نگاهی به کتاب «بیمار اچ. ام.» نوشته «لوک دیتریچ»؛ اخلاق پزشکی یا دستاورد علمی

On Aug. 25, 1953, a Connecticut neurosurgeon named William Beecher Scoville drilled two silver-dollar-size holes into the skull of Henry Molaison, a 27-year-old man with epilepsy so severe he had been prohibited from walking across stage to receive his high school diploma. Scoville then used a suction catheter to slurp up Molaison’s medial temporal lobes, the portion of the brain that contains both the hippocampus and the amygdala. The surgeon had no idea if the procedure would work, but Molaison was desperate for help: His seizures had become so frequent that it wasn’t clear if he would be able to hold down a job.

As it happened, Scoville’s operation did lessen Molaison’s seizures. Unfortunately, it also left him with anterograde amnesia: From that day forth, Molaison was unable to form new memories. Over the course of the next half-century, Patient H.M., as Molaison was referred to in the scientific literature, was the subject of hundreds of studies that collectively revolutionized our understanding of how memory, and the human brain, works. Before H.M., scientists thought that memories originated and resided in the brain as a whole rather than in any one discrete area. H.M. proved that to be false. Before H.M., all memories were thought of in more or less the same way. H.M.’s ability to perform dexterous tasks with increasing proficiency, despite having no recollection of having performed the tasks before, showed that learning new facts and learning to do new things happened in different places in the brain. It’s no exaggeration to say that Molaison is one of the most important patients in the history of neurology; it’s likely he was also the most studied experimental subject of all time.

The broad strokes of this story are well known. In 2008, when Molaison died and his name was finally revealed to the public, it was front-page news. Several well-received books have already been written about Molaison, including one published in 2013 by Suzanne Corkin, the M.I.T. neuroscientist who controlled all access to and oversaw all research on Molaison for the last 31 years of his life.

What else, you might wonder, is there to say? According to the National Magazine Award-winning journalist Luke Dittrich, plenty. Dittrich arrived at Molaison’s story with a distinctly personal perspective — he is Scoville’s grandson, and his mother was Corkin’s best friend growing up — and his work reveals a sordid saga that differs markedly from the relatively anodyne one that has become accepted wisdom. “Patient H.M.,” the overstuffed result of Dittrich’s six years of reporting, tries to be many things at once: a lyrical meditation on the nature of memory, an excavation of a disturbing and dark family history, and a damning illustration of the consequences of sacrificing ethics in the name of scientific inquiry. The end result is both spellbinding and frustrating, a paradox of a book that is simultaneously conscientious and careless, engrossing and digressive, troubling and troublesome.

This push-pull is present from the opening section, where Dittrich most obviously (and distractingly) tries to mimic in his narrative the “endless little leaps of time travel during our daily lives” caused by memory. One chapter, which starts and ends atop the George Washington Bridge in 1930 and makes a pit stop at the pyramids in Egypt, includes digressions on the start of Dittrich’s career, his love of Lawrence Durrell’s “Alexandria Quartet” and the record for highest high dive.

Fortunately, Dittrich hits his stride a few chapters later. The story picks up in 1944, several years before Scoville first meets Molaison, when Scoville; his wife, Emily; and their three young children are living in Washington State. What appears at first to be a cozy picture of suburban life takes a sudden, tragic turn when Emily imagines that her 4-year-old son is sending her coded messages to kill herself.

This is just the first in a string of vertiginous revelations that Dittrich successfully threads throughout “Patient H.M.” Within a few months of Emily’s breakdown, the entire Scoville family had moved to Connecticut, where Emily was institutionalized and subjected to a host of the inhumane treatments used on the mentally ill in mid-20th-century America: At one point, she was submerged in a tub of cold water for hours at a time; at another, she was locked in a “copper coffin and cooked” until her temperature reached 105 degrees. (Throughout the book, the visceral horror of what Dittrich describes is well served by his rat-a-tat-tat, neo-noir style.)

Scoville, meanwhile, had become a vocal proponent and prolific performer of psychosurgeries; by the time he began treating Molaison in the mid-1940s, he was a participant in a study that lobotomized mentally ill patients in the hope of easing overcrowding in Connecticut’s asylums. But it wasn’t until 1953 that Scoville drilled into Molaison’s skull. Why the delay? One obvious answer is that Scoville had initially tried, and failed, to control Molaison’s seizures with medication. Dittrich speculates that there was another, more sinister explanation. In the era of early brain mapping, when identifying the function of a specific region could secure lasting glory, Scoville had become frustrated with the limitations of operating on patients with acute psychological problems. What could removing a portion of the brain in someone who wasn’t “normal” possibly tell him about the role of that area in someone who was healthy?

Molaison, however, was psychologically intact — but the locus of his seizures was unknown. “Lacking a specific target in a specific hemisphere of Henry’s medial temporal lobes, my grandfather had decided to destroy both,” Dittrich writes in one of the book’s many chilling passages. “The risks to Henry were as inarguable as they were unimaginable. The risks to my grandfather, on the other hand, were not. At that moment, the riskiest possible option for his patient was the one with the most potential rewards for him.” This is heavy stuff: Dittrich ultimately puts his grandfather’s actions on a continuum with those of Nazi doctors who tortured Jews to test the limits of human endurance. While that comparison is a bit strained — Molaison was, after all, a willing patient who was actually sick — Dittrich does make a convincing (if implicit) case that Scoville violated the Nuremberg Code adopted in the wake of World War II to govern research on humans.

Dittrich’s righteous indictment of his own grandfather is undeniably powerful. Of the two most compelling accusations of medical and scientific misconduct in “Patient H.M.,” it’s also the one that has been aired before. But Dittrich also raises a number of issues relating to Suzanne Corkin’s actions, including whether she properly received informed consent for her tests on Molaison, that have not been addressed in public previously — and in many ways these are just as unsettling.

Corkin, who died of liver cancer in May, first encountered Molaison in the 1960s, when she was a graduate student in Montreal, but it wasn’t until 1977 that she fully took over his case. Over the following decades, Corkin and more than 100 collaborators conducted countless experiments, many of which involved activities a typical test subject would find invasive or unpleasant: In one, Molaison was fed multiple meals in a row to see if he remembered just having eaten; in another, a device heated to an intensity other subjects found unbearable was repeatedly pressed into his skin to test his pain threshold.

The entire reason Molaison was given these tests was that he was incapable of remembering more than 20 or 30 seconds in the past — and yet for 12 years, from 1980 until 1992, Molaison signed his own consent forms. At that point, Dittrich writes, Corkin arranged for the son of Molaison’s former landlady, who may have been a distant relative, to serve as his conservator despite the fact that Molaison had several first cousins living nearby.

Dittrich also appears to have uncovered evidence that Corkin’s published work painted an incomplete picture of Molaison. In her book, Corkin described Molaison as carefree and easygoing, a sort of accidental Zen master who couldn’t help living in the moment. In one of her papers, which makes reference to but does not quote from a depression questionnaire Molaison filled out in 1982, Corkin wrote that Molaison had “no evidence of anxiety, major depression or psychosis.” Dittrich located Molaison’s actual responses to that questionnaire, which had not been included in Corkin’s paper. Among the statements Molaison circled to describe his mental state were “I feel that the future is hopeless and that things cannot improve” and “I feel that I am a complete failure as a person.”

That disclosure raises the question of whether there is more unpublished information that could yield new insights into Molaison. Corkin, however, told Dittrich in a recorded interview that she was shredding her files on Molaison lest future researchers misinterpret her data. When several of these revelations appeared in a New York Times Magazine excerpt from Dittrich’s book, Corkin’s former colleagues, at M.I.T. and elsewhere, cried foul. The question of whether files were actually destroyed remains unsettled, while the issue of informed consent has not yet been addressed. (I am a professor at M.I.T.; I did not know Corkin and don’t know any of the principals involved in the response to Dittrich’s work.)