The Patient Experience

In order to fully understand the rise, height, and fall of the American lobotomy, it is critical to examine the experience of patients during these times. After exploring several case studies by Dr. Freeman, Dr. Kolb, and Dr. Miller between 1948 to 1955, it is determined that a certain type of patient was selected for the treatment generally. While these patients were recommended to undergo a reasonable amount of psychotherapy and alternative treatment prior to having a lobotomy, Dr. Freeman harkens that lobotomies are not “the last desperate remedy.”[1] Dr. Freeman believed that timing was of the essence, reporting that a patient who received the treatment within six months of diagnosis had a two to one chance of returning to work while a patient who waited two years had only a third of a chance to return to work.[2]  Another key factor in the patient’s return to normalcy was the support or indifference of the family. The doctors concurred that the support system of the patient is essential to the patient’s recovery. Doctor Kolb claimed that “the failure of the family to adjust to the returned patient often results in his readmission to the hospital.”[3] Finally, doctors consistently reported that lobotomies are not for all types of mental illness. They recommended the treatment for schizophrenic disorders, affective disorders, psychoneuroses, and personality disorders.[4]  The largest group of patients who received this treatment was the schizophrenics with as many as 73% having lobotomies as reported by Dr. Miller and 60% as reported by Dr. Kolb.[5]  While the doctors admitted that hallucinations were less likely to be relieved, the patient’s countenance became more docile and manageable leading the doctors to conclude the treatment was successful.

The lobotomies of Rosemary Kennedy, Jean, and Howard Dully represent some of the patient generalities from the above case studies. Kennedy’s 1941 lobotomy exemplifies the family’s power in the success or failure of the treatment. Jean Heuser, a schizophrenic who was lobotomized in 1954, represents the most common disease treated with a lobotomy. Finally, Howard Dully’s tale of his lobotomy in 1960 reveals the ethical dilemma of the treatment as well as the impact of the family.  These three cases, more importantly, represent the progressive perception of lobotomies over time. Rosemary (1941) having a prefrontal lobotomy with minimal results. Jean (1954) being one of the first to receive the new transorbital lobotomy. Finally, Howard (1960) undergo a transorbital lobotomy during the decline of the operation’s public acceptance. Through these patients, we can track the American lobotomy from a its start as a shameful treatment to commonplace practice to  its decline as controversial surgery.

Freeman-Watts Leucotomes. L-R, two modified icepick leucotomes for standard transorbital lobotomy; curved leucotome for radical prefrontal lobotomy; blunt-edge leucotome for prescision-method lobotomy; curved leucotome; blunt-edge leucotome, side view’ leucotome for deep-frontal-cut transorbital lobotomy; original icepick leucotome; deep-frontal-cut leucotome.

I included the picture above because it is emblematic of how much the leucotomy/lobotomy has changed over three decades. The surgery was every changing in terms of where to cut and how to destroy the white matter. Above are the various leucotomes (surgerical tools to destory the brain’s white matter) that Dr. Freeman used.  Most interestingly is the icepick (literally from the freezer) that Freeman used during his first transorbital procedure; hence the name “icepick lobotomy”.