Thursday, July 12, 2007

Now I guess I'll have to tell 'em that I got no cerebellum

Ever since I started reading The Lobotomist: A Maverick Medical Genius and his tragic quest to rid the world of mental illness by Jack el-Hai, I've been trying to decide which line from the Ramones' "Teenage Lobotomy" would be the title of this post. As el-Hai addresses in his prologue, "lobotomy" has kind of become a shorthand for stupidity. When it's considered seriously, of course, it has all sorts of negative connotations. So el-Hai's book is a valuable work, as it considers the man behind the treatment in the context of his times, and presents the tale of a flawed, driven man, both respected as an innovator and reviled as a cowboy among his peers.

Walter Freeman did not actually invent the procedure, but is credited with popularizing it in the US. He got the idea from a Portuguese colleague, and refined it several times, along with a partner. At this time (1920s and 1930s), there was nothing that could be done for mentally ill people. They were warehoused in institutions for decades. There is an excellent exhibit touring New York State of suitcases that had been found in the attic of a now-closed mental institution of this era. Using case records, they talked briefly about the people that packed them. Some of them spent 40 or more years in the institution.

No doctor in his (they were mostly "he's") right mind would choose, then, to specialize in mental illness. Freudian analysis was a relatively new idea and was just starting to take hold, but for the most part, it was a monumental, hopeless task, and the best they could hope for was that the mentally ill person would remain relatively physically healthy and not harm themselves or anyone else. That was a successful treatment. So when Freeman and his partner, neurosurgeon James Watts, developed the lobotomy, which provided hope, it was very warmly received.

The word "lobotomy" conjures up someone with no affect and little intelligence today, but as el-Hai points out, those were the failures. Those who were successfully lobotomized enjoyed a remission of debilitating symptoms. Some got well enough to hold a job and maintain personal relationships. With others, the only improvement seen was that they could be cared for at home instead of in an institution. But with the burgeoning population of asylums, this was no small thing.

The man himself is as interesting as the context of his times. Walter Freeman was a driven, intelligent father of six, and also a real showman. When he was a lecturer, he taught himself to make anatomical drawings on the chalkboard with both hands at once. He was so popular that, during the depths of the Depression, his students would bring dates to his class. He did not curb this tendency when demonstrating his technique. A refinement of his technique was called the "ice-pick lobotomy" because that was what Freeman used. He would go in through the eye with an icepick, and would often line up 20 or 25 pre-selected patients at a hospital and do them all in one day. He'd use a rubber mallet because it made a better show, even though there were special hammer that doctors used. This earned him a lot of disdain among his colleagues, and heightened the sense that he'd gone too far.

el-Hai's biography is extremely thorough. It passes the Maxwell Perkins test: I would absolutely know Walter Freeman if I met him on the street, as well as many of the other players in the story (Freeman left behind a great volume of material). It describes in great detail the mechanics of the procedure, and why Freeman and Watts felt it would be beneficial. It charts the rise and fall of the procedure, and makes a stunning claim of a possible re-emergence of psychosurgery as a treatment for mental illness. This made the book kind of difficult for me. I mentioned in my last that I haven't taken a bio class since I was old enough to drive. Someone with a strong background in biology would probably be able to write a much better review of it than I did.

But el-Hai refrains from making judgments, leaving this difficult task to the reader. Was lobotomy a boon to the field? There's no question that it was a brutal procedure that would go terribly wrong when it failed, but it brought about a vital change in thinking. It helped us to think of mental illness as treatable, as possibly a phase in someone's life rather than a permanent judgment. Maybe someone could get a mental illness, improve and close the chapter, just like when one breaks a leg. At times, Freeman doesn't seem to have much respect for his patients (such as when he parades them in front of his students in their pajamas) but he also kept in touch with many of them for decades, and devoted his last years to tracking down hard-to-find ones, driving thousands of miles to learn their fates.

Freeman lived long enough to see his work fade into obscurity, and that's a regrettable fate for such a driven, dedicated person. Whether the procedure deserved the gruesome reputation it's earned, though, remains an open question. Although it's not an easy read for someone without a medical background, I do recommend this book to anyone who's interested in mental illness. It definitely changed the way I thought about lobotomies.