Authors: Richard Hollingham
*
In 1949 Moniz received a Nobel prize for his 'discovery of the therapeutic value of leucotomy
in certain psychoses'. There have been campaigns to have the prize posthumously taken
away from him.
When Freeman learnt of Moniz's research he became wild with
excitement. Moniz had proved what Freeman believed all along:
surgery was the answer. Freeman became convinced that many
types of mental illness were caused by the connections between the
thalamus – a small structure deep in the brain – and the frontal
lobe. The thalamus, he believed, was the seat of human emotions.
If he could only sever the connections in the front of the brain, it
would dampen down all these terrible emotions and his patients
would be cured.
Freeman became the Portuguese surgeon's biggest fan. He
decided that he would adopt Moniz's operation and make it his. He
could finally help the patients of St Elizabeths. It could make him
famous – his name would be cited alongside other great medical
pioneers. He could imagine it now: Walter Freeman – the inventor
of the lobotomy.
But Freeman had a problem: he was not a surgeon. So he
enlisted the assistance of someone who was – a young neurosurgeon
named James Watts. Together they planned the first of Freeman's
new lobotomy operations on sixty-three-year-old Alice Hammatt.
The woman had been suffering from depression, anxiety and
insomnia. She was sometimes suicidal, invariably agitated. Without
treatment she would end up being admitted to a mental institution,
where she would undoubtedly spend the rest of her life. To Freeman
she seemed like the ideal patient. On 14 September 1936 in an
operating theatre at George Washington University Hospital in
Washington DC, Hammatt was put to sleep.
With Freeman directing the operation from a stool a few feet
away, Watts cautiously cut three incisions into Hammatt's shaved
scalp. Next he drilled a hole on both sides of her skull – above her
ears and behind her forehead – and stuck the leucotome into the
left-hand hole. Watts pressed the plunger on the instrument and cut
the first core of brain tissue. It was like cutting through butter.
Leaning closer, Freeman instructed Watts to take more cores.
Eventually, under Freeman's guidance, Watts took a total of twelve
cores from the two holes. It was not a particularly precise procedure.
At one point Watts managed to get a blood vessel caught in the
instrument and blood gurgled from the aperture. Still, the patient
seemed OK. Nothing to worry about. An hour or so later the world's
first lobotomy operation was over.
Hammatt recovered quickly. She seemed alert but much calmer.
Her anxiety had disappeared; in fact she had forgotten what had
caused all her problems in the first place. Hammatt could read,
could name members of her family and, for the first time in months,
was sleeping well. Freeman later reported how Hammatt could now
manage 'home and household accounts, enjoys people, attends
theatre, drives her own car'. It was wonderful. 'Great improvement,'
he concludes. Then, a few months after her operation, Hammatt
suffered a convulsion. It was probably related to her surgery. She
fell, breaking her wrist and, according to Freeman, became 'indolent'
and 'sometimes abusive'. Nevertheless, her anxiety never
returned and she lived a relatively normal life.
Freeman declared the operation a great success and rushed off
to tell his colleagues. When he published the details of the case, his
lobotomy operation won mixed reviews. While some considered it a
fine idea, others were outraged that such an untested, extreme
operation was even being attempted. But Freeman was completely
convinced that a surgical breakthrough had been made. Moreover,
he knew how to convince others: he would ignore the medical establishment
and take his radical new operation straight to the public.
In a typically long-winded headline (but with the admirable use
of a semicolon) the front page of the
New York Times
proclaimed:
'Surgery Used on the Soul-Sick; Relief of Obsessions Is Reported'.
The article referred to Freeman's new surgical technique as 'psychosurgery'
and 'surgery of the soul'. His operation could cut away 'sick
parts of the human personality' and transform 'wild animals into
gentle creatures'. Out of the twenty patients Freeman had treated,
the article said, 15 per cent (three) were 'greatly improved', with a
further 50 per cent (ten) of them being 'moderately improved'. The
article went on to detail two case histories, including Hammatt's,
with only passing mention of two deaths following the procedure
and unattributed criticism from some 'leading neurologists'.
The
New York Times
was not alone in trumpeting this new
and exciting operation. It was proclaimed a miracle, an incredible
cure and even, according to one gushing news report, 'one of the
greatest scientific innovations of this generation'. For the first
time in history, here was a doctor who could cure madness; heal
the mind with surgery.
As ever with these things, the reality did not quite live up to the
hype. Many of Freeman's early patients were soon suffering relapses.
His answer was to go back and repeat the operation, gouge out
more bits of brain. Other patients were suffering terrible side
effects. Following their operations they were acting like children:
they had to be retaught how to carry out basic functions (such as
using a toilet); they were lacking in energy and self-control. It was
what had happened to Phineas Gage. They were not the people they
had been before the operation.
Over the next five years Freeman and Watts perfected their
technique as they conducted more and more lobotomies. Other
surgeons took up the procedure, while Freeman worked his way
through an ever-increasing list of patients. Soon he and Watts were
conducting operations on conscious patients using local anaesthetic.
Freeman would have them count or sing a song so that he
could tell what effect the leucotome was having. In one instance he
is even said to have asked his patient to recite the Lord's Prayer – an
unfortunate choice, given the circumstances.
In 1941 Freeman was approached by Joe Kennedy and asked to
operate on his daughter Rosemary – the sister of future President
John F. Kennedy. Strictly speaking, Rosemary was a poor candidate
for a lobotomy. Quiet and beautiful, there is little evidence that
there was anything much wrong with her. She might have been
suffering from a learning disability, or perhaps depression. People
whispered that she was not quite right in the head, and that would
not do for an overachieving Kennedy. Joe Kennedy was very persuasive,
so Freeman and Watts agreed to go ahead with the surgery.
The procedure was carried out in secret. Joe Kennedy did not
even tell his wife. When Rosemary came round from the anaesthetic,
she was a very different person. Slow and emotionless, she
was hardly able to move or speak. Although she eventually learnt to
walk again, she was left permanently disabled and ended up in a
residential institution in Wisconsin. If anyone asked, they were told
that Rosemary was suffering from a mental illness. Better than
saying she had been lobotomized. Freeman never said a word about
the case. It was in his best interests not to publish the details of any
high-profile failures.
Despite the odd setback, everything was going well for Freeman,
but he was not satisfied. Lobotomy operations were taking too long
and the asylums were filling up fast. There was no way he was going
to get through all the patients that needed this miracle surgery of
the soul. To add to Freeman's frustration, the procedure had to be
carried out by a qualified neurosurgeon, but he wanted to do it
himself. He needed a way to make it simpler and faster. Up until this
point he had always made sure to describe the lobotomy as surgery
of 'last resort', but this was about to change.
Washington DC, January 1946
Twenty-nine-year-old Ellen Ionesco arrived at Freeman's office
accompanied by her husband and daughter. Freeman was their last
hope; otherwise they feared that Ellen would have to be admitted to
hospital before she killed herself. Over the past few weeks her condition
had worsened. She suffered from terrible depression and
would lie in bed for days. She was paranoid, suicidal and lapsed into
terrifying bouts of violence. At one point Ellen had even attempted
to smother her six-year-old child.
Sunlight streamed through the windows as Freeman examined
the patient and carefully explained what he was planning to do. It was
clear to him that she needed immediate treatment. Of course, any
new procedure had its risks, but Freeman was so kind and reassuring
that it did not take long for them to agree. Didn't the doctor always
know best? Freeman ushered the patient through to a back room,
where the equipment was already laid out and asked Ellen to lie
down on the examination couch. The operation would not take
long, he told her. Before she knew it she would be on her way home.
He asked his secretary to order her a taxi.
Freeman slipped a rubber tube between Ellen's teeth and
powered up the ECT machine. He fastened a belt containing electrodes
around her head. The ECT machine hummed. He asked Mr
Ionesco to help hold down his wife. Freeman flicked the switch. The
electrodes crackled as Ellen convulsed on the couch, her jaw locked,
her head twisting from side to side. Freeman pushed the switch
again until his patient was finally rendered unconscious by the electricity.
He was ready to begin.
After draping a cloth beneath her eyes, Freeman pulls back one
of Ellen's upper eyelids and picks up an ice pick. It is an ordinary ice
pick – the type found in many American homes. It looks like a chisel
with a wooden handle, a long shaft and a strong, sharp point. It even
has the company's name on the side: the Uline Ice Company.
Holding the upper eyelid in his left hand, with his right he
inserts the tip of the ice pick into the top of the eye socket. He is
careful not to damage her eyeball as he pushes the ice pick diagonally
upwards into her tear duct, following the line of her nose.
Steadying the pick, he reaches for a hammer.
Bang, bang.
There is a crunch as the ice pick punches through the thin transorbital
bone at the top of her eye socket. Freeman pushes the pick
through the bone and into the frontal lobe of the brain. He wiggles
the tool from side to side, slicing through the nerve tissue. He
pushes it in further, sweeping it across like the blade of a windscreen
wiper. After a couple of minutes, he gives the pick a final twist and
yanks it out of Ellen's eye socket.
In less than ten minutes, the operation is over and the patient
starts to come round. She is helped from the table but can hardly
walk. She is disorientated; the eye Freeman operated on is black and
blue. She looks as if she has been beaten up.
A week later, Freeman performs a second lobotomy through
her other eye. In future he plans to do both eyes at once. After a few
days in bed, Ellen is transformed. She is calm, her crazed mind now
at peace. She takes up gardening, works in a shop and eventually
trains as a nurse. Ellen Ionesco has her life back.
Freeman called his new procedure the transorbital lobotomy. It
was quick and easy. It didn't need an anaesthetist, surgeon or operating
theatre. There was no faffing around with antiseptics, masks or
gloves. As long as he made sure the ice pick was sterilized, that was
good enough. The best thing was that the whole operation was so
simple that almost anyone could do it. Freeman was tremendously
excited. He would be able to transform the lives of thousands of
people with mental illness?he could train other doctors?it would
be a new era of psychosurgery for the masses! Just as Henry Ford
had invented the production-line car, so Freeman had devised the
production-line lobotomy.
Dr Freeman jumped into his camper van and set off across the
United States to spread the word. During the next few years he crisscrossed
the country performing his transorbital lobotomies. He
travelled through Europe; he visited clinics and hospitals, operating
on one patient after another. As he became more adept, he began
to refine the procedure. He would hold the ice pick in his left hand,
even though he was right-handed, drive two ice picks in at once, and
even carried out operations with a carpenter's mallet. It was wonderfully
easy. On one particularly memorable day Freeman got through
twenty-five patients. His operations became performances, as
doctors, reporters and the occasional interested bystander watched
with horrified fascination.
The sight of an ice pick being pushed into a patient's eye socket
was bad enough, but the sounds were, if anything, even more gruesome:
the buzz of the ECT followed by the thump of the hammer
and the crack of bone, the swishing back and forth of the ice picks
and the faint plop as Freeman yanked them out. As each disorientated
patient staggered from the table, their black eyes smarting, the
doctor could notch up another success.
Freeman was getting through an awful lot of patients. He
personally performed around three and a half thousand lobotomies,
and trained doctors across the world. In total, it is thought
that around one hundred thousand people were lobotomized. The
results were mixed. Some, like Ellen Ionesco, returned to their
families to lead relatively normal lives; Ellen's daughter speaks of
Freeman with affection. Other patients were not so fortunate.
Following lobotomy their personalities were irrevocably changed;
they became docile, placid, mindless; dead to the world around
them. A slip of the ice pick left some patients paralysed after the
operation. Some died from complications. But Freeman seemed
blind to the failures and oblivious to criticism. By the 1960s his
notion that lobotomy was a surgery of 'last resort' – to be
performed only on the desperately ill – had gone completely out
of the window.