Seasonal Affective Disorder

It’s that time of year – the clocks have gone back, it’s cold, and already getting dark on our commute home. Whilst many people moan about this time of year, for some it can trigger symptoms of low mood and depression.

Seasonal Affective Disorder is defined as “a type of depression that comes and goes in a seasonal pattern.” (NHS Choices). It’s typically worse from December to February, getting better in spring and summer. For SAD to be diagnosed, there has to be clear evidence of worsening symptoms during winter, which can’t be explained by other circumstances (DSM-IV). In addition, there needs to be evidence for part or full remission during the summer months. Symptoms of SAD are similar to those of depression: low motivation and self-esteem, sleep problems, changes in appetite, withdrawing from social interactions and persistent negative thoughts.

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Estimates of the prevalence of SAD range from 0 – 9.4% of the population, depending on who is being studied (Magnusson, 2000). One study compared rates of SAD at 4 different latitudes in the USA and found that is was most common in the northern latitudes (Rosen et al, 1990), which would be expected as SAD can be triggered by lower levels of natural light. This study also found higher rates of SAD in females than males (this finding is in line with overall levels of depression between men and women). It is thought to be caused by the lack of sunlight in winter months disrupting our circadian rhythm, which can be described as our internal body clock. This can affect the serotonin system in the brain, which is responsible in part for mood regulation.

There are various different treatment options for SAD, including light therapy, cognitive behavioural therapy, or antidepressants (Lurie et al, 2006). I’ve spoken about CBT before on this blog (see here for more information), so today I’ll just focus on light therapy and antidepressants as treatments for SAD.

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Light therapy involves sitting by a specialised lamp, which emits a specified wavelength and brightness of light (at least 2500 lux). It is thought to work by encouraging the brain to produce serotonin – a neurotransmitter which is linked to feeling happy. Sitting by a lamp for 30 minutes to an hour each morning is the recommended ‘dose’ of light (NHS.uk). One meta-analysis has shown that light therapy is as effective as drug therapy in treating SAD (Golden et al, 2005).

Some antidepressants also work by increasing our serotonin levels. Known as SSRIs (selective serotonin reuptake inhibitors), they work by stopping as much serotonin from being reabsorbed at synapses in the brain and therefore leading to an increase in our mood. For antidepressants to be optimally effective in SAD, the NHS recommend starting to take them before winter and continue until spring.

 

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A week of Mindfulness

I’m sure by now you’ll have heard of mindfulness. It seems to have exploded in popularity in recent years, and is recommended as everything from a cure for severe depression to improved concentration.

Mindfulness can be described as being aware of the present, in particular how we feel on the inside. It generally involves bringing focus back to the body and how it feels at that time. Focus is directed towards the present moment, as opposed to worrying about past or future events. Eyes are typically closed, and attention is directed towards the breathing as opposed to any outside stimuli. Rather than try and block out our thoughts, mindfulness aims to help us acknowledge our thoughts and feelings, but lets them pass without paying them too much attention, which can lead to stress or anxiety.

 

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For someone with an interest in all things psychology and mental health, I’m almost ashamed to say I’ve never properly tried mindfulness myself, with the exception of a couple of group sessions at conferences. I definitely find it easier when I take part in a led session rather than try and do it myself, so I downloaded the Headspace app and decided to give it a go. Here’s how I got on:

 

1st session: It’s been a few months since I’d had last had a guided session at work – I did try to practice a couple of times recently but found it hard to keep my focus. I started off using the Basics package in Headspace, which starts with an introduction to mindfulness and a few tips to get started. I began with a short 3 minute session, and afterwards I felt noticeably more relaxed, I’m definitely looking forward to the next one. The 3 minutes went by really quickly, I found it quite easy to concentrate on my breathing. No massive change but only day 1!

2nd session: Another short 3 minute session. I found it harder to stop myself focusing on thoughts that popped into my head during the session today. I started it as soon as I’d finished studying and found thoughts kept popping into my head – I know this is okay and you’re meant to acknowledge them and move on but that’s quite difficult in reality! I think I’ll try it at a different time tomorrow and see if that makes it easier.

3rd session: I completely ran out of time so ended up practicing just before I went to bed. I switched to the 5 minute session today, and the focus of this session was on letting thoughts pass. This is definitely the bit that I find most difficult, but it was easier than yesterday. I found the session very relaxing, it really put me in the mood for sleep!

4th session: Again ended up practicing just before bed, and I almost feel asleep! Today I found that I was better at paying attending to my breathing (counting helped) and it meant that I couldn’t really focus on other thoughts which popped into my head. The 5 minutes went so quickly too.

5th session: Getting into more of a routine and practicing at the end of the day. Not much change on this session, but I am definitely enjoying it and look forward to practicing.

6th session: Today I really wasn’t feeling in the mood for practicing mindfulness, I’d had a really busy day and it just felt like another thing I had to do. I did feel so much better afterwards and was glad I did, a bit like going for a run! I found my mind didn’t wander too much but things I need to do tomorrow kept popping into my head, which I found hard to ignore.

7th session: The last one in my week’s trial! It feels like the time during the session seems to go quicker every day, and I always feel much calmer by the end of it. This session started with a short animation using the analogy of the calm mind as a blue sky, and thoughts as clouds which pass across it, which I quite liked. I know the app recommends practicing first thing in the morning but for me I think I’ll probably do it more in the evenings. I’ve got a bit more time, and I think it’s a nice thing for me to do at the end of the day – I’m someone who can find it hard to switch off at night so practicing before bed could help me relax.

 

By the end of the week I can’t say I’ve noticed any significant changes but I have looked forward to the sessions. I do have to admit – there were a couple of days in between where I didn’t end up practicing, usually if I was out in the evening and got back too late to want to practice. On reflection. these busy days were probably the ones where I should have made sure to take the time out for it – it’s only a few minutes and makes me feel more relaxed afterwards. By the end of the week I felt like I was better at concentrating on my breathing instead of letting my mind wander, although I still slipped up from time to time. In particular, I kept finding myself thinking about things I could say in this post, so now it’s written maybe I’ll find it easier to focus!

 

I’d definitely recommend giving mindfulness a go, especially if you haven’t already, just to see whether you notice any changes after each session. Have you tried mindfulness before? Let me know in the comments!

World Mental Health Day 2017

Today, Tuesday 10th October is World Mental Health Day – a day aimed to raise awareness of current mental health issues affecting society. The theme this year is mental health in the workplace.

I’ll start by asking you a question: Would you tell your boss you were going to take a day off work due to a mental health problem?

Sick days should be used equally for both mental and physical health, however recent data shows that isn’t the case. In the UK last year, workers took 137 million sick days, with 15.8 million of these being for a mental health problem. To put this into perspective, 34 million sick days were taken for coughs and colds1. One in five people are estimated to be suffering with mental illness at any one time, so why don’t the figures reflect this?

Of course one of the reasons the figure for mental illnesses looks comparatively low could be because they are under-reported – some people may prefer to call in and say they have the flu if they are worried about prejudices at work. People may also be reluctant to take a day off at all if they are struggling with an illness like anxiety, feeling instead like they should be able to carry on. If you had hurt your back and couldn’t move, most people would view this as a legitimate reason to take some time off. But what if you’re struggling to get out of bed due to depression?

 

world mental health day

 

There are several reasons why it makes sense for us to be more open about our mental health at work, without it affecting our rights or how we are treated. The recent positive response of a director when one of his workers took some days off for her mental health shows how actually having the conversation around this topic at work can break down some of the perceived stigma around it. Hopefully the publicity surrounding cases such as these will encourage others to take time off to deal with their mental health when they feel as though they need a break.

As well as the obvious advantages of creating a supportive working environment there are also economic benefits of improved mental health in the workplace. It has been estimated that 91 million work days are lost each year due to mental health problems, with a total cost to employers of £26 billion – or £1035 for every worker in the UK2. This isn’t just due to sick days, but staff turnover and reduced productivity too. When people are happier and healthier their performance will improve – these figures show it pays for companies to care about their employees mental health.

If you’re struggling with your mental health at work, or work as a manager and want to make your workplace a more supportive environment then Mind have some great resources – find them here. 

 

 

  1. http://www.bbc.co.uk/news/uk-40593256
  2. https://www.centreformentalhealth.org.uk/employment-the-economic-case

Thoughts on starting a PhD…

As of last week, I am no longer a full-time employed person. Instead, I’ll be continuing working two days a week as a Research Associate, whilst being a full time PhD student! This isn’t really something which I was expecting to happen this year, as it was never in my career plan to do a PhD. The clinical doctorate to become a Clinical Psychologist always seemed more attractive, possibly because it seemed to flow quite nicely into a career I knew I’d find interesting, and you got paid whilst you were doing it. However, once I realised the tiny number of training places available compared to the number of applicants (probably because of the same reasons I wanted to do it!), I knew I needed to look at other plans.

This was where my job came in. I love what I do, working as a researcher on the Milestone Project – an international research study aiming to improve care for young people approaching the boundary of children and adolescent mental health services. There was an opportunity to do a PhD on the project, but no funding. I was encouraged to apply, and apply to a scholarship on the off chance (it was really competitive but no harm in trying) in case I was successful. A month or so later I found out I’d been offered a place – which led to another anxious 6 week wait until I discovered I had been lucky enough to be offered the scholarship!

Fast forward 6 months, and I’m looking forward to beginning the next stage in my career. It does feel quite daunting, about to being a project which I know will be extremely hard work, and last for the next 3 years (at least) but I’m excited to get started.

Is anyone else about to being a PhD? Please share your thoughts and experiences in the comments!

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image credit: evocellnet.com

 

 

 

Orthorexia – a new type of eating disorder?

You might have heard some of the negativity in the press recently about so called ‘clean eating’ and it’s advocates, who promote a lifestyle which involves cutting out any processed food and often entire food groups (gluten/dairy etc). This is not because of any medical reason, but simply just to be as ‘healthy’ as possible. I’m not going to go anymore into the debate around clean eating today (there’s too much to say, and several people have done it already) but I’ve mentioned it here as it has been linked to a rise in a condition known as orthorexia.

Orthorexia nervosa (so called by Steven Bratman, 1996) is characterised by a fixation with healthy food consumption. More than just dieting, sufferers will become obsessed with healthy food, and food will become preoccupying and a source of anxiety. Other problems often caused by this disorder include social isolation due to having to have complete control over their food intake, and some nutrient deficiencies caused by an extremely limited diet.

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image from http://www.thefullhelping.com/neda-week-2014-considering-orthorexia

People with orthorexia (like some who ‘eat clean’) will often cut whole food groups or types of food out of their diet, thinking this will benefit their health. Common foods to be avoided are those which include artificial colours, flavours or preservatives, or foods perceived as containing too much sugar, or salt (Catalina et al., 2005). Orthorexics will also develop strict rules about food, which may also extend to rituals around food preparation (Chaki et al, 2013).

However, despite it’s increasing recognition, orthorexia isn’t listed as an official disorder by the DSM-V diagnostic manual for mental illness. As it is a relatively new disorder, research on orthorexia is lacking compared to other eating disorders such as anorexia or bulimia. There is some debate about whether orthorexia is a subtype of one of these existing eating disorders (Zamora et al, 2005), an eating disorder in it’s own right (Bratman & Knight, 2000), or a type of obsessive-compulsive disorder (e.g. Mathieu, 2005). Alternatively, some researchers view it as a combination of the above e.g. Brytek-Matera (2012) who describes orthorexia as “a disturbed eating habit which is connected with obsessive-compulsive symptoms.”

As researchers are still unclear how to categorise orthorexia, it is unsurprising it hasn’t yet made it in the DSM-V. However, despite it’s absence, Bratman & Knight (2000) have developed some guidelines for diagnosing orthorexia. These include:

  • preparing healthy food overtaking other activities in life, with sufferers spending over 3 hours a day thinking about or preparing food
  • following a very strict and restrictive diet plan
  • a healthy diet becoming linked to self-esteem, and feelings over superiority over others who do not follow such a strict regime
  • the nutritional value of a meal becoming more important than it’s taste or the joy from eating it

Orthorexia can be treated successfully, with a combination of cognitive behaviour therapy and medication such as SSRIs (a type of antidepressant) being shown to be effective in some cases (Mathieu, 2005). This study also suggested that orthorexics responded better to treatment than suffers of other eating disorders, perhaps due to their concerns and increased awareness about their health.

There is no question that more research needs to be done to establish more data on people living with this condition, which will enable preventative measures and effective treatments to be developed.

 

The Power of Conversation

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It’s a well known fact that a problem shared is a problem halved, right? But when you’re feeling down or worried sometimes talking about your feelings can seem too hard. For some people it could be easier to bury these feelings and try and carry on regardless, or for others admitting how they truly felt would seem a sign of weakness.

As you may know it’s Mental Health Awareness week in the UK, so this year I’ve decided to write about the power of conversation, and why you don’t have to deal with everything on your own.

Talking to others about their feelings is something men can be particularly bad at, especially when it comes to any concerns about their physical or mental health. To quote the columnist and campaigner Bryony Gordon in her recent article “Women are encouraged to talk about their problems. Men just have football.” Prince Harry was recently praised for his honesty in talking about his mental health – something which will hopefully change the stereotypical view that British men should have a ‘stiff upper lip’ and not show any sign of emotion.

This gender divide has led to inequality in mental health. In 2016, 3 times more men committed suicide than women. Suicide takes more lives of men under the age of 45 than accidents or disease.

Why is it that men are more at risk of suicide than women, when more women are diagnosed with a common mental illness? One explanation is that men aren’t as good at accessing healthcare as women – for example in the first 3 quarters of 2015, only 36% of those who accessed Improving Access to Psychological Therapy (IAPT) services were male*. Men are also less willing to let others know if they have a problem, with one survey finding that only a quarter of men said they had disclosed a mental health problem to a friend within a month, compared to a third of women. Almost 30% of men said they never tried to access help for their last mental health problem, compared to just under 20% of women **.

Accessing the correct care early is vital in the successful treatment of mental illness. For most common mental illnesses, talking therapies are used as a form of treatment (possibly in conjunction with medication). These include Cognitive Behavioural Therapy (CBT), Psychotherapy, Dialectic Behaviour Therapy, or Counselling – just to name a few. Having the opportunity to talk about thoughts and behaviours with a trained professional can give you the space to work out the cause of your worry or identify any patterns in your thinking which contribute to negative feelings. Therapies such as CBT also try to change behaviours using set goals agreed between the patient and professional which can lead to an improvement in mental wellbeing.

This evidence shows that the culture has to change. Why should it be taboo for men to speak about their feelings in the pub with their mates, as I do with my girlfriends over dinner? Anyone should feel like they have someone to talk to about their problems, even if that person is a healthcare professional – they’re there to help.

On a final note – one project I’m proud to be involved in which is aiming to reduce the stigma of mental illness is a zine called ‘do what you want’. This includes articles from a range of writers and has been featured in the Guardian, BBC and Grazia. All proceeds go to mental health charities, and the ebook (and print version whilst it’s still in stock!) can be ordered here: http://dowhatyouwantzine.co.uk

* https://www.menshealthforum.org.uk/key-data-mental-health

**https://www.mentalhealth.org.uk/news/survey-people-lived-experience-mental-health-problems-reveals-men-less-likely-seek-medical

Exercise and Mental Health

This blog post was inspired by the recent London Marathon, who’s official charity was Head’s Together (a charity set up by the Duke and Duchess of Cambridge and Prince Harry, which aims to reduce the stigma of mental illness) making it the first mental health marathon.

As well as raising millions of pounds for charities which work to improve our mental health, the physical act of training for and running the marathon can also provide a boost to our mental health.

That high you get after going for a run, dancing with your friends or a hard gym session? It’s caused by an increase in endorphins, a neurotransmitter released by the pituitary gland which have been shown to act as a painkiller, and improve your mood.

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Exercise has been found to have benefits for people suffering from different types of mental illness, from depression (Balchin et al, 2016), bipolar disorder (Ng et al, 2007) and schizophrenia (Gorczynski & Faulkner, 2010). Other studies have suggested that exercise could also help protect people from neurodegenerative conditions which can affect us as we get older, such as Alzheimer’s or Parkinson’s disease, as well as improving symptoms and quality of life for people with these conditions (Deslandes et al, 2009). This could be because exercise stimulates blood flow in the brain as well as improving overall fitness. Increased levels of exercise in older adults has been linked to have several positive outcomes, including improved mental health and social integration (Chodzko-Zajko et al, 2009).

Exercise can also help to improve mood in sedentary (but otherwise healthy) participants. One study in Turkey (Taspinar et al, 2014) compared participants who took part in either a Hatha yoga or a Resistance workout program where they trained for an average of 50 minutes, 3 times a week for 7 weeks, to participants who did no extra exercise. The researchers found that participants in the exercise groups showed improved quality of life, body image, self-esteem and lower symptoms of depression after taking part. Participants in the control group showed no change. Yoga was better for improving symptoms of tiredness and depression, and self-esteem, whilst resistance training led to higher improvements in body image perception. This study also shows that it doesn’t matter what type of exercise you do to get the benefits – although it probably helps to find one you enjoy as it means you’re more likely to continue. In case you’re still not convinced, this graphic summarises the 5 main ways exercise can improve your mood:

Exercise

However it is important to note that if you are suffering from a mental illness, exercise on its own may not be enough. For some people, it may be hard enough to get out of bed in the morning, to them going for a run would be completely unrealistic. This is why exercise can be so effective in conjunction with other therapies, be it medication or talking therapies like CBT. Once symptoms have started to improve, then incorporating exercise could be a good way to manage your mood.

So next time you’re feeling worried about an exam, stressed about a deadline or feeling lacking in motivation why not try going for a walk or a dance class? You might get hooked on a new hobby which can do much more than just improve your fitness.

Imposter Syndrome – Not feeling good enough and how to beat it

I’m sure you’ve all been there – earning a promotion, getting into uni or finding your dream job. All your hard work and sacrifices have paid off, and you should feel on top of the world. And for most of the time, you do. You feel happy and accept people’s congratulations of “I knew you could do it!” But despite all this, what about that niggling feeling of ‘why me?’, the feeling that you don’t quite fit in with your peers and that they are all so much smarter and more deserving to be there than you? Why can you not share the confidence in yourself held by your friends and family? This is known as Imposter Syndrome and tends to affect high achieving individuals, and is especially common in women (although men can of course suffer from this too).

Imposter syndrome can negatively affect your self-esteem, mood, and locus of control (this means you feel as though you have little control over things that happen to you). It has been found to be worse in people who feel as though they are outsiders, which could perhaps lead to feelings of not being as good as those around you.

 

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The term Imposter Syndrome was first coined by Clance & Imes in 1978, where it was identified to affect high achieving women. They studied women who were towards the top of the career ladder, or who were studying at either undergraduate or postgraduate level.

The women in the study who had the condition reported that they felt like a fraud, and thought they had only achieved their PhD or got onto their current role because of other factors, for example a mistake in the admissions process or because of others overestimating their abilities. Despite their excellent achievements they didn’t feel qualified to be working or studying at the level they were at and were fearful of being found out. Clance & Imes explain that the women ‘do not experience an internal feeling of success’ which leads them to overlook their achievements.

This inability to have an internal feeling of success is an important symptom to note. One of the causes of imposter syndrome has been identified as having problems with attributions of success. For someone who suffers with these symptoms, they tend to explain a positive event such as a promotion as being down to an external unstable cause, such as luck or someone else’s mistake. The ‘external’ is important here, as it reinforces the fact that successes are not attributed to their own skills and actions. This has been shown to occur more in women than men, who are more likely to attribute success to an internal cause, such as skill or hard work (Deaux, 1976). This author hypothesised that if a women refers to a success as due to an unstable external factor, it does not give her confidence that she will be successful in the future, which causes a cycle of feelings of being an imposter.

So what next? If you’re suffering from Imposter Syndrome, what can you do to overcome it?

I spent a while searching academic journals for evidence on interventions that have been successful in reducing these symptoms. Unfortunately, any combination of the words *imposter* *syndrome* *treatment* or *overcoming* found no relevant results at all.

So instead, here are some recommendations that I did manage to find – mostly from various news articles or academic blogs (see below) mixed with my own advice. Also please remember that I’m not a healthcare professional, but I hope you find them helpful.

  • Be mindful of your self expectations. Don’t expect to be the best at everything and accept you don’t know it all and that’s okay. Don’t be afraid to ask if you don’t know something, that’s much more productive than sitting there feeling inadequate because of it.
  • Make sure you acknowledge the work you’ve done and remember that you’ve worked hard to be where you are now. Once my colleague corrected me when I described myself as ‘lucky’ for getting my current role – “no you weren’t, you applied to loads and worked really hard”. It turned out to be a very helpful comment – good things don’t just happen, you have to make them.
  • Aim to be ‘good enough’ – it isn’t realistic to strive for perfection. If you’re trying to make something perfect, it is likely you will never finish it. Instead accept that ‘good enough’ can sometimes be the way to go.
  • Finally, talk to someone about how you’re feeling – they will probably say they’ve felt like that before too, and you’ll realise you’re not alone.

 

Whether or not you are a student or work in academia, I can recommend this posts on Imposter Syndrome: http://jameshaytonphd.com/phd-impostor-syndrome/

 

 

Body Image Therapy for Anorexia – what is it and how does it work?

Today’s post is for eating disorder awareness week, which this year has a focus on early detection and intervention. Often, sufferers are unable to access treatment until they have been ill for some time, which makes recovery so much harder than if treatment happened once symptoms first began. As well as having obvious benefits for patients, there is also a financial advantage of early intervention (sadly, cost has to be taken into consideration when deciding if a new treatment is worth it). With the current state of the NHS it is important from a financial point of view, as preventive rather than curative medicine is much cheaper overall. So with the benefits of early intervention being brought to our attention, today I thought I’d write about a type of treatment for anorexia – Body Image Therapy.

For those of you who aren’t already aware of the symptoms, Anorexia Nervosa is characterised by:

  • severely restricting food intake, leading to extremely low body weight
  • a fear of gaining weight
  • distorted body image perceptions, with sufferers believing they are fatter than they are.

 

Contrary to what you might think, it isn’t just girls and young women who can have anorexia, men make up about 10% of total suffers (although some studies estimate higher). It is also becoming more common, with inpatient hospital admissions increasing by about 7% a year since 2005. As well as this increase, raising awareness and improving treatment is so important as anorexia has the highest mortality rate of any mental illness.

One of the reasons anorexia can be so hard to overcome is that sufferers have a distorted body image and believe they are much bigger than they truly are. This reinforces the cycle of restricting food or overexercising, and makes anorexia hard to beat. Studies have also shown (e.g. Fairburn et al, 1985) that the symptom of body image disturbances is also a predictor for relapse once therapy has been completed.

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Diagram adapted from Fairburn et al (2008)

Therefore, it makes sense to include body image therapy when treating a patient with anorexia. It is a type of cognitive therapy, which aims to reduce the harmful thoughts about body and weight. One type of body image therapy is Mirror Therapy, in which patients view their body in front of a mirror during a therapy session. Exposure can be increased over time and leads to an immediate emotional response which can be discussed during therapy. The therapist encourages the patient to look at their body as a whole rather than focus on perceived flaws, and to describe their body accurately as opposed to using negative language. This helps patients to learn that there are other ways of viewing their body and the consequences of negative thoughts about it (Delinsky & Wilson, 2006). Over time, cognitive therapy with mirror therapy has been shown to be more effective in terms of reducing body dissatisfaction and avoidance compared to cognitive therapy alone (Key et al, 2001).

Body image training in anorexia is therefore important as it could help to overcome the cognitive processes which make it hard to break the cycle of disordered eating and improve recovery rates for people suffering from an eating disorder.

Thanks for reading, and don’t forget to help spread awareness using the hashtag #eatingdisorderawarenessweek

If you would like to read more about the possible causes of eating disorders then see a previous post here or read about body dysmorphia in anorexia here

If you or someone you know is suffering from an eating disorder then there is help available. Contact your doctor or charities such as Beat, who can provide you with the correct support.

 

 

Patient H.M.

Today’s blog post is about one of the most studied individuals in psychology and neuroscience. By studying him, scientists were able to massively expand their knowledge of how to human brain is structured, and how different abilities (or “functions”) are located in different cortical areas.
H.M. was born in 1928, and was 10 when he first started having epileptic seizures. These were extremely debilitating, and although several medications were tested, none had any affect. When H.M. was 27, a pioneering neuroscientist called William Scoville worked out where the seizures in H.M.’s brain were coming from, and decided that the best way to stop them was to operate, and cut out the parts of the brain that was responsible.
In terms of removing his seizures, this surgery was largely successful. However it came at a cost: H.M. could no longer form new long term memories, nor remember anything from X years before his operation. The image below is a scan taken of H.M.’s brain, and shows the lesions made during surgery, and how this differs from a normal brain scan.
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As you can see from this image, H.M. was left with extensive damage to the central parts of his brain – this area is known as the medial temporal lobe. By analysing the brain damage, neuroscientists were able to make inferences about where certain brain functions are located. As H.M.’s memory was impaired, but other cognitive functions such as language were not, the medial temporal lobe was identified as being important in the formation of long term memories.
Perhaps unsurprisingly, things aren’t as simple as this. H.M.’s long term memory was affected, so severely that he was unable to remember things that happened a few minutes ago. However his short term memory was intact, with a normal digit span (a string of numbers that you can keep in your mind at once) of 7 +/- 2. Therefore, the structures damaged can’t be involved in short term memory.
There are also distinctions that can be made within long term memory. This can be divided into 3 different types of memory: semantic, which is general knowledge about the world; episodic, which are memories about ourselves and our lives; and procedural, which are learned physical movements e.g. riding a bike. Only H.M.’s episodic and semantic memory were damaged, which shows that our procedural memory must be located elsewhere. Other brain areas such as the cerebellum have been identified as involved in this. Not only was his procedural memory intact, he could also improve it by practicing new movements over time. The image below shows a mirror drawing task, where participants have to trace an image by only looking at its reflection in a mirror.
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H.M.’s performance improved each time he did this task, even though he had no recollection of ever doing the task before! This illustrates nicely the different between the automatic, learned ‘procedural’ memories, and the episodic memories about previous experiences.
One last question remains – why did H.M. lose his episodic memories from the years before the operation, but not ones from when he was much younger? There are several theories for this, with one being that older memories are ‘consolidated’ into the rest of the cortex – only newer memories remain in medial temporal structures such as the hippocampus. Therefore, when this area of brain was destroyed, so were the newer long term memories.
When H.M. died in 2008 aged 82, scientists were able to reveal his real name – Henry Molaison. He made a massive contribution to the field of neuroscience, and is thought to have been one of the most tested patients in medical history.
For those interested in reading more about H.M., I would recommend this article, written while he was still alive: Corkin, S. (2002). What’s new with the amnesic patient HM?. Nature Reviews Neuroscience3(2), 153-160.
And finally, I’ll leave you with a quote from H.M. himself, when he was asked “Are you happy?”
“Yes. Well the way I figure it is, what they find out about me helps them to help other people. And that’s more important.”