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Book Review: Patient H.M. by Luke Dittrich

Today we’re taking a trip inside the brain – quite literally – of the most famous brain surgery patient in history. My review copy of Patient H.M. was graciously provided by the publisher through NetGalley; the book is currently available for pre-order and will be released August 9, 2016. If you don’t know NetGalley, it’s a very cool site that brings new books and authors to bloggers and reviewers (among others).

“The broken have always illuminated the unbroken, and throughout history that breaking was often intentional.”

Wow. Honestly, wow. That’s pretty much the reaction I had when I finished this one. There are so many points in the story – non-fiction at its finest, believe me – when that was the only thought I had. The quote sums it up nicely – this is the story of how one broken brain informed the actions of generations of doctors and patients, a brain that was broken with deliberation and intent. I was vaguely familiar with lobotomy as the historical treatment of choice for many mental – and physical – health issues ranging from “hysteria” (often defined as women behaving badly, according to the men in their lives) to epilepsy to homosexuality. I’ve seen and read Girl, Interrupted and One Flew Over the Cuckoo’s Nest, was familiar with the story of Rosemary Kennedy. I find brain and identity science fascinating – stories like those of Phineas Gage raise extraordinary questions about who we are and what, exactly, makes us, well, us. If you find the tale of Phineas Gage and his personality changes interesting, you have got to read up on Patient H.M. – otherwise known as Henry Molaison.

To make a very complex story very short (and vastly over-simplified), Molaison received what would today be called a traumatic brain injury in childhood (age 7); after the injury he suffered from multiple types of seizures over the course of years, rendering him incapable of living what most would consider a normal life. After years of therapy and treatment, he winds up in the hands of Dr. William Scoville and in the snip of a scalpel (actually, more like “with several scrapes of a spatula”), he is transformed from Henry Molaison into Patient H.M. From there, his “story” becomes world-renowned – the procedure effectively rendered him incapable of generating memories. Why the quotation marks around story, you ask? Simple: the word really no longer applies to Henry after his lobotomy, since his inability to create memories basically removes the concept of story from his life.

“There is in fact only one way we tell stories about other people, and it’s the only way we’ve ever told stories about other people. We find the connections between us and them, and then we use those connections as a bridge.”

“In the end, this is the difference between Henry and us: Henry could no longer hold on to the present, could no longer make new memories, which meant that he could no longer tell or even understand stories, at least ones that lasted more than a few moments.”

Imagine that – a life without story, without narrative. No connections, past to present; no “aha!” moments because everything you encountered was always new, always all you knew. You can imagine it. Henry couldn’t.

Dittrich’s descriptions of the origins of the lobotomy, of the variations and developments in the procedure over time, are written in crisp, clear prose. There are no flowers or flourishes; the words are as sharp and spare as the cuts that they describe. But they are incredibly chilling nevertheless… Dispassionate language aside, the facts remain startling and, to modern sensibilities, pretty unbelievable: asylum patients were freely given lobotomies and viewed as a nearly unlimited research resource for the physicians seeking to perfect the procedure; a disproportionate number of women underwent the procedures, many of whom were treated because they were seen as “intractable” or “difficult” – in other words, because they didn’t conform to the behavior society (and the men in their lives) deemed appropriate. Children were treated with lobotomies; cuts were made without any idea what was being cut into or what might be lost in the process. The procedures that often seem to have been adjusted on the fly, with the patient’s brain literally open to whatever the surgeon felt like trying. If one cut didn’t seem to be making a significant improvement, the next procedure made two; if removing one section of the brain wasn’t enough, more and more were removed until the doctors found different outcomes.

Until Henry. (Sort of.)

After post-operative studies of Henry revealed his “memory disorder” (a euphemistic description if ever there was one), things changed (sort of). Prior to Henry, post-op studies about memory and the role of particular brain lobes and regions were seen as somewhat limited in their descriptive capabilities. Asylum patients, after all, were (at least commonly understood to be) mentally ill. Henry was not; he received a lobotomy in an attempt to resolve his seizures – he was “normal” for all other intellectual, mental, and emotional purposes. So when his surgery resulted in outcomes vastly different than those noted in previous patients, the medical community took notice. The resolution of most of the seizure activity meant that the procedure was viewed as a success; the changes in Henry’s life were fascinating to doctors, psychologists and medical researchers, and the scientific theories and studies that derived from his decades-long immersion in research science still underpin much of what is understood about the brain today. The transcripts of Henry’s interviews and tests throughout the years are often painful to read. His struggles with memory and cognition continued unabated year after year – in inverse proportion to the successes of his surgeon, Dr. Scoville, and his long-term (largely self-appointed) psychologist-gatekeeper Suzanne Corkin. There is no shortage of irony in this story, I assure you, and the battles over Henry’s body and legacy are astonishing from legal and ethical standpoints to say the least…

But Dittrich’s book isn’t just a history of Henry and the lobotomy, it’s also a story about stories. “Sometimes just a few words can change everything you thought you knew about the story you thought you were telling.” So the author comes to realize as his study of the intertwining tale of Henry and Dr. Scoville – Dittrich’s own grandfather. Throughout, Dittrich maintains a level of objectivity that I imagine must have been personally challenging. This is, after all, the story of people he not only knows, but is related to. He demonstrates an unflinching ability to present what are often cold, unvarnished facts and difficult, severe truths, yet to somehow imbue the overall story with compassion and warmth. His grandfather may have needed to maintain a level of distance from his patients; Dittrich does not. He never lets us forget that this is, ultimately, a tale of broken people – broken by chance or biology, by nature or society – and their quest to become unbroken. Or that both the broken and those who sought to fix them were human – and that to be human means we are all fallible, even when we (or society, or family, or our peers) seem to be telling us otherwise. The book is as much Scoville’s story as it is Henry’s, and the delicate maneuvering between past and present and between doctor and patient provides a marvelous tale – and one with a mind-altering (pun intended) realization served up deftly at the end. This is, to me, the hallmark of successful non-fiction writing – there are moments when it is all too easy to forget that this is a tale of scientific and medical history, when the stories overwhelm the science and you find yourself hoping for a nice, tidy, fiction ending. What you get is a lot messier, but exceedingly satisfying.

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