The Myths About Patient K. C. and Patient H. M.

A recent National Geographic article has an interview with Harvard scientist Daniel Schacter, who is identified as a "cognitive psychologist," an unfortunate term making an unnecessary use of the word "cognitive," rather like calling someone a specialist in numerical mathematics.  The article is on the topic of memory, and  nothing Schacter says explains any neural basis for memory.  But Schacter does reiterate one of the unfounded myths of neuroscientists and psychologists, the claim that a patient K. C. (Kurt Cochrane) could not recall any of his episodic memories from before a brain injury.  "It's fair to say that he could not remember a single specific episode from any time in his life," Schacter falsely states. The facts do not support such a claim. 

Patient K.C. had three brain injuries. At age 16 a bale of hay fell on his head. He had another brain injury in young adulthood, one not causing a loss of consciousness. These injuries seemed to have caused no cognitive problems. But he then had a motorcycle accident at age 30, which seemed to be followed by memory difficulties. According to the paper here, "His brain lesions include almost complete obliteration to the right and left hippocampi and extensive atrophy of his left and right parahippocampal gyri (more pronounced on the left)."

Even after all this brain damage, his recognition memory seemed preserved, because a paper on patient K.C. says, "Upon his transfer to the rehabilitation hospital, K.C. was noted to be reading and conversing quite well and began to recognize friends."

There seems to have been no big loss of conceptual memories or learned knowledge in patient K.C. A paper on patient K. C. ("The case of K.C.: contributions of a memory-impaired person to memory theory") says this:

"Retention of the many skills and semantic facts learned in pre-accident years enables K.C. to locate without difficulty cereal and eating utensils in the kitchen, to know that the eight-ball is the last to sink in a game of pool, and to explain the difference between a strike and spare in bowling, and between the front crawl and breast stroke. He can describe the layout of his house and summer cottage, and the shortest route between them, without any recollection of a single event that occurred at either of these places. He expects a new ‘trick’ after four cards are placed in the centre of the Bridge table and anticipates Bob Barker on the 'Price is Right' asking contestants to 'spin the wheel,'  though he cannot foresee what he himself will do when the card game or television show is over. Like many individuals suffering from amnesia, he is also able to learn new information or skills normally, such as sorting books according to the Dewey decimal system in his library job, even though he is unable to recall explicitly the circumstances of this anterograde learning, indicating preserved implicit memory."

Note the observation defying neuroscience dogma. Countless times neuroscientists have made the groundless claim that the hippocampus is vital for forming new memories. But this patient K.C. with "almost complete obliteration to the right and left hippocampi" was able to "learn new information or skills normally." 

The same paper claims that other than weaker performance in episodic memory, patient K. C. had pretty normal cognitive skills, and a normal intelligence. We read this:

"As illustrated in Table 2, results from cognitive testing show that K.C.’s intellectual and cognitive function outside the domain of episodic memory are largely, although not completely, preserved. His verbal IQ on the revised version of the Wechsler Adult Intelligence Scale (WAIS-R; Wechsler, 1981), as administered in 1996, was in the normal range, and his performance IQ was in the lower normal range, which is slightly below expected based on a verbal estimate of premorbid intelligence derived from the National Adult Reading Test (Ryan & Paolo, 1992). Nonetheless, on the Wechsler Abbreviated Scale of Intelligence (Wechsler, 1999) administered in 2003, which produces IQ scores that are highly correlated with those from the full WAIS-R battery, he obtained Full-Scale, Performance, and Verbal IQ scores of 99."

What does the paper tell us about K.C.'s episodic memory? The paper gives us some claims on this topic that contradict other things the paper says. On one hand the paper says, "What makes him different, even from many amnesic cases, is his inability to recollect any specific event in which he himself participated or any happening that he himself witnessed." But in other places the paper gives us data contradicting such claims.  

The paper gives us this data for tests of patient K.C.'s retrograde memory (memory of the past):

Retrograde memory 

AMI autobiographical (/9) 

Childhood 2 

Early adult life 3 

Recent life 1 

AMI personal semantics (/21) 

Childhood 16 

Early adult life 13.5 

Recent life 8

The references to AMI are references to the Autobiographical Memory Interview. According to the web site of the American Psychological Association, this AMI is "a semistructured interview designed to assess memory for autobiographical information, impairment of which is often indicative of retrograde amnesia (inability to recall previously learned information or past events) and potentially associated with a variety of neurological and psychiatric disorders."

The paper here tells us more about this AMI test:

"Personal semantic questions. Subjects were asked questions relating to their personal past, including names and locations of schools attended, home addresses, and names of friends. Each time period had a maximum score of 21 points. 

Autobiographical incidents questions. Subjects were asked to relate incidents that occurred during each of the three time periods and to give temporal and spatial contextual information for each incident described. Three such incidents were probed for each time period, and specifications such as “first day at work” were used as probes. Responses were recorded on the scoring sheets as close to verbatim as possible. Each incident was scored out of a possible score of 3, based on the descriptive richness and specificity in time and place of the response. The maximum score per time period was 9."

We should be suspicious about the reliability of scores given using this test, because the underlined line indicates a subjective type of rating, in which someone rating and familiar with a person's brain damage might be more more likely to assign lower scores, even when someone performs as well as control subjects. 

A look at some of the questions asked on the test indicate that they can be pretty hard, such as asking the birthday of relatives or the address of previous schools. 

Now, patient K.C. had no major memory problem until his injury at age 30. So the results listed above very much defy and contradict the paper's claim that patient K.C. had "an inability to recollect any specific event in which he himself participated or any happening that he himself witnessed." And the results listed above very much contradict Schacter's claim that patient K.C. "could not remember a single specific episode from any time in his life." The test scores above indicate very substantial episodic memory of K. C. regarding the recall of events from both the childhood and early adult stages of his life. 

In the paper we have this claim, in which the second claim contradicts the first: 

"During testing, K.C. could not produce a single episode from his past that was distinct in time and place. Performance on the personal semantics subsections was comparable to that reported by Kopelman et al. for other amnesic patients, with the childhood period classified as ‘acceptable’ according to AMI norms."

There are several questions we should ask about the first sentence in this statement:

(1) Was this first sentence a reference to merely a single testing session in which K.C. failed to recall something in his past when asked to do so only once -- or maybe a few such failures in a few such tests? If so, that is not any good evidence of an inability to recall an episodic memory from childhood or early adulthood. You might ask someone during one testing session, "Please recall an incident from your childhood or early adulthood." The person might lazily say, "Nothing comes to mind." But if the test is repeated a few days later, the patient might be able to recall several or many such incidents. 

(2) Did the patient actually recall events that happened in childhood and early adulthood, but were such recollections arbitrarily ignored because they were not regarded as sufficiently "distinct in time and place"?

We do not know the answers to these questions, so we do not know whether the claim that "K.C. could not produce a single episode from his past that was distinct in time and place" is an extremely misleading claim, based on a single testing session, or based on an unreasonable exclusion of recollections because of some arbitrary decision that the memories were not "distinct" enough. Notably, the statement "the childhood period classified as ‘acceptable’ according to AMI norms" dramatically contradicts claims that patient K.C. had no episodic memories from his childhood. 

We then read this, about an episodic memory test given patient K.C. in 1996:

"K.C. showed a similar pattern of deficit on the Galton–Crovitz task for autobiographical information, which was administered in the version developed by Moscovitch and Melo (1997). His performance improved only minimally when he was provided with additional prompts aimed at facilitating recall." 

Very suspiciously, we are not given any details of the exact score on this test. We merely hear of "a pattern of deficit," a phrase which does not at all explicitly mention a very low score. And we are told that the performance improved later. 

This is all extremely suspicious. We must suspect these authors of withholding very relevant information that contradicted their claim that patient K.C. had an "inability to recollect any specific event in which he himself participated or any happening that he himself witnessed." Why are no specific test scores given for this Galton–Crovitz test taken by Patient K.C? Probably because the numbers contradicted the claim that patient K.C.  had an "inability to recollect any specific event in which he himself participated or any happening that he himself witnessed."

Later in the paper the authors make statements that dramatically contradict their earlier claim about patient K.C.   We read this:

"To do so, we used a formal autobiographical interview requiring generation of personal events from different life periods under varying levels of retrieval support (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002). Similar to results from earlier testing of free recall (Tulving et al., 1988; Westmacott et al., 2001), K.C. was unable to produce a single personal story from any time in his life, however remote the episode. Importantly, with supplementary retrieval support in the form of specific cueing, K.C.’s performance continued to remain well below control levels (see Fig. 9), which contrasts with that of patients with frontal lesions who benefit significantly from cueing (e.g., Svoboda et al., 2002). Even those events that K.C. was able to generate with fairly rigorous verbal prompting were without the richness in episodic detail typical of the personal incidents recalled by control participants."

So, aided by a bit of cueing, which might be something like "did you ever miss a day from school from sickness" or "did you ever learn how to swim," patient K.C. was apparently able to remember pretty well events from his childhood and early adulthood.  We have this diagram (Figure 9), which clearly shows that patient K.C. could remember very many details of things that happened to him in his childhood and early adulthood. I have compacted a horizontally larger diagram to make it easier to read. 

The diagram disproves the paper's earlier claim that patient K.C. had an "inability to recollect any specific event in which he himself participated or any happening that he himself witnessed." The diagram shows K.C. recalling many details from before his accident at age 30. Later the very careless paper authors claim that "K.C. has no episodic memory whatsoever for autobiographical details, whether experienced long ago or in more recent times."  Their own graph shows the untruth of this statement, for their Figure 9 is charting that patient K.C. could recall such details. 

A 2006 paper ("Hippocampal Contributions to Recollection in Retrograde and Anterograde Amnesia") gives a diagram on episodic memory tests on patient K.C.  We have the diagram below. The "Ch." stands for childhood; the Ado. stands for adolescence; and the AE stands for "adulthood, early."  These are different periods of his life K.C. was being asked about. We clearly see that patient K.C. could recall details about events that had happened to him before his brain injury at age 30. He simply recalled fewer details than average people (designated below as controls). 

How can we explain these severe discrepancies in the paper on patient K. C. ("The case of K.C.: contributions of a memory-impaired person to memory theory"), the fact that it says things in one place that contradicts the data it gives elsewhere (and data gathered by others on this patient K.C) ? Being charitable, and trying to avoid the idea that the authors were simply lying, we can explain the discrepancy by simply supposing that the authors were guilty in places of very careless language prone to give someone the wrong idea.  Having a mere observation that in one or two tests patient K.C. did not provide an episodic memory when asked to do so, the authors seem to have carelessly stated this as the claim that the patient could not provide such a memory. 

It is all too easy to imagine how something like that could have happened. There could have occurred something like this:

Doctor: Now, could you recall some event from your childhood. 

Lazy or Unmotivated Patient: Uh, let me see...hmm, my mind's a blank.

Doctor: Oh, very interesting! I will write down "Patient could not recall any episodic memories."

But a "did not" never proves a "could not." There are 101 reasons why someone may fail to do something that he is capable of doing, when asked to do it. I once got a perfect score on the CLEP test of American History. But if you ask me to describe the 1880's in the US, I might well say something like, "My mind's a blank." However, given sufficient motivation, such as a $1000 reward, I could probably recall quite a few details about such a decade. 

Below is a a very important rule involving research on memory and amnesia:

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ONE OR TWO CASES OF "DID NOT" NEVER PROVES "COULD NOT"

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What happened, I think, is that the authors of the paper on patient K. C. ("The case of K.C.: contributions of a memory-impaired person to memory theory") were simply guilty of very careless language. All that they had in regard to patient K.C. was a "did not" when he was asked to recall some particular episodic memory. There was never any justification for concluding that he could not recall any memory from before his final accident. Other data mentioned above suggests that he could do such a thing. And there was never any motivation factor that would have justified a "could not" conclusion about an inability to recall any episodic memory. No one ever gave the patient a strong motivation to engage in some memory retrieval exercise that he might have found burdensome. 

What we must always remember is that those promoting "brains make minds" dogma and "brains store memories" dogma tend to be "give me an inch, and I'll take a mile" kind of people when it comes to arguing for their cherished beliefs. Most claims that they make about amnesia should be treated with suspicion. A neuroscientist may use the term "amnesia" for any type of shortfall on memory performance tests, which might sometimes occur for reasons other than memory deficits, as illustrated in the visual below, in which apathy is misidentified as amnesia. 

At the links below you can watch interviews with patient K.C. (Kurt Cochran), which occurred in 1988, when he was 38 years old.  You may not even notice any difficulty in his mental abilities. 

At the first link here, K. C.  is asked about how long he has lived in his house, and he answers since 1960, apparently a correct recall involving personal memory. He is answered some general knowledge questions, and answers most of them correctly. When asked about whether he owned a motorcycle or a car, he says he owned both of them, apparently a correct recall of his experience before his injury in a motorcycle accident. Asked about the make and color of his car, he answers a brown Honda. He correctly describes how to change a flat tire. In the second video here, he shows good short-term memory, repeating series of digits he is asked to repeat. In the third video here, he shows a moderately good ability to define words that are recited to him, and does moderately well on an ability to recall words that were recited to him. The fourth video has him answering two math problems well. 

In the fifth video, K. C. is shown a report he made at a job he had, which he seems to correctly identify. He is asked to describe a place he worked at, and he says it was a big two-story building. He recalls using the back entrance of the building. Asked to recall any of his co-workers who worked with him at the building, he says, "Not offhand." But then a few seconds later, around the 3:40 mark, he does name someone who worked with him in the building, an old person named John, who he says was "almost my boss." Then at the 3:52 mark K. C. is asked to identify a person who shared his office, about his age, who did the same thing he did. Around the 4:00 mark, K. C. identifies the person as Chris, also giving his last name. "Yes, very good," says the interviewer, who apparently knew that this was the correct answer. 

Here is that fifth video:

Assuming a lack of any deliberate lie by him, it is obvious that Harvard scientist Daniel Schacter did not watch these videos or did not watch them carefully. The videos clearly show Schacter's was very badly misinforming us about K. C. when he stated, "It's fair to say that he could not remember a single specific episode from any time in his life."

After watching these videos, showing fair performance on every main  type of memory, we should be suspicious that the low scores in the tests listed above were probably due to biased judgments of score raters, who knew beforehand of K.C.'s brain injuries, and who were biased judges motivated to give him low scores, to help sell a loss-of-memory-by-brain-damage narrative. If there had been judges "blind" as to his brain condition, such scores might have been much higher.  Tests of short-term memory offer little opportunity for distortion by biased judges. There is no subjectivity in rating whether a person did or did not recall a word or number you asked him to recall. Conversely, scientist appraisals of the strength of episodic memory are very subjective things, involving subjective ratings of things such as "level of detail" and "vividness."  With such a thing there is ample opportunity for rating bias in which the reported effects are largely scientists seeing whatever they were hoping to see. 

Another false claim frequently made by neuroscientists and psychologists (and writers about neuroscience) is the false claim that patient H.M. (Henry Gustav Molaison)  "could not form new memories" after having some experimental surgery in 1953.  That is not correct.

A 14-year follow-up study of patient H.M. (whose memory problems started in 1953) actually tells us that H.M. was able to form some new memories. The study says this on page 217:

"In February 1968, when shown the head on a Kennedy half-dollar, he said, correctly, that the person portrayed on the coin was President Kennedy. When asked him whether President Kennedy was dead or alive, and he answered, without hesitation, that Kennedy had been assassinated...In a similar way, he recalled various other public events, such as the death of Pope John (soon after the event), and recognized the name of one of the astronauts, but his performance in these respects was quite variable."

Another paper ("Evidence for Semantic Learning in Profound Amnesia: An Investigation With Patient H.M.") tells us this about patient H.M., clearly providing evidence that patient HM could form many new memories:

"We used cued recall and forced-choice recognition tasks to investigate whether the patient H.M. had acquired knowledge of people who became famous after the onset of his amnesia. Results revealed that, with first names provided as cues, he was able to recall the corresponding famous last name for 12 of 35 postoperatively famous personalities. This number nearly doubled when semantic cues were added, suggesting that his knowledge of the names was not limited to perceptual information, but was incorporated in a semantic network capable of supporting explicit recall. In forced-choice recognition, H.M. discriminated 87% of postmorbid famous names from foils. Critically, he was able to provide uniquely identifying semantic facts for one-third of these recognized names, describing John Glenn, for example, as 'the first rocketeer' and Lee Harvey Oswald as a man who 'assassinated the president.' Although H.M.’s semantic learning was clearly impaired, the results provide robust, unambiguous evidence that some new semantic learning can be supported by structures beyond the hippocampus proper."

Neuroscientists have no understanding of how a brain could store or preserve or retrieve memories, and they lack any credible theory on such things. Microscopic examination of brain tissue has occurred endless times from endless subjects, with the tissue often coming from just-died people or people living. Although involving the most powerful telescopes such as electron microscopes, such examination has never provided the slightest trace of learned information stored in brains, and has never provided the slightest indication that there exists any system for translating episodic memories or learned knowledge into brain states or synapse states. 

So what do you if you are someone trying to convince people that brains store memories? Again and again, such writers will follow the same deceptive pattern. Typically a writer will claim that we know brains store memories because you need a hippocampus for memory. This is despite very much data showing that claim is not true, and that people with a very badly damaged hippocampus often perform very well on memory tests.  The writer will typically offer as his proof the untrue assertion that patient H.M. had a damaged hippocampus, and could not form new memories. The quotes above show that assertion is false; patient H.M. could form new memories and could learn new things. 

Of course, such writers will never mention the fact that patient K.C. had hippocampus damage just as bad or worse than that of patient H.M, and that patient K. C. had no big impairment in his ability to learn new things.  Referring to patient K.C. we read in the paper here, "His brain lesions include almost complete obliteration to the right and left hippocampi and extensive atrophy of his left and right parahippocampal gyri (more pronounced on the left)." The same K.C. according to the paper here  was able to "learn new information or skills normally." 

Never forget that the literature of neuroscience and psychology is abundantly infested with false statements, and that there are extremely many types of false statements about brains, minds, memory and particular patients, false statements that are endlessly repeated. 

Postscript:  The recent article here documents another myth of neuroscience literature involving a particular person: the case of Phineas Gage. In the 19th century Gage suffered an accident in which a thick railroad spike was driven through his skull. He seems to have suffered no permanent damage from this huge brain injury.  But for many years people have passed false tales claiming Gage's judgment was badly damaged. The article states this:

"The available facts about Gage fly in the face of claims made about his transformation and reduced capacities. Macmillan gave a carefully sourced description of the demanding nature of Gage’s job in Chile: the dependability required of him in rising in the small hours, loading passengers’ luggage and possibly handling fares; the high level of dexterity and sustained attention necessary for driving six horses; the foresight and self-control involved in navigating the unwieldy coach along the crowded and sometimes treacherous Valparaíso-Santiago road. He also pointed out that Gage, at first a stranger to Chile, would have had to learn something of its language and customs and ‘deal with political upheavals that frequently spilled into everyday life’. "

 The article makes clear that no statements on Gage should be trusted unless they come from the nineteenth century, and that the statements about Gage's behavior made in that time are so scant that there is no good warrant for the claim that Gage's judgment or intellect was damaged. One of the 19th century sources says that friends of Gage said he "was no longer Gage," but second-hand testimony like that (one person saying that other unnamed persons said something) should not be highly trusted. The article documents cases of claims about Gage having no basis in sources from his time, cases of embellishments (fictional claims) that were then repeated over and over again by different writers. 

The article says this:

"When discussing social disinhibition, most researchers cite cases in addition to Gage, but very few miss out Gage. His was the story that started off the whole idea and has remained by far the most frequently referenced, both in the clinical literature and in wider English language publishing. Given just how weak the evidence of his disinhibition really is, this level of reliance on his case seems astonishing."

Gage's injury (link)