CHAPTER 5
TURNING THE MIND INSIDE OUT
“Broken! Busted! Everybody has something to repair.”
—Billy Mays, American salesman
Between 1978 and 1991, a Milwaukee man named Jeffrey Dahmer killed 17 men and boys. Dahmer has been the subject of 25 books, hundreds of television programs, and thousands of newspaper and magazine articles. The public’s fascination with Jeffrey Dahmer, however, had little to do with whom he’d killed and everything to do with how he’d killed them.
Dahmer was a special kind of serial killer. First, with the promise of $50 if they posed nude, he lured his victims to his apartment. Then he gave them drinks laced with sleeping pills. When they were unconscious, he strangled them, bludgeoned them, or cut their throats with a paring knife. Sometimes, before killing his victims, he bore a hole into their heads and injected hydrochloric acid or boiling water into the front of their brains, hoping to create, in his words, “zombie sex slaves.”
On February 15, 1992, after deliberating for five hours, a jury found Jeffrey Dahmer guilty on 15 counts of murder. He was sentenced to 15 consecutive life terms totaling 957 years. Two years later, Christopher Scarver, a fellow inmate, beat Dahmer to death with a metal pipe.
Although most people know the story of Jeffrey Dahmer, they don’t know that one of the atrocities performed in his chamber of horrors had—50 years earlier—won a Nobel Prize for its inventor.
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IN AUGUST 1935, at a conference of neurologists in London, two physiologists from Yale, John Fulton and Carlyle Jacobsen, described a study they had done on two chimps: Becky and Lucy. Fulton and Jacobsen had taught the chimps to use sticks to get food that was out of reach. Sometimes the chimps got the food; sometimes they didn’t. Lucy was consistently more patient than Becky. Where Lucy would just keep trying, Becky would fly into a rage, pull her hair, defecate, and throw her feces at the scientists.
The real experiment came next. Fulton and Jacobsen wanted to understand the role of specific areas of the brain in performing tasks that required memory. So they removed Lucy and Becky’s frontal lobes (located just behind the forehead). Following the operation, Lucy no longer remembered how to get the food. The scientists concluded that Lucy’s frontal lobes were responsible for synthesizing and storing recent memories. They also noticed something else. Becky still had trouble getting the food, but now she didn’t care. “It was as though [she] had joined a happiness cult,” said Jacobsen. John Fulton and Carlyle Jacobsen, it appeared, had invented a surgical treatment for anxiety.
Sitting in the audience was a Portuguese neurologist named Egas Moniz. Moniz was impressed by what he had just heard. He knew that many of his patients suffered from intense and often overwhelming anxiety. John Fulton remembered what happened next: “Dr. Moniz arose and asked, ‘If frontal lobe removal prevents the development of experimental neuroses in animals, why would it not be feasible to relieve anxiety states in man by surgical means!?’ ” At first, Fulton, an experienced and well-respected neurologist, thought that Moniz was kidding. “At the time we were a little startled by the suggestion,” he recalled, “for I thought that Dr. Moniz envisaged a bilateral lobectomy.”
Moniz, however, wasn’t thinking about a lobectomy, where the two frontal lobes were completely removed. Rather, he imagined a procedure where the frontal lobes would be cut off from the rest of the brain—something he would later call a leucotomy from the Greek leuko, meaning “white,” referring to the white nerve fibers of the brain, and tome, meaning “knife.” When Moniz’s procedure crossed the Atlantic Ocean and entered the United States, it was called a lobotomy.
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MONIZ WAS DETERMINED to extend Fulton and Jacobsen’s experiments on chimps to people. First, he had to find a surgeon willing to do it. He settled on Almeida Lima, a neurosurgeon at the University of Lisbon. Within a few days, Moniz and Lima—without performing a single experiment on an animal and spending only an afternoon practicing the procedure on a cadaver—had picked their first patient.
On November 12, 1935, Almeida Lima drilled a hole into each side of the skull of a 63-year-old woman from a local insane asylum who suffered from crippling bouts of anxiety and paranoia. After drilling the holes, Lima—in a procedure mimicked by Jeffrey Dahmer decades later—injected half a teaspoon of alcohol into her frontal lobes. Then Lima closed up the holes. The operation took about 30 minutes. A few hours later, the woman was able to respond to simple questions. Two days later, she returned to the asylum and, according to Moniz, was much calmer—her anxieties and paranoia gone. Ecstatic, Moniz pronounced her cured.
Convinced that lobotomies worked, Moniz and Lima repeated the procedure on six more patients. Unfortunately, their technique lacked precision. Neither man felt comfortable that the alcohol they had squirted into the brain stayed in the frontal lobes. So they ordered a special surgical instrument from Paris: a long, thin rod, at the end of which was a wire loop. This allowed the team to remove small cores from the frontal lobes—like coring an apple. Within three months, their new lobotomy knife would be used on 13 more patients, bringing the total number to 20.
Staking his claim on the procedure, Moniz published a 248-page monograph describing his 20 patients: Seven were cured, seven were significantly improved, and six were unchanged. Psychosurgery was born. It was, said Moniz, “a great step forward.” No longer did patients have to suffer from restlessness or bouts of anxiety, or from delusions or paranoia, or from mania or depression.
By the late 1930s, lobotomies had been performed in Cuba, Brazil, Italy, Romania, and the United States. Portugal, however, banned them. The psychiatrist who had initially referred patients to Moniz and Lima refused to provide any more. Soon, other Portuguese psychiatrists refused to provide patients. All had become horrified by the results. It was only later that the reasons for Portugal’s ban became clear. By then, however, it was far too late.
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WHEN EGAS MONIZ ATTENDED the conference in London—and listened to John Fulton and Carlyle Jacobsen describe their chimp studies—it wasn’t the first time that neurologists had learned about the workings of the brain’s frontal lobes.
Perhaps no story was more instructive, more dramatic, or more unbelievable than that of Phineas Gage, a 25-year-old New England railroad worker who, on September 13, 1848, while preparing a hole for blasting powder, suffered a 3.5-foot iron spike driven through his face. The spike entered his cheek and exited through the top of his head, destroying his left frontal lobe. Miraculously, Phineas Gage lived for 11 more years. But, at least according to his friends, Gage was “no longer Gage.” Before the accident, he was energetic, shrewd, and focused; afterward, he was ill-mannered, stubborn, and rude—once a responsible worker, now someone who couldn’t hold down a job.
Patients with frontal lobe cancers had also been instructive. Like Phineas Gage, they became childish and apathetic, often dozed off to sleep, lacked initiative or will, lost their ability to plan ahead or make sound judgments, and had problems with attention, memory, language, and inhibition. One cancer patient, a 39-year-old New York City stockbroker named Joe A., was particularly fascinating. Following surgery for a frontal lobe tumor, Joe’s memory seemed unaffected. Indeed, one group of neurologists examined him for an hour and couldn’t find anything wrong. But Joe was a changed man. He lacked motivation to go back to work, was easily frustrated, spoke harshly about friends and neighbors, and most remarkably, became a hopeless braggart. While watching his son play baseball, Joe claimed that he himself was a better hitter than anyone he knew and that he would soon become a professional baseball player.
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DESPITE HIS BOAST that “the intervention is harmless,” Moniz’s early lobotomy patients didn’t do nearly as well as he had claimed. Patients often suffered from vomiting, diarrhea, incontinence, nystagmus (where the eyes rhythmically vacillate uncontrollably), ptosis (drooping of the upper eyelids), kleptomania, abnormal hunger, and a disturbed orientation of tim
e and space. The Portuguese psychiatrist who had initially provided patients to Moniz and Lima later called the procedure “pure cerebral mythology.”
Members of Sweden’s Nobel Prize committee, however, either ignored or were unaware of any of these problems. In 1949, the committee recognized Egas Moniz “for his invention of a surgical treatment of mental illness.” The New York Times immediately hailed the Nobel Prize winner as a brave explorer of the human brain: “Hypochondriacs no longer thought they were going to die; would-be suicides found life acceptable; [and] sufferers from persecution complexes forgot imaginary conspirators. Surgeons now think no more of operating on the brain than they do of removing an appendix.” Lobotomies had entered the mainstream. Ironically, one country that never embraced lobotomies was Germany, believing them to be a violation of the Nuremberg Code, created to prevent doctors from performing the kind of cruel and unethical experiments that came to light following the Holocaust.
Within four decades of the Nobel Prize Committee’s announcement, 40,000 lobotomies were performed throughout the world, more than half in the United States alone. America’s love of lobotomies was due to the persistence and zealotry of one man—a man who had opened a Pandora’s box of mental health treatments.
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WALTER JACKSON FREEMAN WAS BORN ON November 14, 1895. Like Egas Moniz, Freeman was from a wealthy, prominent family. Freeman’s father was a doctor, and his mother was the daughter of William Williams Keen, America’s most famous surgeon. Although Freeman came to view his father as a second-rate surgeon whose financial dealings would eventually leave his family in ruin, he adored his grandfather. In William Keen, the young Freeman had much to live up to.
William Keen was the first surgeon in the United States, and one of the first in the world, to operate on a brain tumor. To accomplish this feat, he sprayed the entire operating room with carbolic acid, cut a hole in the man’s skull, reached in with his ungloved hand, pulled out the tumor, sewed up the ripped blood vessels, and closed the hole with catgut. The operation was performed without the advantages of x-rays, blood transfusions, local anesthesia, or reliable lighting. Following the surgery, the man lived another 30 years. Keen was also the first surgeon to perform a colostomy, remarkable given that antibiotics hadn’t been invented yet. He was the first surgeon to perform an end-to-end suture of a damaged nerve in a young boy’s hand, allowing the child to continue to play the piano. He was the first surgeon to place a tube in the center of the brain to relieve a life-threatening buildup of spinal fluid. And he was the first surgeon to use open cardiac massage to save a patient’s life. In 1921, Keen was also part of a team of physicians that diagnosed Franklin Delano Roosevelt’s polio.
In short, Walter Freeman was never going to best his grandfather. But that didn’t stop him from trying.
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FREEMAN WAS THE ELDEST OF seven children. Growing up in a luxurious, three-story walk-up near Philadelphia’s fashionable Rittenhouse Square, his childhood was eventful. When he was 14 months old, his grandfather removed 30 enlarged lymph nodes from his neck, leaving him with a permanent tilt of his head and droop of his shoulder. As a boy, he was one of the first to receive the newly made diphtheria antitoxin, imported from Germany, which saved his life.
As a young man, Freeman attended Philadelphia’s prestigious Episcopal Academy followed by Yale University. After graduating from the University of Pennsylvania School of Medicine, he did his internship and residency in neuropathology at Philadelphia General Hospital. Similar to many wealthy physicians in the early 1900s, Freeman extended his studies in Paris and Rome before returning to St. Elizabeth’s Hospital in Washington, D.C., to become its director of laboratories. (St. Elizabeth’s was one of the largest general hospitals in the United States, housing 4,000 staff and 7,000 patients. Charles Guiteau, who had assassinated President James A. Garfield, was a patient at St. Elizabeth’s.) He also joined the faculty of both Georgetown and George Washington University medical schools. In 1928, Walter Freeman became the first chairman of George Washington University’s Department of Neurology and Neurological Surgery.
Like his famous grandfather, Freeman soon earned the respect of his peers. He was elected to head the certification board for neurologists and psychiatrists and, sporting a jutting goatee, sombrero, and cane, was a dynamic and beloved lecturer. Freeman had a flair for the dramatic. While working at St. Elizabeth’s, he took care of a sailor whose girlfriend had slipped a gold ring onto the sailor’s penis during foreplay. When the sailor became erect, the ring got stuck. Freeman cut through the ring, twisted it off with a pair of pliers, fixed it, and kept it on his watch chain as a conversation starter (or conversation ender).
But where William Keen advanced the state of medicine in countless ways, Walter Freeman contributed virtually nothing. Freeman believed he could find structural differences in the brains of people with serious mental disorders. After examining more than 1,400 brains, he incorrectly concluded that patients with manic depression had anatomical differences depending on whether they were manic or depressed. Later, Freeman tried to visualize the brain by injecting a dye directly into its center, a dangerous procedure that would soon be abandoned. But Walter Freeman was unbowed. His mother, who had seen this streak of hauteur in her son from an early age, referred to him as “the cat who walks by himself” (a reference to Rudyard Kipling’s Just So Stories).
In his efforts to best his famous grandfather, Freeman drove himself into the ground. To make time for what he believed would be the definitive textbook on neuropathology, he woke up at 4:00 a.m., wrote for three hours, drove to St. Elizabeth’s where he worked until 5:00 p.m., then drove to his private practice, where he worked until 8:00 p.m. When he got home and tried to get some sleep, he was constantly awakened by his wife “who seemed to cough all night” and by “streetcars pounding along Connecticut Avenue [whose] wheels hadn’t been fixed since the Depression.” He became irritable and depressed. Three events put him over the edge: After being hit by a car, he was forced to dictate the last chapter of his book from his bed. Then William Keen, his grandfather, died from a stroke. Then his mother died.
Following the tragedies, Freeman believed that he, too, was about to die. Certain he had cancer, he fell into a deep depression. Unable to write, work, or drive a car, he decided to take a cruise and attend a neurology conference in London. The year was 1935—the same year that John Fulton and Carlyle Jacobsen presented their study of Becky and Lucy. After arriving at the conference, Freeman set up a booth describing his work. In the booth next to him was Egas Moniz. The two became friends. Seven months later, when Moniz published the monograph describing his first 20 lobotomy patients, Freeman called it “epoch-making work.”
In May 1936, Walter Freeman wrote a letter to Egas Moniz: “I enjoyed particularly your recent work on the reduction of psychiatric symptoms following operation of the frontal lobe. And I am going to recommend a trial of this procedure in certain cases that come under my care.” Freeman found out who had made Moniz’s lobotomy knives and ordered two of them. They arrived in July 1936. At the time that Freeman opened the package, hundreds of thousands of patients filled the mental wards of state hospitals across the United States. And the numbers were growing. Something had to be done. Walter Freeman believed he was just the man to do it.
In Moniz’s lobotomies, Freeman saw his chance to finally enter the pantheon of medical practitioners. “I recognized that I had done nothing important in either explaining mental disorder or treating it,” he had written to Moniz. Lobotomies would soon make Walter Freeman one of the best known physicians in the United States and the world. “It has been said that if we don’t think correctly, it is because we haven’t ‘brains enough,’ ” he reasoned. “Maybe it will be shown that a mentally ill patient can think more clearly and more constructively with less brain in actual operation.”
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WALTER FREEMAN’S FIRST PATIENT was Alice Hammatt, a 63-year-old housewife from Emporia, Kansa
s, who complained of “nervousness, insomnia, depression, anxiety, and apprehension” and often “laughed and wept hysterically.” According to Freeman, she was vain, afraid of growing old, overly concerned about her thinning hair, rigid, insecure, emotional, fussy, claustrophobic, suicidal, a “master at bitching,” and so domineering that her husband led “a dog’s life.” Alice’s husband wanted her to have a lobotomy. She didn’t.
On September 14, 1936, Walter Freeman wheeled Alice Hammatt into the operating room. But not before Hammatt had refused to consent to the procedure, concerned that her hair would be cut off. Freeman assured her that her hair would be spared, a clear misrepresentation of what was about to happen. Freeman didn’t do the surgery. Like Moniz, he wasn’t a surgeon; he was a neurologist. He needed to find a neurosurgeon who was willing to do it. He found him in James Watts, a neurosurgeon at George Washington University Hospital who had received his medical training at the University of Virginia Medical School, and his surgical training at Yale, the University of Chicago, and Breslau, Germany (where he had examined Lenin’s brain). Where Freeman was a fast-talking, impatient showman, Watts was slow, gentle, and retiring.
After Alice Hammatt was wheeled into the operating room against her will, Watts shaved her hair, cleaned her scalp with gentian violet, made one-inch-long incisions on both sides of her head, bored holes through her skull with an auger, inserted his lobotomy knife five inches into her brain, and took six cores from each side. The operation took four hours.
Hammatt awoke with a “placid expression,” and by evening, “manifested no anxiety or apprehension.” When asked about her anxieties, she said, “I seem to have forgotten [them]. It doesn’t seem important.” Now, however, Hammatt was doing something she had never done before. Holding a paper handkerchief in her hand, she rhythmically rubbed her face and arms as if drying herself. But, at least according to Freeman, she was active and alert, slept well, had a good appetite, and was reading magazines. “I knew as soon as I operated on a mental patient and cut into a physically normal brain, I’d be considered radical by some people,” said Freeman, who was nevertheless pleased with the outcome. “We were congratulating ourselves on a brilliant result,” he enthused.
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