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Permanent Present Tense: Pioneering Scientist Suzanne Corkin on How the Famous Amnesiac H.M. Illuminates the Paradoxes of Memory and the Self

“Even if we will never completely understand the way the brain works, whatever small part of the truth we are able to learn will bring us one step closer to understanding who we are.”

Permanent Present Tense: Pioneering Scientist Suzanne Corkin on How the Famous Amnesiac H.M. Illuminates the Paradoxes of Memory and the Self

“It’s the past that tells us who we are. Without it we lose our identity,” legendary cosmologist Stephen Hawking declared in discussing his groundbreaking theory that the rules of physics might break down inside black holes, which would challenge our most fundamental assumptions about space, time, and reality itself. If the past, present, and future no longer inform one another in their standard linearity, then even our memory might be an illusion, the theory suggests.

But here on Earth, where the laws of physics apply unperturbed and govern our lives, memory is the most elemental thread of which the tapestry of experience we call reality is woven. Nothing illustrates this more powerfully than the fraying and rupturing of that thread, and no one has demonstrated this profound cosmogony of personhood more profoundly than Henry Gustav Molaison (February 26, 1926–December 2, 2008), better known as H.M. — perhaps the most famous patient in the history of medicine.

At the age of twenty-seven, in an effort to cure his debilitating epilepsy, H.M. underwent a surgery that removed portions of his brain where the seizures were thought to take place. The seizures stopped, but H.M. developed severe anterograde amnesia — an inability to form new memories. His unusual condition and his willingness to participate in research made him the perfect subject for the study of memory. Over the course of his long life, Henry generously donated his time and, after his death, even his brain to the advancement of science.

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Henry Gustav Molaison shortly before his surgery

The research conducted on H.M. since 1957, which has furnished much of what we know about how memory works, has inspired innumerable papers and books. But none is more significant nor more moving than Permanent Present Tense: The Unforgettable Life of the Amnesic Patient, H.M. (public library) by MIT neuroscientist Suzanne Corkin (May 18, 1937–May 24, 2016) — the pioneering memory researcher who worked with Henry for nearly half a century, gleaned from his case pioneering insight into how memory works, and was, in some sense, his most constant companion and unflinching friend.

The book is as much a fascinating chronicle of how our understanding of memory has evolved over the past century as it is an affectionate tribute to Henry and his patient generosity of spirit in lending his innermost self to the furtherance of scientific knowledge. Permeating Corkin’s rigorous research is a profound empathy and unsentimental sensitivity to the human being behind the patient.

Suzanne Corkin (Photograph: Patrick Gillooly)
Suzanne Corkin (Photograph: Patrick Gillooly)

She contextualizes the reality-warping world H.M. inhabited:

Amnesic patients such as Henry are stripped of their ability to turn their immediately present experiences into lasting memories.

[…]

Henry was a young man of twenty-seven when he had the operation. Now sixty-six, he relied on a walker to prevent falls. But to him, only a short time had passed. In the decades after his operation, he lived in a permanent present tense: he could no longer remember the faces of people he met, places he visited, or moments he lived through. His experiences slipped out of his consciousness seconds after they happened.

[…]

Memory is an essential component of everything we do, but we are not consciously aware of its scope and importance. We take memory for granted. As we walk, talk, and eat, we are not aware that our behavior stems from information and skills that we previously learned and remembered. We rely constantly on our memory to get us through each moment and each day. We need memory to survive — without it, we would not know how to clothe ourselves, navigate our neighborhoods, or communicate with others. Memory enables us to revisit our experiences, to learn from the past, and even to plan what to do in the future. It provides continuity from moment to moment, morning to evening, day to day, and year to year.

Corkin first met Henry in 1962, five years after his surgery and the onset of his amnesia, but the peripheries of their lives had intersected in a strange Venn diagram decades earlier. She recounts the serendipity that only amplifies the deeply humane curiosity animating her scientific relationship with Henry:

When I was seven, I became close friends with a girl who lived across the street from my family. I remember her father zooming up our street in his fire-engine-red Jaguar, and on weekends, dressed in mechanic’s overalls, tinkering with the car’s machinery underneath.

My friend’s father was a neurosurgeon. As a child, I had no idea what a neurosurgeon did. Years later, when I was a graduate student in the Department of Psychology at McGill University, this man reentered my life. While reading articles on memory in medical journals, I came across a report by a doctor who had performed a brain operation to cure a young man’s intractable epilepsy. The operation caused the patient to lose his capacity to establish new memories. The doctor who coauthored the article was my friend’s father, William Beecher Scoville. The patient was Henry.

Many years later, Corkin found herself doing her Ph.D. work at the famed Montreal neuroscience laboratory run by Brenda Milner — the first psychologist to test H.M. after his surgery and the co-author of a germinal 1957 paper about his case, which revolutionized the science of memory and became one of the most cited papers of all time. In 1962, while at Milner’s lab, Corkin got a chance to test H.M.’s memory for her thesis.

So began one of the longest and most fruitful patient-researcher relationships in the history of science.

Although Corkin’s initial investigation lasted only a week, H.M.’s extraordinary case and its unprecedented value to the science of memory continued to haunt her. So, after migrating to MIT, she decided to pursue him as a research subject, to which he generously consented. Corkin went on to study H.M. for the remaining forty-six years of his life and dedicated her own to making light of these findings, which illuminate everything from the psychology of identity to the perplexities of aging.

Illustration by Mimmo Paladino for a rare edition of James Joyce’s Ulysses

Corkin writes:

Our identity is composed of narratives we construct based on our personal history. What happens if we can no longer hold our experiences in our brain long enough to string them together? The link between memory and identity lies at the heart of our apprehensions about aging and cognitive decline. Losing our memory to dementia seems an unimaginable misfortune, yet this is what all of adult life was like for Henry. As his present moved forward, it left no trail of memory behind it, like a hiker who leaves no footprints.

[…]

Memory is not a single event, not a snapshot fixed in celluloid with the click of a shutter. We have learned — initially from Henry — that memory does not reside in one spot in the brain. Instead, memory engages many parts of the brain in parallel. We can think of remembering as a trip to the supermarket to buy all the ingredients for beef stew. We select the meat, vegetables, stock, and spices from different parts of the store and then combine them in a large stew pot at home. Similarly, calling up the memory of one’s last birthday entails pulling information stored in different parts of the brain — the sights, sounds, smells, and tastes—and organizing these stored traces in a way that allows us to relive the experience.

Illustration from The Book of Memory Gaps by Cecilia Ruiz

A crucial point to remember is that if neuroscience today is in its infancy — as Maria Konnikova has noted, it is where astronomy was in Galileo’s time — neuroscience in the 1960s barely existed at all. In fact, the word itself was coined in 1962 — the very year Corkin began working with H.M. At the time, scientists knew very little about the brain and its inner workings, and even less about memory — about what processes it entails, where in the brain they take place, and how they affect the cohesion of our selfhood.

With this in mind, it’s important to appreciate that Corkin’s pioneering contribution is not only to what memory is but also to what it isn’t in the great puzzle of our personhood. In a passage emblematic of the warm humanity undergirding her research, she writes:

One basic yet crucial lesson that Henry taught us was that it is possible to lose the ability to remember, yet remain intelligent, articulate, and perceptive.

Over and over, Corkin makes special note of Henry’s altruism. In addition to allowing her and more than a hundred other scientists to study him for the better half of his life, he continued to make significant contributions even after his death, donating his brain to research. By slicing it and studying its structure, scientists could begin to map physical dimension onto the the half-century of robust psychological and behavioral data. This link between structure and function, Corkin points out, is invaluable to science and to our understanding of how the brain works, which in turn paves the way for developing new methods for repairing what doesn’t work in order to improve and save lives. (If you would like to consider making a similarly generous gift to the advancement of science and human knowledge, MedCure can connect you with a research program to which you can donate your body.)

A slice of H.M.'s brain (Image: Jacopo Annese, University of California, San Diego)
A slice of H.M.’s brain (Image: Jacopo Annese, University of California, San Diego)

Corkin writes:

[Henry’s] story is not just a medical curiosity; it is a testament to the impact that a single subject can have. Henry’s case answered more questions about memory than the entire previous century of scientific research. Although he lived his own life in the present tense, Henry had a permanent impact on the science of memory, and on the thousands of patients who have benefited from his contributions.

[…]

Henry’s case was revolutionary because it told the world that memory formation could be contained in a specific part of the brain. Before his operation, physicians and scientists acknowledged that the brain was the seat of conscious memory, but had no conclusive proof that declarative memory was localized to a circumscribed area. Henry provided us with causal proof that a discrete brain region deep in the temporal lobes is absolutely critical for converting short-term memories into enduring ones.

Art from Neurocomic, a graphic novel about how the brain works

She zooms out into the bigger picture of why this work is so important in the first place:

The ultimate goal of neuroscience is to understand how the billions of neurons in the brain, each with roughly 10,000 synapses, interact to create the workings of the mind.

We will, of course, never fully achieve that goal. Even as I type these words, I wonder what exactly is going on in my overcrowded brain. How do my networks of neurons marshal together the pieces of complex technical information I have learned, synthesize them into thoughts and perspectives, and put the total sum into words my fingers are then directed to type? How remarkable that the brain can fashion simple sentences out of such chaos. We will never have a formula to fully explain how the noisy activity of our brains gives rise to thoughts, emotions, and behavior. But the magnitude of the goal makes pursuing it all the more exciting. This challenge attracts brilliant adventurers and risk takers to our field. And even if we will never completely understand the way the brain works, whatever small part of the truth we are able to learn will bring us one step closer to understanding who we are.

Corkin died six days after her seventy-ninth birthday, having devoted the majority of her life to gleaning insight into the machinery of memory from Henry’s case. Like her patient and friend, she donated her brain to science.

Complement her Permanent Present Tense, which remains both a masterwork of memory research and a love letter to the humanity of science, with Israel Rosenfield’s magnificent exploration of consciousness, memory, and how our sense of self arises, Sarah Manguso on how memory buoys the ongoingness of life, and this beautiful short film about memory inspired by Oliver Sacks.

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How Our Government Helps Us: A Charming 1969 Illustrated Primer

“Good citizens tell the truth.”

How Our Government Helps Us: A Charming 1969 Illustrated Primer

“America, if eligible at all to downfall and ruin, is eligible within herself, not without,” Walt Whitman asserted in his sublime and sublimely timely meditation on democracy, adding: “Always inform yourself; always do the best you can; always vote.” A century later, in her beautiful 1968 case for our individual responsibility in social change, Eleanor Roosevelt wrote: “Government is people… As individuals we can influence our government at every level… A democratic government represents the sum total of the courage and the integrity of its individuals. It cannot be better than they are.”

The end of the 1960s was an era of enormous social change, both hope-giving and vulnerable-making, when a new scientific revolution was bringing humanity closer together and the civil rights movement was finding new ways to keep us from being kept apart. Amid such massive and disorienting change, what people need most is a sense of agency, best acquired by instilling a passion for civic engagement and cultivating a sense of participatory responsibility from an early age.

That’s what writer Muriel Stanek and illustrator Jack Faulkner set out to do in the rare 1969 gem How Our Government Helps Us (public library) — a delightful primary school supplement, part of the same Social Studies Program series that produced How People Use and Earn Money, How People Live in the Suburbs, and How We Use Maps and Globes.

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In vibrant drawings and simple language, the book explains the different layers of government — city, county, state, and federal — and their respective functions. What is edifying to the child is to the grownup reader a wonderful reminder of the many things we take for granted in the seemingly magical functioning of our daily lives, from the trash collection in our cities to public transportation to the parks and playgrounds in our neighborhoods.

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Written mere months before the moon landing, the story honors the dawn of this new era of space exploration and scientific discovery.

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The book is both ahead and very much of its time. The illustrations feature a woman doctor and quite a few people of color, including a police officer and a Supreme Court judge, but almost every instance of government power — cabinet members, senators, governors, the president himself — depicts middle-aged white men. Indeed, what makes the book particularly noteworthy is that it captures the perennial problem of social change — however far we may have come in our earnest effort toward equality, there is still that much further to go, and centuries of cultural conditioning often blind us to the proper direction of the new path.

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For another clarion call for civic engagement from the same era, see urbanism patron saint Jane Jacobs on our civic duty in cultivating cities that foster a creative life.

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The Magic of the Book: Hermann Hesse on Why We Read and Always Will

“If anyone wants to try to enclose in a small space, in a single house or a single room, the history of the human spirit and to make it his own, he can only do this in the form of a collection of books.”

The Magic of the Book: Hermann Hesse on Why We Read and Always Will

I recently decided to teach myself to write with my left hand. This unorthodox pastime was sparked in part by rereading the vintage treasure Essays for the Left Hand by the pioneering Harvard psychologist Jerome Bruner, one of the loveliest and most underappreciated books written in the twentieth century. Since it was National Poetry Month, every day for the month of April I wrote out a poem a day with my left hand.

Beyond the tangible satisfaction of mastery painstakingly acquired, the endeavor had one unexpected and rather magical effect — it opened some strange and wonderful conduit through space and time, connecting me to the version of myself who was first learning to read and write as a child in Bulgaria. Generally lacking early childhood memories, I was suddenly electrified by a vividness of being, a vibrantly alive memory of the child’s pride and joy felt in those formative feats of the written word, of wresting boundless universes of meaning from pages filled with lines of squiggly characters.

Somehow, as we grow up and learn to read, the thrill of mastery hardens into habit and we let the magical slip into the mundane. We come to take this wondrous ability for granted.

No one has restored the transcendence of the written word more beautifully than Nobel-winning German-born Swiss writer and painter Hermann Hesse (July 2, 1877–August 9, 1962) in a sublime 1930 essay titled “The Magic of the Book,” found in his posthumously published treasure trove My Belief: Essays on Life and Art (public library).

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Hesse writes:

Among the many worlds that man did not receive as a gift from nature but created out of his own mind, the world of books is the greatest… Without the word, without the writing of books, there is no history, there is no concept of humanity. And if anyone wants to try to enclose in a small space, in a single house or a single room, the history of the human spirit and to make it his own, he can only do this in the form of a collection of books.

The question of what books do and what they are for is, of course, and abiding one. For Kafka, books were “the axe for the frozen sea within us”; for Carl Sagan, “proof that humans are capable of working magic”; for James Baldwin, a way to change our destiny; for Neil Gaiman, the vehicle for the deepest human truths; for Polish Nobel laureate Wislawa Szymborska, our ultimate frontier of freedom. Falling closest to Galileo, who saw reading as a way of having superhuman powers, Hesse considers the historical role of the written word:

With all peoples the word and writing are holy and magical; naming and writing were originally magical operations, magical conquests of nature through the spirit, and everywhere the gift of writing was thought to be of divine origin. With most peoples, writing and reading were secret and holy arts reserved for the priesthood alone.

[…]

Today all this is apparently completely changed. Today, so it seems, the world of writing and of the intellect is open to everyone… Today, so it seems, being able to read and write is little more than being able to breathe… Writing and the book have apparently been divested of every special dignity, every enchantment, every magic… From a liberal, democratic point of view, this is progress and is accepted as a matter of course; from other points of view, however, it is a devaluation and vulgarization of the spirit.

Hermann Hesse’s typewriter (Photograph by Patti Smith from M Train)

And yet Hesse offers an optimistic counterpoint to the techno-dystopian narratives that have continued to spell out the death of the book in the almost-century since his essay. Writing just a few years after Virginia Woolf’s spirited admonition against the evils of cinema, Hesse argues that new media forms — radio and film then, the internet now — pose no threat to the book, for the book is singular in its spiritual value to human life:

We need not fear a future elimination of the book. On the contrary, the more that certain needs for entertainment and education are satisfied through other inventions, the more the book will win back in dignity and authority. For even the most childish intoxication with progress will soon be forced to recognize that writing and books have a function that is eternal. It will become evident that formulation in words and the handing on of these formulations through writing are not only important aids but actually the only means by which humanity can have a history and a continuing consciousness of itself.

In a remarkably prescient passage, he adds:

We have not quite reached the point where younger rivals like radio, film, and so forth have taken everything away from the printed book, but only that part of its function which is dispensable.

[…]

What the crowd does not yet suspect and will perhaps not discover for a long time has already begun to be decided among creators themselves: the fundamental distinction between the media through which an artistic goal is attempted. When this divorce is final, to be sure, there will still be sloppy novels and trashy films, whose creators are unstable talents, freebooters in areas in which they lack competence. But to the clarification of concepts and the relief of literature and her present rivals this separation will contribute much. Then the cinema will be no more able to damage literature than, for example, photography has hurt painting.

What lends the book this unshakable stability, Hesse argues, is precisely its magical character — a character immutable and irreplaceable however much our media might change. He writes:

The laws of the spirit change just as little as those of nature and it is equally impossible to “discard” them. Priesthoods and astrologers’ guilds can be dissolved or deprived of their privileges. Discoveries or poetic inventions that formerly were secret possessions of the few can be made accessible to the many, who can even be forced to learn about these treasures. But all this goes on at the most superficial level and in reality nothing in the world of the spirit has changed since Luther translated the Bible and Gutenberg invented the printing press. The whole magic is still there, and the spirit is still the secret of a small hierarchically organized band of privileged persons, only now the band has become anonymous.

Illustration from Mr. Tweed's Good Deeds by Jim Stoten
Illustration from Mr. Tweed’s Good Deeds by Jim Stoten

In a tremendously poignant sentiment that illustrates today’s culture-making, culture-breaking difference between artists and writers, on the one hand, and “content-creators” on the other — that is, presaging our vacant contentification of cultural material — Hesse adds:

Leadership has slipped out from the hands of priests and scholars to some place where it can no longer be called to account and made responsible, where, however, it can no longer legitimatize itself or appeal to any authority. For that stratum of writers and intellectuals which seems from time to time to lead because it shapes public opinion or at least supplies the slogans of the day — that stratum is not identical with the creative stratum.

That creative stratum, he argues, consists of timeless works that continue to enchant the public imagination decades or centuries or millennia after their creation, be they the ancient Eastern philosophies newly embraced by the West or the works of Nietzsche, “unanimously rejected by his people, after fulfilling his mission for a few dozen minds, became several decades too late a favorite author whose books could not be printed fast enough.” Hesse uses the word “poet” in that largest James Baldwian sense and in the very act of reaching us from beyond the finitude of his own lifetime, he stands as a testament to his own point:

We can observe every day how completely marvelous and like fairy tales are the histories of books, how at one moment they have the greatest enchantment and then again the gift of becoming invisible. Poets live and die, known by few or none, and we see their work after their death, often decades after their death, suddenly rise resplendent from the grave as though time did not exist.

And what they give us upon rising is precisely that magic of the book, so perennial and inextinguishable, yet so easily forgotten and taken for granted:

If today the ability to read is everyone’s portion, still only a few notice what a powerful talisman has thus been put into their hands. The child proud of his youthful knowledge of the alphabet first achieves for himself the reading of a verse or a saying, then the reading of a first little story, a fairy tale, and while those who have not been called seem to apply their reading ability to news reports or to the business sections of their newspapers, there are a few who remain constantly bewitched by the strange miracle of letters and words (which once, to be sure, were an enchantment and magic formula to everyone). From these few come the readers. They discover as children the few poems and stories … and instead of turning their backs on these things after acquiring the ability to read they press forward into the realm of books and discover step by step how vast, how various and blessed this world is! At first they took this world for a little child’s pretty garden with a tulip bed and a little fish pond; now the garden becomes a park, it becomes a landscape, a section of the earth, the world, it becomes Paradise and the Ivory Coast, it entices with constantly new enchantments, blooms in ever-new colors. And what yesterday appeared to be a garden or a park or a jungle, today or tomorrow is recognized as a temple, a temple with a thousand halls and courtyards in which the spirit of all nations and times is present, constantly waiting for reawakening, ever ready to recognize the many-voiced multiplicity of its phenomena as a unity. And for every true reader this endless world of books looks different, everyone seeks and recognizes himself in it… A thousand ways lead through the jungle to a thousand goals, and no goal is the final one; with each step new expanses open.

Walking library, London, 1930s (VSW Soibelman Syndicate News Agency Archive)
Walking library, London, 1930s (VSW Soibelman Syndicate News Agency Archive)

Half a century before Bob Dylan asserted that “the world don’t need any more songs [because] there’s enough songs for people to listen to, if they want to listen to songs,” Hesse makes the same point — a point with which, as any regular reader would know, I very much agree — about books:

Every true reader could, even if not one new book were published, spend decades and centuries studying on, fighting on, continuing to rejoice in the treasure of those already at hand.

What lends reading its ultimate magic, Hesse asserts, is that this vast body of the written word is at once immensely varied and reducible to the simplest, most universal human truths:

The great and mysterious thing about this reading experience is this: the more discriminatingly, the more sensitively, and the more associatively we learn to read, the more clearly we see every thought and every poem in its uniqueness, its individuality, in its precise limitations and see that all beauty, all charm depend on this individuality and uniqueness — at the same time we come to realize ever more clearly how all these hundred thousand voices of nations strive toward the same goals, call upon the same gods by different names, dream the same wishes, suffer the same sorrows. Out of the thousandfold fabric of countless languages and books of several thousand years, in ecstatic instants there stares at the reader a marvelously noble and transcendent chimera: the countenance of humanity, charmed into unity from a thousand contradictory features.

My Belief remains a boundless treasure of Hesse’s genius, aglow with his luminous wisdom on everything from art to happiness to old age to the legacies of creative titans like Goethe, Dostoyevsky, Walt Whitman, Hans Christian Andersen, D.H. Lawrence, and Carl Jung. Complement it with Hesse’s beautiful correspondence with Thomas Mann, E.B. White on the future of reading, and Neil Gaiman on why we read and tell stories.

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