Many in the medical community weren’t convinced that Freeman and Watt were on the right track. When Freeman asked William White, superintendent at Washington’s St. Elizabeth’s Hospital, for permission to conduct lobotomies there, he was told, “It will be a hell of a long time before I let you operate on any of my patients.”
White had several objections. One of them, he said, was that mental patients often were not competent to agree to the surgery. They didn’t understand what they were agreeing to. And the relatives who could agree to the surgery on their behalf didn’t always have the patients’ best interests at heart. “These sick people cause them a lot of trouble,” White told Freeman. “In the back of their heads…relatives not infrequently desire the death of patients in hospitals.”
Another colleague protested, when Freeman presented a paper on his first surgeries, “This is not an operation but a mutilation.” He pointed out that many of the great men and women of history had suffered from depression, but still made enormous contributions to science and the arts. He asked Freeman, “What will be left of the musician or the artist when the frontal lobe is mutilated?”
Freeman got a mixed reaction from the medical community, but he always impressed the media. He was a real showman, and he courted the press. He often called reporters a day or two before he was going to make a presentation at a medical convention and asked them, “Do you want to see history made?” His partner, Watt, complained that Freeman was “like a barker at a carnival.” On the medical convention floor, Freeman would set up a booth and use a clicker to attract a crowd. Then he’d begin talking about the lobotomy like it was some snappy new kitchen appliance.
He even had reporters attend lobotomies, and showed off for them while conducting the surgeries. One time, to demonstrate the simplicity of the procedure, he replaced the standard operating-room hammer with a wooden carpenter’s mallet. Sometimes he performed a simultaneous two-handed lobotomy, severing both lobes at the same time with a flourish—just like he had impressed his students by using two hands to write on the board at the same time.
The news coverage was universally positive. Freeman’s lobotomy was celebrated with headlines like PSYCHOSURGERY CURED ME, WIZARDRY OF SURGERY RESTORES SANITY TO FIFTY RAVING MANIACS, and NO WORSE THAN REMOVING A TOOTH.
This wasn’t the tabloids. The New York Times ran a story applauding Freeman’s success rate, which their reporter put at 65 percent, under the headline FIND NEW SURGERY AIDS MENTAL CASES.
Freeman’s lobotomy might have gotten popular without the support of the press. America’s hospitals were flooded with mental patients. By the late 1940s, there were more than a million mental cases in hospitals or asylums. More than 55 percent of all patients in American hospitals were mental cases. One study reported that the population of mental patients in American hospitals was growing by 80 percent a year.
There was no real treatment for these people. They were often drugged, shackled, kept in straitjackets, or locked in rubber rooms. Doctors were able to keep them from harming themselves or others, but they had a cure rate of about zero.
Besides, keeping them in hospitals was expensive. Freeman offered a solution. His motto was “Lobotomy gets them home!” Directors of mental institutions heard that loud and clear. One of Freeman’s colleagues said that a procedure that would send 10 percent of mental patients home would save the American taxpayer $1 million a day. Freeman claimed a success rate well above 10 percent. Most hospitals and institutions welcomed him and his lobotomy.
Freeman was sort of like the Henry Ford of psychosurgery. He didn’t invent the procedure, but he turned it into an assembly-line process, streamlining it so it could be done more efficiently, more cheaply, more quickly, and on more patients.
By the early 1940s Freeman was a successful doctor. He was famous. He had married and produced a big family. He and his wife, Marjorie, had six children, one girl and five boys. Freeman liked family vacations. Every summer he’d take his family on long drives to lakes and rivers for hikes or camping expeditions. He might have just enjoyed life and coasted on his reputation as the American father of the prefrontal lobotomy. But he was ambitious.
In the early 1940s Freeman heard about an Italian surgeon who was trying to refine the prefrontal lobotomy by entering the brain without drilling or cutting the skull, through the thin bone at the back of the eye socket—known as the orbit. Freeman read up on this procedure, and in early 1946 conducted America’s first transorbital lobotomy. He used an ice pick on his first patient. (He saved the ice pick. It’s in Washington, D.C., with his archives. It says “Uline Ice Company” on the handle.)
The patient’s name was Sally Ellen Ionesco. She was twenty-nine, and she had suffered years of depression and manic behavior. She sometimes became violent with her young daughter, or with herself, and had tried to jump out a window.
Freeman went into her brain through the eye socket on one side, and had her come back a week later to do the other side.
The surgery was apparently successful. After a rough period of adjustment, the patient found that her violent outbursts were gone. “It was like, ‘Thank God, it’s over,’” her daughter later told Freeman’s biographer. “There was peace.” Although she required a private nurse for a while, Sally Ellen Ionesco gradually became well enough to take care of her daughter, to help her husband in the family business, and later to be licensed as a practical nurse and get work as a nanny.
To Freeman, the new transorbital technique represented an incredible improvement. Without cutting and drilling, lobotomies could be done in doctors’ offices. There would be no surgeon, no anesthesiologist, no hospital stay, and almost no recovery time. Freeman thought he could send his patients home an hour after the procedure.
He began doing lobotomies in his office. He stretched the patients out on a table, knocked them out using electroshock, punctured the skull using his Uline ice pick, and swung the ice pick back and forth across their frontal lobes. He waited for the bleeding to stop, then sent the patient home, sometimes in a taxi cab.
When nothing went wrong, the patients were left with no visible damage except for a pair of very blackened eyes. Freeman was funny about this—in an insensitive way. He said, “I usually asked the family to provide the patient with sunglasses rather than explanations.”
But things did go wrong. The fourth transorbital patient hemorrhaged during the procedure. Freeman couldn’t stop the bleeding. The patient was rushed to a hospital and saved, but suffered from epileptic fits for the rest of his life, which he spent selling newspapers on a street corner.
On another occasion, Freeman stopped mid-surgery to set up the camera and document the procedure. For some reason the ice pick began to slide down into the patient’s brain. He died without ever regaining consciousness.
James Watt refused to assist with the transorbital procedure, which he said was unprofessional and unsafe. Other colleagues agreed. A hospital medical director, one of Freeman’s earlier supporters, wrote to him and said, “What are these terrible things I hear about you doing lobotomies in your office with an ice pick? Why not use a shotgun? It would be quicker!”
Freeman was not bothered by these reactions. He was sure he had found a fast, cheap, and effective way to treat hopeless mental patients. To prove it, he began touring the country and visiting mental institutions. He would perform transorbital lobotomies and, in the process, teach the resident psychiatrists how to do the operation themselves.
He worked hard at it, and he did it practically for free. He charged large institutions twenty-five dollars a patient to perform the lobotomy at a time when, as a private physician, he could have charged thousands. In one year he visited hospitals in seventeen states, and also made presentations in Canada, Puerto Rico, and South America. On one five-week driving tour of America, he visited eight states and performed 111 lobotomies.
He made these tours driving a specially outfitted car that he called “The Lobotomobile.” The first one was a cu
stom-fitted Lincoln Continental. Later he would drive a van. Whatever the model was, he carried in it photographic equipment, to make records of the surgeries and the patients, a card catalog of patients’ records, a portable electroshock machine, a Dictaphone for taking notes while he drove, and his surgical instruments.
One summer he logged 11,000 miles in his Lobotomobile. He kept a diary of his work. The entries alone make you tired.
29 June, Little Rock, Arkansas, 4 patients
30 June, Rusk, Texas, 10 patients
1 July, Terrell, Texas, 7 patients
2 July, Wichita Falls, Texas, 3 patients
9 July, Patton, California, 5 patients
14 July, Berkeley, California, 3 patients
State hospitals tended to be more willing to try the treatment than private ones, because state hospitals were overcrowded and underfunded and would do almost anything to send a few patients home. The Stockton State Hospital in California had more than 4,000 patients when it started doing lobotomies, and between 1947 and 1954 did 232 of them. Most of the lobotomy patients were women. The author Joel Braslow, in his book Mental Ills and Bodily Cures, said almost the same number of patients died from the operation as were sent home by it—21 percent were killed, and 23 percent were cured.
Freeman was ready to do the surgery whenever, wherever. One of his surgical assistants—Jonathan Williams, who replaced James Watt after Watt refused to go along with Freeman’s plan to do lobotomies in his office, without a surgeon present—later told a story about a patient who had been brought to Freeman for a lobotomy. The day before the surgery, though, he’d gotten cold feet and refused to go through with the operation. He locked himself in his hotel room. Freeman, contacted by the patient’s family, drove to the hotel and convinced the patient to let him in. Using a portable electroshock machine he had designed and built for himself, he administered a few volts to the patient to calm him down. According to Williams, “The patient was…held down on the floor while Freeman administered the shock. It then occurred to him that since the patient was already unconscious, and he had a set of leucotomes in his pocket, he might as well do the transorbital lobotomy then and there, which he did.”
Williams said that, over time, the portable electroshock device began to fall apart. First the dial for setting the voltage broke. Then the timer broke. In the end, Freeman would simply connect the patient to the machine, plug it in, and flip the switch—relying on his own instincts to guess how much juice was going into the patient, and how long to leave it running.
There’s all kinds of evidence that Freeman did not have much patience for standard medical practice, and that he preferred to get right to work without taking the ordinary precautions. Sometimes this resulted in Freeman breaking off the ends of the leucotomes while they were still in the patient’s skull. On more than one occasion, Williams had to open the skull the old-fashioned way and surgically remove two or three inches of broken-off steel from behind the eye sockets, cleaning up after Freeman had made a mess.
Williams said that Freeman hated wasting time on creating a sterile environment for the surgery. He wasn’t worried about what he called “all that germ crap,” Williams said. “I often had to assert myself, insisting, ‘Walter, at least let me drape the patient.’”
Freeman’s cross-country campaigns spread the lobotomy far and wide, and fast. Dozens of doctors trained by Freeman began performing their own surgeries. There are no official numbers on this, but some estimates say Freeman did more than 5,000 lobotomies in his career. People taught by him may have done 40,000 more.
Freeman’s lobotomy began falling out of favor. By the early 1950s it was still a common surgery, but its long-term benefits were beginning to be questionable. Then, in 1954, the Food and Drug Administration approved use of the chemical compound chlorpromazine, which was sold under the name Thorazine. Freeman dismissed it as “chemical lobotomy,” and thought it was inefficient. The patient would have to continue taking the drug forever, while the lobotomy required one procedure for life. But the medical community embraced Thorazine, and many other drugs developed afterward. They were easy to administer, required no training to administer, didn’t have fatal side effects, and could be stopped at any time without permanent damage.
The lobotomy passed into literature and legend—Ken Kesey’s One Flew Over the Cuckoo’s Nest, and the bar joke “I’d rather have a bottle in front of me than a frontal lobotomy”—and became increasingly unpopular as a medical procedure. (I’ve heard it was Tom Waits who made up the line about the bottle. Kesey had a job at a mental hospital—maybe the Veterans Administration hospital in Palo Alto—where he saw firsthand the results of lobotomy and other mistreatment.)
The lobotomy may have become passé, but Walter Freeman never stopped believing in it, promoting it, or performing it.
In 1954, he left Washington, D.C., for the West Coast. He was fifty-eight. It was clear to him that he could go no further professionally in the medical establishment. His work was too controversial for him to ever be head of the American Medical Association or run a major psychiatric institution. Besides, he had always hated the weather—too cold in winter, too muggy in summer. He moved to California.
There were personal reasons, too. Two of his children had finished their university educations, married, and settled in the Bay Area. And in California he could be closer to the places he loved to walk and hike—Yosemite, the Sierras, the Grand Canyon.
In addition, his wife was a heavy drinker, and that had become a problem. A fresh start for him would be a fresh start for her, too.
Freeman, being Freeman, didn’t just move. He moved with style. He knew he wanted to live somewhere around Palo Alto, but he wasn’t sure which community was best for him. So he hired a private plane, and spent half a day having a pilot fly him over the area. Some guys would’ve just looked at a map and talked to some real estate agents. Not Freeman. By the end of the day, he settled on green, leafy, high-class Los Altos. He and his wife bought a house in the foothills.
Freeman was sort of a celebrity in the medical world, and he was welcomed by the local medical community. But his lobotomy was not. Freeman set up offices at 15 Main Street, right in central Los Altos, but no hospital in Los Altos would allow him to operate. He had to go all the way to Doctors General Hospital, on the outskirts of San Jose, to perform his procedure.
This was more than a medical decision. Los Altos was a nice place. It wasn’t supposed to have problems like mental illness. Los Altos had manicured gardens and clean sidewalks and showcase homes. It didn’t have crazy people. Even though Freeman was an educated and cultured man, erudite and charming, the people of Los Altos probably thought his medical procedure was low-rent and tacky. It was for people in loony bins, and there weren’t any loony bins in Los Altos. The local attitude was, “We just don’t do lobotomies here.”
I don’t think my stepmother was shopping for a lobotomy the first time she met Freeman. But she was fed up with me, that was certain.
On October 5, 1960, Lou had her first meeting with Dr. Freeman. Freeman’s notes from the first session read like this:
Mrs. Dully came in to talk about her step-son who is now 12 years old and in the 7th grade. There are four other boys in the family, two of hers, aged 17 and 12, another of his, aged 9, and a four-year-old that belongs to both of them. Mrs. Dully’s first husband was an alcoholic who impoverished her, ran off with a girlfriend who took him for a ride and divorced him, and he doesn’t seem to enter the picture. Mrs. Dully’s boys are good-natured and well behaved. Howard’s mother had a third child before she died of cancer; this child was adopted and turned out to be a mental defective and, I believe, is in an institution and not expected to live beyond puberty. Mr. Dully is a teacher of the 6th and 7th grades in the Hillview School for the last six or seven years while Mrs. Dully didn’t finish high school. She got to know Mr. Dully shortly after he was widowed when Howard was about five years old; she did some sewing and washing and commis
erating, and according to Mrs. Dully, her husband is the best husband imaginable, kind, considerate, a good provider, willing to do without, sharing her problems, with no difficulties in regard to religion, money or politics, but he can’t see anything wrong with Howard, and that’s where they disagree most particularly.
Freeman was a great keeper of notes. I don’t know if he wrote them, or dictated them to a secretary, or used that tape recorder he carried around in the Lobotomobile. But he kept close notes. The first meeting generated two full pages, single-spaced. The whole file on me runs about thirty pages. Each page is topped with the patient’s name—it doesn’t mention Lou; it’s DULLY, Howard (F: Rodney L.)—address and phone number, and date. The referring doctor’s name, Marazzo, appears on every page, too.
Freeman didn’t write much about what he thought. But he wrote a lot about what other people said. Unlike the psychiatrists Lou had already seen, Freeman didn’t seem interested in talking to her about her. The file was about me. In fact, the first interview with Lou read like testimony in a murder trial. Freeman even referred to it as “the articles of indictment.”
The first time Mrs. Dully saw the boy she thought he was a spastic because of his awkward swing of the arms in walking and a peculiar gait. He seems to have poor muscular control but he’s good at many of the athletic games at school. He dislikes to work with his hands; he doesn’t build. His younger brother, Bryan [Freeman wrote it like that] likes to build houses, walls, castles of blocks, and Howard knocks them down, throws the blocks at the walls and pounds Bryan on the head with them. He objects to going to bed but then sleeps well. He watches his chances and is clever at stealing but always leaves something behind to show what he’s done. If it’s a banana, he throws the peel at the window; if it’s a candy bar, he leaves the wrapper around someplace, and hides things in such obvious places as behind the bureau and under the bed. He doesn’t play with toys, rather he uses them as weapons or is destructive with them. There’s a dog in the home and he teases the dog until it becomes excited and then he punishes the dog for getting excited. He scowls and frowns if the TV is turned on to some other program than what he likes, which is mostly blood and thunder. He does a good deal of daydreaming and when asked about it, he says: “I don’t know.” He is defiant at times—“You tell me to do this, and I’ll do that.” He has a vicious expression on his face some of the time.
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