The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness – by Jack El-Hai

The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness

by Jack El-Hai

John Wiley & Sons, 368 pp.

CLR [rating:5]

The Management of Despair

Walter Jackson Freeman was a man gifted with energy, optimism and an ice pick. The two former attributes gave Freeman the moxie to wield the latter in the service of science by driving its point into the brains of thousands of patients, severing the neural connections between their frontal lobes and much of the rest of their brains. These lobotomies were notorious even among Freeman’s fellow psychiatrists and neurologists during his lifetime. Thirty-odd years after his death, they seem pointlessly (pardon the pun) barbaric.

Jack El-Hai does nothing to redeem the practice of lobotomy in this fascinating biography of a true American medical pioneer. Parts of The Lobotomist can best be read curled in a fetal position, but the reader would be well-advised to make the effort to wade through the relievedly short gruesome passages. That’s because Walter Jackson Freeman is a man worth getting to know, a classic American archetype of genius whose one crucial idea is wielded over and over again.

Lobotomy’s story starts in the late 1800s when European scientists first began charting the brain’s physiology and discovering what different parts of that complex organ did. El-Hai documents the back-and-forth, titanic struggle for the soul of brain science between organicists, who believed that mental illness could be traced to the brain’s function, and psychologists, who believed those same illnesses could more readily be ascribed to early experience and trauma and an inability to emotionally adapt to the damage they caused.

Spurred by the work of Portuguese doctor and future Nobelist Egas Moniz, Freeman, a trained neurologist, became fascinated with Moniz’s ideas that mental illness could be traced to the reifying powers of the frontal lobe. Block the neural communication between the frontal lobe and the rest of the brain and one could cut the powerful emotions often associated with a wide range of psychiatric phenomena from depression to psychosis.

Despite Moniz’s rather mixed results with early lobotomies, Freeman and his associate, neurosurgeon James Watt, pressed forward with experimental surgery. The duo drilled into patients’ brains and used a metal loop to cut selected fibers connecting the frontal lobe with other parts of the brain.

Freeman would eventually simplify the procedure in a gruesome direction by developing the transorbital lobotomy. This involved slipping the point of an ice pick under a patient’s upper eyelid, shoving it through the thin skull bone and manipulating the pick back and forth to cut tissue linking the frontal lobe with the thalmus and other parts of the brain.

The frightening aesthetic of transorbital lobotomy, which was preceded by electroshock therapy to prepare the patient for the ice pick, left grown physicians fainting in operating theaters where Freeman demonstrated the technique (he and Watts split over transorbital lobotomies; the neurosurgeon felt Freeman approached the procedure in much too cavalier a manner).

Freeman became a devout herald of this new psycho-surgery, traveling all over the United States to perform lobotomies in psychiatric hospitals that warehoused patients for whom there was no other hope of recovery. His results were mixed at best. Some patients were able to resume somewhat normal lives after their lobotomies, others weren’t and still others died from the procedure, an outcome that never seemed to give Freeman pause for second thoughts.

What had seemed a promising approach to organically changing the brain to heal mental illness fell prey to the opposition from Freudian analysis, which swept the U.S. at the same time that lobotomies were becoming mainstream during the 1930s through the early 1960s, and to new drug therapies of the 1950s that promised much better results for those seriously ill with schizophrenia and psychoses.

Freeman himself, however, never changed, never grew or expanded his scientific horizons. Dedicated to lobotomy as a wonder procedure that could free people from their psychic ghosts and, more importantly, reintegrate them into society as productive citizens, Freeman shrugged off the criticism of his work.

There is much to admire about Freeman despite his wrong-headed insistence that lobotomy offered the best path to improving mental health for seriously ill patients. He spent a large part of his life keeping in touch with his patients and documenting their successes and failures in reintegrating back into their families and their communities. He was passionately dedicated to emptying psychiatric hospitals, which until then had simply served as cesspits of despair, housing the mentally ill in abominable conditions, often for decades on end. He used his power as a leader in the District of Columbia’s medical community to end professional segregation and bring African-American doctors into the mainstream.

Freeman, prone to overwork and affairs, would never win any awards for being a husband, but he was an outstanding father, many of whose children followed him into the medical profession. He was conscious of his responsibilities as a professional neurologist and worked to improve the scientific rigor of his specialty and to mentor younger practitioners.

One comes away from The Lobotomist with mixed feelings about Freeman. How could a man so brilliant allow himself to drift into such a dubious career cul-de-sac? How could he not question himself about the worth of what he was doing? Kudos to Jack El-Hai for giving us all we need to frame the answers for ourselves without undue pressure. His is a deft biographical touch which does much to recommend Walter Jackson Freeman the man and the doctor to our attention without needlessly sensationalizing or editorializing about the debatable kindness of lobotomizing human beings to relieve their misery.

Sam Stowe

History of Yoga