Author: Donald G McKay
This book is about Patient HM, probably the most important patient in the history of neuroscience because of what his brain revealed about how memory works. Known since his death by his real name, Henry Molaison, he developed profound amnesia following brain surgery to treat uncontrolled epilepsy, and the author was one of numerous psychologists who examined him all through his life to understand the anatomical underpinnings of memory formation. The author’s assessments of Henry, more than 25 in total, explored a wide range of memory functions such as ‘language comprehension, visual cognition, sentence production, word knowledge, reading aloud, creativity, and sense of humor‘ (page 22). The importance of this book lies in how the author’s major finding, that Henry was not a pure amnestic, diverged significantly from the conclusions of many other psychologists who studied Henry, including those who had the most access to him (page 332). It is in this context that the author set out to correct what he sees as the inaccuracies in the conventional understanding of memory. As he dedicated the book to Henry’s contributions to science, ‘a legacy that will reverberate long after his death‘, he also extracted useful lessons from Henry’s life which he promoted as a guide for people to ‘maintain their memory, mind, and brain‘ (pages 11-14 and 82-84).
Whilst the author was clear that his book is ‘neither a biography nor an autobiography‘, it nevertheless presented the major landmarks in Henry’s life, from the epileptic seizures he experienced from the age of 10, to the extensive brain surgery which would ‘shatter‘ his memory (pages 24, 73 and 13). The author painted a clear picture of the severe amnesia that complicated the operation which was performed by the neurosurgeon William Beecher Scoville. Henry, for example, was unable to ‘retrace his steps back from the hospital bathroom to his bed’, or remember ‘what he had for breakfast that day’, or recognise someone he had just met (pages 75, 323-325 and 91). Whilst his ability to learn and retain names was largely preserved, his personality was markedly altered as he become ‘passive, docile, and tractable‘, and emotionally cold to his mother (pages 323-325 and 75). The author was however unstinting in his appreciation of this remarkable man, describing his impact on neuroscience as ‘a major earthquake that forever reshaped the intellectual landscape of memory, mind, and brain‘. The book highlighted the capacity of one person to teach us so much about the brain, revelations such as the importance of the hippocampus in memory formation, and the existence of ‘not just two, but hundreds of different kinds of memory’ (pages 24, 91 and 255).
The most consequential message of the book is undoubtedly the author’s strong contention that Henry was not a pure amnesic. This assertion, which went against the established consensus about Henry’s memory deficits, was supported not just by his own assessments of Henry, but also by his interpretation of the studies carried out by other psychologists. His rather convincing argument was that Henry’s cognitive deficits went far beyond his inability to remember facts and events. His research, for example, revealed that Henry’s language abilities were grossly abnormal because he performed poorly on tests of word comprehension, and he demonstrated ‘major deficits’ in sentence production. The author also noted that Henry ‘peppered’ his speech with ‘hundreds of filler words and cliches‘, and ‘spoke a mixed language that seamlessly and unpredictably switched between standard-English and Henry-English, an idiosyncratic language that cannot be translated’ (pages 160-164, 91-95, 212 and 69). He cited several other language deficits such as his vague, incoherent, and incomprehensible utterances; his inability to appreciate ‘metaphors; and his ‘inability to form appropriate new ideas‘ (pages 70-72). Because of these, and several other cognitive impairments, the author described Henry as an impure aphasic, impure anosognosic, impure anomic, impure dyslexic, impure visual agnosic, and impure amnesic (page 218).
A major theme of the book is how the author’s contrary opinion of Henry’s cognitive impairment set him up on a collision course with other psychologists who have characterised Henry as a pure amnesic (page 93). He acknowledged that the other psychologists found his conclusions ‘troubling‘, and their concern was understandable judging from his opinion that their views about Henry were driven, not by the facts, but by intuition, misconceptions, and methodological flaws (page 93 and 234-235). He was particularly critical of the conclusions of Suzanne Corkin and Brenda Milner, the psychologists who were the first to study Henry, and his denunciations were occasionally quite scathing. Such was the case, for example, when he characterised Corkin’s impression of Henry’s amnesia as presumptions that were ‘outside the bounds of science‘, and in ‘the realm of creative fiction‘ (page 212-215). For practical reasons, he was concerned that not recognising that Henry had other deficits beyond amnesia meant that he was not provided with ‘available remedial treatments that might have helped him’ (page 334). Perhaps expectedly, his uncompromising stance on Henry created a professional rift between him and Corkin, a conflict that culminated in Corkin withdrawing his access to Henry. She also denied him access to her raw research data, a measure which he said violated standard publication guidelines (page 39).
Beyond its academic importance, the book was also of practical value in the detailed recommendations the author made to help prevent age-related memory loss. His prescriptions were mostly derived from the insights he gained from Henry’s cognitive impairment, and many of these made intuitive sense, for example his encouragement to read books, to write, to participate in social activities, to maintain a balanced diet, to exercise, and to engage in humour (pages 64 and 20). He also encouraged readers to join book clubs, play word games like scrabble and crosswords, and discuss shared experiences such as visits to art exhibits and movies (pages 47-48). The book also advocated strategies to help in remembering peoples’ names, and these included the practice of elaborative repetition and the forming of face-name links (page 311-321). The author also found, in Henry’s selfless dedication to science, a recipe for attaining a ‘meaningful purpose‘ in life, and a panacea for the negative feelings of ‘inferiority, failure, worthlessness, panic, despair, and hostility‘ (pages 298-299, and 83-84).
Among the many other memory-related cognitive topics the book covered, one of the most relevant is the tip-of-the-tongue phenomenon, and the ‘corrective intrusions‘ that frustrate attempts to overcome it. These are what he called the unwelcome ugly sisters; words that have similar sounds, spellings or meanings to the required one (pages 55-57 and 273-274). Other similarly interesting topics the book explored include memory binding, metaphors, illusory word phenomena, repetition blindness, the mirror neuron theory, and the role of the hippocampus in consciousness (pages 149-151, 202-204, 227-228, 277-278, 99 and 223-228). The book also referred to several experts in the field of memory such as Hermann Ebbinghaus on the decay of recent memories; Giacomo Rizzolatti on mirror neurons; Rudolph Meringer and Carl Meyer on speech errors; and Daniel Schacter on memory failure (pages 53, 97-98, 108-109, and 111-112). The text is also complemented with interesting anecdotes, such as that of Clive Wearing, the British musician and composer who contracted herpes encephalitis; the ensuing damage to his hippocampus meant that ‘he experienced everything as continually and disturbingly new’ because the damage ‘forever flipped his hippocampal novelty-switch to on’ (pages 264-265).
This book is a fine mix of science and self-help, written for the general reader but also addressing topics fundamental to the science of memory. It brings the reader up-to-date with the current understanding of how the brain encodes memory and how it learns. The author bases his conclusions and recommendations on what one patient has taught neuroscience. The author’s view, contrary to the previous understanding that Henry Molaison was a pure amnesic, would have been controversial but for the convincing argument he makes to support them. His writing style, conversational and focused on self-help, ran the risk of diluting the significant academic impact of his conclusions. An obvious omission in the book was the lack of reference to the fact that Henry had surgery to both sides of his brain. This however did not appear to diminish the contents or conclusions of the book.
This is clearly an important and seminal book with significant impact on our understanding of memory and learning. It puts in context the extensive experiments carried out on the singular Henry Molaison, thereby enabling the right conclusions to be made about the structure and function of memory. The author is balanced and dispassionate, and his arguments successfully demonstrated what Henry’s cognitive deficits actually implied. This is an important contribution to the wider understanding of how we learn and remember, concepts essential for healthcare, and I recommend the book to all doctors.
Publisher, Place, Year: Prometheus Books, New York, 2019
Number of chapters: 26
Number of pages: 400
Star rating: 5