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'Lobotomist' Serves as a Warning

Walter J. Freeman performs a lobotomy in 1949. The surgery aimed to cure mental illness.
Walter J. Freeman performs a lobotomy in 1949. The surgery aimed to cure mental illness. (Bettmann/corbis)
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By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, January 15, 2008

One of the most horrifying medical treatments of the 20th century was carried out not clandestinely, but with the approval of the medical establishment, the media and the public. Known as the transorbital or "ice pick" lobotomy, the crude and destructive brain-scrambling operation performed on thousands of psychiatric patients between the 1930s and 1960s was touted as a cure for mental illness.

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Its prosaic name comes from the instrument initially used to perform it: an ice pick plucked from the kitchen drawer of the procedure's tireless proselytizer, Walter J. Freeman, who pioneered the operation in 1936 while at George Washington University Hospital.

The story of how Freeman sold his procedure to credulous colleagues, assiduously courted the press and convinced desperate families that sticking an ice pick through a patient's upper eye sockets and twirling it like a swizzle stick through brain matter would cure psychosis, depression or troublesome behavior is the ultimate in cautionary medical tales.

As the riveting hour-long "American Experience" documentary "The Lobotomist" (scheduled to air Jan. 21 at 9 p.m. on WETA and other PBS stations) makes clear, Freeman's operation reflected the neurologist's peculiar combination of zealotry, talent, hubris and, as one of his trainees noted, craziness. Sometimes Freeman, who relished putting on a show, used a carpenter's mallet instead of a surgical hammer during demonstrations of his operation. At other times, he would operate left-handed rather than right-handed.

Based in part on the much-praised 2005 biography "The Lobotomist" by medical writer Jack El-Hai, who appears in the film and served as a consultant, the film by Barak Goodman and John Maggio features chilling black-and-white home movies as well as haunting photographs of patients before and sometimes after their lobotomies. Many of the movies are narrated by a gravel-voiced Freeman demonstrating the procedure he performed on more than 2,900 people, the youngest of whom was 4.

As the filmmakers note, lobotomy flourished in a therapeutic vacuum: Until the mid-1950s when the groundbreaking tranquilizer Thorazine swept through mental hospitals, ushering in the era of psychopharmacology, medicine had virtually nothing to offer psychiatric patients.

State hospitals were teeming, squalid warehouses that had become permanent homes to thousands who had little hope of ever leaving. One of the most notorious was Washington's St. Elizabeths Hospital, where Freeman began his career in the 1920s and was struck by the sight of 5,000 patients "whose lives were going nowhere, would go nowhere," in the words of El-Hai.

The solution, Freeman believed, lay in a radical experimental procedure invented by a Portuguese neurologist who in 1949 would win the Nobel Prize in medicine. He claimed the drastic brain operation had cured a substantial number of people with mental illness.

The scion of a distinguished Philadelphia medical family who had a burning desire for fame, Freeman began experimenting and developed the ice pick procedure. His operation severed the frontal lobe from the thalamus, the repository of emotions and the site where Freeman believed mental illness originated.

A few patients and their families claimed lobotomy was beneficial, especially in reducing agitation, which was Freeman's measure of success. But others died on the table or were left irreparably damaged: childlike, docile, vacant and incontinent. Among them was Rosemary Kennedy, the 23-year-old mildly retarded sister of John F. Kennedy, who spent 56 years of her life in an institution after Freeman operated on her in 1941.

Undaunted by his failures, Freeman's pitch that lobotomy cured mental illness was seized on by the press -- the Washington Star called it among "the greatest innovations of this generation," and the New York Times pronounced it "history-making." Many doctors embraced it as a 10-minute operation that promised to empty mental hospitals and return patients to their families. Opponents, mostly psychiatrists who practiced Freudian talk therapy, didn't matter much: In those days public criticism of a doctor by his peers was regarded as unethical.

By the early 1960s lobotomy had fallen out of favor, in part because of its low success rate and the disastrous harm it inflicted on many patients.

Freeman, who died in 1972, performed his last lobotomy in 1967; his privileges at Herrick Hospital in Berkeley, Calif., were revoked after the patient died.

While several of his relatives appear on camera, one of the most affecting interviews is with Berkeley bus driver Howard Dully, who was lobotomized by Freeman at age 12 after his stepmother complained he was difficult.

The issue at the heart of this powerful and unsettling film is not, as one writer puts it, "how a man could go off the rails, but how science could go off the rails."

It's a question well worth pondering. ¿

Comments:boodmans@washpost.com.


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