Mrs. Molaison also benefited from Mrs. Herrick’s attention. In February 1977, however, she had what Mrs. Herrick called “another bad spell” and was hospitalized with high blood pressure. She left the hospital after a week, but at age eighty-nine, she clearly required more care than Mrs. Herrick could give. Mrs. Molaison went to live in a nursing home, where she spent the rest of her life, demented and delusional. Without the ability to recollect where his mother was and why, Henry had trouble adjusting to her absence. He often asked when his mother and father were coming to visit him. That year, one of our lab members noticed that he had written two notes to himself, which he kept in his wallet, one saying “Dad’s gone,” and the other “Mom’s in nursing home—is in good health.” We do not know whether Mrs. Herrick prompted him to write these notes or whether he did it on his own initiative when she gave him this information, but either way the notes protected him from the anxiety of not knowing where his parents were.
Mrs. Herrick occasionally took Henry to visit his mother. He was always happy to see her and just as happy to leave, reassured that she was OK. She died in December 1981 at the age of ninety-six. According to one of Henry’s caregivers, he did not take the news of her death too badly and was not overwhelmed with grief. He spoke only of what a nice woman she was and described how she had taken care of him all his life.
Henry continued to live with Mrs. Herrick until 1980, when she was diagnosed with terminal cancer. Henry, in his mid-fifties, then moved to nearby Windsor Locks, Connecticut, to Bickford Health Care Center, a long-term care facility founded by Mrs. Herrick’s brother, Ken Bickford, and his wife Rose. Bickford Health Care was a friendly environment where Henry received round-the-clock attention from a large staff of specialized, dedicated caregivers for the remaining twenty-eight years of his life. His hospital chart initially listed me as “the only interested relative, friend, or contact.” I was there on the day of his admission to see that he would be well cared for and protected. Medicare, Medicaid, and Social Security covered the cost of Henry’s stay at Bickford, as well as his visits to local hospitals.
With Mrs. Herrick gone, I became Henry’s sole keeper, in the sense that I felt responsible for his well-being. I watched over him. When he visited us at the MIT Clinical Research Center, he always had a physical and neurological exam, which helped us pinpoint any new symptoms and find ways to alleviate them. Luckily, we could rely on the resources of the MIT Medical Department and the nursing home staff to carry out the physicians’ orders. I kept in close touch with Henry’s Bickford caregivers, who always called me when a new concern arose, such as when he had a grand mal seizure, broke his ankle, or showed obstreperous behavior. I also tried to enhance his quality of life by sending him clothes, cards, photographs, and movies and the equipment to play them.
I was now in the position of knowing more about Henry than any living person. Mrs. Herrick had become the custodian of the Molaisons’ mementos, collected on vacations and from family events, and she passed them on to me. In 1991, the Probate Court in Windsor Locks, Connecticut appointed her son, Mr. M., to be Henry’s conservator, meaning that he was responsible for protecting Henry’s interests and supervising his personal affairs. He was my best resource for information about Henry’s past, filling me in on details of the Molaison family history and giving me a treasure chest of mementos, which on several occasions I have had the pleasure of sharing with the general public. All these stories and keepsakes have helped me reconstruct the family’s past.
We might see the five decades of Henry’s life with amnesia—first with his parents, then with Mrs. Herrick, and finally at Bickford—as extremely impoverished. Although he was always looked after, could amuse himself, and rarely appeared to suffer, what kind of life could he have lived without his memory? If he were forever trapped in a single moment, could he be a fully realized human being? Some philosophers, psychologists, and neuroscientists have argued that without memory, we lack identity. Did Henry have a sense of who he was?
There is no doubt in my mind that Henry did have a sense of self, even though it was fragmented. Over the years of working with him, we came to know his personality and the quirks and traits that made him who he was. Henry’s beliefs, desires, and values were always present. He showed a general spirit of altruism and frequently articulated his hope that what we learned about him would help others. That possibility was a source of satisfaction for him.
Henry knew that he had undergone an operation and was aware that he had trouble remembering things, but he had no idea how far back in time his memory loss extended. Here is how he talked about his operation in a 1992 conversation with me:
SC: Tell me about that [the operation].
Henry: And I remember it if—I don’t remember just where it was done in—
SC: Do you remember your doctor’s name?
Henry: No, I don’t.
SC: Does the name Dr. Scoville sound familiar?
Henry: Yes, that does.
SC: Tell me about Dr. Scoville.
Henry: Well—well, he went—he did some traveling around. He did—well, medical research on people. All kinds of people in Europe, too, and the royalty, and out in the movie stars, too.
SC: Did you ever meet him?
Henry: Yes, I think I did. Several times.
SC: Do you know where you met him?
Henry: I think I met him in his office.
SC: And where was that?
Henry: Well, I think of Hartford right away.
SC: Where in Hartford?
Henry: Well, tell you the truth. I can’t tell you the address number or anything, but I know it was down the main part of Hartford in—but it was off the main section. Off of Main . . .
SC: Was it at a hospital?
Henry: No. The first time that I met him was in his office. Before I went to a hospital. And there—well—well, what he learned about me helped others too, and I’m glad about that.
Henry’s recollections were largely correct. While he never expressed any resentment toward Scoville or about the outcome of the operation, he did seem to have processed on some level that something very bad had happened as a result of his surgery. Henry mentioned many times that he had once dreamed of becoming a brain surgeon, but said he had given up on the idea because he wore glasses and was worried that he might make a mistake and hurt a patient. It was not unusual for him to repeat versions of this little story three or four times a day. In one scenario, an attendant wiping Henry’s brow inadvertently dislodged his glasses; in another, blood spurted up on his glasses and obstructed his vision; and in a third, little specks of dirt on his glasses blocked his view. In all versions, Henry expressed concern that he would make a wrong move, resulting in the patient’s sensory loss, paralysis, or death. The resemblance between these recurring narratives and Henry’s description of his own experience is striking. In 1985, Henry shared these thoughts with a postdoctoral fellow in my lab, Jenni Ogden, a neuropsychologist from New Zealand:1
Ogden: Do you remember when you had your operation?
Henry: No, I don’t.
Ogden: What do you think happened there?
Henry: Well I think it was, ah—well, I’m having an argument with myself right away. I’m the third or fourth person who had it, and I think that they, well, possibly didn’t make the right movement at the right time, themselves then. But they learned something.
Henry’s kindness was apparent in many routine ways. Socially, he was courteous, friendly, and chivalrous. When we walked together from one MIT building to another, he would cup my elbow with his hand to escort me down the sidewalk. He also had a sense of humor and enjoyed cracking jokes, even at his own expense. In 1975, during a conversation with one of my colleagues, Henry gave his usual line, “I’m having an argument with myself,” in response to a question about the date. My colleague joked, “Who is winning the argument? You or you?” Henry laughed, repeating, “You or you.” Henry snapped at me only once in forty-six years: I was t
rying to help him learn a complex procedure, and he had become frustrated. “Now you’ve got me all balled up!” he scolded me.
In shaping the Henry we knew, several variables were likely at play: his inherent nature, his protected living situations, and his operation. His behavior was influenced in part by the removal of his left and right amygdalae. A component of the limbic system, this almond-shaped structure is critical for processing emotion, motivation, sexuality, and pain responses, particularly feelings of aggression and fear. Was this sweet, tractable man pacified by his operation? From what we know of Henry, he had always been an agreeable, passive person—similar in behavior to his father—and his parents made no mention of any personality change after the operation. Indeed, Henry had not lost his capacity for emotion. He could even be aggressive—when he attacked a staff member at the Hartford Regional Center, or when he fought with his mother. He also was capable of feeling grief for lost loved ones. As we saw during Henry’s stay at MIT in 1970, he was able to miss his mother and to show tenderness toward her when he saw her after an extended absence. Henry’s emotions may have been blunted by his operation, but he was able to take part in most of the feelings we all experience.
Still, Henry lacked self-awareness in many basic ways. He was largely unable even to evaluate his own physical state—whether he was sick or well, energetic or tired, hungry or thirsty. Henry’s complaints of physical pain were infrequent. He sometimes reported ailments such as stomach-aches and toothaches, but other conditions, such as bouts of hemorrhoids, went without comment. When he broke his ankle, he considered the injury so trivial as to not warrant an X-ray. We also noticed that Henry rarely spoke of being hungry or thirsty, but when asked if he was hungry, he would say, “I can always eat.” In 1968, Mrs. Molaison reported that, for the first time, Henry agreed with her when she told him that he should be hungry. He said, “Yes, I guess I’m hungry.” He never sought out food for himself; it was simply given to him by his caregivers.
How much of Henry’s apparent inability to register his internal states was a result of his amnesia, and how much of it was due to the missing amygdalae? To systematically document our observations that Henry rarely commented on such internal states as pain, hunger, and thirst, we conducted two experiments in the early 1980s. In one study, we tested his ability to perceive pain, and in another, we asked him to rate his feelings of hunger and thirst before and after meals. Healthy control participants also performed both tasks. Because limited memory ability might have influenced Henry’s reporting of internal states, we compared his performance with that of five other amnesic patients whose amygdalae were spared.2
Neuroscientists have been studying the amygdala since the early nineteenth century, with an evolving understanding that this structurally and functionally diverse unit plays a role in a host of behaviors, including pain, hunger, and thirst. Because Henry had almost all of his left and right amygdalae removed, it was important to document the effects of these lesions on its known functions. Each amygdala is part of a dedicated pain-processing circuit that incorporates two other areas—one in the midbrain, the periaqueductal gray matter, and the other just under the frontal lobes, the anterior cingulate cortex. This network evolved to protect animals and humans from adversity and to enhance their chances for survival. The amygdala, in concert with several other brain regions, including the hypothalamus, also contributes to the appreciation of hunger and thirst.3
In 1984, my lab began to examine the extent to which Henry could process signals related to pain, hunger, and thirst by first testing Henry’s pain perception, using a hairdryer-like contraption that projected a spot of heat onto his skin. We instructed him to apply heat at different levels of intensity to six places on his forearm. The heat was never hot enough to burn his skin. During three test sessions, he rated the intensity of each heat stimulus on an eleven-point scale—absolutely nothing, maybe something, faintly warm, warm, hot, very hot, very faint pain, faint pain, pain, very painful, and withdrawal (intolerable). We evaluated Henry’s pain perception on three occasions. Our analysis of his responses yielded two measures of pain perception—how well he could discriminate between two stimuli of different intensities, and his propensity for calling a stimulus painful. When we compared Henry’s performance to that of the healthy control group, he was impaired on both measures. Not only did he have more difficulty than normal participants in discriminating between levels of heat, meaning that he tended to confuse the stimuli, he also did not label any of the stimuli as painful, no matter how intense they were. Remarkably, he never withdrew the heat before the three-second interval ended. The performance of the other amnesic patients was similar to the controls’, indicating that Henry’s deficit in appreciating pain was not an obligatory component of amnesia. Instead, his amygdala lesions caused this deficit in pain perception.4
In another experiment, we compared Henry’s ability to perceive the intensity of his hunger to that of healthy participants as well as other amnesic patients. At mealtime, most of us can mentally look inward and assess our hunger—do we or do we not want to eat? Then, after finishing a meal, we have a conscious sense of fullness in our stomach, a feeling that tells us whether to skip dessert. When we investigated whether Henry would experience these two measures of appetite, we found that his subjective appetite (How hungry am I?) and his sense of fullness (How full am I?) were both deficient.5
In 1981, we asked Henry to rate his hunger on a scale from zero (famished) to one hundred (too full to eat another bite) both before and after his meals. He consistently gave a rating of fifty whether he was about to eat or had just finished. One evening, after he had eaten a full dinner and his tray was whisked away, a kitchen staff member replaced it, without comment, with another tray containing a meal identical to the one he had just finished. Henry ate the second dinner at his usual slow but steady pace, until only the salad remained. When we asked him why he had not eaten his salad, he simply said that he was “finished,” not that he was completely full from having eaten too much. Twenty minutes later, we asked him to rate his hunger again. He gave a score of seventy-five, meaning that he was conscious of being somewhat full. Only by making doubly sure he was full had we finally brought him above the rating of fifty, but he still fell far short of reporting that he was satiated.6
The pain-perception test indicated that Henry’s capacity for pain detection was disproportionately compromised, compared to his capacity to detect light touches to his skin, which was normal. Although he could discriminate among different levels of pain intensity, his scores were inferior to those of other amnesic patients and healthy controls. His reports of pain did not increase as the intensity of the heat increased.
Because abnormal pain perception was not observed in the amnesic patients whose damage left the amygdala intact, we reasoned that Henry’s abnormal tolerance of pain was caused by the removal of both amygdalae. The related findings that he showed no difference in his ratings of hunger or thirst from before and after a meal, and that he was unable to express a feeling of satiety, supported our conclusion that information about current internal states was either lacking or less accessible to Henry than to other amnesic patients. We attributed his failure to label and express his internal states—pain, hunger, and thirst—not to his memory deficit, but instead to his amygdala lesions.
Our experiments confirmed what we had seen in Henry’s daily life: a failure to appreciate pain and poor monitoring of his appetite. We concluded that the bilateral resection of his amygdala accounted for his poor appreciation of internal states. Without his amygdalae, Henry did not sense when he was hungry or thirsty, and could not engage the brain circuits that told him he had had enough to eat and drink. Fortunately, his overall appreciation of food was not diminished. He told us that he preferred cake to salad, was very fond of French toast, and disliked liver.
The amygdala also plays a role in the expression of sexual drive, and lesions of the amygdala may increase or decrease a patient’s li
bido. To the best of our knowledge, Henry did not show any sexual interest or behaviors after his operation. In 1968, fifteen years postoperatively, Scoville wrote that Henry “has had no sexual outlets, nor does he appear to have a need of them.” Henry’s lack of libido may have been a casualty of his operation. He had mentioned interactions with girls in his youth, and letters he received from two friends suggested that he had been interested in women prior to his operation, although he apparently did not have any serious romances. A photograph in Henry’s family album of an attractive young woman in a pinup pose is inscribed, “To Henry with love, Maude. Taken May 1, 1946.” Of course, his lack of intimate relationships may have resulted from his severe epilepsy and the antiepileptic drugs he was taking. Knowing that he could have a seizure at any moment must have made him extremely self-conscious in social situations; the potential embarrassment of having a convulsion during a date, or of slipping into a medication-induced nap, could be enough to discourage anyone from dating.
One of the greatest challenges to understanding who Henry was, and how he perceived his world, was that his memory of his life prior to the surgery was highly imperfect. He certainly suffered from anterograde amnesia—he could not remember events and facts that occurred after his brain was damaged. But he also experienced retrograde amnesia—he could not retrieve unique events he had encountered before the brain damage occurred.
Studying retrograde amnesia poses greater challenges than studying anterograde amnesia. To test for anterograde amnesia, all a researcher has to do is give a patient some items to remember—a picture, a sentence, a story, a complex drawing—and test later to see whether the patient has retained the information. On the other hand, studying retrograde amnesia is more difficult because it is challenging to figure out what information people had stored in the past. For this reason, researchers often personalize tests by using specific events and facts that are unique to the patient’s own life and knowledge.
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