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Walter Freeman, a neurologist and psychiatrist
practiced in Washington for 28 years and he began a wave of psychiatric
surgery that was used on 40,000 to 50,000 Americans between 1936 and the
late 1950s.
Freeman gave lobotomies to children, adults,
old people, and people with depression, manic-depression, schizophrenia,
obsessive-compulsive disorder and a variety of undiagnosed psychiatric
illnesses.
It is difficult to say how many benefited. Few controlled studies were
ever conducted, and Freeman's own summaries of his results were difficult
for others to interpret.
By the time Freeman died in 1972, his theory that
mental illness could be cured by physically attacking
the brain's frontal lobes had been discredited. While things
have not exactly come full circle since then, there is much in today's
neuropsychiatric climate that Freeman would recognize.
Many psychiatrists no longer practice "talk"
therapy and instead treat their patients' brains. In 1999 Surgeon General
David Satcher issued a 450-page report on mental health making the case
that many psychiatric illnesses are actually brain disorders, and that
often the most effective treatments affect the transmission of messages
in the brain's neuro-pathways.
Walter Freeman kept a record of 3,439
lobotomies he performed during
his career. His technique of trans-orbital lobotomy was such a breeze
that he could teach it in a day or two to state-hospital psychiatrists
who, like himself, had no certification in surgery.
He believed in lobotomy, defended it, promoted it and demonstrated it
during psychosurgical road trips he took to more than 55 hospitals in
23 states. He felt certain that lobotomy could return psychologically
disabled people, many of whom had no other prospect of effective medical
treatment and who lived in oppressive psychiatric wards, to useful lives.
"Lobotomy gets them home" was his motto.
Dr. Walter Freeman believed he'd found an answer for mental illness. Nearly
3,500 operations later, his techniques were
universally discredited. Today, some of his
ideas are coming back.
Frank Freeman remembers hiking with his father in
the woods, going fishing with him, and setting off on cross-country driving
trips that could last for weeks. He also recalls one occasion in 1952
when he helped his father perform a trans-orbital lobotomy on a patient.
Absolutely Gruesome
The procedure, which his father, Walter J. Freeman,
popularized and perfected, involved first knocking the patient unconscious
with two or three jolts of electricity from
an electroshock therapy machine. "I was there to hold the person's
legs down," Frank Freeman says. "We all went for a ride when
he threw the switch."
After the convulsions subsided and the patient lay
insensate, 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.
"I was kind of impressed," Frank Freeman
recalls. "He made it look so easy."
Freeman's enthusiasm for lobotomy, which developed
through his work with his colleague James Watts at George Washington University
Hospital.
Freeman would fully agree. He believed that lobotomy
succeeded because it severed neural connections
between the frontal lobes of the brain and the thalamus, which he characterized
as the seat of human emotion.
Mentally ill people were too self-aware, he maintained,
and their overactive emotions caused them to obsess about their problems.
Sixty years ago few of Freeman's colleagues, especially psychiatrists
for whom psychotherapy was the preferred treatment for psychiatric disorders,
believed that brain disorders caused mental illness. Now we live in an
era in which a biological and brain-centered view of mental illness reigns
supreme.
But do today's neuroscientists celebrate Freeman
as a pioneer, far ahead of his time in his focus on the brain in treating
psychiatric disorders? Far from it. Researchers investigating new methods
of surgically treating the brain for mental illnesses find his
legacy a hindrance to the public's understanding and acceptance
of their research.
Why, 34 years after his final lobotomy, does Walter
Freeman continue to cast a shadow over psychiatric surgery? The answer
lies in the complex tangle of Freeman's personality and motivations, and
in the public's fear of past abuses.
When Freeman arrived in Washington in 1924 to direct
the laboratories at St. Elizabeths Hospital -- one of the nation's preeminent
institutions for the insane -- he carried with him more
baggage than medical textbooks and instruments. He also shouldered
a load of high expectations, courtesy of his family. Born and reared in
Philadelphia, Freeman belonged to a prominent and hard-working medical
clan.
His maternal grandfather, William W. Keen, served
as a surgeon during the Civil War, removed a tumor from the jaw of President
Grover Cleveland, experimented with an early form of cardiopulmonary resuscitation,
and was a president of the American Medical Association. Freeman's father
was an otolaryngologist with a practice of modest attainments.
Freeman himself attended Yale and the University
of Pennsylvania School of Medicine before studying neurology and psychiatry
in Europe. Initially, he regarded mental hospitals with what he called
in his unpublished memoirs "a rather weird mixture of fear, disgust,
and shame." These feelings soon were transformed into indignation:
"I looked around me at the hundreds of patients
and thought what a waste of manpower and womanpower." Freeman thought
the idleness and confinement of vast numbers of patients a great social
tragedy, and he wanted to do something about it.
He set about -- ultimately unsuccessfully
-- to discover measurable differences between normal brains and those
of schizophrenics. While working at St. Elizabeths, Freeman opened a private
practice and joined the medical faculty of George Washington University
as a professor of neurology.
By the mid-1930s he had introduced several new therapies
for mental patients at GW Hospital: insulin shock therapy,
metrazol shock therapy and electroconvulsive
therapy. All of these treatments were intended to fight psychiatric
disease by subjecting patients to chemicals or jolts of electricity that
might disrupt unhealthy neural activity in the brain.
It's easy to imagine Freeman -- his high forehead,
steel-rimmed glasses and goatee making him look the part of the consummate
1930s mental doctor -- convincing seriously ill patients and their desperate
families that these experimental treatments held the only hope for recovery.
For many Americans with psychiatric diseases, hospitals could offer little
else except the agonies of cold-water therapy and long-term storage in
facilities that echoed with the screams and moans of the hopeless.
In 1935 Freeman caught his first glimpse of yet
another treatment that could join his arsenal. At a London conference,
he attended a presentation by a Yale researcher on the behavioral effects
of surgical damage to the frontal lobes of
chimpanzees.
The animals became subdued and inactive. Rather
impulsively, another conference attendee, a Portuguese neurologist named
Egas Moniz, rushed home and began performing similar operations on mentally
ill people. Moniz's subsequent reports on these experiments crossed the
Atlantic and further intrigued Freeman.
To him, the intoxicating thing about psychosurgery
-- Moniz's coined term for psychiatric surgery -- was its potential to
sever the links between the over-excited emotions of an unhealthy thalamus
and the behavioral functions of the prefrontal lobes of the brain. If
it worked, the destruction of these nerve fibers would prevent the thalamus
from poisoning patients' thinking.
First Patient In 1936
He absorbed the details of Moniz's work and, with
GW neurosurgeon Watts, began figuring out how to adapt the Portuguese
physician's techniques. Freeman and Watts used brains from the hospital
morgue to practice the coring of sections of the prefrontal lobes with
a leucotome. By the summer of 1936 they were ready for
a live patient: a Mrs. Hammatt from Topeka, Kan.
Sixty-three years old and suffering from agitated
depression, she came to Washington with her husband, desperate for an
improvement to her sleepless and hysteria-filled life. Freeman explained
to her that without a lobotomy -- the name he and Watts gave for their
surgery -- she faced an indefinite stay in a mental hospital. She decided
to take her chances with this new operation, which was scheduled for September
14, 1936.
When the day arrived, Mrs. Hammatt tried to change
her mind when she found out that her head had to be shaved. Freeman and
Watts promised to spare as much of her hair as they could, before forcibly
anesthetizing her. Later, Freeman recorded that her last words
before surgery were, "Who is that man? What does he want here? What's
he going to do to me? Tell him to go away. Oh, I don't want to see him,"
followed by a scream.
Freeman and Watts then performed America's first
lobotomy. They drilled six holes into the
top of Mrs. Hammatt's skull and inserted a leucotome into each. The two
physicians shared the task of lesioning the brain, as they did for all
of the approximately 1,000 lobotomies they performed together. They rinsed
the openings with saline solution and sutured the wounds.
By Freeman's account, Mrs. Hammatt emerged a transformed
woman. She felt a great relief of her anxiety. After a hemorrhage scare
on the third day of recovery, she was discharged from GW Hospital about
a week later. "She survived five years, according to Mr. Hammatt
the happiest years of her life," Freeman noted in his autobiography.
"As she expressed it, she could go to the theatre and really enjoy
the play without thinking what her back hair looked like or whether her
shoes pinched."
Deaths From the Procedure
Thus encouraged, Freeman and Watts went on to perform
more operations and further refine their technique. They replaced Moniz's
coring leucotome with one resembling a butter knife and moved the entry
holes to the sides of the skull. They developed a "radical"
procedure that made more cuts into the brain.
Some patients needed multiple lobotomies; others died. They operated on
an alcoholic lawyer and Rhodes scholar who escaped from the hospital on
Christmas Eve and was found, drunk, in a downtown Washington bar.
Freeman and Watts headquartered their increasingly
lucrative private practice in a house at 2014 R St. SW. Watts occupied
an office at ground level, their assistant manned the first floor, and
Freeman worked upstairs.
Lobotomy Patient No.
157 once returned to threaten their lives and two others pulled guns on
Freeman when he recommended psychosurgery.
As much as some of Freeman's colleagues lamented
the practice of damaging healthy brain tissue in order to treat mental
illness and the absence of scientific evidence that lobotomy actually
worked, doctors were even more critical of Freeman's hunger for public
recognition.
More than once, AMA
members tried to censure him for advertising his services, which was then
considered an unethical practice for physicians.
The suspect advertising appeared, his accusers said,
in the colorful lobotomy exhibits Freeman set up every year from 1939
through the early '40s at the annual AMA convention. Freeman targeted
his displays not at other doctors, but at the press.
"I found the technique of getting noticed in
the papers," he later acknowledged. "It was to arrive a day
or two ahead of the opening [of the convention] and install the exhibit
in the most graphic manner and then be alert for prowling newsmen."
Playing the role of barker, entertainer and scientist, Freeman used hand-held
clackers to draw reporters and frequently displayed a lobotomized animal.
The results were immediate. Freeman described what
happened after journalists viewed the exhibit in 1939: "That night
our monkey died but Watts and I made the headlines even though we did
not get an award." A photo of Freeman and Watts in the operating
room appeared in Time magazine in November 1942, and many other magazines
and newspapers published laudatory accounts of the Freeman-Watts operation.
By his own reckoning,
52 percent of their first 623 surgeries yielded "good" results,
32 percent "fair," and 13 percent "poor."
Three percent died during
or after surgery.
At first glance, those results seemed miraculous,
given that few other treatments held much promise for hard-core cases
of depression, agitation and obsessive behavior.
But Freeman and Watts
often did not define what they considered improvement to be.
Relapses frequently
occurred.
In addition, a certain
number of these cases were bound to get better on their own.
And the aftereffects of lobotomy, separate from
the symptoms of mental illness, often crippled the emotions, inhibitions
and personalities of patients.
Nurses who cared for Freeman-Watts patients immediately
after the operations grew accustomed to dealing with people who needed
to be retaught how to eat and use the bathroom.
The patients often made clumsy passes at their caregivers,
urinated on their shoes, sat unmoving for hours, stubbornly refused to
follow instructions and behaved childishly.
Nurses learned that spanking and tickling could
reliably distract patients from delusions and perceived threats.
The most famous failure
of Freeman and Watts from this period is Rosemary Kennedy (JFK's sister),
who was probably the first mentally retarded person to receive a lobotomy
and who has needed full-time care for the past 60 years.
Freeman believed that many of these changes were
not only acceptable, but also therapeutic.
He saw laziness, indifference
and dullness as signs that the overcharged emotional impulses of the thalamus
had successfully been derailed. The less that patients paid attention
to their own troubles, the better.
Officials at state mental hospitals and veterans
hospitals across the country also found the trade-offs acceptable. (An
exception was William Alanson White, superintendent of Freeman's own St.
Elizabeths, who never allowed lobotomies in the hospital during his tenure.)
Lobotomy arrived on the scene at a time when these
institutions overflowed with patients, many of them servicemen who developed
mental illnesses during World War II, with no reliable courses of treatment
ahead of them. Mental health practitioners desperately needed new therapies.
By 1945, however, Freeman was starting to doubt
the effectiveness of his standard lobotomy procedure.
Be sure to read Part
2
Washington
Post February 4, 2001;
Page W16
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