Get Well Soon

by Jennifer Wright

  There were downsides. The patients suffered from physical side effects—like respiratory attacks—as well as the psychological difficulties that stemmed from having lost so many years. But they had their minds and their energy, their quirks and passions and interests. After so many years of shadowy half-life, how wonderful it must have been for them to return to the world.

  But, tragically, the effects of L-dopa didn’t last. Many of the patients were overwhelmed by tics. Some exhibited manic behavior. Sacks recalled one patient who “liked exchanging kisses with the nurses. Then the erotic fantasies became more extreme. He wanted a brothel service to be set up.”35 This is very unfortunate, but I have seen the movie One Flew Over the Cuckoo’s Nest (1975) enough times to appreciate that guy’s style. The experiment was discontinued, although some of Sacks’s patients continued to receive L-dopa until the end of their lives. The drug is still used to treat Parkinson’s today, but many patients experience a “wearing off” effect after four to six years.36

  Sacks’s patients fell back into their former states and could not be awakened again. Does that mean that their brief awakening was meaningless? Well, if life is only important if it is going to last forever, the whole human race is in bad shape. One patient, who before L-dopa had been so hunched that she was forced to always stare at the ground, went on a day trip to a local park while experiencing her awakening. When she came back she said, “What a perfect day—so peaceful—I shall never forget it! It’s a joy to be alive on a day like this. And I do feel alive, more truly alive than I’ve felt in twenty years. If this is what L-DOPA can do, it’s an absolute blessing!”37 Another patient claimed, following his awakening, “If people felt as good as I did, nobody would make wars.”38

  At the end of our lives I think many of us would do anything to have one more good day. All of this life seems so precious. I can’t think of anything as a failure that allows people even one more happy day. Sacks claimed: “They were not only patients but teachers and friends, the years I spent with them were the most significant of my life. I want something of their lives, their presence, to be preserved and live for others, as exemplars of human predicament and survival.”39

  There is still no cure for EL, and its rise and subsequent disappearance is still regarded as something of a mystery. But if within a time span of fifty years we can research a disease and come up with a drug that can bring people back, even if only temporarily, imagine what we will be able to do in the next fifty. The sufferers of this disease won’t be the only ones awakened. If we study and research and devote energies to science, hopefully there will be many Lazarus bodies dancing to and fro through the parks in our lifetime.

  Lobotomies

  I’d rather have a free bottle in

  front of me than a prefontal

  lobotomy.

  —TOM WAITS

  As we learned from my excellent line drawing in the last chapter, medical science advanced at an astonishing pace in the twentieth century. On the whole, that is wonderful. That is a great boon for humanity. But there can be a downside to new medical science, as when it is wielded by a charismatic demagogue who cares more about his own reputation than the well-being of his patients.

  Now, there have always been charlatans who claimed to have cures for dangerous diseases despite having no such thing (see: Alexander of Abonoteichos of the useless charms for the Antonine plague). Their outrageous conduct meant that patients often died—a good indication that their treatment didn’t work. However, with scientific advances, quacks could offer more than just charms to ward off disease. By the twentieth century medical science had advanced to a point where unscrupulous individuals could cause irreversible damage to patients without actually killing them. And then they could call their procedures “successes.” And people were not vigilant enough, or not sufficiently aware, to say, “No, that is not what success means.” What happens when a “cure” causes more harm than good?

  Which brings us to lobotomies, the scariest procedure that you never want performed. This is a plague induced by human stupidity, not disease, but I couldn’t write a book on deadly medical horrors without talking about the terror wreaked by Walter Jackson Freeman II.

  The first leucotomy or lobotomy was performed on a human by the Portuguese neurologist Antônio Egas Moniz in 1935. This operation involved drilling holes into a patient’s skull and then making cuts into the brain’s frontal lobes to sever their connections to the rest of the brain.1

  He was inspired by a similar surgery that had been performed on chimpanzees at Yale University. According to “The Lobotomist,” an episode in the PBS TV series (2010) American Experience, “Two chimps, Becky and Lucy … showed that once their frontal lobes were removed, they lost the capacity to solve simple problems.” But scientists also noticed that Becky was no longer frustrated when she was unable to solve problems. She was not bothered in the way a puzzle-solving chimpanzee should be at all. Dr. Carlyle Jacobsen, who performed the procedure, claimed that she seemed to have joined a “happiness cult” or “placed her burdens on the Lord.”2 Lucy didn’t seem so happy, but absolutely no one paid attention to her. You could say that they … did not love Lucy. (That joke would have gone over gangbusters in 1950.)

  There was some precedence for these observations—and with a human, not a mellow chimpanzee. In the 1840s there was a well-known medical case involving a man named Phineas Gage who had survived having an iron bar driven into his frontal lobes. While he recovered physically, his personality was so severely altered that he seemed to be “a child in his intellectual capacity and manifestations.”3 By 1871 the Scottish neurologist David Ferrier had separately discovered that intellect seemed to reside in the frontal lobes of the brain.

  The takeaway from the chimp experiment should have been, “Well, that was interesting. But let’s not mess around with anyone’s frontal lobes. Let’s just not do that. This whole experiment was just a reminder about intellect and problem solving. Okay, we are all agreed. Let’s have lunch.” But Becky’s response to the procedure stood out. A reduction in anxiety and negative emotion is striking and, at first glance, seems like a very good result.

  Dr. Moniz believed that such an operation would make life far better for the insane. And if “better life” just constitutes “being less worried and agitated,” he was correct. There is one problem, though: worrying about stuff serves a purpose. It’s not fun and can keep you awake at night, but it means you are capable of caring and solving problems. Which means you are qualified to be an empathetic, adult human being.

  Dr. Moniz was not considering the disadvantages of a life without worry.

  The first lobotomies involved drilling two holes about three centimeters deep directly into a patient’s skull over the frontal lobes. Then alcohol was injected into the frontal lobes in an attempt to disrupt neural pathways. When the ethyl alcohol proved less than entirely effective, Moniz and his team began cutting the lobe with wire, using an instrument called the leucotome. A wire loop extended from the end of a handle and would be rotated in a circle to cut neural fibers. They didn’t actually remove the frontal lobes, à la a casual dinner party with Hannibal Lecter; they just severed the connections between the frontal lobes and the rest of the brain. That’s a delicate bit of neurosurgery but only took around an hour to complete.

  Unlike Moniz, Walter Jackson Freeman II, while a physician, was not a surgeon, let alone a neurosurgeon. This man had no business whatsoever operating on any part of the body, but he especially should not have been operating on an organ as delicate as the brain. That did not stop him. He and his partner James Watts performed the first version of this surgery in the United States in 1936. Their patient was a sixty-three-year-old woman named Alice Hammatt. She suffered from severe depression—perhaps aggravated by the fact that one of her children had died, as had her sister and brother-in-law in a murder-suicide pact. She entertained thoughts of suicide. Moreover, according to Freeman, she was just no fun to be around. She was “a
master at bitching and really led her husband a dog’s life … She worried if he was a few minutes late in coming from the office and raised the roof when things did not suit her.”4 No one seemingly pointed out that severe depression is a valid and understandable response to the tremendous amount of unexpected death that had touched Ms. Hammatt. Also, it’s nice when people are punctual. People should text if they’re going to be late; it’s just respectful.

  After the operation Hammatt was free from anxiety. That said, after the operation she was also only able to flip through magazines and draw pictures. She misspelled words on her pictures when she tried to caption them. She wasn’t able to have a coherent conversation. She ultimately regained her ability to speak, although “her husband and maid did most of the work” around her home, according to Freeman. But she was very happy with the procedure and felt that she spent a lot less time worrying. She was even able to spend pleasant time with acquaintances she had before found extremely annoying. Freeman thought “the result was spectacular.”

  This may just be me, but the thought of finding the people I consider annoying suddenly agreeable strikes me as anything but a spectacular result.

  Perhaps the most famous example of a lobotomy gone very wrong was Rosemary Kennedy, the daughter of Rose and Joseph P. Kennedy and one of the sisters of President John F. Kennedy. The third Kennedy child, Rosemary was always a little bit slower than the rest of her extremely competitive siblings. But, to be fair, all of us are a little slower than the ultracompetitive, hyperathletic, superattractive Übermenches that are the Kennedy clan.

  Rosemary was born in Boston in September 1918. I think we all know what was happening then. Or, in case you like reading chapters out of order—I do!—the influenza epidemic was devastating the United States. A doctor was supposed to come to the Kennedy household when Rosemary’s mother went into labor, but he was delayed because he was treating so many influenza patients. The nurse at the Kennedy home told Rosemary’s mother to cross her legs and try to hold on until the doctor got there, which she did. When Rosemary still appeared to be coming, the nurse pushed the baby back into the birth canal.

  The shortage of oxygen during her birth resulting from this clear case of medical malpractice likely caused brain damage; Rosemary’s IQ was later estimated to be low. How low precisely isn’t known, though she attended a school that accepted girls with IQs of 65 to 90. Did this mean she had an unhappy life? No, of course not! Forrest Gump’s IQ was 75, and he had a great life. He played Ping-Pong and traveled the world and everything! Rosemary was hardworking, affectionate, and fiercely devoted to her family. She was also very good with children. Those all seem like qualities that contribute to a pleasant and fulfilling existence. As she grew older, however, and her other siblings moved on to their own seemingly more exciting lives, Rosemary became increasingly prone to temper tantrums. Her father, Joseph, was terrified that she’d have premarital sex, possibly get pregnant, and embarrass the family at a time when he was mapping out his sons’ political careers. In 1941, when Rosemary was age twenty-three, he decided a lobotomy might be a cure for her unpredictable behavior. Spoiler for all of history: Joseph Kennedy was a monster.

  Rosemary’s sister Kathleen (known as Kick) investigated the procedure and was told by a reporter who was writing a series on the treatment that lobotomized people “don’t worry so much, but they’re gone as a person, just gone.”5 Journal of the American Medical Association wrote: “It is inconceivable that a procedure which effectively destroys the function of this portion of the brain could possibly restore the person concerned to a wholly normal state.”6

  None of this information deterred Joseph Kennedy. He engaged Freeman and Watts to perform a lobotomy on Rosemary. She was kept awake for the procedure as they asked her to recite the lyrics to simple songs like “God Bless America” and the months of the year. They kept cutting until she became incoherent.7 After the operation she was unable to walk or talk. She was incontinent. Some of her siblings stopped visiting her. Even with years of rehabilitative efforts, she was only ever able to speak a few words. The nurse who assisted at the operation quit the profession altogether.8 However, at the time the public never learned about what happened to Rosemary or cases like hers. It was in neither the Kennedy family’s nor Freeman and Watts’s interest to let people know about the horrifying effects of her operation.

  What’s so scary about this?

  Results like these weren’t enough to deter Freeman. Remarkably, he came to think that Moniz’s technique was not efficient enough to lobotomize all the people who he believed could benefit from the procedure. He and his partner thought that the drilling was the most bothersome part for patients. They claimed: “Apprehension becomes a little more marked when the holes are drilled, probably because of the actual pressure on the skull and the grinding sound that is as distressing, or more so, than the drilling of a tooth.”9 I would go with “more so.”

  So they developed the transorbital lobotomy, which involved inserting an ice pick into a patient’s skull through the bone known as the orbit at the back of the eye socket. Patients were generally subdued with electroshock therapy beforehand. Then the ice pick was driven through the back of the eye with a hammer. There, it would be moved back and forth in the same motion as an eggbeater, severing connections between the thalamus (which controls the motor systems of the brain, extending to basic functions like movement and consciousness) and frontal lobes (which regulate higher intellect). The operation itself could be performed in less than ten minutes, and as soon as the bleeding stopped, patients were sent home (generally in a taxi) just as if they had been to the dentist.10

  Freeman certainly wanted to make this procedure seem like it was no big deal. Which is outrageous. Bear in mind that after a lobotomy a lot of the patients could barely remember who they were when they were being herded into a taxi. If they read something, they couldn’t recall it afterward. Many fumbled with their genitals. Despite Freeman and Watts’s frequent comparisons to going to the dentist, I beg to differ. Going to the dentist sucks, but afterward you can remember who you are: namely, a person with a sore mouth who wishes you had not just been to the dentist.

  In 1946 Freeman performed his new transorbital operation on Sallie Ellen Ionesco. She was severely depressed, so much so that she stayed in bed for days at a time. She had tried to commit suicide, and she had tried to smother one of her children. It does indeed seem like her quality of life was not great. After the lobotomy she was never violent again. When she was interviewed about it later, she claimed, “[Freeman] was a great man, that’s all I can say … I don’t remember nothing else, and I’m very tired.” Her daughter, however, did say that she wished Freeman “hadn’t gotten quite so out of hand.”11

  Many of the people who were lobotomized were untroubled by the results. According to John B. Dynes and James L. Poppen in their 1949 American Medical Journal article “Lobotomy for Intractable Pain,” after patients were operated on, “they never admitted they were mentally depressed and at no time did they show grief or shed tears.”12 However, all of the patients that Dynes and Poppen surveyed who before their lobotomies had been classified as “normal” or in some cases in an “anxiety state” were afterward classified as “retarded” or “euphoric” (which, as far as I can tell, meant “mentally impaired but pleased about it”). In addition to feeling no depression: “They were indifferent to sorrow or grief, and seemed incapable of sensing or appreciating the feelings of others.”13

  Often Freeman was inclined to see his operations as successful, while those closer to the patients saw them as anything but. Regarding the “success” of the operation on a twenty-four-year-old schizophrenic, Freeman reported: “Except for drinking too much, he presents no aggressive misbehavior. It apparently requires some imagination, as well as some emotional driving force, to bring about misbehavior at the legally reprehensible level and this the patient is incapable of.”14 Okay, that’s sort of nice that the patient wasn’t doing anyth
ing illegal. However, that patient probably did not have time to misbehave given his brother’s statement that “he had lost all sense of time, spending four to six hours a day washing his hands but nevertheless going around with dirty clothes.”15

  The more lobotomies Freeman performed, the more obvious the disadvantages of the operation became. Even Freeman admitted, “Every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality.”16

  What is that elusive “sparkle”? Is it a certain panache that accompanies the telling of one’s stories? An almost Fitzgeraldian gleam in someone’s eye as they exclaim, “To the wine cellar, Maurice! We’re going to fill this bathtub with champagne!”

  Nope. That “sparkle” was “adult intellect.”

  Discover magazine lays out the situation more clearly: “The operation did have disturbing side effects. Patients often suffered major personality changes and became apathetic, prone to inappropriate social behavior, and infatuated with their own toilet habits. They told pointless jokes and exhibited poor hygiene.”17 So they often behaved like toddlers. The granddaughter of a woman who was operated on in 1953 claimed that afterward “she was strange because she would do things like rock in place. She didn’t make a lot of sense when she talked. And she didn’t talk about the same things that other adults talked about. She was—childlike is probably the best description.”18

  Freeman didn’t seem to regard a reversion to toddler-hood as a distressing outcome. Of a patient he operated on in 1947 in an attempt to treat her schizophrenia, he reported:

  [Postoperative day 10] Rose is a smiling, lazy and satisfactory patient with the personality of an oyster. She pours and pours from an empty coffee pot. She can’t remember my name.

  [Postoperative day 18] Rose is delighted to be going home. She doesn’t say much, is very ticklish.19