Six days after the operation, Alice Hammatt became disoriented, began stuttering, misspelled words, couldn’t write legibly or carry on a conversation, and continued with her odd rubbing movements. But she was placid, slept without medication, and lived without a nurse’s care. And although her husband and her housekeeper now did most of the work—and although Hammatt was embarrassingly outspoken with friends—her anxieties were gone. Alice Hammatt died five years later of pneumonia. Her husband called her remaining years “the happiest of her life.”
Seventeen days after the surgery, Freeman reported the case of Alice Hammatt to the Medical Society of the District of Columbia. “The woman went back home in ten days and is cured,” he said. The word “cured” didn’t sit well with the audience. Dr. Dexter Bullard, a psychiatrist and superintendent of a private psychiatric hospital in Rockville, Maryland, rose to object. “Walter, you can’t say that!” he screamed. Others in the audience nodded in agreement; some shouted their disapproval. A few months after the surgery, Alice Hammatt had a prolonged seizure during which she fell and broke her wrist.
Freeman and Watts published the results of Hammatt’s operation in the Southern Medical Journal. Titled “Prefrontal Lobotomy in Agitated Depression: Report of a Case,” it was the first time the word “lobotomy” had appeared in print. (Moniz and Lima had always used the term “leucotomy.”)
In anticipation of the upcoming Southern Medical Association’s meeting in Baltimore, Freeman and Watts rushed to perform five more lobotomies. It would be Freeman’s second chance to show his American colleagues just how remarkable lobotomies could be. This time, however, Freeman wanted to ensure a better reception. So he called a Washington Star reporter named Thomas Henry and offered him an exclusive interview. Days before the meeting, a glowing report of Freeman’s work appeared in the Star. Henry wrote that lobotomies “probably constitute one of the greatest surgical innovations of this generation…It seems unbelievable that uncontrollable sorrow could be changed into normal resignation with an auger and a knife.” Before he had even presented his findings, Walter Freeman, at least according to the press, was a hero. “As expected, there was considerable journalistic interest when I arrived in Baltimore,” Freeman crowed.
On November 18, 1936, Walter Freeman stood before a group of stunned neurologists and psychiatrists and described the results of his procedure. He explained that all six of his lobotomy patients had improved. No longer did they suffer from disorientation, phobias, confusion, hallucinations, and delusions. And their worry, apprehension, anxiety, sleeplessness, and nervous tension had disappeared. Patients were now calm, content, and much easier to manage. “We are able to say that no patient has died and none has been made worse,” said Freeman. “All of our patients have returned home and some of them are no longer in need of nursing care.”
Spafford Ackerly of Kentucky rose in support of Freeman’s findings. “This is a startling paper,” he said. “I believe it will go down in medical history as a noted example of therapeutic courage.” But, as had happened when he first presented the case of Alice Hammatt in Washington, D.C., not everyone at the Baltimore meeting was supportive. Joseph Wortis, a Manhattan psychiatrist, argued that lobotomies had merely shocked patients into some degree of normalcy. “I have seen patients get better after a broken leg,” said Wortis. Then, Adolf Meyer, the dean of American psychiatry and professor of neurology at the prestigious Johns Hopkins Hospital, rose to speak. “I am not antagonistic of this work, but find it interesting,” he said. “There are more possibilities in this operation than appear on the surface.” Given his influence, had Meyer been critical, the number of lobotomies performed in the United States might have ended at six. But Meyer had demurred. Encouraged, Freeman and Watts dove back into their work, intent on performing 20 lobotomies by the end of 1936. They wanted more cases to present at a pivotal meeting coming up in Chicago. Adolf Meyer might have felt differently about lobotomies if Walter Freeman had been honest about the outcome of his first six patients. The fifth patient, who had clearly suffered severe, permanent brain damage following inadvertent severing of a cerebral artery, was epileptic and incontinent for the rest of her life.
In February 1937, Walter Freeman stood before hundreds of colleagues at a meeting of the Chicago Neurological Society. It would be his biggest test to date. Freeman and Watts had operated on 20 patients in a period of three months; almost all were women. Freeman remained upbeat, stating that his patients’ memories, concentration, judgment, and insight had remained intact and that their ability to enjoy their lives had improved after lobotomies. The only negative, he argued, was that “every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality.” Although Freeman had faced opposition to his procedure in Washington and Baltimore, it was nothing compared to what he was about to encounter in Chicago.
Several doctors argued that the procedure, because it involved blindly removing cores from the brain, was bound to injure cerebral vessels. (In truth, it already had.) Another said that Freeman and Watts couldn’t draw any conclusions from their patients because anxiety states could wax and wane; also, patients had been examined for only a short period of time. Another wondered what was to become of the musician or artist whose frontal lobes were mutilated. Others argued that the procedure had no “anatomical basis” and was justified by “loose reasoning.” Yet another argued the procedure was “immoral.” Freeman countered that “a brain can stand a good deal of manhandling,” and that “most of the damage is reversible.” Nonetheless, Walter Freeman had been shaken by the criticism; he decided to cancel his next public appearance in St. Louis. “I almost bit the stem of my pipe off trying to regain control of myself,” he recalled.
As had been the case with his presentations in Baltimore and Washington, Freeman hadn’t been completely honest during the Chicago meeting. Eight of his original 20 patients had relapsed, requiring repeat lobotomies. Freeman and Watts had been so disappointed with the early outcomes that they’d increased the number of frontal lobe cores from six to nine and drilled deeper into the brain to get them. Two patients had died from cerebral hemorrhages due to the deeper drilling, and another died soon after the surgery from a heart attack. A fourth, who had been a secretary for 13 years, slid into a dysfunctional state and never recovered, spending the rest of her life in a mental facility. Several patients had residual seizure disorders, and some had difficulty moving their arms and legs. William White, the head of St. Elizabeth’s Hospital, who was probably best informed about the early lobotomies, refused to allow them to be performed on anyone in his hospital. Like the Portuguese psychiatrists, White had been horrified by what he had seen.
Not all physicians were against lobotomies. The New England Journal of Medicine, the nation’s foremost clinical journal, wrote that lobotomies were a “rational procedure.” And the New York Times wrote that the “new operation marked a turning point in treating mental cases.” Indeed, on June 7, 1937, a front-page article in the New York Times declared—in what read like an advertisement for a patent medicine—that lobotomies could relieve “tension, apprehension, anxiety, depression, insomnia, suicidal ideas, delusions, hallucinations, crying spells, melancholia, obsessions, panic states, disorientation, psychalgia (pain of psychic origin), nervous indigestion, and hysterical paralysis,” and that the operation “transforms wild animals into gentle creatures in the course of a few hours.”
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DESPITE THE TORRENT OF CRITICISM at the Chicago meeting, Walter Freeman and James Watts didn’t stay down for long. With Time, Newsweek, the New York Times, and the New England Journal of Medicine on their side, they were back in business, speaking at scientific and medical meetings in New Haven, Boston, New York, Philadelphia, and Memphis, as well as at the prestigious annual meeting of the American Medical Association in Atlantic City. They received hundreds of letters from people across the country begging them to treat mental illness as well as a variety of other
medical disorders. One writer asked Freeman to cut out the part of his brain that caused asthma. During the next four decades, more than 20,000 lobotomies would be performed in the United States. Walter Freeman would be personally responsible for almost 4,000 of them.
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TODAY WE VIEW LOBOTOMIES AS cruel, freakish, and comical. They’re a drink (the “Frontal Lobotomy” is made with amaretto, Chambord, and pineapple juice), a saying (Tom Waits’s, “I’d rather have a bottle in front of me than a frontal lobotomy”), and a slogan (during the Iraq War, protesters wore T-shirts with a picture of George W. Bush above the words, “Ask me about my lobotomy”). Lobotomies now share a shelf in the dusty cabinet of medical sideshows next to whips, chains, snake pits, truth serums, phrenology machines, and trephining, the ancient ritual of drilling holes in the brain to loose the evil spirits. So why were lobotomies so readily accepted, indeed sought after, in the late 1930s through the early 1970s? Three reasons.
First, psychiatrists, families, and patients were desperate to do something, anything to treat untreatable mental disorders, most commonly schizophrenia. And there weren’t any other good options.
Second, state mental hospitals were bursting at the seams. The number of patients rose from 159,000 in 1909 to 480,000 in 1940, a rate twice the growth rate of the general population. Indeed, in the 1940s and 1950s, as many people were hospitalized with mental disorders in the United States as for all other diseases combined. Lobotomies provided a seductive way out of an unmanageable situation.
Third, conditions in state hospitals were hideous. In May 1946, an article written in Life magazine titled “Bedlam 1946” described just how badly things had deteriorated. Patients were beaten, abandoned, provided little clothing, put in dark, damp, padded dungeons, restrained in straitjackets for weeks, and forced to lie in their own excrement. Facilities resembled “concentration camps on the Belsen pattern.” The staff—which was often composed of uneducated transients who were plucked from local jails—raped, sodomized, and occasionally murdered patients. And physicians were nowhere to be found; the ratio of patients to physicians was 250 to 1.
Another reason that lobotomies were not only accepted but embraced can be found in a comment made by Joseph Wortis, the Manhattan psychiatrist who had argued during the Baltimore meeting that Freeman’s lobotomies had merely “shocked” patients into normalcy. In 1940s America, the key to many psychiatric therapies was to shock patients out of their illnesses. Lobotomies weren’t much worse than what psychiatrists had already been doing.
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IT STARTED IN THE MIDDLE AGES. To shock patients with mental illness, physicians either nearly drowned them or forced them to walk down a dark hallway at the end of which was a snake pit. In the early 20th century, four other therapies were based on the same concept, all of which were, according to one observer, “like trying to fix a watch with a hammer.”
In 1917, Julius Wagner von Jauregg invented malaria therapy. Von Jauregg found that patients suffering from paralysis and mental illness caused by syphilis could be treated by injecting them with blood from patients with malaria. The goal was to induce fevers as high as 106°F, which were felt to be curative. For his discovery, von Jauregg won the Nobel Prize in medicine in 1927. It was the first Nobel Prize ever awarded for a psychiatric therapy. Egas Moniz, for his invention of lobotomies, won the second. At this point, it seems reasonable to wonder whether Nobel Prizes awarded in the first half of the 20th century came in Cracker Jack boxes. But the truth is that von Jauregg’s malaria therapy really did work on patients suffering from syphilis, which is caused by a spirochete. As it turns out, spirochetes are sensitive to high temperatures. After patients improved, they were given quinine to end the malaria infection. The problem with malaria therapy was that it was also used for many other psychiatric illnesses, for which it offered nothing. (Remarkably, malaria therapy isn’t dead. Believing that they are suffering from “chronic Lyme disease,” some Americans still travel to Mexico to get injected with malaria parasites.)
In 1930, Manfred Sakel invented insulin shock therapy. Sakel, who worked in Vienna, had accidentally given too much insulin to a morphine addict and found that the mistake cured the addiction. He then tried insulin therapy on 15 more patients, all, according to him, with the same result. Then he tried his therapy on people with schizophrenia, claiming an 88 percent cure rate. Following Sakel’s lead, patients in the United States were given larger and larger doses of insulin until their blood sugars were so low that they slipped into a coma. Clinicians would then administer varying amounts of glucose by nasogastric tube, hoping to maintain the coma without killing the patient. Typically, patients were in a coma for one to two months. Many died.
In 1935, Ladislas Joseph Meduna, a Hungarian researcher, invented Metrazol shock therapy. Metrazol caused seizures, and Meduna believed that seizures could treat schizophrenia. He claimed that after treating a patient with catatonic schizophrenia who had been lying in bed for four years, the man got up, dressed himself, put on his hat, and walked out of the hospital. Meduna treated ten more patients, supposedly with the same result.
In 1938, Ugo Cerletti, working in Italy, invented the shock therapy to end all shock therapies: electroshock. Cerletti first tried his therapy on a man with schizophrenia who had been wandering around a police station. He attached electrodes to each side of the man’s head and flipped the switch. The man stopped breathing, turned blue, suffered a seemingly endless stream of seizures, and recovered. Cerletti insisted that from that point on, the man acted normally. Electroshock therapy was the easiest and most commonly used of the shock therapies.
By 1942, at least 75,000 psychiatric patients, mostly with schizophrenia, had received some form of shock therapy. Today, electroshock, which is used for patients with severe depression, is the only one that has survived. When lobotomies were first introduced in the United States, they were competing with what one psychiatrist called “the therapies of despair.”
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BETWEEN 1936—when Walter Freeman and James Watts performed their first lobotomy—and 1942, about 300 lobotomies were performed in the United States. In 1943, another 300 were performed; by 1947, another thousand; in 1948, another 2,000; and in 1949, another 5,000. By August 1949, more than 10,000 lobotomies had been performed. About 60 percent were performed in state mental hospitals, mostly on women, even though fewer women were housed in state institutions than men. By the end of 1951, Freeman and Watts and their trainees had performed more than 18,000 lobotomies. People were lining up to get them. Middle-aged women wanted lobotomies to cure their depression; college students wanted them to cure their neuroses; and parents wanted them to cure their misbehaving children.
Although lobotomies had become enormously popular, the reason that the number increased so quickly and so dramatically was that Walter Freeman had changed the way that he did them—creating what could reasonably have been called the “drive-through lobotomy.”
In January 1946, Freeman performed a lobotomy on Sallie Ionesco. This time, however, James Watts didn’t do the surgery; Freeman did. Freeman didn’t do it in an operating room; he did it in his office. He didn’t sterilize his instruments or sterilize the operative site. He didn’t use general anesthesia; rather, he used electroshock to anesthetize the patient (even though electroshock caused unconsciousness for only a few minutes). And he didn’t use a scalpel to cut open the skin at the side of the skull or an auger to bore holes; he used an ice pick bearing the label “Uline Ice Company” that he had taken from his kitchen drawer. Freeman inserted the ice pick into the bone on the upper and inner aspect of Sallie Ionesco’s eye socket, drove it about three inches into her brain with a small hammer, and wiggled it around. Then he repeated the procedure on the other eye socket. Freeman’s new ice pick lobotomy didn’t take four hours; it took seven minutes. And, at least according to Freeman, anyone could do it—even if they hadn’t received any formal surgical training. James Watts knew nothing about this. When he walk
ed into Walter Freeman’s office and saw an ice pick sticking out of Sallie Ionesco’s face, he was appalled. Watts believed that any procedure that required disruption of brain tissue should be performed in an operating theater where the brain could be visualized. Otherwise, the lobotomist increased the chances of accidentally tearing a cerebral artery, causing fatal hemorrhage. Watts and Freeman never worked together again.
With his new ice pick method, Walter Freeman moved lobotomies into the express lane of quick-fix cures. He hopped in his car—ice picks in his jacket pocket—and sped around the country demonstrating his procedure to anyone who would listen. He visited state mental hospitals in California, Texas, Arkansas, Minnesota, Ohio, New York, Washington, Missouri, and Maryland, logging more than 86,000 miles. (He called his car the “Lobotomobile.”) At the Weston State Hospital in West Virginia, Freeman operated on 228 patients in 12 days; performing 22 operations in 135 minutes—an average of 6 minutes per patient. When he was finished, Freeman had visited 55 hospitals in 23 states as well as psychiatric institutions in Canada, the Caribbean, and South America. His daughter called him “The Henry Ford of Psychiatry.”
Ever the showman, Freeman became so comfortable with the procedure that he could disrupt the frontal lobes behind each eye at the same time. A nursing student named Patricia Derian witnessed Freeman conducting one such operation in 1948. “He looked up at us, smiling,” she recalled. “I thought I was seeing a circus act. He moved both hands back and forth in unison, cutting the brain identically behind each eye. It astonished me that he was so gay, so high, so ‘up.’ ” (Today, radiologists reading MRIs and CT scans are occasionally surprised to find the characteristic tracts of disrupted brain in patients who had previously been subjected to Walter Freeman’s ice pick lobotomies.)
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