Recognition memory is thought to depend on two distinct processes: recollection and familiarity. There is debate as to whether damage to the hippocampus selectively impairs recollection or whether it impairs both recollection and familiarity. If hippocampal damage selectively impairs recollection but leaves familiarity intact, then patients with circumscribed hippocampal lesions should exhibit the full normal range of low-confidence and high-confidence familiarity-based recognition. High-confidence, familiarity-based decisions are ordinarily accompanied by successful recollection (when memory is intact). However, patients with hippocampal lesions, if recollection is impaired, should frequently experience high-confidence, familiarity-based recognition in the absence of recollection, and this circumstance (termed the "butcheron-the-bus" phenomenon) should occur more often in patients than in healthy controls. We tested five patients with circumscribed hippocampal damage, asking them to recognize recently studied words as well as to remember the context in which the items were studied. Relative to controls, the patients exhibited no increased tendency to experience the butcher-on-the-bus phenomenon. The simplest explanation of the results is that hippocampal damage impairs familiarity as well as recollection. The same conclusion was suggested when two competing models of recognition memory were used to analyze the data.amnesia | recognition | source memory T he ability to accurately recognize a previously encountered item is generally thought to be based on two processes: recollection and familiarity. Recollection involves remembering the source of a prior encounter, whereas familiarity involves simply knowing that the item was previously encountered despite the absence of any information about its source. The following anecdote, offered by Mandler (1), illustrates these two processes:Consider seeing a man on a bus whom you are sure that you have seen before; you "know" him in that sense. Such a recognition is usually followed by a search process asking, in effect, Where could I know him from? Who is he? The search process generates likely contexts (Do I know him from work; is he a movie star, a TV commentator, the milkman?). Eventually the search may end with the insight, That's the butcher from the supermarket! (pp [252][253] The initial sense of familiarity reflects strong recognition of the item itself, whereas the subsequent experience of recollection (if it occurs) reflects the retrieval of source information associated with that item. A pure, familiarity-based experience of strong recognition in the absence of source recollection has come to be known as the "butcher-on-the-bus" phenomenon (2-4).An issue of considerable interest is how the structures of the medial temporal lobe support recollection and familiarity. According to one view, recollection depends on the hippocampus, whereas familiarity depends on the adjacent perirhinal cortex (5, 6). Alternatively, it has been proposed that the functional differe...