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I saw this title at the library, read the back cover, and checked it out. I have always been interested in the mind-brain conundrum and the fascinating lessons learned from the study of various types of brain injury. This is a documentary of the most extensively-studied memory-deficient patient ever, written by the grandson of the neurosurgeon responsible for the damage, but it is much more than that. It is also a documentation of the changing and, by modern standards, primitive state of the art of psychiatric treatment and “psychosurgery” until very recently. The esteem of the Nobel prize in medicine is forever tarnished by the awarding of it to Egas Moniz in 1949 for his development of the frontal lobotomy.
H.M. underwent ablation of part his normal temporal lobes by a pioneering neurosurgeon in 1953 in an effort to treat his epilepsy, in turn the result of previous brain trauma. The resulting complex memory problems were very extensively studied by many researchers over four decades until his death in 2008, resulting in hundreds of papers, and in a complete change in the theories regarding how we process, store and retrieve information and memories.
The list of psychologists, psychiatrists and neurosurgeons involved with H.M. is extensive and include many famous names, including the eccentric flamboyant Dr. William Scofield, who was so convinced of the value of frontal lobotomies that he performed one on his psychotic wife. Their biased attitudes and enthusiasm for their own approaches to problems in the era before controlled trials, and the damage resulting from this is very well documented. Their personality conflicts, eccentricities, unjustified enthusiasm, and ambitions are at times frightening, although I can assure readers that there is no shortage of eccentrics with blind ambition, hypertrophied egos and personality conflicts in modern academic medicine. In this menagerie of egotistical researchers, Wilder Penfield, the founder of the Montreal Neurological Institute stands out as the most cautious ethical, methodical man of the lot. He never did or advocated frontal lobotomies. One psychologist seemed to think of H.M. as her household pet, controlling access to him, and not bothering with such mundane matters as informed consent for the research she and others did on him. Most of the story takes place in Hartford Connecticut or at the Yale New Haven Hospital. I realized that I probably crossed paths with some of the researchers during my three years of training at Yale, but, appropriately for a discussion about memory research, if so, I have forgotten.
What has hopefully changed since the 1950s is the societal tolerance for experimentation without proper ethical constraints and review. The use of various forms of frontal lobotomy to treat a wide variety of mental problems, with little regard for informed consent continued until at least the 1980s and at one time it was even used to ‘treat’ homosexuality. The sliding scale of unethical experimentation by doctors ranging from the atrocities of those in Nazi concentration camps to electroshock therapy is discussed, but only superficially. The modern reader may think that electroshock treatment is cruel and condemn those who applied electrodes to non-consenting subjects to induce convulsions but it is still being used occasionally, although it has been subjected to only limited randomized controlled trials, and is being gradually replaced by focused magnetic brain stimulation. I assisted in ECT a few times in the late 1960s. (At that time, I lived in the now defunct London Psychiatric Hospital for two years as an impoverished medical student, getting free room and board in exchange for some questionably appropriate services.) It is easy to forget that there were very limited options for controlling violent psychotic patients in the days before the extensive array of chemical straightjackets now available. And it is very easy to condemn the ethical standards of our forbearers by applying the standards we now use to them. Will our grandchildren condemn our unethical pollution of the environment which we will leave them?
The unseemly fights between various institutions for possession of the brain of H.M. following his death in 2008 dramatizes the blind conviction of those involved that the study of it is going to forever solve the mystery of how Homo sapiens collect, store and retrieve memories. The hyperbole about the important information to be gleaned from the study of one brain is grating. How useful can the study of one brain be, particularly one that came from a man who died after developing severe dementia on top of his pre-existing brain injuries.
The author intersperses stories of his personal eccentricities and adventures, sometimes with a tenuous connection to the theme, such as his bullfighting in Mexico and his illegal climbing of the Great Pyramid. There are some glaring lapses in copy-editing and proof-reading. “…they laid open men whilst alive-criminals received out of prison the king- and while they were still breathing…”.
This book is enlightening for those readers interested in the history of medicine, and particularly the history of psychiatry, but otherwise not a must-read.
The Passionate Reader 