John McManamy

Thinking of giving someone a piece of your mind? Stay clear of Walter Freeman.

The field of mental health suffers no shortage of weird and offbeat and arguably despicable characters, but the Washington Post several years ago outdid itself for its story on Walter Freeman, father of the lobotomy. Sample this lurid paragraph for starters:

"Walter Freeman lifted the patient's eyelid and inserted an ice pick-like instrument called a leucotome through a tear duct. A few taps with a surgical hammer breached the bone. Freeman took a position behind the patient's head, pushed the leucotome about an inch and a half into the frontal lobe of the patient's brain, and moved the sharp tip back and forth. Then he repeated the process with the other eye socket."

Freeman kept records of 3,439 lobotomies he performed over his long career, and he promoted the procedure to more than 55 hospitals in 23 states. At AMA meetings, he set up graphic exhibits and used hand-held clackers to draw audiences.

In all, lobotomies were used on 40,000 to 50,000 Americans between 1936 and the late 1950s. Freeman believed lobotomies worked because the procedure severed connections between the frontal lobes of the brain and the thalamus, thought to be the seat of human emotion, which the mentally ill apparently had in overabundance. Although his theories have been discredited, Freeman was one of the few psychiatrists of his era who believed that mental illness had a physical biological component.

Freeman attended Yale and the University of Pennsylvania School of Medicine, then studied neurology and psychiatry in Europe. Motivated by the tragedy of wasted lives in mental hospitals, he introduced insulin shock therapy and ECT for patients at George Washington University Hospital in Washington DC, where he served on the faculty. He also had a private practice and was director of the laboratories at St Elizabeth's Hospital.

Upon finding out that chimpanzees became subdued when their frontal lobes were damaged, and spurred into action by Portuguese neurologist Egas Moniz' experiments on people, he and colleague James Watts started practicing on brains from the hospital morgue, and in 1936 they were ready for their first patient, a Mrs Hammatt, 63, who suffered from agitated depression and sleeplessness. The technique of entering the frontal lobes through the eye sockets was still far off into the future. Instead, they drilled six holes into the top of her skull.

According to Freeman, Mrs Hammet emerged transformed, able to "go to the theatre and really enjoy the play ... " She lived another five years.

Freeman and Watts claimed 52 percent of their first 623 surgeries yielded "good" results, but they did not offer a clinical yardstick for what constituted an improvement. Patients often had to be retaught how to eat and use the bathroom. Relapses were common, and three percent died from the procedure. The most famous Freeman-Watts failure was JFK's sister, Rosemary Kennedy, who needed full-time care for 64 years (she died in Jan 2005).

Nevertheless, hospitals were willing to put up with lobotomies and all their shortcomings for no other apparent reason than post-operation lethargic patients were easier to care for than pre-operation emotionally-charged ones.

In 1967, Freeman performed a lobotomy on one of his original patients in Berkeley, California. He severed a blood vessel, and the patient died three days later. This effectively brought his career full circle. During the last five years of his life, he performed no more lobotomies. He died from cancer in 1972, age 76.

Today, according to the Washington Post, there are probably fewer than 20 brain operations a year (not lobotomies) in the US to treat psychiatric disorders, part of the negative legacy of Freeman that has scared away researchers and funders.

In 1949, at Freeman’s urging, Moniz received the Nobel Prize. As S Nassir Ghaemi MD of Emory University in a review comments

“It is quite ironic that in that same year, the Australian psychiatrist John Cade would discover lithium ... yet after the Moniz fiasco, the Nobel committee apparently has shied away from giving awards for direct treatment of mental illness, and thus the discoverers of lithium, antipsychotics, and antidepressants have never been duly recognized.”

One day that may change. But first the ghost of Freeman needs to be thoroughly lobotomized.

A Brief History of the Lobotomy
Dr. C. George Boeree

The idea of brain surgery as a means of improving mental health got started around 1890, when Friederich Golz, a German researcher, removed portions of his dogs’ temporal lobes, and found them to be calmer, less aggressive. It was swiftly followed by Gottlieb Burkhardt, the head of a Swiss mental institution, who attempted similar surgeries on six of his schizophrenic patients. Some were indeed calmer. Two died.

One would think that that would be the end of the idea. But in 1935, Carlyle Jacobsen of Yale University tried frontal and prefrontal lobotomies on chimps, and found them to be calmer afterwards. His colleague at Yale, John Fulton, attempted to induce “experimental neurosis” in his lobotomized chimps by presenting them with contradictory signals. He found that they were pretty much immune to the process.

It took a certain Antonio Egaz Moniz of the University of Lisbon Medical School to really put lobotomy on the map. A very productive medical researcher, he invented several significant improvements to brain x-ray techniques prior to his work with lobotomy. He also served as the Minister of Foreign Affairs and the Ambassador to Spain. He was even one of the signers of the Treaty of Versailles, which marked the end of World War I.

He found that cutting the nerves that run from the frontal cortex to the thalamus in psychotic patients who suffered from repetitive thoughts “short-circuited” the problem. Together with his colleague Almeida Lima, he devised a technique involving drilling two small holes on either side of the forehead, inserting a special surgical knife, and severing the prefrontal cortex from the rest of the brain. He called it leukotomy, but it would come to be known as lobotomy.

Some of his patients became calmer, some did not. Moniz advised extreme caution in using lobotomy, and felt it should only be used in cases where everything else had been tried. He was awarded the Nobel Prize for his work on lobotomy in 1949. He retired early after a former patient paralyzed him by shooting him in the back.

Walter Freeman, an American physician, with his colleague James Watts, performed his first lobotomy operation in 1936. He was so satisfied with the results that he went on to do many thousands more, and in fact began a propaganda campaign to promote its use. He is also famous for inventing what is called ice pick lobotomy. Impatient with the difficult surgical methods pioneered by Moniz, he found he could insert an ice pick above each eye of a patient with only local anesthetic, drive it through the thin bone with a light tap of a mallet, swish the pick back and forth like a windshield wiper and -- voilà -- a formerly difficult patient is now passive.

Freeman recommended the procedure for everything from psychosis to depression to neurosis to criminality. He developed what others called assembly line lobotomies, going from one patient to the next with his gold-plated ice pick, even having his assistants time him to see if he could break lobotomy speed records. It is said that even some seasoned surgeons fainted at the site. Even Watts thought he had gone too far.

Between 1939 and 1951, over 18,000 lobotomies were performed in the US, and many more in other countries. It was often used on convicts, and in Japan it was recommended for use on “difficult” children. There are still western countries that permit the use of the lobotomy, although its use has decreased dramatically worldwide. Curiously, the old USSR banned it back in 1950 on moral grounds!

In the 1950s, people began getting upset about the prevalence of lobotomies. Protests began, and serious research supported the protesters. The general statistics showed roughly a third of lobotomy patients improved, a third stayed the same, and the last third actually got worse!

There have been a few famous cases over the years. For example, Rosemary Kennedy, sister to John, Robert, and Edward Kennedy, was given a lobotomy when her father complained to doctors about the mildly retarded girl’s embarrassing new interest in boys. Her father never informed the rest of the family about what he had done. She lived out her life in a Wisconsin institution and died January 7, 2005, at the age of 86. Her sister, Eunice Kennedy Shriver, founded the Special Olympics in her honor in 1968.
http://webspace.ship.edu/cgboer/lobotomy.html

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Source: http://www.mcmanweb.com/lobotomy.html