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.”
By Maria Popova
“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.
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.
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.
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.
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.)
[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.
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.