Out of the 2,000 to 3,000 prefrontal lobotomies performed in the United States since 1936, I have had the opportunity, in the last few years, to come in particularly close contact with one case. From the details of this single case, perhaps, the reader may be able to judge for himself the moral and medical rights and wrongs involved in psychosurgery. But before setting down the events in the life of Larry Cassidy, as I shall call him, I must remind the reader that these things happened, that the incidents here put down are fact, not fiction.
One might say that the real story of Larry Cassidy began in 1943, when, at the age of twenty-nine, he began to have headaches, sudden unaccountable fits of crying, terrible attacks of depression, and a growing inability to work or play. Actually, though, as even the most amateur psychiatrist may guess, and as Larry himself learned quickly enough from professional analysts, it had all begun back in the dim shadow of remembrance that was his childhood.
Larry’s father was a big barrel of a man, a naturalized citizen, well-educated, hot-tempered, given to ranting when angry, and righteousness when controlled. He owned a small, prosperous weekly newspaper in New York City, which adequately provided for his large family. Larry’s mother was a tentative creature, hovering in the background, gentle and cowed, beloved by father and sons alike.
There were five boys. Next to Tim, Larry was the oldest. Of the others, the one who would remain the closest to Larry and play the most important role in the drama that lay ahead was Jack, the youngest, born when Larry was already eleven. From his earliest years, Larry, alone, reacted strangely to his father’s severity and bursts of anger. If one of the boys committed mischief, and the culprit hid behind silence, Larry would usually step forward to take the blame. When he was punished, he took it stoically. The others would let out normal yelps and shed normal tears when spanked. But no one remembered that Larry ever cried.
The boys had one thing in common. They resented their father, each for a different reason, and they all constantly trooped to their mother for consolation and soothing. Each was, in his own way, bright, but Larry was brilliant. By the age of nine, he had devoured most of the classics. On Sundays, when the family sat around and listened to symphonic music, and the boys took turns imitating Toscanini with a ruler for a baton, it was Larry who was the most expert and feverish conductor.
When Larry was thirteen, his father suddenly became blind. The elder autocrat remained fiercely proud. He dressed himself, and shaved himself, and continued to go about his business as if nothing had happened. No one in the family ever dared mention his blindness in front of him.
Shortly after Larry entered high school, at fourteen, he broke out in a rash and became mildly ill. The family doctor said that the boy had been studying too hard, was run down, and just needed a little rest and he would be fine. However, despite his illness, in high school Larry excelled in his studies, played tennis and swam with efficiency, enjoyed watching the New York Yankees, liked to browse through the Museum of Modern Art, or attend an occasional movie recommended by The New Yorker magazine. He seldom dated. And when he accompanied his brothers and friends to a dance or a bar, or around town to raise hell in general, he was always with the group but not a part of it. Occasionally, he forced himself to participate. But he preferred to observe.
Larry wanted to become a college professor, since he thought he could do well in this field. (His father objected, saying that there wasn’t any money in it, and he expected Larry to begin taking over the weekly paper when he finished school.) At the time he entered Princeton, in 1932, at the age of eighteen, Larry was a shy-mannered, pleasant-looking young man of middle height. He was gentle, kind, unselfish, given to introspection and to never expressing an opinion until he had read all sides of a subject, and even then he would usually say that he was not sure what he thought. He roomed with a clever, more energetic young man named Burt, the son of a wealthy New York magazine publisher, who became his best friend and remains his best friend today.
During his freshman year, Larry wrote a letter home, the first of many to follow, on the uselessness of life. The family did not take it seriously. “That Princeton punk,” a relative said with amusement, “he’s just found Schopenhauer.” But Jack, the youngest brother, still remembers the impact of the letter on his own immature mind. “It was brilliantly written, terribly logical, and at the time seemed practically unanswerable.”
Larry majored in English. He planned to become a professor, even though his father continued to regard this as an impractical whim and still expected him to take over the weekly paper. Except for playing tennis and golf, Larry buried himself in books and avoided campus social life. His I.Q. was over 150, in the “near genius” category, as compared to the more common I.Q. of between 85 and 114 possessed by 66 percent of the population. An essay he wrote won him a $300 university prize. He became a Phi Beta Kappa, and when he graduated from Princeton in 1936, was among the top ten in his class. He was the only member of his class who did not bother to show up for the commencement exercises.
After Princeton, despite the elder Cassidy’s insistence about the family newspaper, Larry took a job with Burt writing detective stories and movie features for the pulp magazines published by his roommate’s father. The work soon bored him, and he quit. He obtained a job in the New York World-Telegram advertising department, but this bored him even more, and he quit again. Finally, he went to work on his father’s weekly newspaper. He kept irregular hours. Usually he went to the office at ten in the morning, and called it a day at noon. He had no patience with the work, even though what he did he did well. After the two hours in the office, he spent the afternoon home reading. He rarely left the house. By eight in the evening, he was in bed.
This was 1939. And during that year Larry’s mother suddenly died. It was a crushing blow, not only to Larry but to his father and brothers. His father had loved his wife deeply. And for the boys, it seemed the one light in the house had gone out. For a full year after her death, the six men, blind father and five sons, met at the dinner table and exchanged hardly a word. The only smiling face in the house, during that period, was Harriet’s. She was the housekeeper, a rather plain, simple girl, in her middle twenties, who had never gone beyond the fourth grade in school and who had come to New York from a small Ohio farming town located near Dayton. She was given to easy laughter and quick enthusiasms. She worshiped Larry.
About a year after their mother’s death, the boys left home to go their separate ways. Larry and his youngest brother. Jack, stayed on with their father several months.
Larry was increasingly erratic about performing his job on the weekly newspaper. He spent more and more time alone at home with his books, skimming three or four a day, and he became more and more morose. He began suffering attacks of nausea. He could not hold food in his stomach. For a period after each meal, he would regurgitate.
Presently, almost naturally, the threesome broke up. Jack was placed in a boarding school. Larry, accompanied by Harriet who insisted upon nursing him, went to Albuquerque to join his older brother. Larry still thought that he might become a schoolteacher. Meanwhile, the elder Cassidy had given up the old family house and moved to a hotel. There, though blind, he lived in brooding silence, stubbornly taking care of himself and his room. Daily, he made his way to the hotel restaurant by himself, always on time, always taking the same place at the same table.
In Albuquerque, despite the devotion of his brother, Tim, and Harriet, Larry became more and more ill. He continued to vomit after meals. He became gloomier. He suffered a multitude of aches and pains. But he steadfastly ignored suggestions that he visit a psychiatrist. Although advanced in many subjects, Larry was backward in this one. He stubbornly insisted that the causes of his condition were physical, not mental—and he obstinately believed that psychiatry, still a world war away from being fully popularized, was for the idle rich and the near insane.
With the Japanese attack on Pearl Harbor, Tim enlisted in the army. On impulse,
Larry tried to enlist with him. He was rejected because of high blood pressure. Left alone with Harriet, Larry was now more nervous than ever. Gradually, watching Harriet, fascinated by her good humor and tenderness, he got the notion that he wanted to marry her. In the years when she had been the family servant, he had hardly noticed her. All the brothers, Larry included, had playfully taken her to ball games and movies. In the previous weeks in New Mexico, even though they were close and he was dependent on her cheer, Larry had never suggested that their relationship be anything more than friendly. In fact, he had never once formally dated her. Abruptly, he proposed marriage. And she, long secretly in love with him, accepted. They were married by a justice of the peace early in 1942.
Harriet was good for Larry’s frame of mind, but not good enough. Her zest for living, her animal spirits, her constant curiosity, stimulated him briefly. But presently the vomiting and depression returned. Finally, one morning, short weeks later, he emerged from the bathroom, razor in hand. “I’m going to kill myself,” he said. She hurried him to a doctor, a nearby general practitioner. The doctor diagnosed a few physical ills, a bad case of hypertension, and prescribed regular shots and a long rest.
In July, 1942, Larry was notified by his draft board to report for an army physical. When he appeared, he was in much worse shape than when he had been rejected a half year earlier. But if he was in worse shape, so was the army. The doctors ignored his condition and passed him.
Larry was in the United States Army almost six months. He did not see one day of active military service. During his first morning, after induction at Fort Bliss, Texas, he suddenly broke down, falling into a fit of uncontrollable crying. He was promptly transferred to a Texas army hospital, and placed in a ward with violent mental cases. Today, his family feels that if it was a single experience that was responsible for shoving Larry over the line, this confinement in the mental ward of an army hospital might be regarded as that experience.
Harriet, who kept up their apartment in Albuquerque and worked in a five-and-ten-cent store, visited Larry as regularly as possible. He complained to her constantly of the insensitivity of certain officers and army nurses. Once, he came up for discharge. But someone noticed his I.Q., the highest in the hospital, and he was turned down. An officer remarked, and the remark was passed along to Larry, “His I.Q. is too damn high. He’s officer material.” In desperation, Larry secretly stored his barbiturates. He decided, if he were not discharged soon, he would commit suicide. In December, 1942, he was discharged.
Larry returned to Albuquerque and Harriet. The army had given him some mild drugs to relieve his pains. He took these, then resumed taking shots from the young doctor he’d been seeing before he had been drafted into the army. He spent his days reading and working crossword puzzles. A few weeks later, he received word that his father, aged sixty-three, had died on New Year’s Day in a violent accident precipitated by his blindness. The father, who had dominated him all his life, was gone. At last, Larry was free. But it was too late. When Larry received the news, he hardly blinked. He simply returned to his crossword puzzles.
Now, Larry became dangerously ill. Each morning was a calvary. He could hardly get out of bed to face the day. Once out of bed, he feared each thought, each pressing moment. “Days torture me,” he told Harriet. “Thoughts come. I can’t blot them out.” He continued to weep irrationally. He constantly wanted to scream. His body perspired and his palms were always wet. He changed shirts as often as six times a day. In desperation, Harriet sent for his younger brother, Jack.
With Jack’s arrival, there began a running battle with time. Each day had to be made to pass swiftly. Jack encouraged Larry to stay up late, reading. This was easy, since Larry dreaded sleep. Larry would read until three in the morning, then sleep until one the next afternoon. In the afternoons, Larry, avoiding any volumes that might provoke introspection, would rent three or four mystery books from a nearby library, and read them through the rest of the day and night. Before he left Albuquerque, he had read the entire wall of mysteries in that library. He saw every new movie that opened, played golf daily, until he could chip a ball into a tin can at thirty feet.
Meanwhile, the young doctor, who had been giving him shots and pep talks, finally realized the source of his ills. Larry had been begging the doctor for drugs. “Give me anything to stop the pain,” he pleaded. “Give me morphine, heroin, opium, anything. I just want five years of peace, and then death.” Finally, the doctor told him, “Larry, your pain may not be from physical causes at all. Either try shock treatments, or try psychoanalysis. Matter of fact, there’s a great psychiatrist right here in Albuquerque.”
Larry went to the great psychiatrist. As a result, he was on the couch three or four times a week for eight months. The first day was the worst. After an hour with the analyst, Larry returned to the apartment to meet Jack. He walked into the apartment unsteadily, face white, and suddenly broke into racking sobs. Jack rushed to him, alarmed. “What’s happened, Larry?” Larry pulled a sheet of paper out of his pocket and handed it to his brother. Jack remembers it was a crude sketch of two telephone switchboards. One switchboard had the circuits properly plugged in, the other had its cords all tangled. The psychiatrist had explained to Larry that the human mind was like the first telephone switchboard, with the plugs ordinarily all neatly in place. But in Larry’s mind, the cords had gotten badly mixed up and needed straightening out. “From that day on,” Jack remembers, “he began to understand, for the first time, that his sufferings were not physical but mental. He began to look upon himself as a hopeless mental case. He became obsessed by this and seemed to deteriorate steadily.”
During this time, there was only one bright period. That was during the seventh month of his analysis. And it had nothing to do with his treatments. Harriet became ill with flu, and was put to bed for two weeks. Larry attended her hand and foot. He appeared happier than he had been in years.
Shortly after Harriet recovered, and returned to her dime store job. Jack left to join the Air Transport Command in California. Larry quickly lapsed into his old black rut. Meanwhile, the psychiatrist was making a little progress. It was established that Larry was suffering from a manic-depressive psychosis, with overtones of anxiety. He was being suffocated by melancholia. The root of this, most likely, was father domination. Too, he had a strong Oedipus complex, as evidenced by his marriage to Harriet, who was older than he and in whom he saw his adored mother.
The psychiatrist knew what was wrong with Larry, and how his psychosis was being evidenced, but was extremely doubtful whether analysis could lead him back toward normality. It was one afternoon, in the latter stages of treatment, that the psychiatrist mentioned a new operation known as prefrontal lobotomy. Had Larry ever heard of it? He had not.
But soon, reading voraciously, Larry knew a great deal about it. He learned that, before 1935, medical men understood little of the function of the frontal lobes in the human brain, though they realized that whenever these lobes were damaged or removed in tumor operations, the mental makeup of the patient changed. A celebrated case, concerning a middle-aged member of the New York Stock Exchange, had been reported on by Dr. Richard M. Brickner, a New York neuropsychiatrist. In this case, while removing the patient’s brain tumor, both frontal lobes, a quarter of a pound of tissue, had been cut away. Recovering, the patient underwent a complete personality change. Though his intelligence was unimpaired, he lost his ability to reason as logically as before, lost his feelings of self-consciousness, became an abnormal braggart and became indifferent to his earlier illness and to worries in general.
Meanwhile, in 1935, a group of Yale research scientists, headed by Dr. Carlyle F. Jacobsen and Dr. John F. Fulton, had given a chimpanzee a series of tests, before and after removing its frontal lobes, with significant results. According to one medical report of this experiment, “Before operation, if the animal made a few mistakes, he would scream with rage, urinate and defecate in the cage, roll in the feces, shak
e the bars and refuse to continue the experiments. After the operation, the same animal would continue in the experimental situation long beyond the patience of the examiner, making mistake after mistake, without the least indication of being upset emotionally.”
In 1936, a distinguished Portuguese neurologist, sixty-one-year-old Dr. Egas Moniz, appeared in Paris to report to the Academy of Medicine that he had devised an operation to help psychotic patients, an operation called prefrontal leucotomy or lobotomy. Dr. Moniz, a professor at Lisbon University, the author of three hundred medical papers, and onetime Foreign Minister of Portugal, working with an associate, Almeida Lima, had bored buttonlike holes in the foreheads of his patients, inserted a slender, needle-thin scalpel, and cut through brain tissue and nerve fibers connecting the frontal lobes with other parts of the brain. He had found this technique fairly successful in paranoia or persecution mania cases and in schizophrenia or split personality cases. He had found that while the operation seemed to cut away the patient’s ability to imagine and anticipate, it also cut away his cares and anxieties. In 1936, Dr. Walter Freeman and Dr. James W. Watts, of George Washington University, Washington, D.C., began performing Dr. Moniz’s prefrontal lobotomy in the United States, and by the end of the year had performed twenty such operations. On learning that Drs. Freeman and Watts were the foremost lobotomy specialists in the United States, Larry tried to read all he could about them and their cases. In the Albuquerque library, he located an issue of Time magazine, published late the year before, that had the most recent report on the team of psychosurgeons. “Of their 136 cases,” he read, “Drs. Freeman and Watts regarded 98 as greatly improved, 23 as somewhat improved, 12 as failures. Only 13 patients are still in mental hospitals; most are back to their jobs or housekeeping after one to six years of psychotic incapacity.”
The Sunday Gentleman Page 19