Saturday, November 14, 2009

The Lobotomy: What the hell were we thinking?

I am a psychiatric social worker and I work with adults with severe and persistent mental illness. I have been thinking about one particular patient as of late. This person (whom I will not specify due to HIPAA laws and ethics I hold as a professional) has several issues and one of them is that he underwent a labotomy during a time when they were still deemed acceptable.

Due to this procedure and other stressing factors, this person is unable to remember basic bits of information. In fact he will forget what he has been told almost instantly. He has no quality of life and it is heartbreaking.

I do not blame all of his issues on the lobotomy procedure however his set of circumstances had me reflecting on a particular story.

Years ago I read a memoir entitled My Lobotomy by Howard Dully.



Howard is a husband, bus driver and survivor.
He was one of the youngest people to receive what is known as a transorbital lobotomy or "ice pick lobotomy".

His step mother considered Howard to be an unruly kid. Was he unruly? Didn't seem to be. Seemed that he was like most 12 year old boys. Never the less Howard's step mother took him to see Walter Freeman. Dr. Walter Freeman was known as the "father of lobotomy". He was part surgeon, part showman.

Freeman took photos of himself performing lobotomies and bragged about how he could even perform two at once. The procedure took all of 10 minutes and was completed with an actual ice pick. Freeman would peel back the eyelid, tap the ice pick with a hammer and sever the frontal lobes.

Freeman began his procedures in 1952 and before his death in 1972, he performed transorbital lobotomies on some 2,500 patients in 23 states. After the drug Thorazine was introduced to hospitals his procedures were deemed unnecessary. Additionally, one of Freeman's patients died on the table and he was stripped of his hospital privileges. Some patients ended up like zombies in that they lacked motor and cognitive skills. Howard did not end up like these patients however he did suffer. He was bounced around from hospital to hospital, home to home as his step mother insisted that he was a bad seed and Freeman agreed. Howard did not grow up like most kids and young men and as a result did not gain a sense of independence.

Some 40 years later Howard went on a journey to find out what happened to him and why. He conducted interviews and obtained his old files. He was able to confront and interview his father who never opposed his lobotomy. His father maintained that he was manipulated and was not at fault for anything negative that happened to his son.


Howard Dully

Howard states that despite this he now feels free and has a sense of peace.


Lobotomy - PBS documentary on Walter J. Freeman

According to a 2007 article from Neurophilosophy, the lobotomy was first performed on humans in the 1890s. About half a century later, it was considered by some to be a miracle cure for mental illness. During the 1940s and '50s, the lobotomy was performed on approximately 40,000 patients in the United States, and on around 10,000 in Western Europe. The procedure became popular as there was no alternative. The doctors who carried much faith in the procedure felt it alleviated depression, anxiety and general unruliness.

Lobotomies began to decline in the mid- to late-1950s as there had always been critics of the technique. In addition anti-psychotic medications became available. Many of the initial medications such as Thorozine (which is an older drug that is not used as widely today) were considered to be "chemical lobotomies".

One of Walter Freeman's most famous failures was the sister of president John F. Kennedy. In 1941, Rosemary Kennedygiven a lobotomy at the young age of 23. Rosemary was described as a shy and easygoing child, but in her teenage years, she became rebellious and moody.

The operation actually made Rosemary more manageable, but only because left with the mental capacity of an infant. She couldn't speak intelligibly and could not control some of her bodily functions. She was noted as staring into space for hours on end. Rosemary spent the rest of her life in an institution.

Some researchers have claimed that she was mildly mentally delayed prior to her lobotomy, while others say that she had some form of mental illness. Rosemary's sister Eunice Kennedy Shriver later helped to found the Special Olympics in her honor.

According to How Stuff Works, lobotomies were also given to criminals, in attempts to "cure" them of their criminal ways. Some battle-fatigued World War II vets were lobotomized so they could free up space in the hospitals. How sick is that?

When patients couldn't consent to the operation themselves, family members often did so. Unfortunately, some family members were more interested in getting rid of their problem than helping the patient.

Can we fault early doctors who believed the lobotomy procedure was beneficial? Perhaps not. I think that some genuinely felt the lobotomy had positive affects. Unfortunately, individuals like Walter Freeman played to their own egos which came at a great consequence. So, to some degree perhaps we can say that at the time science didn't know any better. But where does the responsibility come in?

Walter Freeman eventually lost his liscence when a patient died of a brain hemorage. Lobotomies declined but did not disappear.

According to Psychosurgery.org, lobotomies are almost never utilized to treat mental disorders but are most often used to treat epilepsy. Surgeons actually continue to utilize lobectomies (the removal of the frontal lobe or lobes) as well.

I have no idea as to whether the medical community felt any shame or embarassement after it was learned that lobotomies were not helpful.


In the brilliant 1975 film One Flew Over the Cuckoos Nest (adapted from the book) Jack Nicholson plays R. P. McMurphy. McMurphy is given a lobotomy as punishment after he attempts to kill Nurse Rachet.

This film influenced how the mainstream viewed lobotomies. Lobotomies are still viewed as quite barbaric. Considering the fact that it is an invasive (yet short timed procedure) surgery that rarely benefited anyone, I'd say that is an accurate claim.

According to an article from the website How Stuff Works, the brain is essentially composed of two different types of matter: gray and white. The gray matter includes the neurons with their blood vessels and extensions. The white matter consists of nerve fibers, that connect the areas of gray matter and carry messages between them through electrical impulses. A lobotomy was intended to sever the white matter between different areas of gray matter.

I am no psychiatrist or surgeon however I can't imagine why a lobotomy would even be considered (no matter how remotely) for someone with mental illness.

I do witness patients who are treated with strong medications and are unphazed. It is quite heartbreaking when some medications don't even make a dent. Some of the patients I have come across will never have much quality of life.

Every working day I interact the best I can with a particular patient who can barely function due to mental illness and a lobotomy.

It pains me to know that psychiatry has failed him. I can hear the Tom Cruises of the world shouting, "Well of course psychiatry is a pseudo-science!" I have faith in psychiatry...however I also have doubt. Currently in 2009 I can honestly say scientists have come a long way. I can only hope that ego will not continue to inhibit progress.

5 comments:

  1. Just a quick correction if I may, it was not my mother-in-law, it was my step mother. It is hard to express how much more difficult it is to succeed at anything after a operation like this. Just maintaining a normal life is a major challenge.

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  2. Hello there.
    Thank you for correcting me. I see that at one point I wrote step mother and at another I wrote mother in law. I have now gone back and corrected my error.

    I thank you for taking the time to read my little post.

    I course can only imagine what your journey has consisted of. The journey of overcoming physical, mental and emotional obstacles. Including obstacles of forgiveness and acceptance.

    I want to thank you for sharing your story with the rest of us. It has been quite a gift, I hope you realize. Your story has humbled and encouraged me.

    You, Mr. Dully are quite a trooper and I sincerely hope that you are doing well.

    Thanks for stopping by..

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  3. Ha! Isn't ironic that you posted it on walter freeman's birthday

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    Replies
    1. I did? I had no idea! Thanks for letting me know, Anonymous!

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