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Question:WhenDoctorWalterFreemanperformedthelobotomywithhismethod,wastheentirefrontal
lobeseveredfromthebrainorwasonlypartofthefrontallobesevered?Also,howdidDoctorFreeman
determinehowfaranddeepheneededtoinserthisicepickstoseverthefrontallobeandnotprotrude
intotheotherpartsofthebrain?W.T.H.,FallsChurch,VA
AnsweredbyElliotS.Valenstein:
WalterFreemanperformedtwotypesoflobotomies.Originally,he
performedwhatcametobecalledthestandardFreemanWatts
lobotomywhichentersthebrainfromthesideofthefrontallobes.
Thetransorbitallobotomywaswhatyoureferredtoasthe"icepick"
lobotomyandtheinstrumententeredthebrainthroughtheorbit
abovetheeyeball.Inbothcases,hetriedtoseverparticular
connectionsbetweenthemedialthalamusandtheventromedialpart
ofthefrontallobes.Theventromedialpartofthefrontallobesand
themedialpartofthethalamuswere(andstillaretoacertain
extent)believedtoplayapartinemotions.Theentirefrontallobe
wasnotdisconnectedfromtherestofthebrain.
Question:IreallyenjoyedreadingMr.ElHai'sbook.Notatopicthatyou'dthinkwouldbearealpage
turner,butitwas.
Fromaculturalstandpointwhatisitaboutthepracticeoflobotomy,asopposedtoothermedicalpractices
thatarenolongerconsideredacceptable,thatsofascinatesus?Books,PBSspecials,songs,playground
taunts,etc.Why?BarryGisser,Omaha,NE
AnsweredbyJackElHai:
You'veaskedagoodquestion.You'reabsolutelyrightthatthinking
aboutlobotomyaffectsusdifferentlythanthinkingaboutdiscarded
treatmentsforsuchdiseasesas,say,whoopingcoughorpolio.
Weallhavealotoffearbuiltintoourresponsetolobotomyfearof
tamperingwiththebrain,fearofalteringourpersonalitiesand
souls,andfearofeverythingthatwefailtounderstandaboutmental
illnesses.Insomepeoplethefearmakesthemshrink,butinothers
(includingme)itproducesanattractionthatmakesthemwantto
lookmoreclosely,likeatahighwayaccident.Thenthereareothers
whotrytochannelthefearintoaffectedindifferenceorridicule(manyofthesonglyricistsandschoolchildren).
Anothercauseoflobotomy'sfascinationisthemysterysurroundingthetreatment:Whywouldanyoneproposesucha
treatment,gothroughit,orcondoneit?Thoseweresomeofthequestionsthatledmetowritemybook,andIfound
answersinthecontextsofmidtwentiethcenturymedicalpracticesandinFreeman'sownlife.TheAmerican
Experiencedocumentaryraisesitsownwonderfulquestions,aswell.
Question:Whydidthedoctornotexperimentonanimalsbeforeoperatingonhumansandbepublished
andreviewedbyhispeers?Howandwhendidthatchange?Iassumethatsuchathingcouldnothappen
todaynotjustbecausedoctorsarenotafraidtocriticizeotherdoctorsinpublicnow.Alsoattheendofthe
programitsaidthattheoperationisstilldonetoday.Whereandwhy?K.P.,Portland,OR
AnsweredbyRobertWhitaker:
Thissurgerydid,infact,ariseoutofalonglineofresearch,includingresearchonanimals.Theresearchinvolvedstudying
thefunctionofthefrontallobes(whichwerethepartofthebraindestroyedordisconnectedinalobotomy),andwhat
changeresultedfromdamagingthefrontallobes.
In1861,theFrenchneurologistPierrePaulBrocaobservedthatthefrontallobesweremuchmorepronouncedinhumans
thaninotheranimals,andconcludedthatitwasthisregionofthebrainthatgaverisetothe"superiorfaculties"ofhumans.
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Next,in1871,England'sDavidFerrierreportedthatdestroyingthis
brainregioninmonkeysandapesmarkedlyreducedtheir
intelligence.Theanimalsbecame"apatheticordullordozedoffto
sleep,respondingonlytothesensationsorimpressionsofthe
moment."ItalianneurologistLeonardoBianchiconductedsimilar
experimentsinthe1920swithdogs,foxes,andmonkeys,andhe
concludedthatthehumanintelligenceresponsibleforcreating
civilizationcouldbefoundinthefrontallobes.
Atthesametime,manysoldiersinWorldWarIsufferedfrontallobe
injuries,andthisledtoanumberofclinicalreportsthatpeoplewith
damagedfrontallobesbecamechildish,apathetic,losttheircapacitytoplanahead,andcouldnotmakesoundjudgments.
Theiremotionsseemedflattenedoroutofsyncwithevents.Frontallobeinjuriesledtoarecognizablesyndrome,
dubbedWitzelsucht,thatwascharacterizedbychildishbehavior.
ThenextstepinthislineofresearchcamefromCarlyleJacobsenatYaleUniversity.Inastudywithtwochimps,Beckyand
Lucy,heshowedthatoncetheirfrontallobeswereremoved,theylostthecapacitytosolvesimpleproblems.Thefrontal
lobes,Jacobsenconcluded,wereresponsibleforanorganism'sadjustmenttoitsenvironment.Jacobsenwrotethatthis
regionofthebrainsynthesizedinformation,includingmemoriesformedfromrecentevents,anditwasthisprocessthat
producedintelligentaction.
In1935,neurologistsfromEuropeandtheU.S.gatheredinLondonforacongressthatincludedanalldaysymposiumon
frontallobefunction.Neurologistspresentedcasehistoriesoftheirpatientswhohadsufferedfrontallobeinjuries,and
Jacobsenpresentedtheresultsfromhischimpstudies.WalterFreeman(thelobotomistinthedocumentary)attendedthe
symposium,andafterlisteningtothesepresentations,heconcluded:"Theaudiencewasimpressedbytheseriouslyharmful
effectsofinjurytothefrontallobesandcameawayfromthesymposiumreinforcedintheirideathatherewastheseatof
thepersonalityandthatanydamagetothefrontallobeswouldinevitablybefollowedbygraverepercussionsuponthewhole
personality."
NowPortugueseneurologistEgasMonizwasalsoatthemeeting.Buthewasinspiredbyoneothermessagethatwas
deliveredatthemeeting.Jacobsen,inhisreportonBeckyandLucy,notedthatthesurgeryproducedamarkedemotional
changeinBecky.Beforethesurgery,Beckywouldgointoarageifshecouldn'tsolveaproblem(andthusobtainthefood
thatwasthereward).She'drollonthefloor,defecate,andotherwiseshowsignsofextremeemotionaldistress.Butafter
havingherfrontallobesremoved,Beckywasn'ttheleastbitbotheredwhenshecouldn'tsolveaproblem.Itwasasthough
shehadjoineda"happinesscult,"orplacedher"burdensontheLord,"Jacobsensaid.Monizseizedonthiskernelof
information.Thisoperation,hereasoned,couldremovetheanguishofmentallyillpatients,andhefiguredthatthe
intellectualdeficitsproducedbydestroyingthefrontallobeswouldn'tbethatextreme.Hesaidthathumanswhohad
sufferedinjuriestothisregionofthebraincould"stillunderstandsimpleelementsofintellectualmaterial,"andthus
concludedthat"evenaftertheextirpationofthetwofrontallobes,thereremainsapsychiclifewhich,althoughdeficient,is
neverthelessappreciablybetterthanthatofthemajorityoftheinsane."
Sowecanseeinthishistorytherewasagreatdealofresearchthatwasdonepriortothissurgerybeingtried,andit
revealedwhatsurgeonscouldexpectfromdoingitonhumans.Therewouldbeadiminishmentofintellectualfaculties,and
adiminishmentoftheperson'semotionalengagementwiththeworld.Thatwasallverywellunderstood.However,Moniz
andmanyotherswhofollowedinhisfootstepsconcludedthatthiswasachangethatwouldbenefitthe"mentallyill."
Nowwhiletherecertainlyweredoctorsandsurgeonswhoworriedaboutdoingthissurgery,andapproacheditvery
cautiously,nearlyallofthosewhoinitiallytrieditreportedgoodresults,andpublishedtheirfindingsinmedicaljournals.
Indeed,in1943,aresearchertallieduptheresultsof618lobotomiesperformedat18differentsitesintheUnitedStates
andCanada,andconcludedthat518patientswere"improved"or"recovered,"andthatonlyeighthadbeenmadeworseby
thesurgery.Theresearcherconcluded:"Wehaveknownforalongtimethatmanmaygetonwithonelungoronekidney,or
partoftheliver.Perhapshemaygeton,andsomewhatdifferently,withfewerfrontalfibertractsinthebrain."
Thus,lobotomyaroseoutofascientificprocess.Firsttherewasanimalresearchdone,andtherewerediscussionsabout
whatfrontallobeinjurydidtopeople,andthenthedoctorswhotriedthesurgeryreportedtheirresultsinmedicaljournals,
andtheysaiditworked.Anditdidwork,inthesensethatitchangedpeopleintheexpectedways.Peopleoperatedondid
becomechildish,lessemotional,andintellectuallydulled.Thesurgerydidwhatscientistssaiditdidthequestioniswhy
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didtheyjudgethistobeagoodthingforthosesaidtobementallyill?Itwasthatevaluationprocessthatprovidedacontext
forFreemanandotherstodothesurgery.
So,couldsomethinglikethishappentoday?Couldpsychiatryorsomeotherbranchofmedicineadoptaformofcare
thatwewouldlatercometoseeasharmful?Thehistoryofmedicinecertainlywarnsusthatdoctorscanbedeludedabout
themeritsoftheirtherapies,andtodaythatwholedecisionmakingprocessisgreatlyinfluencedbypharmaceutical
companies'money,whichonlyincreasesthepossibilityofmedicinegoingastray.Thelobotomystoryreallyshouldremind
usofthatpossibility.
Intermsofwhetherthesurgeryisstillbeingdonetoday,surgeonswilloccasionallydoabilateralcingulotomy.Thecingulate
gyrusisasmallareainthebrainthatconnectsthelimbicsystemtothefrontallobes,andthesurgerytargetsthatstructure.
Inthesensethatalobotomydisconnectedthefrontallobesfromotherregionsofthebrain,thereisacertainsimilarity
betweenthetwooperations,butobviouslythisisamuchmorefocusedsurgery,anditis,Ibelieve,usedsparinglyasa"last
resort,"afterothertreatmentshavefailed.
Question:WhatarethesideeffectsofThorazineandarethereanyeffectstothebrainafterthemedication
isnolongerbeingused?V.C.,Albuquerque,NM
AnsweredbyAnandPandya:
Aswithmostmedicationsthatrequireaprescriptionmany,manysideeffectsarereportedfor
Thorazine(alsoknownasChlorpromazine)butonlyafewarecommonenoughtowarrant
discussion.AmongthemostcommonsideeffectsofThorazinearesedation(feelingtiredor
sleepy),drymouth,constipationandblurredvision.Thesearesideeffectsthatareusuallyvisible
veryearlyintreatmentsoifthesedonotoccurinthefirstfewdays,theyarelesslikelytooccur.
Somepeopleareabletogetusedtothesesideeffectssosometimesitisworthwaitingtoseeifthe
medicationbecomeseasiertotoleratewithtime.Othersideeffectsincludefeelingrestless(known
asakathisia),rigidity(peoplereportthattheyeitherfeel"stiff"orappear"stiff")andashuffling
gait.Thesesideeffectscanbetreatedsoitisimportanttoletyourdoctorknowifyouhaveanyof
thesesideeffects.Somepatientsexperiencewrithingorjuttingmovements.Thesearesometimes
describedas"spasms"andcanbequiteunnervingbecauseitmayfeelasifyouhavemomentarilylostcontroloverpartof
yourbody.Youshouldcontactyourdoctorimmediately,ifthesesideeffectsoccur.Theremaybemedicationsthatcan
addressthissideeffectoritmayrequireyoutochangemedications.Finally,inthelongerrun,somepeoplegainweighton
Thorazine.
Almostallofthesesideeffectsarereversiblewithtwoexceptions.Onetypeofjutting/writhingmovementcausedby
Thorazinemaybecomeirreversibleifitisnotaddressedpromptly.Thisisrelativelyrarebutitisoneofthereasonswhyit
isimportanttotellyourdoctorrightawayifyouarehavinganyunusualmovementsonThorazine.Also,asweallknow,itis
usuallyeasiertogainweightthantoloseitsopeoplewhogainweightonThorazinemayneedsometime(andalotof
motivation)toshedanyextrapounds.
Question:ForAngeleneForester:Doyouthinkthelobotomywasapositiveoperationandwouldyouhave
agreedtohavingyourmotherundergotheoperationifitwasuptoyou?A.M.,McLean,VA
AnsweredbyAngeleneForester:
Yes,ifitwasinthesametimeperiod,withthesamefacilities
availableandthetechnologyandmedicineofthetime,
unequivocally,yes.Ifitwastoday,no!Iwouldn'tbecausewehave
otherthingstoday,wehavemedicine.ManyoftheailmentsthatDr.
Freemanwasfixingtocure,wenowknowarechemical.Manyofthe
ailments,notonlyinmymother,butthatotherpeoplehadinthe
show,arebeingtreatedtodaychemicallyquitesuccessfully.My
motherwastreatedsuccessfullyattheend,withchemicals.So,yes,if
ithadsavedtime,Iwouldhavedoneit.Today,withtechnological
enhancementsandmedicine,no.
Thereisoneotherthing.Theelectroconvulsivetherapythatshewassubjectedtoisusedtodayvery,verysuccessfullyto
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treatsuicidaldepression,whichisoneofthebiggestthingstheytookhertoDr.Freemanfor,anditdidcurethat.Shewas
neverdepressedorsuicidalagain.So,theywouldprobablystilltreatherwiththeelectroconvulsivetherapy.Butforthe
otherproblems...mymother,overtheyears,hadbeenunderthecareofapsychiatristallthattime.Shewasschizophrenic,
paranoid,delusional,andshesufferedfromauditoryandolfactoryhallucinations.Themedicinetheyputheronstopped
themcompletely.ShewaslikethemotherIalwayswanted.Anditwasverysuccessful,withthemedicaltreatmentwehave
today.Itjustshowshowfarwe'vecome,andI'mgladshelivedsolongtobeabletotakeadvantageofthemedicineand
becomemymother.
Question:Whatpercentageofthelobotomizedpeoplewereabletoliverelativelynormallives(gainfully
working,marrying,havingfamily,managingtheirfinances...)?Whatpercentageofthosewhopriortothe
operationwereratherhopelesslydetainedinmentalinstitutions?SvatoSchutzner,Washington,D.C.
AnsweredbyWalterFreemanIII:
Myfather'sstatisticsshowedthatonethirdoflobotomypatients
returnedtonormallives,onethirdreturnedtolivingwiththeir
families,andonethirdremainedinstitutionalizedfortheremainder
oftheirlives.Therewasadramaticdecreaseintheincidenceof
suicideamonglobotomizedpatientscomparedwithuntreated
patients.Thelikelihoodofdischargefromstatementalhospitals
withoutlobotomypriortotheintroductionofdrugsandtheuseof
lobotomywasunder5%.Andthelikelihoodofmentalanguish
continuingforyearswithagitateddepressionandselfinflicted
violencewasveryhigh,untileventualburnout.Theimagesshown
inTheLobotomistoftheovercrowdedstatehospitalsshowedtheresultsofabandonmentofthepatientsbytheirfamilies,as
they"closedranks"inmyfather'sphraseandmovedon.Oneofhisgreatpioneeringachievementswastointroducea
psychiatricwardinacommunityhospital,sothatacutelyillpatientscouldbetreatedclosetotheirhomesandreturned
thereinordertoavoidbeingwarehousedinthestateinstitutions.
Question:InthiscenturywhereMRIandnewtoolsareavailable,hasanyphysicianormedicalschooltried
tounderstandwhatwerethepositiveandnegativeeffectsoflobotomy?Whatwasreallyhappeningtothe
brainsofthesepeople?
AnsweredbyRobertWhitaker:
AnMRIorothermodernimagingtoolcouldn'treallyprovideanynewinsightintothesurgery.Freemanandothersknew
withsomeprecisionwhatfiberstheywerecuttinginthebrain,andhadagoodsenseoftheimportanceoffrontallobe
functiontothehumanintellect.Thefrontallobes,infact,wereoftensaidtobetheseatofhumanconsciousness,thevery
partofthebrainthatgaverisetothefacultiesthatseparatedusfromourprimatecousins.
Indeed,the"positive"effectsoflobotomycouldbefairlyeasilydescribedbackinthe1940sthesurgerydidmakepeople
lessemotionallyengaged,andthatenabledsomepeopletoleavementalhospitalsandgohome.Itoftendidreducetheir
psychicpain.However,thatlossofemotionalengagementwithlifecouldalsobedescribedasanegativeeffect.Andthen
youhadothernegativeeffectsaswellthechildishbehavior,theapathy,thedullingoftheintellect.Thus,modernimaging
toolscan'thelpusdecidewhetherthesurgeryshouldberememberedasbeneficialorharmfulthequestionisreallyone
thatgoestomoralvalues.Wasthisagoodchangeforthementallyillornot?Andbeforeyouanswerthatquestiontoday,you
needtoask:Whatchanceofrecoverydotheseriouslymentallyillhaveintheabsenceofsuchaggressivetreatments?The
answermaysurprisemany,giventhatwearetoldthatpeoplewithschizophreniahaveabiologicalillnessandarepretty
muchdoomedtobecomechronicallyill.Infact,manypeoplewithschizophreniaandotherseriousmentalillnessescanand
dorecoverovertime.Freemanandothersreasonedthatlobotomywasjustifiedbecausethementallyillweredoomedtobe
illforever,thattheyreallyhadnohopeofgettingbetter.Butthatisnottrue,andsoyouhavetofactorthatpossibilityof
recoveryintoanymoralequationofthissort.
Weshouldnotethatthissamequestionarisesforoursocietytoday.Asthedocumentarynoted,whenThorazinewas
introducedin1955,itwashailedforproducinga"chemicallobotomy."Antipsychoticdrugscanmakepeoplelessemotionally
engaged,moreapathetic,andintellectuallydulled.Butthedrugsaresaidtobeworthwhilebecausetheyaresaidtoreduce
psychoticsymptoms.Theyremovedistressingsymptoms,muchliketheoperationdid,butatasignificantcost.Andwhile
oursocietyisconvincedthatantipsychoticdrugsaregoodfortheseriouslymentallyill,manywhoareaskedtotakethemdo
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notsharethatsentiment.Theycomplainabouthowthedrugsmakethemfeellikezombies,etc.Sothemoraldilemmathat
isattheheartofthelobotomystoryhasn'treallygoneaway.
Question:Inoticetheshowdidn'tmentionit,butdoyouthinkthattheclosingofsomanystatehospitals
overthepast1520yearshashadanegativeeffectonmanymentallyill?Forexample,thelargenumbersof
mentallyillinprisonorhomelesswhodon'tgetanytreatment,etc.WhatwouldDr.Freemanthinkofthe
nation'sdeinstitutionalization?P.C.,Gary,IN
AnsweredbyFranklinFreeman:
Iknowthere'sbeenalotofcriticismaboutclosingthebighospitals
andsoon.Buttheywerehorribleplaces.Duringthelate1940s,most
statelegislaturesbudgeted$2adayperpatientforroom,board,
medicaltreatment,staffsalaryandsoon.Therewasverylittleleft
overfortreatingthepatients.Andofcourse,psychiatryfromthe
early20stothe1950sandbeyondwasdominatedbythe
psychoanalysts,andpsychoanalystscouldnotdealwiththese
intractablecases.Sothesepatientswerejustconfinedtotheback
wardswheretheygotpreciouslittletreatmentifatall,andthey
simplydeteriorated.Andthat'saknownfact.
So,atthesametime,beginninginthelate1930s,theideaofcommunitypsychiatrycameonboard.Dad[Dr.Freeman]was
oneofthefirstinWashingtontotreatpatientsinthelocalcommunityhospitalmostlyelectroshocktherapy,thatsortof
thing.Graduallythethinggrew.DadwasinvolvedinthebuildingoftheElCaminoHospitalinSantaClara,California.It
wasoneofthefinestpsychiatricfacilitiesinthestate.MybrotherPaulandIstoppedinthereonetime.Nicecourtyardwith
flowers,obviouslyverywellkept.Sotheideawastoclosethoseterribleplacesandputtheminthecareoflocalhospitalsand
localpsychiatrists.
Now,someofthesepeople,theygetawayandtheyjustdon'ttaketheirmedication,theyendupcommittingcrimes,they
havecommittedsuicidebythreateningapoliceofficerwithaknifeorsomethinglikethat,andsurprise,surprise:they're
shot.Sowestillhavethatsortofthing,butonthewhole,psychiatryhascomeaverylong,longwaysincethoseterribledays.
Question:Mygrandfather,CharlesArmstrong,receivedadoublefrontallobotomyfromDr.Freemanin
1948or1949whichwasatotalsuccessintreatinghisdepression.Hewentbacktoworkandlivedtotheage
of95stillreadingtheHarvardClassicsdaily.Hehadnonegativeeffectsfromthetreatment.Howmany
otherpositivecaseswerethereamongFreeman'spatients?BrianArmstrong,MillstoneTownship,NJ
AnsweredbyAndrewScull:
Letmebeginbysayingthatyourgrandfatherwasavery,very
fortunateman.Storieslikethisonedoexist,andtheyundoubtedly
helpedFreemanandthosewhoemulatedhimconvincethemselves
thatlobotomieshadmerit.Buttheywererare,andfarfromthe
norm.
Afewpointstoconsider:thehumanbrainisaphenomenally
complexorgan,atonceverydelicateandyetsurprisinglyresilient.To
graspthisinanothercontext,thinkofpeoplewhosufferserious
strokes.Manyincurbraindamagesoseverethattheyneverrecover
vitalmotorandmentalfunctions.Inothers,evenwithextensivepathology,thebrainlearnstoadapt,andfunctionis
graduallyrestored.Lobotomieswereextremelycrudeoperationsthatinflictedquitevariedpatternsofdamageon
individualpatients.Somepeoplewererelativelyfortunate,andwereabletocompensatefortheresultingdeficits.Many
morewereleftwithpermanentproblemsinitiatingaction,acripplinglackofinhibitions,aninabilitytoplanforevenshort
termgoals,incontinent,andsoforth.Noonecantellyouhowmany"good"resultsFreemanobtained,forthesimplereason
thatnosystematicdataofthissortwerecollected,andsuchinformationasdoesexistwasmostlygatheredbyFreeman
himself,andisthoroughlyunreliable.
Asageneralmatter,theassessmentofmedicaltreatmentsisenormouslydifficultandcomplex,andfraughtwiththe
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possibilityofbiascreepingintotheevaluations.Thecomplexprotocolsthatgovernclinicaltrials,andtheinsistenceamong
mostresearchersondoubleblindcontrolledtrialsarebothsymptomaticoftheseproblems,andrepresentanattemptto
minimizetheireffects.Thesedifficultiesarecompoundedwithrespecttopsychiatrictreatments,whereoneisconcerned
withmakingacomprehensiveassessmentofpatients'mentalandsocialfunctioningacrossanextraordinaryarrayof
dimensions.Thesedayspsychopharmacologistsattemptingtotestdrugeffectsoftenrelyonratingscalestotrytomeasure
outcomes.Whileprovidingamoresystematicwayofmeasuringimprovementoritsabsencethananythingthatwasusedto
evaluatelobotomy,theseratingscalesarenotwithouttheirownflawsandproblems,andoftenglossoverorignore
importantissuesthataredifficulttomeasurebutofcrucialimportance.
Finally,oneshouldbewarethetendencytorelyonanindividualpieceofanecdotalevidence(orevenahandfulofsuch
examples)whenassessingwhetheratreatment"works."Lobotomywasamutilatingandirreversibleoperationthat
possessedlittleornoscientificwarrant,andwasusedinremarkablycarelesswaysonpatientswhoeitherhadnosayinthe
matter,orwhoweregulledbyruthlessenthusiastslikeWalterFreeman,whofedthemgrosslyinaccurateinformationabout
whatwasbeingdonetothem.Manyoperationsweredoneonpeoplewhoseproblemswererelativelyminorandtransient,
andtheselessdisturbedindividualsundoubtedlyprovidedthemajorityofFreeman'ssuccesses.(Notethepassagesinthe
programwhereFreemanisperformingtheoperationonoutpatients,orpeoplelikepoorRosemaryKennedy.)Lobotomy
waspresentedasalastresortoperationtobeusedonburnedoutschizophrenicsonwhomeverythingelsehadbeentried.
Somepatientsofthissort,particularlythosewhoposedmajormanagementproblems,wereindeedoperatedon.But
Freemanhimselfconcededthatresultsinsuchcaseswerealmostalwayspoor.Instead,hepreferredtoseekoutthe
depressed,theobsessivecompulsivecases,theneurotic,andevenchildrenlikeHowardDully,whomyousawonthe
program.Thesepatientssufferedfromconditionswhichweresometimespersistent,butoftensawspontaneousremissions
(i.e.,theysimplygotbetterovertime,unlesstheirtreatmentmadethemworse).PerhapsthathelpsexplainFreeman's
eagernesstoextendthe"benefits"ofpsychosurgerytotheseformsofmentaldisturbance.
Question:Verygoodandinterestingshow.Dr.Freeman'sprocedureandattitudedoesseemrather
cavalier.Itseemedthatthejudgmentsofthevalueofthisprocedurewerecoloredbythehorrificnatureof
theprocedureandsupportedwithanecdotaldata.Hastherebeenanyquantitativefollowupeverdoneon
thesideeffectsandbenefitsofthisprocedure?N.S.,Linden,NJ
AnsweredbyBarakGoodman:
Thequantitativeanalysisoflobotomywasmeager.Theobstaclestoagoodstudy
oflobotomywerenumerous:thepatientswereoftenabandonedinmental
hospitalsandthereforehardtoaccesscontrolledstudieswereofcourse
impossibleandnotwopatientsgotthesameoperation(Freeman'soperation
wastruly"astabinthedark").Thestigmaattachedtotheoperationmadeita
lessthandesirableareaofresearchandstudy.Perhapsthemostthorough
analysiswasdonebyFreemanhimself,whokeptintouchwithhundredsofhis
patientsandtriedtoassembledatatosupportlobotomy'sefficacy.Ithinkwe
havetoregardthatdataassuspect.
Question:Whentravestiessuchastheseareuncovered,what,ifanything,iseverdonetorectifythe
damagethat'sbeendoneordoeseveryonejustwalkawayshakingtheirheads?HowardDully,SanJose,
CA
AnsweredbyAndrewScull:
DearMr.Dully,
Sadly,Ithinktheanswerisoftenevenworsethanthealternativesyouoffer.Thosewhoattempttoblowthewhistleonthese
sortsofthingsareoftenostracizedorpunishedbytheirfellowprofessionals,whoprefertosweepprofessionalmisdeeds
undertherug.Herearetwoexamples:
AtaboutthesametimethatFreemanwasexperimentingwithlobotomy,asubstantialnumberofpsychiatrists,hereandin
Europe,wereputtingschizophrenicsintoextendedcomasbyinjectingthemwithinsulin.Theyclaimed70to80percent
cures.Theprocedurewasdangerous,anditsinventorclaimedit"worked"bystarvingthebrainofoxygen.In1953,ayoung
Britishpsychiatrist,HaroldBourne,publishedapaperinTheLanceton"TheInsulinMyth,"arguingthatthetreatmentwas
ashamandafailure.Hisreward,intheweeksthatfollowed,wastobedenouncedinvituperativetermsinthepressandin
professionaljournalsbytheleadinglightsofBritishpsychiatry.Fiveyearslater,anextensivecontrolledtrialdemonstrated
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thatBournewasright.Iamnotawarethathe(orthosewhohadbeenputintothecomas)everreceivedanapology,public
orprivate.
Adecadeandahalfbeforelobotomy,thesuperintendentoftheTrentonStateHospital,HenryCotton,hadclaimedtocure
85percentofhispatientsbyremovingtheinfectionsthatheclaimedcausedallformsofmentalillness.Inpursuitofhis
goals,heremovedteeth,tonsils,stomachs,spleens,colons,anduteri,virtuallyevisceratingmanyofhispatients,andkilling
almosthalfofthosehesubjectedtoabdominalsurgery.Thousandsofotherswereleftmutilatedbyhisdepredations.(He
waseverybitassincereasFreeman,pullinghiswifeandhischildren'steethinanattempttopreventtheirgoingmad
bothhissonssubsequentlykilledthemselvesandarrangingtohavehisownteethpulledwhenhehimselfhadamental
breakdown.AfterwhichhewasallowedtoreturntoTrentonandtooperateonmanymorepatients.)America'sleading
psychiatrist,AdolfMeyer,whohadsentoneofhisprotges,PhyllisGreenacre,toinvestigatetheseclaims,suppressedher
reportdocumentingthesedisasters,andwhenCottondiedsixyearslater,wroteanobituaryintheAmericanJournalof
PsychiatrylamentingCotton'sprematuredeath,andthecuttingshortofhisgrandexperiment!(Thewholetravestyis
recountedinmybookMadhouseforthosewhoareinterested.)
Occasionally,afterthefact,lawsuitsarelaunchedattemptingtosecuredamagesforthevictims.ThisoccurredinCanada,for
instance,afterthedeathofEwenCameron,formerpresidentoftheAmerican,Canadian,andWorldPsychiatric
Associations,andamemberoftheNurembergmedicaltribunalwhichhadinvestigatedNazidoctors.Cameron,practicing
atMcGillUniversity,hadexperimentedwith"depatterning"and"psychicdriving,"extraordinaryexperimentswhere,inter
alia,hewipedoutpatients'memorieswithrepeatedelectroshocksdesignedtoreducethosesubjectedtothemtothestatus
ofhelpless,incontinent"infants,"whosepsycheshethenpurportedtorebuild.Cameronathisdeathwasahighlyrespected
figureinhisprofession.OnlyafteritemergedthatmuchofthisworkhadbeensecretlysupportedbytheCIAwerelawsuits
brought,someofwhichweresuccessfulinsecuringmonetarydamagesforhisvictimsand/ortheirfamilies.Whether
moneycouldeveradequatelycompensateforwhathasbeendone,forsuicidesandruinedlives,isverydoubtful,asI'msure
youwouldagree.Butthelegalacknowledgementofthedepthofthewrongthathasbeenwroughtis,ofcourse,worth
something.
Remarkably,scholarswritingaboutsuchepisodesinrecentyearshaveadoptedamorebenignviewofthesehuman
experiments.Theyhaveurgedthatthesedoctors'actionshavetobeseeninthecontextoftheirtimes,andthedepthofthe
dilemmastheyconfronted.Thereismerittothesecontentionstoapoint,butIfeartheycaneasilytoppleoverinto
apologetics.Freeman,Cotton,andMeyerwere,inmyview,moralmonstersajudgmentthatrequiresmoreextended
analysisthanIcangiveithere.Oneneeds,tobesure,tounderstandhowtheycametodowhattheydid,andhowtheywere
abletopersuadetheirfellowprofessionalsofthemeritsoftheapproachestheychampioned.Buttounderstandisnotto
excuse,andIbelieveitisimportanttosaysoloudlyandclearly.
Question:I'mwonderingifFranklinFreemanmightcaretocommentfurtherontheE!
MysteriesandScandalsbroadcastwherehestatesthathisfatherlobotomizedFrancesFarmer,nowthatI
haveprovidedthesourceofthepicturehestateswasofFarmerbeingoperatedon(it'sactuallya1949
SeattlePIserieswherethepatient'sfaceisseeninanotherphoto)andalsoretrievedthecomplete
lobotomylogsfromWesternStateHospital,whichshowalllobotomiesDr.Freeman(andthosehe
trained)performed.Franceswasnotthepatientinthephotonorissheinthelobotomylogs(orany
surgerylogs,forthatmatter).Thankyouforyourtime.JeffreyKauffman,Portland,OR
AnsweredbyFranklinFreeman:
ManyyearsagoFrancesFarmer'sfiledisappearedfromthepatient'srecordsatWesternStateHospital.
Question:Doyouapproveordisapproveofyourfather'swork?A.R.,McLean,VA
AnsweredbyWalterFreemanIII:
Istronglyapprovemyfather'sworkdeveloping,applying,andprovingthevalueofsurgicalinterventiontorelievethe
sufferingfromotherwiseincurablementaldiseaseleadingtophysicalandemotionaldevastationandoftensuicide.Ialso
approvethetransorbitalprocedure,becauseitsratesofmortalityandpostoperativeepilepsyareonethirdthoseofstandard
procedures.Istronglydisapprovetheuseoflobotomytoeasethecontrolofaggressiveandunrulypatients,asappearsto
haveoccurredinthecases,underparentalpressure,ofRosemaryKennedyandHowardDully.Idisapproveequallystrongly
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theuseofthisvaluablesurgicalproceduretoreducethecostofmentalhealthcare,bymyfatherandbyanyoneelse.
Question:HowwasDr.Freemanabletoperformalloftheselobotomieswithoutconsentfrompatientsor
familymembers?A.D.,Waukesha,WI
AnsweredbyJackElHai:
WalterFreemandidsecurelegalconsentformostofthelobotomiesheperformed,atleastbythestandardsofthetime.
Manyofhispatientswerewardsofthestate,institutionalizedingovernmentpsychiatrichospitals.Ifthehospital
administrationdecidedthatsuchpatientswouldbenefitfromalobotomy,theygotone.Inothercases,Freemanobtained
consentfrompatientsthemselves(iftheyseemedcompetenttogiveit)orfromfamilymembersandnextofkin.Inthe
earlyyearsoflobotomy,Freemanwasquitescrupulousingainingfamilialconsent,becausehebelievedthatthefamilies
hadtobeonboardtoprovidetheextensiverecoverycareathomethatmostpatientsrequired.
Asoneantilobotomypsychiatristpointedoutinthe1940s,however,familiescouldhavemixedmotivesforapprovinga
patient'soperation.Somedesperatelyhopedforamiraculousrecovery,butothersmayhaveunconsciouslywantedtoenda
patient'sburdensomeexistence.Somechronicallyillpatientslaterconfessedthattheyhadwantedtodieasaresultoftheir
lobotomyapassiveformofsuicide.
Question:Isthereanywayonecanfindoutforsureifalobotomyhadbeenperformedonhim/herasa
youth,somefiftyyearsago?Thankyou.S.Smith,LakeTahoe,NV
AnsweredbyBarakGoodman:
IwouldrecommendyoucontacttheGeorgeWashingtonUniversitylibrary,whereFreeman'spapersarekept.Ifyouarea
familymemberofoneofFreeman'spatients,it'spossibleyoucangainaccesstohisrecords.beyondthis,itmaybedifficult
tofindoutforcertainifalobotomyhasbeenperformedforitleavesnovisiblephysicaltrace.
Question:Didhavingafatherwhowasnoticedinthepubliceye,positivelyandnegatively,haveanimpact
inyourlife?NguyenMyAnh,McLean,VA
AnsweredbyWalterFreemanIII:
Unlesstheparentisapresident,governor,orsuperstarincinema,sportsormusic,verylittleofpublicfamespillsoverto
thespouseoroffspring.Inmyexperiencetheeffectofhavingaparentwhowasgreatlyadmiredbysomeanddetestedby
otherswaslimitedtotheadoptionofanattitudetowardmethatwascoloredbyenhancedfriendlinessorovertavoidancein
socialencounters.AsfarasIcantell,thefamedidnotcarryovertoovertpreferentialtreatmentinadmissiontoschoolsor
openingsforjobs.Tothecontrary,Iwasimpressedthatpeoplewhohadanegativeattitudetowardmyfatherweremore
likelytobescrupulousinvisitingthatanathemaonmyhead.
Question:IfthechemicaltreatmentThorazinehadnotcomeintouse,wouldlobotomystillbeconsidered
anacceptableformoftreatment?ThomasKohlbrenner,McLean,VA
AnsweredbyAnandPandya:
AsidefromthediscoveryofThorazine,thereareseveralothertreatmentsthatweredevelopedorrefinedaroundthesame
timeandthosetreatmentsalsohavemanyadvantagesoverfrontallobotomies.TheseincludeLithium,tricyclic
antidepressantsandelectroconvulsivetherapyaswellasthedevelopmentofpsychosocialinterventionssuchasclubhouses
andresidentialmodelsthatempowerpatients,andcognitiveandbehavioraltherapy.Together,theseinterventionswould
likelyhavedisplacedfrontallobotomy.
Inaddition,startinginthesixties,wehavehadarevolutioninsociety'sattitudesabouttherightsofpeoplewithmental
illness.Itisnotacceptable(and,ofcourse,itnevershouldhavebeenacceptable)toignorethepreferencesoftheperson
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withtheillnessandtheirfamily.Norisitacceptabletoengageinsuchinvasiveprocedureswithoutofferingthepatientand
theirfamilyinformationabouttherisks,benefitsandalternatives.Ibelievethatthesereformswouldhavereducedthe
practiceoffrontallobotomiesevenifwedidn'tdevelopbettertreatments.ThedocumentaryTheLobotomistvividlyshows
thatlobotomiesmayhavebeenhelpfulforsomepeopleandwereclearlynotappropriateforothers.Ibelievethatifwedid
nothavemoderntreatments,wewouldhaveatleastlearnednottousefrontallobotomiesonlyoncarefullyselectedcases.In
fact,psychosurgeryisstillperformedonpatientswithseverecasesofOCDbutsuchpatientsarecarefullyselectedandthere
isaprocessforinformedconsent.
Yourquestionacknowledgesthatmostfrontallobotomieswereactsofdesperationinatimebeforemedication.In
thecenturiesbeforefrontallobotomies,therewereevenmoredangerousattemptstotreatmentalillnesssuchasbleeding.
Likebleeding,frontallobotomiescouldcalmapatienttemporarily.Whenyoulookbackoverthecourseofhistory,you
realizethatfrontallobotomiesseemlikejustasteponalongpath.Ourmodernmedicationsareprobablyjustanotherstep.
TheyarefarbetterthanafrontallobotomybutIbelievethatsomedaywewillhavetreatmentsthatarefarbetterstill.
Thisdoesn'tmeanthateverythingisalwaysgettingbetter.Thelivesofpeoplewithmentalillnesscanandhasbecomemuch
worseattimeswhensocietyisnotwillingtotreatallpeoplewithdignity.Hopefully,wecanlearnthislessonfromthe
tragediesoffrontallobotomies.
Question:Whyisitexactlythatmanyofthesurgerypatientssufferedthroughnegativeconsequences?Did
Dr.Freemancutthewrongnerveconnections?Ifso,whatpartofthebraincausesmentalillnesses?
ManaswiSangraula,McLean,VA
AnsweredbyWalterFreemanIII:
Therearenoexactanswerstoyourquestions,becausethereisnoonepartofthebrainthatcausesmentalillnesses,and
thereisnooneconnectiontocurethem.
Myfatherwasaimingtodisconnectthethalamusfromthefrontalcortex.Themosteminentneurophysiologistofthe1920s
and1930s,JohnFultonatYaleSchoolofMedicine,foundintwochimpanzees,BeckyandLucy,thatcuttingthenerve
connectionsbetweenthalamusandfrontalcortexgreatlyreducedtheemotionalbehaviorsofthechimps.Hepresentedhis
findingstoaninternationalmeetingin1934.EgasMonizwenthometoPortugalandoperatedon12chronically
institutionalizedpatients.Heshowedthatfourwereabletoreturntowork,fourwereabletoliveathome,andfourwereno
betterorworse.HereportedhisworktoacongressinLondonin1935.MyfatherlearnedfromtalkingwithMoniz,notjust
fromreading.
Thepositiveconsequencesofcuttingbetweenthalamusandfrontalcortexwerelossoffearandanxiety.Thenegative
consequencesofcuttingwerelossofsocialinhibition(lossofguilt,shame,fearofdisapproval)andlossoftheabilitytothink
ahead(noambition,eatingtoexcess,inabilitytoreadthemindsofothers).
ThissameHobson'schoiceholdsforsocalled"chemicallobotomy."PeoplewhostarttakingProzac,Miltown,orother
tranquilizersnolongersufferanxietyandfearofthefuture,buttheyloseambition,libido,andthecapacityfordeep
feelings.Thatisthecostoftreatment.Neithersurgerynordrugscurethementalillness.Theyonlyrelievethesuffering,and
thecostishigh.Mostpatientswhoarenotsufferingtoomuchprefertocontinuetosufferthantoaccepttheloss.Other
patientssuffersointenselythattheykillthemselvesratherthancontinueliving.Forthem,lobotomyoffersaoneinthree
chanceatreturningtoanormallife.Butiftheoperationfails,theystillgetrelieffromtheirdemons,thoughtheymayno
longercare.
AnsweredbyAnandPandya:
Unfortunately,wedonotcompletelyunderstandwhatcausesmentalillnessbutitisclearthatratherthanaprobleminone
partofthebrain,mostmentalillnessesarecausedbyacomplexinteractionbetweendifferentpartsofthebrain.Today,
neurosurgeonsareabletofigureoutfairlypreciselywheretheywanttointervenewithinthebrainbasedonavarietyof
testsandtheuseofCTscansandMRIs.Thesewerenotusedinlobotomiesandthusitislikelythateachlobotomyaffected
manydifferentpartsofthefrontallobes(thefrontpartofthebrainresponsibleforavarietyofthingsincludingplanning
andexecutingcertainbehaviors).Itislikelythattheyfrequentlycutthe"wrongnerve"(althoughwewouldtechnicallycall
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these"neurons"ratherthan"nerves").
Moreimportantly,thisdocumentarymakesitclearthatthetreatmentwastriedonabroadvarietyofpatientswithabroad
varietyofproblems.Itislikelythatforsomeofthesepatientstherewasno"rightnerve"tocutintheirfrontallobes.Thus,
oneofthelessonsfromthistragedyisthatweneedtobeverycarefulbothcarefulinthewaywedoourtreatmentsand
carefulinmatchingtherighttreatmenttotherightpatient.
Question:WhenIwatchedtheprogramandheardaboutthechildrenthathadhadlobotomies,Ihadto
wonderifanythinghasreallychanged.Therearemanychildrentodaybeingtreatedwithantipsychotics,
andsomeareveryyoung.FromwhatIcantellmanyofthesechildrenareinfostercare,andaredruggedto
keepthemundercontrol.Aretherenotanyrules,regulationsoroversightintothe"chemical
lobotomizing"ofourchildren?Aretherelikelytobeadverseeffectsfromtreatingpeoplewiththesedrugs
whentheyarenottrulymentallyill?M.W.,Tomball,TX
AnsweredbyAndrewScull:
Thankyouforyourexcellentquestion.TheissueofdruggingchildrenwithsuchthingsasRitalin,antipsychoticsand
antidepressantsisacomplexone.Iamnotoneofthosewhobelieves,asdoesthepsychiatristPeterBreggin,thatall
psychopharmacologicalagentsaretoxic,andtheiruseneverdefensible.Forsomechildren(andforsomeadults),whenused
withcare,drugtreatmentshavetheirplace.Itisimportant,however,tounderstandthelimitsofdrugtreatmentsfor
psychiatricdisorders.Eveninthebestofcircumstances,theyarenotpsychiatricpenicillin.Theyalleviatesymptoms,
sometimesandforsomepeople.Theydonotcure.Thatlimitedsuccessisnonethelessaworthwhileaccomplishmentwhen
theywork,whichisfarfromuniversally.
Thereisstillanothersetofproblemsthatneedtobeacknowledged:whenthelaypersonhearsthatsomethingrepresentsa
significantimprovementasatreatment,thenaturaltendencyistobelievethat"significant"meansthatitrepresentsa
"major"improvement.Whatitreallymeansisthatitmeetsastatisticaltestofsignificance,oftenaverylowthreshold.The
improvementthetreatmentoffersmaybemarginal,orevenaproductoftheparticularratingscalethatwasdevisedto
measurethedrugeffect.Thatratingscalemayignoreoroverlookotherimpactsofthedrug,andmayindeedhavebeenvery
preciselytailoredto"prove"thatthedrugworks.Enormoussumsofmoneyareatstakehere.Pharmaceuticalcompanies
investmanymillionsofdollarstobringanewdrugtomarket,andstandstomakebillionsifanewmedicationwithbroad
applicationsisapproved.Outsidetherealmofpsychiatry,therecentrevelationsaboutthemanipulationofdataonthe
safetyofVioxxillustratehowthesemarketincentivescaninfluencethebehaviorofthepharmaceuticalindustry,tothe
detrimentofpatients.
Oneshouldharbornoillusions.Contemporarypsychiatryislargelyinthralltothebigdrugcompanies,andtheclassification
ofdiseasesincontemporarypsychiatryisessentiallydrivenbytheimpactofthosecompanies,asrefractedthroughthe
academiccommunity.Onesymptomofthisistheexplosionintherangeofbehaviorswhicharepathologizedand
"psychiatrized,"somethingyoucanreadilyseeforyourselfbygettingholdofsuccessiveeditionsoftheAmericanPsychiatric
Association's"bible,"theDiagnosticandStatisticalManual.Thisexpansionofthepsychiatricuniversehasentailedthe
redefinitionofallsortsofproblemsinlivingasmedicaldiseases,forwhich,conveniently,thedrugcompanieshavea
suitablepilltosell.(Foranexcellentandsophisticateddiscussionoftheseissues,Irecommendyoureadabookbythe
BritishpsychiatristDavidHealy,calledTheAntiDepressantEra.ItispublishedbyHarvardUniversityPress.)
Nowherehasthisdubiousexpansionofpsychiatriclabelsbeenmorecommonthanwithchildren.HowardDully,whomyou
sawintheprogram,wastreatedwithalobotomy.Hiscontemporaryequivalentsaretreatedwithpills.Isthisan
improvement?Onthewhole,yes.Forthemostpart,evenifthedrugsdon'twork,theydon'tinflictthelastingandgrave
damagethatalobotomydid.Butthatisnotthewholestory.Foronoccasion,thesedrugshavedevastatingeffects.After
yearsofdenial,andsuppressionoftherelevantclinicaltrialdata,drugcompanieshavefinallybeenforcedtoacknowledge
thatcertainantidepressantscarrywiththemanincreasedriskofsuicideamongchildrenandadolescents.Antipsychotic
drugsoftendullthementalfaculties,andtheycarryrisksofseriousiatrogenicconsequences,manyofwhicharemaskedas
longasthepatientremainsonthepills,butthensurfaceandareessentiallyuntreatable.Fortwentyyearsafterthe
introductionofThorazine,psychiatrydeniedthatitsusewasassociatedwiththeriskofpermanentdisablingand
stigmatizingticsandgrimacesadisordercalledtardivedyskinesia.Thisisnowarecognizedriskofusingthesedrugs.It
almostcertainlyreflectsneurologicaldamageattributabletothedrugs,anditremainssomethingwecannotreverseand
veryoftencannoteffectivelymitigate.Onanotherlevel,treatingwhatareoftenbehavioralandmaturationalissuesthrough
drugsisaterribleevasionoftheunderlyingissues,andillegitimatelyredefineswhatareoftenasmuchsocialand
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psychologicalproblemsasbiologicalamongotherthings,adreadfullessontoteachourchildren.
Question:ForAngeleneForester:Howdidyourmotherdolongtermafterherlobotomy?Didsheever
needfurthertreatmentfordepressionormentalillness?Wasshedependentandchildlike,inneedof
support,likesomepatientswere?M.H.,Woodstock,GA
AnsweredbyAngeleneForester:
Mymotherneverneededanyfurthertreatmentfordepression,andshenevershowedanysignofdepressionafterthe
treatmentshowever,shehadothermedicalproblemsasfarasmentalillnessgoesandshedidrequiretreatment.Atthe
timetheyweredevelopingnewpharmaceuticals,andshewasonthemfortherestofherlife.Shedidquitewellonthem.
Shedidnotdevelopanyofthesideeffectsthatsomepeopledid.Shewasnotchildlikeinanyway.Shewasanadultshewas
abletoholdajob,shebecameanL.P.N.Sheworked,shewasananny.Shehadanormallifeafterthat.Ineverlookedupon
heraschildlikeatall.Shelivedbyherselfaftermyfatherdiedandshedidquitewell.Sheshopped,shehadfriends,she
wentout.Therewerenootherproblemsatallwiththemedicationandthetreatment.Shedidn'tbecomehamperedatall
likesomeoftheotherpatientsI'veheardof.Shewasafullhumanbeing,andwasinfullfaculty.
Question:ThiswasoneofthemostdifficultepisodesofahistoricaldocumentaryIhaveeverviewed.Ihave
aTivoandhadtostopafterjustafewminutesandwatchtheshowinitsentiretyatalatertime.Itwasvery
difficulttowatch.Imissedtheinformationinthisepisodeabouttheconsequencesofalobotomy.Whatis
therangeofcapabilitiesapatientcanhopetoexperienceafterthisprocedure?Aretheycommittedtoan
institutionforlifeorcantheyinteractwithothersinameaningfulway?Thedocumentary(orisitjustthe
procedureitself)seemshorrificforthepatient.Whatarethebenefits?
HistorythatevokesanemotionalresponselikethestoryofDr.Freemanisworthwatching.Thanksfor
tellingthisstorydespitehowdifficultitistowatch.JohnPowell,Austin,TX
AnsweredbyBarakGoodman:
Oneofthedifficultiesinassessingthelobotomythenandnowisthefactthatresultsvariedsowidely.Notwopatients
receivedthesameoperationittrulywas"astabinthedark."Furthermore,Freemanoperatedonsuchawiderangeof
patientsfromtheprofoundlymentallyilltothemerelybadlybehavedthatanyrealscientificunderstandingofthe
effectsoflobotomywastrulyimpossible.Finally,therewereveryfewrealstudiesoftheprocedure.Bythetimesuchstudies
werecommonlyundertakeninthe1950s,lobotomywasalreadyonitswayout.Thatsaid,itispossibletostatesome
generalities.Freemanhimselffollowedupwithhispatientsverycloselyandpublishedresultsinhisownbooks.Ingross
terms,hesaid,athirdoflobotomypatientswerehelped,athirdwerelargelyunaffected,andathirdgotworse.Notgreat
results.Evenforthosewhowere"helped,"theremightbeanalleviationofthesymptomsoftheirillness,butthatcamewith
acost.Patientswereoftenpermanentlyimpaired.Theylostallinitiative,hadlittleornoambitionordrive,losttheirability
tomakesocialjudgmentsordecisions.Theywerechildlikeintheirnaivetabouttheworldandtheimpressiontheymade
onothers.Afewluckyoneshadnonoticeablesideeffectsatall.Forthem,lobotomymighthavebeenthegreatestthingthat
everhappened.Thereseemedtohavebeenveryfewofthesepatients.
Question:WasDr.Freemaneversuedbyanyofhispatients'families,ordisciplinedbythemedical
profession?C.D.,Lorton,VA
AnsweredbyJackElHai:
Theshortanswerisnoanindicationofanearlierage'sdistasteforlitigationandreluctancetoapplyprofessional
oversight.
ApatientoncedidtakelegalactionagainstFreeman,notforlobotomy,butforinjuriesshesustainedasaresultof
electroconvulsivetherapy(ECT)headministered.BackbeforedrugscouldpreventECTconvulsions,Freemanwasshortof
helpandtriedtorestrainthepatientsinglehandedlyduringthetreatment.Hefailed,andthepatientbrokealimb.Heand
thepatienteventuallysettledoutofcourt.Freemanruefullyremarkedthatheshouldhaveknownthatthepatientwasbetter
suitedforlobotomythanforECT.
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Ihaveheardsecondhandthatalobotomypatient'slawsuitagainstFreemanwasintheworksduringtheearly1970s,but
thatthepatientabandonedituponFreeman'sdeathin1972.
Exceptforthehospitalsthatwithdrewhissurgicalprivilegeswhenlobotomyfellfrompopularityattheendofhiscareer,no
medicalbodyeverdisciplinedorpenalizedFreeman.Infact,Freemanlongservedintheleadershipofseveralmedical
organizations,includingtheMedicalSocietyoftheDistrictofColumbia,whichheiscreditedwithraciallyintegrating
duringthe1950s.

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