The paper also described a variety of institutionalized men and women my grandfather had performed similar operations on—Patient M.B., Patient A.Z., Patient A.R., and Dr. Patient D.C., among others—but the clear focus was on Patient H.M., who combined a mind unmuddied by mental illness with bilateral medial temporal lobe lesions as extensive as any performed on the psychotics. The important takeaway was a broad one: “In summary, this patient appears to have a complete loss of memory for events subsequent to bilateral medial temporal lobe resection.” By extension, H.M.’s case pointed “to the importance of the hippocampal region for normal memory function.” My grandfather and Milner concluded with the stark, unequivocal, and deceptively revolutionary declaration that “bilateral medial temporal lobe resection in man results in a persistent impairment of recent memory” and that the medial temporal lobe structures must therefore be “critically concerned in the retention of current experience.”
In other words, the location of the seat of memory, that ancient mystery, had been revealed. And it is that revelation, borne out by more than a half century of subsequent research, which made this paper the single most cited paper in memory science. It is in many ways the field’s founding text.
—
Brenda Milner is ninety-three years old. Most of the people she’s ever known are gone now, of course.
Wilder Penfield.
My grandfather.
Henry.
But sometimes the memories they created are so strong that the fact of their absence is hard to process.
“People ask if he was unhappy,” Milner said to me at one point, talking about Henry. “I think he’d never known happiness. I mean, this is the thing about H.M. Any of these other patients, one would say, ‘This thing that happened is catastrophic.’ I mean if you’ve got a real life with a family, and you’re interested in politics, and you’re good at your job, and so on, and you suddenly can’t remember what you had for breakfast, then this is a catastrophe. But if you had major convulsive seizures in spite of heavy medication for years and years and years, so that although you were potentially bright you couldn’t think clearly, and it took so long to get through school, and you were rejected….You can imagine that he did not really have a very good life with all the medication and all the seizures and the isolation. And since the surgery, since he is so amiable, and since he really likes doing tests, he likes doing something for science…”
She paused.
“I keep on saying ‘likes.’ I can’t believe he’s not here. I feel like I’ve lost a friend, and that is a funny thing, too, because you think of friendship as reciprocal, right? You’re friends with someone and they’re friends with you. And yet this is very one-sided. Because he doesn’t know me.”
TWENTY-ONE
MONKEYS AND MEN
I remember the bull’s speed, and the sound of its hooves in the dirt, and the tendons tightening on the top of its neck as it lowered its head and prepared for impact. I don’t remember the way it smelled, though I’m sure it did: They always do, a sour mix of sweat and manure. And I don’t remember if it was grunting or making any other sounds. Sometimes they do, sometimes they don’t.
It was the beginning of 2001, and for the previous couple of months I’d been hanging around the Academia Municipal Taurina, a bullfighting school in Guadalajara, Mexico. The students ranged in age from twelve to eighteen, and every day I’d come and watch them train, taking notes for a magazine story that I had no home for but was convinced could be great. These ambitious, talented, brave kids, trying to take their first steps in this risky business while navigating the usual pitfalls of teenagerhood: It was like Death in the Afternoon crossed with Glee.
Usually the kids trained without bulls. Instead they themselves would play the bulls, leaning down low and charging at each other, hard and fast, learning the intricacies of cape-and-foot work. Often they’d use a strange contraption, a custom-built wheelbarrow-like thing with real bull horns mounted on its front to make the fake charges a little more menacing.
Sometimes, though, they used real bulls.
Or, to be more precise, becerros. A becerro is a young bull, barely more than an adolescent at two to three years old and weighing around 300 pounds; they weigh a mere fraction of the full-grown toros bravos you usually find in bullrings, the NFL linebackers of the animal kingdom, which can easily top 1,500 pounds. Were one of these kids to get hit full-force by a toro bravo, that might be it for the kid. With a becerro there was more room for error, more room to make mistakes and learn. Which isn’t to say that getting hit by a three-hundred-pound animal is pleasant. It isn’t. As I was about to find out.
We’d driven in a caravan out to a ranch that afternoon, where one of the patrons of the school, a rich local farmer, had a small bullring on his property. There was a becerro waiting for us there in the ring. Jet-black, wiry, and wired. The bullfighting world is full of stories about the techniques used to prep bulls for training or matches. That they’re amped up with amphetamines or have cords cinched tightly around their testicles. I don’t know what had been done to this becerro, if anything, but it looked ready to fight.
I watched the kids take their turns with it. Mauro, Daniel, Rodrigo. One after another, they stepped into the ring. They weren’t dressed in their formal bullfighting attire, those spangly, stiff, coruscating, pageant-ready suits. Instead they were dressed down, jeans or sweatpants, T-shirts, sneakers. They shared a capote. It was pink on one side, a sort of dull off-white on the other, heavier than you might expect, made of a coarse canvas. When it came his turn, each boy would step out from behind one of the chest-high wooden barriers arranged at four points along the inner circumference of the ring. There was enough room for a person to stand behind these barriers but not enough room for a bull, was the idea. They’d step out, often when the bull was facing away from them and on the other side of the ring. They’d take a few steps forward, then stop, straighten their backs. The top edge of the capote had a sturdy wooden rod fixed along its edge, and the student would hold it out, letting its full surface area billow below the rod, the pink side facing the bull. If the bull still didn’t notice, the student would stomp his foot in the dirt, kicking up a tiny explosion of dust.
“Ay,” he’d shout, his voice tight, and as commanding as he could muster. “Toro!”
Eventually, the bull would turn.
They were good, these kids. They’d stand their ground, shoulders pulled back, chins up, their posture designed to project confidence, not fear, no matter what they felt inside. They’d shake the capote, once, twice, three times—“Toro! Toro! TORO!”—keeping it perpendicular to the horns of the bull, the bull that was by now eyeing them intently.
And then it would charge.
The color of the capote didn’t matter. It’s a myth that red enrages. Bulls are color-blind. What they see is movement, what they hear is noise, what they feel is threatened, what they want is contact, and, with it, conquest. The capote took up more space, on a two-dimensional plane at least, than the kid did. It moved more, too. The capote was the flag—whipping up and down, back and forth—and the kid was the flagpole.
The bull went for the cape. Why wouldn’t it?
And the kid, like Lucy snapping up the football just as Charlie Brown attempts to kick it, lifted the capote in a flourish, twirling in time with the bull just as it attempted to make contact. Usually the bull followed the capote as it moved, rotating around the axis of the kid, bucking its head impotently against the fabric. One pass. Two. Maybe three. And then the kid stepped away, took shelter behind another one of the barriers, and the next kid readied himself, waiting for the bull to settle a bit before he picked up the borrowed capote and took his own steps into the ring.
They trained like this for forty-five minutes while I stood behind one of the barriers, my notepad propped against the top of it, my ballpoint scratching out words, my skin reddening under the blue Mexican sky, trying to take it all in. It was almost lunchtime when the
last kid—I think it was Mauro—had his time in the ring. And then I don’t remember who it was that suggested I give it a try.
I took the capote. I stepped into the ring. I walked forward a few steps. I tried my best to pull my shoulders back, to stand straight, to stick out my chin. The bull was in the opposite corner, looking away from me. I held the capote out.
“Ay! Toro! Toro! TORO!”
It turned. It seemed to hesitate for a few moments, looking at me with its blank, dull eyes. I could see its flanks heaving. It was tired. It must have been frustrated, too. It hadn’t connected, not even once.
I shook the capote again, and it charged.
I remember the approach, the lowered head, the clomping hooves, the way my hand whitened around the rod that supported the cape. I remember shaking the cape with increasing urgency. I remember wondering why the bull didn’t seem to be paying any attention to the cape, why all it seemed to see was me. A good matador, when the bull is about to make its pass, stands even straighter than straight, thrusting his hips forward while he pulls back his shoulders, an act of postural symbolism so obvious it needs no explanation. My hips receded as I stuck the capote out as far as I could, away from my body, shaking it harder and harder, trying to make the bull change its unchangeable mind.
Its forehead connected with the side of my hip, lifting me off the dirt and into the air. I remember twisting, trying and failing to get my feet under me. I hit the ground hard. It was on me. I remember holding one of its horns, gripping it tighter than I’d gripped the capote, holding it away from me so that it wouldn’t come close to my head, my neck. I heard the kids come rushing, yelling at the bull, one of them smacking its flank, trying to distract it. After maybe five seconds it worked: The bull turned its attention away from me, took a tentative lunge toward Mauro. I scrambled to my feet and ran behind one of the barriers, laughing with excitement. I had so much adrenaline in my veins that I didn’t notice the swelling hoofprint embossed on my stomach till later.
So why had the bull connected with me and not the others?
An obvious answer, and a correct one, is that I’m a terrible matador. But there’s another answer, one equally true, and to find it we return to Henry’s story.
—
The lines dividing human and animal research during the 1950s were blurry almost everywhere, but nowhere more so than at my grandmother’s asylum. In 1949, the same year the superintendent, Charles Burlingame, built my grandfather the first operating room devoted exclusively to psychosurgery, he also, in the same building, opened a monkey research laboratory. Burlingame hired a young, ambitious neurosurgeon turned neuropsychologist named Karl Pribram to head the laboratory and become the institute’s director of research. Pribram arrived at the asylum straight from John Fulton’s laboratory at Yale, and his mandate was described in the institute’s annual report that year: “Thus, follow-up studies can be carried out on several problems arising from psychosurgical (lobotomy) work on humans, making possible a more rational approach to this controversial mode of therapy in psychiatry.”
Even before Pribram left Fulton’s primate laboratory to start his own at the Institute of Living, his interests, like those of many of his contemporaries, had begun to migrate from the frontal lobes deeper into the brain, toward the temporal lobes. He and an even younger researcher, a visiting PhD student from McGill named Mortimer Mishkin, set out to pick up where Paul Bucy and Heinrich Klüver had left off the decade before, investigating the behavioral and neurological effects of bilateral temporal lobe ablations. In their first efforts, they requisitioned ten animals: one adult male chacma baboon, one female guinea baboon, and eight young rhesus macaques. They tested each animal extensively on a variety of tasks. Pribram then opened their skulls, one by one, and removed various portions of their temporal lobes before retesting them. They were generally kept alive for approximately four to eight months postoperatively, and efforts were made to control and keep tabs on most elements of their lives, including what they ate and their body temperatures; Pribram, however, noted that although “we believe that all spilled food was recovered and weighed we cannot be certain of this. In the same manner, although every precaution was taken to accustom the animals to the rectal temperature-taking procedure, it cannot be said with certainty that the relaxation of the animal was the same pre-and postoperatively.” After sufficient data was collected, they were killed and their brains analyzed to provide a precise measurement of the extent of their lesions.
What they found in many ways confirmed what Klüver and Bucy had found. For example, the animals with temporal lobe lesions seemed willing to eat almost anything. Pribram and Mishkin would soak pieces of potato and cotton ball in foul-tasting quinine and offer them to the monkeys. The lesioned monkeys would chew whatever was proferred without hesitation. They would also eat meat, which these vegetarian primates would have otherwise avoided. This newfound adventurousness extended beyond their palates, too: They seemingly had appetites for all sorts of things they didn’t care for before. The researchers would offer the monkeys items considered noxious, such as razor-sharp pieces of metal and burning pieces of paper, and the monkeys would repeatedly pick them up and examine them without hesitation, despite the damage such items caused them. “A stimulus object is considered noxious if it visibly injured the animal’s integument by cutting or burning,” they wrote. “The number of times in a session that an animal would approach, accept, and examine such an object is recorded.” On several occasions, after a monkey took the burning paper, “the animal’s whiskers would catch fire,” and in general, “in spite of the obvious discomfort these noxious agents seemed to cause, the animal would return over and over again to expose himself to injury.”
Pribram and Mishkin also noted that the animals showed the classic “tameness” and “lack of fear” that Klüver and Bucy had described in their animals. They tested this in part by yelling at the animals in a threatening manner, and on several occasions crawling into the cages of the once ornery, now placid primates. “Without prior planning, the authors independently felt it safe to enter the animal’s cage and ‘petted him for a considerable time.’ When the observer placed his hand in the animal’s mouth it was chewed very gently.” They also placed nonlesioned monkeys in the cages with the lesioned ones to see what would happen. “When attacked by a larger animal he would not attempt to escape but would sit quietly ducking the debris thrown at him, wincing or grimacing briefly when hit or bitten.”
Along with these rehashings of Klüver and Bucy’s original protocols, Pribram and Mishkin also administered some new tests. Chief among these was the so-called delayed-response task, which was supposed to test their memories. The task was taught to all of the animals prior to their surgeries to make sure they had a basic understanding of the method. It worked like this: The animal would watch as a researcher hid a single peanut under one of two identical upside-down cups. The researcher would then lower a screen in front of the animal and the cups. The screen would remain in place for about fifteen seconds, then the researcher would raise it, and the animal would be allowed to reach for one of the cups. If he chose correctly, he’d get to eat the peanut. Prior to operation, the animals were each run through the task one hundred times and chose the peanut-concealing cup 85 percent of the time. Then, after large portions of their medial temporal lobes were removed, they were administered the task again.
They did fine. As Pribram and Mishkin wrote in their paper, “performance in the delayed-reaction test was unimpaired.” Which is to say that as far as they could tell, when primates lost their hippocampi and other nearby structures it did not damage their ability to remember things. Whatever was happening to the monkeys as a result of the lesions, it did not seem to be affecting their memory systems.
But then, H.M.
By the time my grandfather operated on Henry, Pribram had already established his laboratory at the Institute of Living, and although he and Mishkin were both still affiliated with Yale, they liv
ed and did most of their work in Hartford. Henry’s operation was performed at Hartford Hospital, not the Institute of Living, but Pribram heard about it and was immediately intrigued. In fact, in the original letter my grandfather wrote to Wilder Penfield inviting Brenda Milner to come study Henry and his other medial temporal lobe cases, my grandfather added that Pribram “also would like to study these cases which, of course, is quite all right with me.”
Pribram never ended up conducting any studies involving H.M. or the other patients. His specialty was the study of nonhuman primates, and maybe he simply found the transition from macaque to Homo sapiens too difficult. But although Pribram and Mishkin didn’t study H.M. directly, they and countless other brain researchers had to grapple with what H.M. meant. If human and nonhuman primate brains were similar, functionally speaking—which after all was the animating principle behind monkey research—then why were monkeys with medial temporal lobe lesions apparently left with intact memory systems? How did they remember which cups those peanuts were hidden under?
Soon researchers everywhere were poking at this apparent discrepancy, trying to replicate H.M.’s lesions in primates and seeing if doing so would induce amnesia. My grandfather was among them: Along with a neuropsychologist named Robert Correll, he established a small colony of macaques in a lab at Hartford Hospital. For a while, during his off-hours, my grandfather fell into the habit of visiting the lab and doing to a macaque exactly what he had done to Henry, removing its medial temporal lobes bilaterally. He and Correll attempted to test the memories of the primates pre-and postoperatively, presenting them with various tasks, rewarding them with bits of food or banana-flavored pellets. His results, however, were largely the same as Pribram and Mishkin’s had been: The lesions seemed to leave the macaques’ memories unaffected, at least their memories as measured by delayed-response studies. My grandfather attributed this failure in part to “the absence of a generally accepted operational definition of memory.” Eventually he sacrificed all the monkeys, made slides from their brains, and moved on.
Patient H.M. Page 24