Psychology Discusion Week 6

H. M., an Unforgettable Amnesiac, Dies at 82 – Obituary (Obit) – NYTimes.com Page 1 of 4December 5, 2008H. M., an Unforgettable Amnesiac, Dies at 82By BENEDICT CAREYHe knew his name. That much he could remember.He knew that his father’s family came from Thibodaux, La., and his mother was from Ireland, and he knew about the 1929 stock market crash andWorld War II and life in the 1940s.But he could remember almost nothing after that.In 1953, he underwent an experimental brain operation in Hartford to correct a seizure disorder, only to emerge from it fundamentally andirreparably changed. He developed a syndrome neurologists call profound amnesia. He had lost the ability to form new memories.For the next 55 years, each time he met a friend, each time he ate a meal, each time he walked in the woods, it was as if for the first time.And for those five decades, he was recognized as the most important patient in the history of brain science. As a participant in hundreds ofstudies, he helped scientists understand the biology of learning, memory and physical dexterity, as well as the fragile nature of humanidentity.On Tuesday evening at 5:05, Henry Gustav Molaison — known worldwide only as H. M., to protect his privacy — died of respiratory failure at anursing home in Windsor Locks, Conn. His death was confirmed by Suzanne Corkin, a neuroscientist at the Massachusetts Institute of Technology,who had worked closely with him for decades. Henry Molaison was 82.From the age of 27, when he embarked on a life as an object of intensive study, he lived with his parents, then with a relative and finally inan institution. His amnesia did not damage his intellect or radically change his personality. But he could not hold a job and lived, more sothan any mystic, in the moment.“Say it however you want,” said Dr. Thomas Carew, a neuroscientist at the University of California, Irvine, and president of the Society forNeuroscience. “What H. M. lost, we now know, was a critical part of his identity.”At a time when neuroscience is growing exponentially, when students and money are pouring into laboratories around the world and researchers aremounting large-scale studies with powerful brain-imaging technology, it is easy to forget how rudimentary neuroscience was in the middle of the20th century.When Mr. Molaison, at 9 years old, banged his head hard after being hit by a bicycle rider in his neighborhood near Hartford, scientists had noway to see inside his brain. They had no rigoroushttp://www.nytimes.com/2008/12/05/us/05hm.html?pagewanted=print 4/5/2010H. M., an Unforgettable Amnesiac, Dies at 82 – Obituary (Obit) – NYTimes.com Page 2 of 4understanding of how complex functions like memory or learning functioned biologically. They could not explain why the boy had developed severeseizures after the accident, or even whether the blow to the head had anything do to with it.Eighteen years after that bicycle accident, Mr. Molaison arrived at the office of Dr. William Beecher Scoville, a neurosurgeon at HartfordHospital. Mr. Molaison was blacking out frequently, had devastating convulsions and could no longer repair motors to earn a living.After exhausting other treatments, Dr. Scoville decided to surgically remove two finger-shaped slivers of tissue from Mr. Molaison’s brain. Theseizures abated, but the procedure — especially cutting into the hippocampus, an area deep in the brain, about level with the ears — left thepatient radically changed.Alarmed, Dr. Scoville consulted with a leading surgeon in Montreal, Dr. Wilder Penfield of McGill University, who with Dr. Brenda Milner, apsychologist, had reported on two other patients’ memory deficits.Soon Dr. Milner began taking the night train down from Canada to visit Mr. Molaison in Hartford, giving him a variety of memory tests. It was acollaboration that would forever alter scientists’ understanding of learning and memory.“He was a very gracious man, very patient, always willing to try these tasks I would give him,” Dr. Milner, a professor of cognitiveneuroscience at the Montreal Neurological Institute and McGill University, said in a recent interview. “And yet every time I walked in the room,it was like we’d never met.”At the time, many scientists believed that memory was widely distributed throughout the brain and not dependent on any one neural organ orregion. Brain lesions, either from surgery or accidents, altered people’s memory in ways that were not easily predictable. Even as Dr. Milnerpublished her results, many researchers attributed H. M.’s deficits to other factors, like general trauma from his seizures or some unrecognizeddamage.“It was hard for people to believe that it was all due” to the excisions from the surgery, Dr. Milner said.That began to change in 1962, when Dr. Milner presented a landmark study in which she and H. M. demonstrated that a part of his memory was fullyintact. In a series of trials, she had Mr. Molaison try to trace a line between two outlines of a five-point star, one inside the other, whilewatching his hand and the star in a mirror. The task is difficult for anyone to master at first.Every time H. M. performed the task, it struck him as an entirely new experience. He had no memory of doing it before. Yet with practice hebecame proficient. “At one point he said to me, after many of these trials, ‘Huh, this was easier than I thought it would be,’ ” Dr. Milnersaid.The implications were enormous. Scientists saw that there were at least two systems in the brain for creating new memories. One, known asdeclarative memory, records names, faces and new experiences and stores them until they are consciously retrieved. This system depends on thefunction of medial temporal areas, particularly an organ called the hippocampus, now the object of intense study.Another system, commonly known as motor learning, is subconscious and depends on other brain systems. This explains why people can jump on abike after years away from one and take the thing for a ride, or whyhttp://www.nytimes.com/2008/12/05/us/05hm.html?pagewanted=print 4/5/2010H. M., an Unforgettable Amnesiac, Dies at 82 – Obituary (Obit) – NYTimes.com Page 3 of 4they can pick up a guitar that they have not played in years and still remember how to strum it.Soon “everyone wanted an amnesic to study,” Dr. Milner said, and researchers began to map out still other dimensions of memory. They saw that H.M.’s short-term memory was fine; he could hold thoughts in his head for about 20 seconds. It was holding onto them without the hippocampus thatwas impossible.“The study of H. M. by Brenda Milner stands as one of the great milestones in the history of modern neuroscience,” said Dr. Eric Kandel, aneuroscientist at Columbia University. “It opened the way for the study of the two memory systems in the brain, explicit and implicit, andprovided the basis for everything that came later — the study of human memory and its disorders.”Living at his parents’ house, and later with a relative through the 1970s, Mr. Molaison helped with the shopping, mowed the lawn, raked leavesand relaxed in front of the television. He could navigate through a day attending to mundane details — fixing a lunch, making his bed — bydrawing on what he could remember from his first 27 years.He also somehow sensed from all the scientists, students and researchers parading through his life that he was contributing to a largerendeavor, though he was uncertain about the details, said Dr. Corkin, who met Mr. Molaison while studying in Dr. Milner’s laboratory and whocontinued to work with him until his death.By the time he moved into a nursing home in 1980, at age 54, he had become known to Dr. Corkin’s M.I.T. team in the way that Polaroid snapshotsin a photo album might sketch out a life but not reveal it whole.H. M. could recount childhood scenes: Hiking the Mohawk Trail. A road trip with his parents. Target shooting in the woods near his house.“Gist memories, we call them,” Dr. Corkin said. “He had the memories, but he couldn’t place them in time exactly; he couldn’t give you anarrative.”He was nonetheless a self-conscious presence, as open to a good joke and as sensitive as anyone in the room. Once, a researcher visiting withDr. Milner and H. M. turned to her and remarked how interesting a case this patient was.“H. M. was standing right there,” Dr. Milner said, “and he kind of colored — blushed, you know — and mumbled how he didn’t think he was thatinteresting, and moved away.”In the last years of his life, Mr. Molaison was, as always, open to visits from researchers, and Dr. Corkin said she checked on his healthweekly. She also arranged for one last research program. On Tuesday, hours after Mr. Molaison’s death, scientists worked through the nighttaking exhaustive M.R.I. scans of his brain, data that will help tease apart precisely which areas of his temporal lobes were still intact andwhich were damaged, and how this pattern related to his memory.Dr. Corkin arranged, too, to have his brain preserved for future study, in the same spirit that Einstein’s was, as an irreplaceable artifact ofscientific history.“He was like a family member,” said Dr. Corkin, who is at work on a book on H. M., titled “A Lifetime Without Memory.” “You’d think it would beimpossible to have a relationship with someone who didn’thttp://www.nytimes.com/2008/12/05/us/05hm.html?pagewanted=print 4/5/2010H. M., an Unforgettable Amnesiac, Dies at 82 – Obituary (Obit) – NYTimes.com Page 4 of 4recognize you, but I did.”In his way, Mr. Molaison did know his frequent visitor, she added: “He thought he knew me from high school.”Henry Gustav Molaison, born on Feb. 26, 1926, left no survivors. He left a legacy in science that cannot be erased.ReprintsThis copy is for your personal, noncommercial use only. You can order presentation-ready copies for distribution to your colleagues, clients orcustomers here or use the “Reprints” tool that appears next to any article. Visit www.nytreprints.com for samples and additional information.Order a reprint of this article now.December 6, 2010No Memory, but He Filled In the BlanksBy BENEDICT CAREYHe did two crossword puzzles a day, sometimes more, working through the list of clues in strict order, as if to remember where he was.And, perhaps, what he was doing.Henry Gustav Molaison— known through most of his life only as H.M., to protect his privacy — became the most studied patient in the history ofbrain science after 1953, when an experimental brain operation left him, at age 27, unable to form new memories.Up until his death in a nursing home in 2008, Mr. Molaison cooperated in hundreds of studies, helping scientists identify and describe the brainstructures critical to acquiring new information. He performed memory tests; he filled out questionnaires; he sat for brain scans and performedcountless research tasks, each time as if for the first time.In between it all he did puzzles, books upon books of them, a habit he’d picked up as a teenager. Near the end of his life he kept a crosswordbook and pen with him always, in a basket attached to his walker. His solving opened a window on the brain, and demonstrated puzzles’ power, andtheir limitations, in stretching a damaged mind.“For someone with this profound amnesia, the question was: Why, of all the pastimes out there, would he find crosswords so reassuring?” said Dr.Brian Skotko, a clinical fellow in genetics at Children’s Hospital Boston. “Well, in a world that was buzzing by and not always so easy tounderstand, I think finding solutions gave him great satisfaction. He had those puzzle books nearby morning, afternoon and night, and he turnedto them if nothing else was going on. It was his go-to activity.”In a series of experiments, Dr. Skotko led a team from Duke University and M.I.T. who used crosswords to test Mr. Molaison’s language aptitude,as well as his capacity to learn new facts.As expected, the puzzles stumped him badly if they drew on events that happened after 1953, the year that a surgeon removed two finger-shapedslivers of tissue from the brain to relieve severe, chronic seizures. Those slivers included a structure called the hippocampus, whichscientists nowknow is critical for acquiring so-called declarative memories, those concerning people, places and facts. The Nixon presidency, the gulf war,the rise of Starbucks, the Internet bubble and its bursting — they all came and went without leaving any accessible trace on his memory.Yet the researchers found that Mr. Molaison was a competent puzzle solver, compared with healthy people his own age, when allowed to draw onwhat he’d learned in the years before the operation. He knew about the 1929 stock market crash, the Great Depression and Pearl Harbor. Hislanguage skills, once acquired and uploaded from his then-intact hippocampi to higher areas in the cortex, were entirely independent, protectedfrom surgical damage.“We found that learned language is a robust dynamic,” Dr. Skotko said. “He often came up with answers to the clues that others did not.”Mr. Molaison stunned researchers over the years by learning some new facts, said Suzanne Corkin, a professor in the department of brain andcognitive sciences at M.I.T. who worked with him in the last decades of his life. He knew that Archie Bunker called his son-in-law “Meathead,”on the 1970s show “All in the Family,” one of his favorites. He knew that Raymond Burr played a detective on TV. He knew about the moon landing,she said, perhaps because of his lifelong interest in rockets.In particular, Dr. Corkin said, he seemed to be able to update pre-1953 memories.. To see whether his love for crosswords could help thisprocess, Dr. Skotko, Dr. Corkin and others performed another study, this time testing Mr. Molaison’s ability to solve post-1953 clues that hadpre-1953 answers. For instance: “Childhood disease successfully treated by Salk vaccine” (announced in 1955); and “_____Pact, military allianceof 7 European communist nations enacted to counter NATO” (also 1955).After repeated trials on the same puzzles, the man who lost his memory learned to fill in the right answers. “We found that he could learn newsemantic, factual information as long as he had something in his memory to anchor it to,” Dr. Skotko said.Mr. Molaison, who grew up in Hartford, would certainly have known about polio: the city suffered through an epidemic during his childhood, saidDr. Corkin, a fellow Hartford native who, though younger, remembers it herself. “This would have been an emotional memory; he certainly wouldhave know people who had polio, and maybe some who died of it,” she said. That emotion, she said, seemed to enhance his brain’s ability toupdate previous memories.At least two processes may have been at work when H.M. learned new facts, Dr. Corkin argues. One is a weak signal from tissue around hishippocampus that survived the surgery; recent research shows that these surrounding areas are active in acquiring new facts.But research also suggests that anytime the brain retrieves a stored memory, it updates and reshapes it. This process, called reconsolidation,occurs in higher cortical areas that were intact in Mr. Molaison’s brain. It does, however, apparently depend on the hippocampus to retain theupdates. H.M., after he stopped practicing the study puzzles, soon forgot the post-1953 answers he had learned.Not that he minded. In a 1992 interview, he admitted to Dr. Corkin that he did have trouble remembering things. “One thing I found out is that Ifool around a lot with crossword puzzles,” he said. “And, well, it helps me, in a way.”It helps you remember? Dr. Corkin asked.It did, he said. And, he added, “You have fun while doing it, too.”1. What is your reaction to the case studies of Benjaman Kyle and Henry Gustav Molaison, known until his death in December 2008 as “H.M.”?Based on the two case studies and your own perspectives, discuss some ways that people with disorders such as amnesia, Alzheimer’s disease, andrepressed memories can function despite an inability to create and/or retrieve memories. Explain.