Permanent Present Tense

by Suzanne Corkin

  After the death of her husband in 1966, Mrs. Molaison continued to be Henry’s sole caregiver. In the hope that increased activity would lift his spirits, she secured a place for him at the Hartford Regional Center, a workplace for mentally disabled people. There, he performed simple, repetitive jobs such as packaging multicolored rubber balloons into small bags, or attaching key chains to simple cardboard display stands. Every morning, Henry’s neighbor Arthur Buckler—a short, rotund man in his sixties, who had an affectionate, sentimental attachment to Henry—drove him to the Regional Center. There, Buckler oversaw the grounds-maintenance crew and worked as a vocational teacher. He guided Henry through menial tasks like packaging balloons, instructing him to count the balloons and, when each bag had the right number, staple it closed. Henry did not suffer from low intelligence; in fact, his IQ was above average—120 in 1962. But even though his intelligence far exceeded the demands of this simple task, he had trouble with it because of his amnesia. He would become engrossed in inspecting the balloons one after the other and forget to stop at the right number. One day, however, Henry had an idea about a better way to do one of the jobs. A distant relative remembers Henry’s contribution as “a mechanical thing that eliminated some steps.” He shared his idea with the staff, and they adopted his suggestion. He must have been very proud of himself, if only for a moment.

  Buckler later employed Henry as a general handyman at the Center, painting buildings, tidying up the machine shop and boiler room, and helping with outside maintenance work. Buckler would sometimes send Henry to the tool shop to fetch a hammer or wrench, only to find that Henry had forgotten his mission by the time he reached the shop. Buckler resorted to drawing a picture of the tool he needed on a piece of paper for Henry to take with him, which turned out to be a successful strategy.

  In the spring of 1970, when Henry was working at the Regional Center, he experienced a breakdown. Mrs. Molaison noticed that Henry was much more nervous and irritable. When she talked to him, he would sometimes snap back brusquely instead of answering with his usual good-naturedness. One Sunday afternoon, he was behaving strangely, sitting around with his eyes closed, saying he wanted to be left alone. At one point, he jumped up and started pounding the door. Around five o’clock, he had a seizure, his body becoming rigid all over and his head lolling from side to side. After about ten minutes, the seizure ended, but instead of falling asleep after the seizure as he normally did, he started having one petit mal after another. Each time, he was briefly unresponsive and after, when his mother spoke to him, he said, “Stay out of my way,” and slammed the bedroom door. It took him an hour and a half to get undressed for bed.

  By the next morning, Henry’s behavior was back to normal. He woke up and, as part of his usual ritual, asked his mother, “Now what am I doing today?” She answered that he was going to his job at the Hartford Regional Center, so he dressed and got in the car with Mr. Buckler. Because Henry’s left hand was swollen and bruised, they stopped at Manchester Hospital to have it X-rayed. The films showed that he had broken his little finger, and it was put in a cast.

  Two weeks later on a Tuesday morning, when Henry was packaging balloons at a table at the Regional Center, he went into a totally unexpected and unprecedented rage. He jumped up, shouted that someone had taken his balloons, and yelled that he had no memory, was no good to anyone, and was just in the way. He threatened to kill himself, and said he was going to hell and would take his mother with him. When others approached him, he kicked at them, and even flung a man across the room. He then turned to a wall and began to bang his head against it forcefully. A doctor arrived and injected Henry with a sedative, and after he calmed down, he was driven home to his mother.

  Henry resumed work the next day without incident but seemed nervous. Mrs. Molaison called Teuber to report her son’s alarming shifts in behavior. She believed the outbursts were some sort of seizure, and she was not afraid of his threats. She also wondered whether he was more upset because his memory was improving—or at least, she thought sometimes that his memory was better than it used to be. Perhaps, she reasoned, Henry was becoming more conscious of his situation and growing despondent with the realization that he was different from everyone else. She may have been correct: the constant repetition of memory failures at home and at the Regional Center possibly fostered despair and a sense of worthlessness in Henry. Over time, he gained the insight and accepted that he had a bad memory and that his condition was permanent. Mrs. Molaison worried that he would be sent to a mental hospital if he continued to have public tantrums, or that he would no longer be allowed to work at the Regional Center, which she believed gave him a sense of purpose.

  Henry continued to have occasional tantrums, sometimes showing frustration at his inability to remember. Then in May 1970, he developed a new symptom, severe stomach pains, especially in the mornings, and one night, the sound of his moans woke his mother. She noticed that the pains seemed worse on weekdays when he was scheduled to go to the Regional Center, which made her wonder whether someone there was teasing him or giving him cause to be upset. She thought the pain might represent a dimly perceived anxiety he felt on the days when she told him he was going there. She also felt he was surlier in the mornings, except on his days off. These problems troubled Mrs. Molaison; she had no way of knowing the true cause of Henry’s symptoms and did not know how to cope or help him.

  The same month, Henry’s mother called Teuber and explained what was happening. After Henry continued to complain of severe stomach pains over the next week, Teuber reassured her that he would arrange for Henry to have a thorough physical examination. Mrs. Molaison was worried that he was losing weight and said that the staff at the Regional Center thought his health was deteriorating.

  My colleagues and I felt an obligation to ensure that Henry was looked after, even though we were researchers and not caregivers. Teuber consulted with Milner, and then with Scoville, who felt that he could not arrange for an examination in Hartford without creating substantial medical expenses for Henry’s mother. In the end, they decided to bring Henry to Cambridge for an extended visit and medical evaluation at the CRC at no cost to the Molaisons. All of Henry’s medical attention at MIT was free and placed no financial burden on the Molaison family.

  Accompanied by his son Christopher, Teuber drove to East Hartford to pick up Henry. They pulled up to the one-story house on Crescent Drive, a small building in cream-colored wood with white trim, surrounded by a simple yard with a lawn and several trees. Inside, they found Henry neatly dressed, with a small suitcase packed for what would be his third visit to the CRC, a planned stay of three weeks. Mrs. Molaison thanked Teuber for his assistance, and remarked that this would be her first vacation from her role as Henry’s caretaker in nearly twenty years. She was looking forward to visiting people without Henry and to going out in the evening.

  During those three weeks at the CRC, Henry underwent a thorough medical examination by MIT physicians, but his stomach pains seemed to have subsided. Henry remained calm but disoriented throughout his stay. One evening, Teuber found him sitting in his darkened room, a crossword puzzle nearby. He asked Henry whether he was feeling any physical discomfort. “Well, mentally, I’m uncomfortable,” he said, “to be so much trouble to everybody—not to remember.” He searched for the right words. “And I keep debating with myself if I said anything that I shouldn’t have, or done something that I shouldn’t have done.” Whenever Henry was struggling to retrieve a memory, he would say, “I’m having an argument with myself.” It was a constant refrain. Teuber reassured him and said he would call his mother that night. In an unusual moment, Henry turned to the subject of his father. “There I am having a debate with myself—about my dad,” Henry said. “You see, I am not easy in my mind. On the one side I think he has been called—he’s gone—but on the other I think he’s alive.” He began to tremble. “I can’t figure it out.”

  Henry was not an anxious man, but the conversation with Teuber re
vived his sadness and uncertainty surrounding the death of his father. He could not hold on to the fact that his father had died long enough to come to terms with his death. He had no memory of saying goodbye to his father, attending his funeral, visiting his grave, or being comforted by the love and sympathy of his family and friends. The trembling that Teuber observed was a physical expression of Henry’s emotional state.

  After three weeks at the CRC, it was time for Henry to return home. He did not complain about abdominal pain during the entire visit, suggesting that the problems that prompted his CRC admission were stress related, likely stemming from his activities at the Regional Center. Henry was smoking a pack of cigarettes a day, and X-rays detected lung disease not visible in his 1968 X-rays. Teuber called Mrs. Molaison to discuss Henry’s return trip and then passed the phone to Henry. He was visibly moved, his voice nearly breaking as he told his mother it was good to hear her. Teuber drove Henry back to his house in East Hartford. Mrs. Molaison came to the door when the car pulled into the driveway and remarked how well Henry looked, much better than when he left. The two of them embraced without speaking for a few moments, as Henry stroked her cheeks and shoulders.

  Clearly, Henry could feel and communicate emotions—both positive and negative—despite missing almost all of his amygdala, one of the key structures underlying emotions. In formal testing, he could judge the emotion in pictures of faces, for instance, indicating whether an expression was happy or sad. He was usually on an even keel, but on rare occasions would become very angry. These aggressive episodes were short-lived responses to his frustration at not remembering important information and to fellow patients who irritated him. Henry was not a violent man. On the contrary, he was mild mannered, friendly, and patient, and his behavior in social situations was exemplary. At the CRC, he was always docile and friendly.

  The science of emotion explains why Henry could experience and exhibit positive and negative moods. Emotions cover a wide range of experiences. In 1969, psychologist Paul Ekman proposed that people across all cultures experience six basic emotions: sadness, happiness, anger, fear, disgust, and surprise. Various combinations of these core emotions give rise to many others, such as affection, hope, empathy, ambivalence, outrage, and shame. Feelings vary with respect to two distinct variables: the extent to which they are pleasant or unpleasant, and the extent to which they are arousing or calming. Underlying your conscious experience of emotions are increases in your heart rate, blood pressure, breathing, blood glucose, and stress hormones. An accompanying increase in the flow of blood to your body and brain prepares you for actions that enable you to express your emotional state. You are ready to run away, fight, or hug, depending on the situation. Your brain regulates all the biological variables, and the brain circuit that is activated varies with the nature of the emotion being generated.4

  In 1970, on the drive up for his third visit to the CRC, Henry witnessed an unusual incident that gave us additional insight into the nature of his emotional memory. When Teuber picked up Henry in Hartford, it was raining heavily. Route 15 was awash with water and mud as Teuber, his son Christopher, and Henry began driving north toward Boston. Teuber was in the right-hand lane when a light brown Impala ahead suddenly spun out of control, ramming into a steep bank on the right side of the road. The car teetered on its left wheels and then settled back on all four wheels. The front frame was bent, and the deflating rear wheels hissed loudly over the sound of the rain.

  Teuber stopped his car a few feet behind the wreck, which protruded into the right-hand lane. He told Henry to stay in the car and left to check on the passengers—a twenty-year-old girl and her mother, both upset but unhurt. The mother, a large woman, began crying hysterically, while another car veered around the wreck and stopped. A young man jumped out of the car, and he and Teuber led the women away from traffic. Teuber returned to the car for a raincoat, but decided he was too drenched for it to matter. After looking at the car, they decided it could still be driven on the flat tires. Teuber blocked traffic while the young man drove the wrecked car off the embankment and parked it in the emergency lane at the side of the road.

  With everyone out of danger, Teuber returned to his car and drove away. For several minutes, Henry spoke worriedly with Christopher about the possible causes of the accident. Their conversation then drifted to the continuing downpour. About fifteen minutes after leaving the site of the accident, they passed a police car with lights flashing, parked in a turnout at the side of the road, behind a blue station wagon with a red trailer attached. Henry remarked that the police car must have been protecting the car with the trailer so that no one would pull into the turnout behind it. After a pause, Teuber asked Henry, “Why am I all wet?”

  “Well, you went out to offer help in an accident, when a car went off the road,” Henry answered.

  “What kind of car?”

  “A station wagon—no, a station wagon and a truck.”

  Teuber asked Henry the color of the wrecked car.

  “There I am having a debate with myself,” Henry answered. “The station wagon that went off the road—it was lying on one side—was blue. But then it comes to mind—brown.” A couple of minutes later, Henry said that a state trooper had been at the accident redirecting traffic. About twenty minutes later, Teuber asked Henry again why he was wet.

  “Because you got out—to inquire about the way.”

  The accident, an emotional event that had made a vivid impression on Henry, gradually became intermingled with new information—a police car, flashing lights, a different vehicle at the side of the road—that pushed out the old memory. Over a very short time, the memory seemed to have vanished completely. Still, the intense excitement of the incident left an unusually clear impression in Henry’s mind.

  After arriving at the CRC, when asked about the drive, Henry said that there had been a lot of traffic, and they went through a detour, but nothing else had been amiss. That night, however, Teuber again asked Henry if he remembered anything about the trip that day. Henry said no.

  “Did I get wet?” Teuber asked.

  “Yes, you got wet when you went out after the accident.”

  “What accident?”

  “When the car spun around, and went part of the way up the bank—a girl was in it. You went out into the rain to see if anyone was hurt.”

  “Was there just one person in the car?”

  “No, another one—another lady—a fat one.”

  This story illustrates several principles central to the nature of memory function. On this trip, Henry encountered two exciting episodes that caught his interest and raised his level of arousal. When we pay careful attention to an event and are excited by it, our memory for that experience will be enhanced. The circuits in Henry’s brain devoted to attention and emotion were firing away during this episode, so he was able to encode details of the people, vehicles, and action. Just at the time when Henry might still have been reliving and rehearsing these details, the three travelers encountered a police car and trailer, which caught Henry’s attention. Henry turned his focus to this second event and absorbed all that was going on there. In doing so, however, he interfered with the processing of the first event and lost some pieces of information.

  Interference is a major cause of forgetting for all of us. In this case, the new encounter involving the police car, station wagon, and trailer competed with information from the accident and interfered with the maintenance of the older information. Farther down the road, Teuber cued Henry’s memory of the accident by asking why he was all wet, and Henry’s reply blended details of the two episodes, indicating that both memory traces were fragile and incomplete.

  In healthy brains, such delicate memory traces become more robust over time through a process called consolidation. Henry was unable to consolidate new information because that activity required interactions between the hippocampus and the cortex—impossible in his brain. When consolidation occurs, emotional situations enjoy privileged p
rocessing in memory circuits, resulting in memories that are relatively hard to erase. By the time Henry reached the CRC, he had no recollection of the trip’s excitement, but that night, Teuber again cued him by asking whether he got wet. As before, this tip helped Henry to recall the action, the girl, and the lady. By then, he had had time to rest, have dinner, and re-experience whatever fragments of his trip he had been able to hold onto. The mechanism by which he did this could not have been the same as in a healthy brain, but, remarkably, he successfully engaged other circuits to establish temporary traces. At the time, we did not know about the remaining medial temporal-lobe tissue around the hippocampus, which together with preserved emotional memory areas, likely supported Henry’s brief recollection.5

  Until the early 1980s, our information about Henry’s emotional state came from people who witnessed and documented his emotional behavior. Around that time, my colleagues and I decided to take a more objective and broader look at Henry’s personality. Because his operation damaged his amygdala, it was appropriate to formally examine his emotional state. We had not done this evaluation previously because in the 1960s and 1970s, many neuroscientists, including members of my lab, shunned topics that belonged in the realm of clinical psychology and psychiatry.

  We gave Henry a range of standardized personality tests. The results revealed that his level of emotion was somewhat blunted, but he was still capable of displaying a range of emotions. We also determined that with respect to self-care, he was somewhat negligent and required supervision. For example, someone had to prompt him to shave and take a shower. Measures of his personality and motivation indicated that he was socially interactive but lacked initiative. Importantly, the tests showed no evidence of anxiety, major depression, or psychosis. Healthy people experience grief, sadness, and frustration, not unlike Henry’s emotions when his father died and when he could not remember things. On rare occasions, he did become extremely angry, but this kind of reaction is not unheard of in people faced with serious handicaps.