Adventures With an Ice Pick:
A Short History of the Lobotomy
No one has ever practiced lobotomy so enthusiastically as Dr. Walter Freeman, who developed the new art with a recklessness bordering on lunacy. This is the story of Dr. Freeman’s life, and the early development of the psychosurgical procedure that became known as the “Ice Pick Lobotomy”.
AMERICA, 1847: a highly competent and, by all accounts, pleasant manual laborer of Irish extraction named Phineas Gage is involved in rock-blasting operations in mountainous terrain. In the course of one sadly uncontrolled explosion, an iron bar is picked up by the force of the blast and driven clean through the front part of his head. Phineas is sent flying, but, to everybody’s surprise, he survives the removal of the protruding bar. As he recovers, however, it is observed that his personality has dramatically changed, though his memory and intelligence remain apparently unaffected. In 1868, a physician named Harlow from Boston writes about him: “His equilibrium, or balance, so to speak, between his intellectual faculties and animal propensities seems to have been destroyed. He is fitful, irreverent, indulging in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires.” The now extremely rude Phineas Gage is an object of immense medical interest, for it seems clear, from his somewhat crude experience of psychosurgery, that one can alter the social behavior of the human animal by physically interfering with the frontal lobes of the brain.
In 1890, Dr. Gottlieb Burckhardt, the superintendent of a psychiatric hospital in Switzerland, drills holes in the heads of six severely agitated patients and extracts sections of the frontal lobes, altering their behavior with varying degrees of success. Two of the patients die. His surgery is considered morally reprehensible at the time, but his work is not forgotten. Phineas and his iron bar have started a train of thought that win come to a strange and tragic fruition in the next century.
It took a few years, and the work of a dedicated band of pioneers, to establish the various forms of lobotomy as everyday treatment for psychiatric patients. But by 1955 over 40,000 men, women and children in the United States alone had undergone psychosurgery which left large parts of their brains irreparably vandalized by doctors who didn’t even need a formal qualification to practice the operation.
The greatest advocate of psychosurgery was Walter Freeman. Born in Philadelphia in 1895, the son of a doctor with strong Calvinist beliefs, Freeman had been appointed Professor of Neurology at George Washington University in the aftermath of the First World War. America was suffering from a huge increase in psychiatric disorders. An influx of shell-shocked soldiers and bereaved, disturbed relatives was swelling the asylum population. In addition, there was still no cure for tertiary syphilis, which had been discovered to cause up to half the known cases of dementia praecox, or schizophrenia. The need for practical measures to counter madness had never been more urgent.
In July 1935, Freeman, then aged 40, attended a neurological conference in London. It was quite a gathering. Also in attendance were the celebrated Russian, Ivan Pavlov, whose trained salivating dogs were to make him legendary; and Egas Moniz, the celebrated Portuguese neurosurgeon, who had pioneered cerebral angiography, the process of mapping the parts of the brain by injecting “contrast” solutions which can be seen by X-rays.
Pavlov might not have brought his dogs to the conference, but John Fulton from Yale University had brought two chimpanzees. These were the subject of a day- long symposium which both Freeman and Moniz attended. Fulton had completely removed the entire frontal lobes from these two animals – a lobectomy – which had radically altered their behavior. He could no longer generate experimental forms of neurosis in the animals. They were seemingly unperturbable. The symposium was fascinated, and the discussion about the significance of the frontal lobes went on and on, as the assembled company hedged gently around the delicate issue that Fulton’s chimpanzees raised. Eventually, to much surprise, it was Egas Moniz who stood up and asked the question that Freeman, for one, had been desperate to put.
“If the frontal lobe removal prevents the development of experimental neurosis in animals and eliminates frustrational behavior,” he asked, “why would it not be possible to relieve anxiety states in man by surgical means?”
Many attending were shocked to hear it put so frankly; they believed that Moniz was talking about performing the full lobectomy on humans. Freeman, however, was struck by Moniz’s courage.
A year later, he came across Moniz again, this time in the pages of a French medical periodical. In September 1935, in a Lisbon surgery, Moniz had participated in the first controlled attempt to put into practice the ideas raised at the London conference. With the neurosurgeon Almeida Lima, he had attempted to perform the first leukotomy, on a female asylum patient. The object had been, not to destroy the actual frontal lobes, but rather to destroy (by injecting alcohol into them) the fibers, the white matter or leukos, which connect the frontal lobes – the area they believed to be most immediately concerned with social behavior – to the main body of the human brain.
The results were inconclusive. After surgery, the woman was certainly less agitated and overtly paranoid than she had been before. But she and the other three patients from the asylum who subsequently underwent the same procedure were also, Moniz admitted, somewhat more apathetic and frankly duller than he had hoped. In addition they suffered from nausea, sphincter disorders, sluggishness and disorientation. Still, the results were spectacular enough for Moniz to be encouraged.
Unfortunately, he found that the director of the asylum was suffering twinges of professional jealousy and was unwilling to supply any more surgical subjects. Quite apart from this, he was, as Lima put it, experiencing “doctrinal and ethical” doubts about the nature of the operation. In order to maintain his flow of patients, therefore, Moniz not only had to exercise his considerable powers of charm, but began to withhold the results of his work that suggested it was less than perfect, so that it appeared that the operation was already a success, and was so simple that it could be quickly applied on a wide, public basis.
When he did publish his results, it was in six countries simultaneously. And, as one contemporary said, “Seldom in the history of medicine has an experimental procedure been so promptly adapted to the treatment of sick patients everywhere.”