Summary and Analysis of Patient H.M.: A Story of Memory, Madness, and Family Secrets: Based on the Book by Luke Dittrich
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Summary and Analysis of Patient H.M.: A Story of Memory, Madness, and Family Secrets: Based on the Book by Luke Dittrich
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This short summary and analysis of Patient H.M.: A Story of Memory, Madness, and Family Secrets includes:
- Historical context
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About Patient H.M. by Luke Dittrich:
Patient H.M. tells the extraordinary true story of Henry Molaison, a young man who underwent a lobotomy in 1953 in hopes of curing his epilepsy. Instead, he suffered extensive memory loss and would became the most studied patient in the history of neuroscience.
Luke Dittrich, whose grandfather performed the surgery, artfully combines family history, medical science, and investigative journalism to create a suspenseful and unsettling narrative on the search to understand the most elusive of scientific research topics: the human memory.
The summary and analysis in this ebook are intended to complement your reading experience and bring you closer to a great work of nonfiction.
Product Details
| ISBN-13: | 9781504046466 |
|---|---|
| Publisher: | Worth Books |
| Publication date: | 05/16/2017 |
| Series: | Smart Summaries |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 30 |
| File size: | 3 MB |
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Summary and Analysis of Patient H.M.: A Story of Memory, Madness, and Family Secrets
Based on the Book by Luke Dittrich
By Worth Books
OPEN ROAD INTEGRATED MEDIA
Copyright © 2017 Open Road Integrated Media, Inc.All rights reserved.
ISBN: 978-1-5040-4646-6
CHAPTER 1
Summary
Prologue
Luke Dittrich introduces the characters who will play a central role in the book: his grandfather, the neurosurgeon Dr. William Beecher Scoville; Henry Molaison, later to become Patient H.M.; neuroanatomist Jacopo Annese, who dissected Patient H.M.'s brain; and the author himself.
Need to Know: Dittrich lets the reader know the book is both a true story and a treatise on memory, that essential but largely unknown function of the human brain.
PART I: ORIGINS
One: The Fall
As a young boy in Connecticut, Henry Gustave Molaison was hit by a bicycle, causing a brain injury that led to his epilepsy, a disease that has been studied by physicians since the time of Hippocrates. Henry, who suffered epileptic seizures and, later, long-term memory loss, would become the most studied patient in the history of neuroscience. However, his identity was kept a well-guarded secret, both by the surgeon who operated on him, Dr. Scoville, and the researcher who later studied him, Dr. Suzanne Corkin.
Need to Know: This chapter relates the beginning of Henry Molaison's journey from accident victim to epilepsy patient to prized scientific specimen. It also reproduces, in dialogue form, some of Henry's interviews with researchers, giving an idea of how fragmented and incomplete his memory was.
Two: Crumpled Lead and Rippled Copper
At his Connecticut home, Dr. Scoville kept a collection of ancient instruments used in brain surgery, which was practiced as early as four thousand years ago by the Egyptians. Papyrus scrolls show that they treated head injuries — which were usually sustained in battle — with a combination of religious incantations and practical medicine. Their treatment was conservative and their guiding principle was that the injuries should be dressed, but that the brain itself, even if it were exposed, should not be touched.
Need to Know: Throughout history, physicians who treated head injuries did not explore the brain itself, given their lack of knowledge about it. This did not change until the 1880s, when the first neurosurgeries were performed by Dr. Gottlieb Burckhardt in Switzerland.
Three: Dream Jobs
Henry Molaison suffered his first epileptic fit at age fifteen. The seizures became more frequent, causing him to be fired from his job at a factory. He returned to high school and graduated, but was not allowed to receive his diploma in the ceremony with the rest of the students for fear he might have an episode.
Years later, when being interviewed by researchers at the Massachusetts Institute of Technology (MIT), Henry had vague and disjointed recollections of his childhood, and of anything prior to the lobotomy that was performed on him at age twenty-seven.
Dr. Scoville, the surgeon who operated on Henry, was the son of a wealthy Philadelphia family. As a young man, he was plagued by self-doubt, a quality that clashed with the brilliant and arrogant adult he later became. William eventually overcame his uncertainties and enrolled in medical school at the University of Pennsylvania.
Need to Know: After he was lobotomized, Henry Molaison's constant state of mind was that of having been recently awakened from a dream, a condition known hypnopompia. In his dreams, oddly enough, he imagined becoming a brain surgeon.
Four: The Bridge
Norman J. Terry was a daredevil stuntman who died in 1930 when he attempted to dive into the Hudson River from the still-unfinished George Washington Bridge. Not long after, William Scoville, then twenty-four, climbed the long suspension cables to one of the bridge's towers, where he spent the night in the cold and descended the following morning. Afterward, he recounted the story many times.
Years later, the author undertook a similar ascent in Egypt, where he climbed to the pinnacle of the Great Pyramid in Cairo. As to why he did it, Dittrich says it was a way of commemorating his entry into professional life; he had just obtained his first full-time job as a journalist. Dittrich theorizes that this was also the motivation for the climb by his grandfather, who at the time he ascended the bridge was halfway through medical school and had begun curing patients.
Need to Know: Young William Scoville's daring ascent of the George Washington Bridge is interpreted by the author as a rite of passage into adulthood and professional life. However, it also portends the recklessness that Scoville would later display as a surgeon.
Five: Arline
During his many interviews with researchers, one of Henry's most outstanding memories was of a boyhood crush on a girl named Arline, a fellow student at Catholic school in Connecticut. However, as a result of the lobotomy, Henry had no sexual desire or interest in women; doctors concluded that the operation had rendered him asexual.
Nor did he feel physical pain. During repeated experiments with a dolorimeter — an instrument used to inflict pain for research purposes — Henry never reacted. He was also capable of eating large amounts of food, at times consuming two entire dinners, one after the other. This was due partly to his amnesia — he couldn't recollect having eaten the first meal.
Need to Know: The operation that severely reduced the functions of Henry's brain and cut off its natural responses to food, sex, and pain, would later lead to discoveries that revolutionized the field of neuroscience.
PART II: MADNESS
Six: Pomander Walk
Dr. Scoville was drafted into the army in 1943, commissioned as a major and posted to Walla Walla, Washington. There, in January 1944, Scoville's wife Emily suffered a paranoiac, delusional outburst that culminated in a suicide attempt. Her husband, shocked by the episode, moved the family back to Connecticut, where his wife was confined to the Institute of Living, a mental hospital, at the time considered to be one of the most progressive in the country. Upon arrival at the institute, Mrs. Scoville went into a violent outburst, prompting attendants to remove her to South One, a building where a range of therapies were performed.
Need to Know: Despite its reputation as a forward-thinking mental hospital, the Institute of Living employed therapies and procedures that are today regarded as brutal, including electroshock therapy and lobotomy.
Seven: Water, Fire, Electricity
At the Institute of Living, Emily Scoville was subjected to the therapeutic treatments in use at the time. The first was hydrotherapy, which consisted of long periods of immersion in cold water to induce hypothermia (dangerously low body temperature), a state that was believed to have sedative effects. She was also given pyretotherapy, in which fevers of up to 106 degrees were artificially induced by placing the patient in a closed, heated chamber. When she didn't respond adequately to either, Emily was given electroshock therapy.
Need to Know: Dr. Scoville kept close watch on the treatments being applied to his wife while she was confined to the Institute of Living because he was a consulting neurosurgeon there.
Eight: Melius Anceps Remedium Quam Nullum
The first attempts to cure mental illness with brain surgery began in 1888 with a Swiss physician, Gottlieb Burckhardt. His first patient, a fifty-one-year-old woman, was transformed from "a dangerous and excited demented person to a quiet demented one." (In his writings, Burckhardt invoked the Latin phrase "Melius anceps remedium quam nullum": "it is better to do something than nothing.").
The procedure caused such an outcry among physicians that it was largely discredited until the 1930s, when Portuguese surgeon Egas Moniz began performing leucotomies, a removal of "white matter," the connective neural tissue in the brain. This technique was later perfected by Dr. Walter Freeman, who coined the term "lobotomy," to describe an incision into the prefrontal lobe of the brain. The effect on patients was to cure their aggressive traits but to turn them into emotional shells, often with severely reduced intellectual capacity.
Need to Know: The attempts to cure mental illness with brain surgery reached their zenith in the late 1940s and '50s, when Dr. Walter Freeman promoted the lobotomy as an effective procedure to cure aggressive or violent patients. Dr. Scoville was among the neurosurgeons who adopted and advocated the procedure.
Nine: The Broken
Throughout the history of medicine, physicians have learned most of what they know about the functions of the brain from patients who suffered injuries to it. One of the most celebrated cases was that of Phineas Gage, a Vermont railroad worker whose skull was pierced by an iron rod. He suffered a severe personality change, going from an affable, reasonable man into a "surly drunk" who regularly flew into uncontrollable rages. The many papers written on Gage concluded that the frontal lobes, which in Gage's case were pierced by the rod, were crucial for impulse control.
Likewise, a nineteenth-century French mental patient known only as Monsieur Tan was able to read, write, and understand everything that was said to him, but could say only one word ("Tan"). After the patient's death, the autopsy revealed his inferior frontal lobe was damaged.
Need to Know: The study of injuries to the brain, known as the "lesion method," gave rise to most of the knowledge about the different areas of the brain and the functions they control. However, the function of memory, and the place that controlled it, remained elusive.
Ten: Room 2200
During the post-World War II period, mental asylums in the United States were filled to overflow. The "insanity epidemic" pressured authorities into seeking ways to reduce the patient population. "Psychosurgery" was one of the methods they chose. Connecticut was the first state to adopt a large-scale program of lobotomies and Dr. Scoville was soon to become one of its most skilled practitioners. Within months after the program was implemented in 1946, he was performing as many as three lobotomies in a single day.
Need to Know: The post-World War II increase in the numbers of mental patients was due in part to returning veterans with emotional problems. It coincided with the advent of the lobotomy, which offered a surgical alternative to psychiatric care in hospitals.
Eleven: Sunset Hill
After four months undergoing different therapies at the Institute of Living, Emily Scoville was discharged and went on a holiday at Sunset Hill, a vacation home her family owned in upstate New York. The author remembers seeing his grandmother there and recalls her as a kindly but passive, and increasingly detached, older woman (she lived to be 101). Curiously, Emily's older self was completely at odds with the young person her family described in stories: an outgoing, adventurous, independent woman who loved music and, after graduating from Vassar, travelled to Vienna to live on her own for a year.
Need to Know: The author's musing about the apparent change in his grandmother's personality over her lifetime, combined with the knowledge from the previous chapters that his grandfather was an avid practitioner of lobotomies, point to the book's final revelation.
Twelve: Experiment Successful, but the Patient Died
Physicians have always known that some medical mysteries could only be solved by experimenting on living patients. The moral question that arises is whether humans should be injured, or even allowed to die, in the interests of serving some greater scientific purpose. The Nazis had no such qualms; their experiments on concentration camp prisoners, to test their ability to survive in extremes of heat or cold, were aimed at finding ways to help German soldiers endure such conditions. If the prisoners died during the experiment, their death was merely anecdotal; many of the reports of these trials concluded with the phrase "Experiment successful but the patient died."
Although the Nazi doctors who supervised these experiments were universally reviled — twenty-three were sentenced to death at the Nuremberg trials — a similar attitude has prevailed among medical researchers in other parts of the world, including in the United States. During the postwar period, one of the many new psychiatric therapies being tested was hypothermia, in which patients were subjected to extremely cold temperatures, similar to the experiments the Nazis had carried out.
Need to Know: Despite the revulsion provoked by Nazi experiments on concentration camp prisoners, the general attitude toward human experimentation throughout history has been that it was justified if the scientific benefit was sufficiently great.
Thirteen: Unlimited Access
By the late 1940s, lobotomy was gaining respectability as a surgical procedure that could cure mental illness. Dr. John Fulton, whose experiments on chimpanzees led to the development of the lobotomy for humans, was one of the promoters of the procedure. In conversations and correspondence with colleagues — particularly neurosurgeons — he encouraged them to become pioneers in an area he expected would have tantamount importance. However, some surgeons questioned the ethics of carrying out what was still an experimental procedure on human patients, and the lack of scientific rigor in reporting the results.
Drs. Walter Freeman and James Watts were the most active in performing and promoting lobotomies. They were supported by press reports that told excitedly how "raving maniacs" could be cured by the "wizardry of surgery." The Veterans Administration also supported lobotomies as a way to cure combat-shocked veterans. Meanwhile, the country's overcrowded mental hospitals were offering "unlimited access" for neurosurgeons to perform lobotomies on patients who could be released afterwards.
Need to Know: The proliferation of lobotomies in the late 1940s marked a fundamental change in the way research on the human brain was conducted. Instead of examining "broken" patients — those who had suffered brain damage accidentally — medical researchers were intentionally inflicting damage on human brains, with no clear idea of what the results might be.
Fourteen: Ecphory
Henry Molaison, absent from the narrative for the last two hundred pages, now reappears. As a teenager, his epilepsy worsened and his parents took him to see Dr. Scoville. While Henry recounted the story of the bicycle accident that caused his head injury, Dr. Scoville probably recalled his own brother Henry, who was killed in a bicycle accident.
This recollection prompts a long digression into Scoville family history. William Scoville's great-grandfather, Henry Ward Beecher, was a celebrated nineteenth-century preacher and abolitionist whose reputation was tarnished by accusations of adultery. Although he was acquitted in a scandalous, high profile trial, Beecher's reputation never quite recovered.
Need to Know: Like his famous ancestor Henry Ward Beecher, Dr. Scoville was a man whose life harbored successes and failures, darkness and light. He saved many patients' lives and lost some, but was always willing to admit his failures.
Fifteen: The Vacuum and the Ice Pick
As more and more lobotomies were performed, a debate arose among practitioners over the best way to carry out the procedure. Dr. William Scoville found the standard method to be sloppy and imprecise, as it mutilated too much of the frontal lobes. He invented the "orbital undercutting" method, which could only be performed by a highly skilled neurosurgeon. In contrast, Scoville's rival, Walter Freeman, who was not a surgeon, simplified the standard procedure even further by using an icepick to cut through the patient's orbital bone, just above the eyelid. This procedure didn't allow the physicians to see exactly which neural connections they were severing. However, the "ice pick lobotomy" could be performed almost anywhere, at a greatly reduced cost.
Need to Know: Whichever method was used, the purpose of the lobotomy was to effectively obliterate the patient's former personality, leaving him or her open to the construction of a new one, a task to be performed by psychiatrists afterwards.
PART III: THE HUNT
Sixteen: It Was Brought into the Sea In 1950, Brenda Milner, a young British psychologist, began working at the Montreal Neurological Institute, which was then at the forefront of human brain research. At the "Neuro," surgeons and scientists collaborated to try to unravel the mysteries of the brain. This often involved operating on patients while they were conscious, but with their skulls under local anesthesia. By stimulating different parts of the brain with electrodes and seeing the patients' responses, the surgeons were able to map the brain's different areas and the functions they controlled. Based on this knowledge, the doctors would perform surgeries aimed at curing illnesses, including epilepsy. Milner's assignment was to examine the epilepsy patients of Dr. Wilder Penfield to determine the result of the "unilateral partial temporal lobectomy" he performed on them.
(Continues...)
Excerpted from Summary and Analysis of Patient H.M.: A Story of Memory, Madness, and Family Secrets by Worth Books. Copyright © 2017 Open Road Integrated Media, Inc.. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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Table of Contents
Contents
Context,Overview,
Summary,
Timeline,
Cast of Characters,
Direct Quotes and Analysis,
Trivia,
What's That Word?,
Critical Response,
About Luke Dittrich,
For Your Information,
Bibliography,
Copyright,