He couldn't remember where he was, how he had arrived there, or what he had been doing moments before. When shown a drawing he had made just minutes earlier, he would have no recollection of creating it. Yet remarkably, some aspects of his mental function remained intact. He could still carry on conversations, solve complex arithmetic problems, and even learn certain types of skills-though he would have no memory of having learned them.
Through extensive interviews, researchers revealed something remarkable about Henry's amnesia: not only could he form no new episodic memories after surgery, but virtually all his pre-operative episodic memories had also vanished. His entire past had become "semanticized"-reduced to disconnected facts without narrative context. Henry could recall his birthdate but couldn't describe any birthday party. When asked about his favorite memory of his mother, he could only state "that she's my mother." Asked if he'd ever fallen in love, he acknowledged he had but couldn't recall any specific instance or event.
Henry's mind lacked the fundamental human capacity for autobiographical storytelling, leaving him with only disconnected facts about himself and the world. In one interview, when told his father had died (information he'd forgotten), Henry showed no emotional reaction. He carried a note in his pocket: "Father's dead. Mother's in a hospital, but she's well." This emotional numbness, alongside his complete lack of sexual desire, was a stark consequence of the surgical intervention that transformed an ordinary boy into the famous Patient H.M.
第6章
The Scientific Revolution and the Birth of Memory Science
Henry's case launched a revolution in neuroscience. Before his surgery, scientists had little understanding of how memory worked or where in the brain it was located. Some, like neurologist Karl Lashley, believed memory was distributed throughout the brain rather than localized in specific regions. Others, like neurosurgeon Wilder Penfield, thought memories were stored in a specific "memory cortex."
Brenda Milner, a psychologist who had been studying patients with brain lesions at the Montreal Neurological Institute, became one of the first scientists to work with Henry. Her meticulous testing revealed that despite his profound amnesia, Henry could still learn certain types of skills-like tracing a star while only seeing his hand through a mirror. This discovery led to the groundbreaking realization that the brain has multiple memory systems that operate independently.
Milner's work with Henry established that the medial temporal lobes, particularly the hippocampus, are crucial for forming new declarative memories-memories of facts and events that can be consciously recalled. However, procedural memory-memory for skills and habits-is processed by different brain systems and remained intact in Henry. This distinction between declarative and procedural memory revolutionized our understanding of how the brain organizes information.
In 1957, Scoville and Milner published their landmark paper "Loss of Recent Memory After Bilateral Hippocampal Lesions" in the Journal of Neurology, Neurosurgery & Psychiatry. The paper, which became the most cited in memory science, established that "bilateral medial temporal lobe resection in man results in a persistent impairment of recent memory" and that these structures are "critically concerned in the retention of current experience"-effectively revealing the seat of memory.
Decades later, at 93, Milner reflected on Henry with deep affection, noting that despite his profound amnesia, his participation in research gave purpose to a life previously dominated by seizures and isolation. "I feel like I've lost a friend," she said, "and that is a funny thing, too, because you think of friendship as reciprocal... And yet this is very one-sided. Because he doesn't know me."
第7章
The Ethical Dilemmas of Human Research
Henry's case raises profound ethical questions about human research. For decades, he participated in countless experiments without being able to truly consent. His profound amnesia made it impossible for him to remember agreeing to any study, and his missing amygdala likely made him neurologically predisposed to comply with researchers' requests.
During the first two decades of research, Henry's parents had provided consent, with Henry co-signing. After his father died and his mother developed dementia, his landlady began signing consent forms when dropping him off at MIT. From 1980 to 1992, Henry alone signed his forms, despite his inability to remember doing so. Many researchers simply assumed proper consent protocols had been arranged.
The issue became so problematic that in 1992, MIT sought a formal conservator to make decisions on Henry's behalf. This legal arrangement became necessary because Henry had been without a legal guardian since his mother's death in 1980. Thomas Mooney, son of Henry's former landlady, claimed to be Henry's cousin on his application and became his legal conservator.
Beyond consent issues, Henry received no compensation for his decades as a research subject. When asked directly, researcher Suzanne Corkin explained they had obtained a waiver from the Institutional Review Board exempting them from paying Henry and other amnesic patients, claiming they received benefits like medical care and occasional gifts instead.
The case also raises questions about data ownership and scientific integrity. After Henry's death, disputes erupted between institutions over who should control his brain tissue and the data derived from it. Most shockingly, when asked about her plans for Henry's experimental files-the raw data collected throughout his life as a research subject-Corkin revealed she had already shredded much of it during a recent move and planned to destroy the rest. She justified this by claiming "nobody's gonna look at them" and that only peer-reviewed published material was worth preserving.
Scientists were horrified by this destruction of primary source material from history's most important memory research subject. UCLA psychologist Donald MacKay noted this fit a pattern of "outrageous data protection strategies," citing a 2006 incident where Corkin refused to share Henry's crossword puzzles that formed the basis of a published paper.
第8章
The Hidden Struggles Behind the Scientific Narrative
While the scientific literature portrayed Henry as a docile, content research subject, the reality of his life was far more complex. In December 1974, Henry's deteriorating home situation came to light when a visitor found his mother Elizabeth lying on the floor while Henry sat nearby, oblivious to her distress. Both had clearly neglected personal hygiene for days. Elizabeth was diagnosed with dementia, and the pair moved into the home of Lillian Herrick, a retired psychiatric nurse.
At Herrick's home, Henry's relationship with his mother revealed itself as deeply troubled. They fought frequently, with Henry sometimes becoming physically aggressive-kicking her shins or hitting her forehead. This wasn't isolated behavior; Henry had previously broken his hand punching a door during an argument, and once had a violent outburst at his workplace, the Hartford Regional Center for the Mentally Retarded, where he threatened suicide and began smashing his head against a wall until sedated.
Strikingly, Henry's behavior in Cambridge contrasted sharply with his Hartford outbursts. At MIT, researchers described him as "sweet, tractable," "docile," "passive," and "uncomplaining"-the perfect research subject who would sit indefinitely where placed and rarely express needs. Researchers attributed this docility not to an innate personality trait but to his brain lesions. Neuroscientist Howard Eichenbaum explained that the removal of Henry's amygdala, along with his hippocampus, created this passivity-a known effect in animals with similar lesions.
Despite Corkin's public portrayal of Henry as contented, unpublished personality questionnaires revealed his inner turmoil. In 1982, Henry's responses to the Beck Depression Inventory showed he felt "the future is hopeless," considered himself "a complete failure," was "dissatisfied with everything," and "guilty all the time." Other assessments revealed he felt "enraged," "terrified," and "cannot relax"-contradicting Corkin's published claim that there was "no evidence of anxiety" in Henry.
While Corkin romantically described Henry's condition as Buddhist-like present-moment awareness, the reality was far darker. His outbursts occurred primarily in Hartford rather than at MIT because in Connecticut he faced constant reminders of his condition-watching his mother age while having no memory of the intervening years, or struggling with simple tasks at a workplace for the mentally disabled despite his intelligence.
第9章
The Legacy of Patient H.M.
Henry Molaison died on December 2, 2008, at age 82, after months of profound dementia and muteness. His death made front-page news in The New York Times, which revealed Patient H.M.'s real name for the first time. In accordance with his wishes, his brain was preserved for scientific study.
Neuroanatomist Jacopo Annese meticulously prepared Henry's brain, embedding it in gelatin and flash-freezing it before slicing it into 2,401 paper-thin sections. The dissection was live-streamed to hundreds of thousands of viewers worldwide. This preservation marked a transition point-after fifty-five years of seclusion and scientific protection, Henry's brain was about to be exposed to the world in an unprecedented way.
Examining the stained slides of Henry's brain, Annese revealed surprising findings that could "shake up the field of memory science." Contrary to long-held assumptions that Henry's remaining hippocampal stump was completely atrophic, Annese found it appeared to be "in pretty good shape." This raised profound questions: When Scoville closed a door in Henry's mind, had he left it "open just a crack"? Could this explain the surprising exceptions to Henry's amnesia?
Henry's case continues to influence neuroscience and our understanding of memory. His tragedy transformed our knowledge of how the brain works, leading to better treatments for epilepsy, amnesia, and other neurological conditions. The ethical questions raised by his case have helped shape modern research protocols and patient protections.
Perhaps most poignantly, Henry's case forces us to confront fundamental questions about identity and consciousness. What makes us who we are if not our memories? Henry lived for 55 years without forming new episodic memories, yet maintained a sense of self and personality. His case suggests that identity transcends memory in ways we're still struggling to understand.
第10章
The Personal Connection: A Surgeon's Legacy and a Grandson's Quest
For author Luke Dittrich, the story of Patient H.M. is deeply personal. As the grandson of Dr. William Scoville, the surgeon who performed the fateful operation, Dittrich's investigation into Henry's case became a journey into his own family history.
Dr. Scoville was a complex figure-brilliant, reckless, and driven. He was known for his surgical innovations and his love of fast cars and motorcycles. Enzo Ferrari reportedly once refused to sell him a sports car, warning: "Dr. Scoville, if I sell you this car you'll be dead within the year." This recklessness extended to his surgical approach, where he was known to take risks that more conservative surgeons would avoid.
In a private note to Dittrich's uncle, Scoville revealed his driving motivation-his wife Emily's "constitutional and grave" mental illness had inspired his twenty years studying and operating on mental illness "in the hopes of contributing to a cure." Emily Scoville, the author's grandmother, had suffered a mental breakdown in 1944 and was committed to the Hartford Retreat for the Insane, where she endured treatments including hydrotherapy, pyretotherapy, and electroshock therapy.
As Scoville aged to seventy-seven, he refused to retire despite declining skills, once even asking a nurse "Which way is the head?" during surgery. Hartford Hospital restricted his surgical privileges, though he secretly obtained privileges elsewhere to continue brain operations. Even in his final years, he remained obsessed with fast cars, writing to his son about his dream of "having one more good sport car before I die."
Through his investigation, Dittrich discovered unpublished materials that contradicted the established narrative about Henry. Psychologist Liselotte Fischer's preoperative assessment-largely unpublished-showed Henry already had "severely impaired" memory before Scoville's operation, noting he had "immediate difficulties in recalling tasks" when attempting arithmetic problems. This crucial detail had been minimized in scientific literature, with Corkin attributing these deficits merely to "seizures and nerves."
Dittrich's quest to understand Henry's story and his grandfather's role in it reveals how science, medicine, and personal ambition intersect-sometimes with profound consequences for individuals caught in their path. It also demonstrates how scientific narratives can be shaped and controlled, with inconvenient facts sometimes pushed aside in service of cleaner, more compelling stories.
第11章
Memory, Identity, and the Meaning of Life
Henry's case forces us to confront profound questions about what makes us human. Without the ability to form new memories or access most of his past, Henry lived in an eternal present-a condition that both fascinated scientists and evoked deep philosophical questions about consciousness and identity.
In one revealing 1970 interview, Henry tried to explain his unique thought process, describing how he had to "figure them all around, and then go through it again" while others could "pick out what they have thunk" from memory. He poignantly articulated his inability to improve: "by not remembering things, you can't improve them. And you can't remember either way-the good way and the bad way-and you can't put them together." This internal struggle manifested in what he called "the argument with yourself," constantly wondering "Is the right thing right?"
Henry's condition illuminates the crucial role memory plays in our sense of self. Without the ability to connect past, present, and future, Henry existed in a fragmented reality where each moment stood alone, disconnected from the narrative thread that gives most lives their meaning and coherence. Yet despite this profound limitation, Henry maintained a personality and sense of self that persisted across the decades.
The author reflects on connections between his grandfather and Henry. Both experienced a constricted field of view-his grandfather by choice when wearing surgical loupes that provided extreme magnification but a narrow field of vision, Henry by permanent condition after surgery removed his ability to see beyond the present moment. This metaphor captures something essential about the human condition-how our perspective shapes our reality, and how the choices we make about what to focus on determine what we see and understand about the world.
In the end, Henry's case reminds us that memory is not just a cognitive function but the foundation of our personal narratives and relationships. When Henry met with Karl Pribram, they discovered a shared dream of making an overland trip from Cairo to Cape Town. But when Scoville returned to the room after being called away, Henry asked Pribram, "Have you been in here before?"-a poignant demonstration of how his condition prevented him from building connections that last beyond the moment.
Despite living for decades without the ability to form new memories, Henry's contribution to science gave his life meaning and purpose that transcended his limitations. His tragedy became a gift to humanity's understanding of itself-a legacy that continues to unfold as new generations of scientists study his preserved brain and the data from his life. In this way, Henry achieved a form of immortality that few of us will ever know.
