Dr. Lobotomy

An East Isles author crawls inside the head of America’s most famous lobotomist

At the height of his powers, Walter Freeman could take an ice pick, hammer it into a person’s brain twice and, in six minutes, sever the fibers at the bases of the frontal lobes. The doctor changed thousands of lives forever with that procedure and psychosurgical techniques like it; he calmed some patients’ wildly jangled existences and condemned others to imprisonment in their immobilized bodies and minds.

Freeman biographer and East Isles resident Jack El-Hai theorizes that the American neurosurgeon was perhaps second only to Nazi physician Josef Mengele among the 20th century’s reviled doctors.

Freeman is the subject of El-Hai’s "The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness," recently released by scientific and medical publisher Wiley.

El-Hai began his journey inside Freeman’s mind in 1996 and has found that the lobotomist has moved into his head, too.

"Coexisting with Freeman is by turns distasteful and intriguing," El-Hai said. "I’m still haunted by the many photographs I saw in his collected papers, including before and after portraits of lobotomy patients and a gruesome series of photos he took of dead patients, suspended by a clamp attached to the head, from St. Elizabeth’s Hospital in Washington, D.C.

"My oldest daughter Natalie, who is 7, knows all about lobotomy, lobotomists and psychiatric disorders. That makes me a little uncomfortable. But overall, I think spending time with Freeman and his work has enlarged my life and made me more open-minded."

El-Hai said when he first proposed the book, he expected to write a condemnation of a monster who had ruined thousands of lives with lobotomies.

"As I got into reading his papers, [they] included a lot of things that were very unexpected to me, like hundreds of Christmas cards from his patients," El-Hai said. "As I plowed through that mountain of stuff, I saw the story was a little more complicated – fortunately for me, because the character-assassination biography wouldn’t have been a very interesting book to read or to write."

Part of what makes the book a riveting read is El-Hai’s intricate dissection of a man determined to make a difference in the ruins that were his patients’ lives.

Freeman was a complex set of contradictions: a good father and lousy husband; a doctor who was both caring and callous; a man with an intense dislike of drunkenness and a fondness for the barbiturate Nembutal; and a brilliant pioneer who refused to let go of the discredited medical procedure that had secured his fame and infamy.

"He was not some charlatan working on the fringes of medicine," El-Hai said as he sipped coffee in a downtown café. "He was a highly respected doctor, leader of all kinds of neurological and psychiatric doctors’ associations, and he cared about his patients. That was obvious.

"He had seen more of America’s psychiatric hospitals probably than any other doctor ever."

Swapping symptoms

Freeman began performing lobotomies in 1936, when Freudian psychoanalysis held sway and pharmaceuticals for mental illness simply didn’t exist.

The mentally ill were dumped in "psychiatric hospitals" – a cruel euphemism for often-filthy places where the demons of mental illness ran free in the heads of the afflicted, who largely went without treatment of any kind.

Said El-Hai, "The lobotomy offered promise as a quick way to get them out."

Freeman designed an imperfect escape from those hospitals known as the transorbital lobotomy; a much simpler version of the previous technique, known as the radical lobotomy.

Freeman believed the six-minute transorbital lobotomy could help thousands of severely mentally ill patients lead productive lives.

The technique was cost-effective – it could be performed sans pricey surgeons, operating rooms and anesthesia – and simple, making it practical for doctors at psychiatric hospitals to perform.

"Freeman saw it as an outpatient procedure that any doctor could learn to do, whether the doctor had ever performed surgery or not," El-Hai said.

Freeman began the procedure by administering ECT (electroconvulsive therapy), passing electricity through the patient’s brain to render them unconscious. (He didn’t use ECT for its disputable therapeutic effects.) He would then take an everyday ice pick and insert it between the patient’s eyeball and eyelid, aimed toward the brain. He’d give the pick a couple of quick, hard raps with a hammer to drive it through the transorbital plate and into the frontal lobe that helped control reasoning, planning, parts of speech, movement, emotions and problem-solving.

There the pick was rotated to sever the connections between the frontal lobe and the rest of the brain. The procedure was then carried out on the other eye socket and adjacent frontal lobe.

"About a third of his patients who had been hospitalized did leave the hospital, trading the symptoms of their old psychiatric disease for the symptoms of damaged frontal lobes," El-Hai said. "Freeman thought that in most instances, that was a better trade-off. That the frontal lobe damage was more manageable and made people better able to function than the old symptoms of paranoia, hallucination, suicidal feelings, that kind of thing."

Here, too

The successes and failures of lobotomies were visited upon Minnesota in the procedure’s heyday of the 1940s and ’50s.

El-Hai said 500 to 600 lobotomies were carried out in Rochester and Hastings by a pair of Freeman’s disciples.

"Freeman knew them both well; he sent them complimentary copies of his books as they came out."

In addition, there was a Dr. Peyton at the University of Minnesota who experimented with a procedure known as a lobectomy, in which he removed slices of the brain rather than simply cutting the organ, as was common in lobotomies.

"One of the people who I talked to early in my research was a retired U of M neurosurgeon named Lyle French," El-Hai recalled. "He saw Freeman demonstrate lobotomies at Hastings State Hospital and had a very vivid memory of it. He didn’t like it, even though he did lobotomies himself in the ’50s.

"He didn’t like the way Freeman did transorbital lobotomies because he considered the technique unclean."

The Minnesota connection is one of the things that attracted El-Hai to the complex story of the lobotomist, he said.

"Once I learned about the practice of lobotomy in the Midwest and heard the briefest details of Freeman’s life, I felt that he offered a bottomless pit of a subject that I couldn’t afford to avoid," he said. "No one before had taken a biographer’s approach to his work or life. I knew that writing about him would stretch my knowledge and abilities, and the fascination of his life convinced me to take up the challenge."

No apologies

In the course of his research, El-Hai came across an instructional film Freeman had made so that fellow doctors could perform lobotomies.

"It was difficult to watch," the author said quietly with understandable understatement. "Freeman narrates it. It’s a very dispassionate narration, a very flat, matter-of-fact description of what’s going on, when what you’re seeing on the screen is terrifying in a lot of ways. It shows the electroshock on this female patient – it shows everything."

El-Hai noted that ECT has made something of a comeback in psychiatric treatment of severe mental illness. He said he doubts that the lobotomy, which hasn’t been performed in this country since the 1970s, will ever return, however.

"And it shouldn’t," he said. "But psychiatric surgery is coming back."

He cited the recent news that a company called Cyberonics has received conditional Food and Drug Administration approval of an implanted product that sends a pulsed electrical signal to the vagus nerve in the neck and upward into the brain to treat a variety of neurological disorders, including chronic depression, anxiety, epilepsy, eating disorders and Parkinson’s disease.

"A good thing about this [therapy] is that if there are bad side effects, you can deactivate [the device] pretty easily and there’s no permanent damage," El-Hai said.

Freeman’s operation was, of course, an unending alteration of the patient’s cerebrum and life.

"When he didn’t get good results from an initial lobotomy, he’d sometimes try it again," El-Hai said. "Two, three, even four times in a few cases."

As he talks about lobotomies, El-Hai pauses between thoughts to sort out just the right words. His softly spoken syllables don’t carry beyond the table where he’s seated. Eavesdropping is impossible, but if it were, would people become angry with the writer? Would they accuse him of apologizing for what is today seen as cruel and unusual treatment of the ill?

"I expect that," El-Hai said in his typically quiet way. "But the biographer’s job is to try and understand motivation. So I see myself as someone who has made an effort to understand Freeman rather than to apologize. And the book doesn’t apologize for him. It plainly acknowledges his flaws, and his mistakes are amply documented.

"[Lobotomies] destroyed some people and changed others in a way that, by Freeman’s standards, were successful. No one would apply those standards now. I think the mistake is to project ourselves in 2005 back to 1936 when he started all of this, with what we know and what we expect from psychiatric medicine."