The Beginning

Dr. Fulton and His Chimpanzee

The history of lobotomies in the United States has largely been associated with Dr. Walter Freeman. More importantly, many scholars attribute the beginning, height, and fall of the psychosurgery to the personal ambition of Dr. Freeman. While Freeman is renown in the US for his lobotomies, the story is actually much bigger than his personal experimentation and implementation of the surgical procedure. The story of lobotomies begins at the July 1935 Second International Neurological Congress in London.  The conference gathered neurologists, neurosurgeons, neuroanatomists, psychologists, and physiologists all exploring the functions of the human brain. Among the numerous medical scholars presenting their research were Drs. Dandy and Brickner. They conducted an experiment in which they concluded that the frontal lobes were not associated with intellect.[1]  Similar conclusions were drawn by Dr. John F. Fulton, a Yale physiologist, and his colleague, Carlyle Jacobson.  Dr. Fulton presented a paper on their chimpanzee brain experimentations. At first, they tested the brains of the chimps to determine their intelligence level. Then, they removed part of the chimps’ frontal lobes and reran the tests and determined chimp intellect was not affected by the frontal lobes. The doctors noticed the chimps’ temperaments negatively changed following the procedure and the animals would “shake and kick the box, pull their hair, and sometimes urinate and defecate, throwing their excreta.”[2] They decided to experiment further by removing the chimps’ frontal lobes completely. The doctors noted that the chimps who were once easily frustrated became more docile. From these studies, Fulton and Jacobson alluded that the frontal lobes were potentially associated with emotions and temperaments.[3]

Attending this conference were the world’s foremost medical experts such as Dr. Walter Freeman and James Watts and the father of the lobotomy, Egas Moniz. Dr. Watts, in an interview 1979, recalls Moniz reaction to Dr. Fulton and Jacobson’s report,

“Professor Moniz attended that conference and he said ‘Those are just like my patients, I think that might be done in man’. So, he went back to Lisbon and with the aid of his surgical associate, Almeida Lima, performed a series of twenty leucotomies.” [4]

Moniz developed his leucotomies almost immediately after the conference and, by November of 1935. he performed his first human leucotomy. His leucotomy consisted of injecting alcohol into the frontal lobe to destroy the white matter.[5] Dr. Freeman, initially intrigued by the idea of leucotomy, kept in constant correspondence with Moniz during the development of the procedure. In 1936, when Moniz published his first monograph entitled Experimental Surgery, he inscribed one copy to Fulton, his inspiration, and another to his protégé, Freeman.  Freeman is cited as referring to Experimental Surgery as “bread and butter of neurology.”[6] Freeman depended upon Moniz’s initial procedure in his development of the American lobotomy, even using the same instrument to penetrate the brain and administer the alcohol destroying agent.

Egas Moniz

Moniz’s political struggles against the Portuguese monarchy and the Catholic Church left a permanent scar on his academic career. Portuguese society never fully accepted Moniz’s leucotomy because Moniz, himself, was considered controversial.[7] Furthermore, World War II rendered Europe incapable of focusing on new psychological treatments.[8] During the Depression and World War II, societal anxiety in the United States led to a rise in the number of patients committed to mental institutions. Mental institution historian, Gerald Grob, reports that overcrowding increased about 10 to 16 percent.[9] At the same time, Grob notes that approximately 30 percent of the doctors and medical professionals were away from their position in the hospitals for the war effort.[10]  Doctors, desperate for a solution, turned to medical researcher for new cures or at least some solution to lessen the number of patients requiring institutionalization. Freeman, founding secretary of the American Board of Psychiatry and Neurology and head of the George Washington University Department of Neurology had considerable academic freedom, community respect, and resources.[11] With the aid of George Washington University’s neurosurgery, James Watts, the two had enough experience, clout, and ambition to popularize the lobotomy in the United States.

Dr. James Watts

The rise, height, and decline of the American lobotomy can be attributed to its most famous advocate, Dr. Walter Freeman. Freeman performed his first lobotomy in 1937 –  a year after Moniz published the first monograph about lobotomies. Freeman and his counterparts, including Drs. Kolb and Miller, helped transform lobotomies from a surgery of last resort to a commonplace treatment.  During this time, Freeman worked feverously, not only to win over the support of his colleagues but to gain the support of the press and the general population. While being interviewed, Dr. Watts, Freeman’s assistant, described Freeman in this way,“I don’t use the word brilliant or genius as very often, but he bordered on both of them. He was good and he was a great showman.”[12] Indeed, Freeman was good at gaining people’s support. In 1940, Freeman produced a movie on lobotomy which he used as part of his lecture.[13] He utilized the media from the outset as numerous articles published Freeman’s work and his operation photographs. Historian and author of The Lobotomy Letters: The Making of American Psychosurgery, Michal Raz attributes the positive media coverage to the increase in patient and family consent over the years. A letter written to Dr. Freeman and published in The Lobotomy Letters states,

“I came across the article ‘Operation Icepick’ written by John Maloney. … My in-laws have tried time and again to have him cured through various treatments. … I could take him to see you or another doctor you feel would be as capable to handle him.”[14]

Patients and families, through the media, were given renewed hope that there was a cure for their mental illness. Mental institution scholar Gerald Grob likewise attributed the success of psychosurgeries to the positive press reports, “Newpapers and magazines as well as radio disseminated information about these therapies and created the impression that they represented major breakthroughs.”[15] It is evident that the personal efforts of Dr. Freeman to publicize lobotomies allowed for its growth as a commonplace treatment.

Dr. Walter Freeman

The use of lobotomies reached its peak in late 1940s to the early 1950s in part because Freeman refined a new version of the lobotomy. Called the transorbital lobotomy, this procedure was significantly cheaper, less invasive, and faster to perform.  This new lobotomy was again promoted through film in which live transorbital lobotomies would be recorded.[16] Unfortunately, most medical experts, including Dr. Watts, perceived this new procedure as reckless. Dr. Watts, Freeman’s assistant, claimed that the fallout between the two doctors can be attributed to the creation of the transorbital lobotomy.  In addition, Freeman believed that the transorbital lobotomy could be performed by psychiatrists, not just neurosurgeons. Dr. Watts, in his 1979 interview, stated that

“Dr. Freeman believes that transorbital lobotomy is a simply, effective method of relieving mental and emotional symptoms and it is safe to entrust it to a psychiatrist. Dr. Watts believes that any procedure which involves the cutting of brain tissue is a major operation and should remain in the hands of the neurological surgeon.”[17]

The lobotomy became more controversial and fewer families and patients were giving their consent to the treatment.  Ultimately, in the 1960s, lobotomies fell out of popular acceptance due to the increased politicization sparking the antipsychiatry movement.

One of the films Dr. Freeman produced

[youtube]http://www.youtube.com/watch?v=70JA1sqDdVM.[/youtube]