The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness • The Pest Maiden: A Story of Lobotomy

Years before I was a psychiatry resident I worked as an aide in two different psychiatric hospitals. At each hospital I participated, in one form or another, in procedures that I thought had already become part of psychiatry's history. The first was packing in a wet sheet, a procedure about which there have been many stories of horror but that the patient later described as being remarkably soothing and helpful. The second was a lobotomy that the patient had pleaded with her psychiatrist to receive. This procedure I found to be crude, frightening, and bordering on incomprehensible.

Interest in lobotomy, which has been quiescent but has never entirely gone away, seems to have erupted with the publication of The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness, by Jack El-Hai. The Lobotomist is the story of Walter Freeman, a maverick physician, who almost single-handedly brought lobotomy to the United States and perpetuated its practice for decades.

The reawakened interest in lobotomy is demonstrated by an editorial in the New England Journal of Medicine by Barron H. Lerner on July 14, 2005, titled "Last Ditch Medical Therapy—Revisiting Lobotomy" (1). The interest is also evident in Associated Press coverage in the print media and on the Internet, with titles such as "Controversy Over Lobotomies Resurfaces," an article that discusses the efforts of relatives of lobotomized individuals to posthumously strip lobotomy pioneer, Portuguese neurologist Egas Moniz, of his Nobel Prize (2).

That lobotomies would stir up controversy even decades after the intervention passed from surgical practice will surprise no one who reads The Lobotomist. Walter Freeman's story is a psychologically interesting one, as we view a physician dealing with his paternal lineage and his own lifetime quest to make a contribution and become famous. Freeman, the grandson of well-known physician William Williams Keen and the son of a physician of no particular distinction, performed his first lobotomy in the United States in September 1936. Before venturing into the world of destroying healthy brain tissue in the name of remediating all manner of psychiatric and neurologic symptoms, Freeman had rather impeccable credentials, including positions at Georgetown University, the U.S. Naval Medical School, and George Washington University.

El-Hai does a credible job of weaving through Freeman's history the impact of his early development, his character traits, his quest for greatness, his profound desire to be taken seriously as a scientist by his peers, his record keeping, and his lifelong interest in photography. The resulting tale is one that shows how developments in medicine are affected by one individual and how the individual is affected by developments in medicine. Celebrities who are known for their lobotomies appear throughout these pages, including Frances Farmer and Rosemary Kennedy. While acknowledging his role in lobotomizing Kennedy, Freeman denied his involvement with Farmer and her treatment.

The Lobotomist is also the tale of a medical intervention gone awry. Potential small successes in the beginning are parlayed into a treatment that has far broader application than was conceivable at the outset. As has been seen in psychiatry with many other treatments, such as ovariotomies in the 19th century and electroconvulsive therapy (ECT) in the 20th century, treatments became bastardized and became so widespread that it is almost impossible to ascertain for whom, if anyone, they might have worked. The public villainizes these treatments, and what might be successful for some has the potential to be lost. Ovariotomies as a means of treating insanity most probably never made sense, whereas ECT has proven to be an extremely effective treatment when targeted at a narrow range of psychopathology.

The Lobotomist is recommended for anyone who is interested in the history of psychiatry or even the more general topic of how treatments in medicine evolve.

There would, of course, be no history of and no controversy around lobotomies without patients who had been lobotomized. There are few autobiographies by individuals who had lobotomies, and the authorship of some of the more well-known, such as Frances Farmer's Will There Really Be a Morning? (3), is in question. Nor are there very many biographies about individuals who were the recipients of lobotomies. With The Pest Maiden: The Story of Lobotomy, Penelope Scambly Schott has written a book-length narrative as a series of poems that is the story of her maternal grandmother's first cousin's daughter's lobotomy.

In this biography, Schott, who mentions that she has her own psychiatric history, never met the subject of her story. She did, however, have regular contact with the subject's aunt, Viola Paradise, from whom she "inherited" a file box that included letters from, to, and about Jean, the young woman who was lobotomized. The author quotes from these letters and also uses primary and secondary sources in the neurologic and psychiatric literature, including Walter Freeman's description, "how to perform my new transorbital lobotomy." On one hand Schott's tale is a very personal one, but on the other hand it provides information about not only the development of lobotomies and their effects on an individual patient but also their ripple effects on an extended family.

Jean Heuser received her lobotomy at Rockland State Hospital on Monday, February 15, 1954. It is both ironic and poignant that the following month—March of 1954—the U.S. Food and Drug Administration approved chlorpromazine for use among psychiatric patients. It was this first antipsychotic that heralded the end of what Schott calls "the epic of mass lobotomy."

The power of Schott's presentation is no better appreciated than through her words themselves: "The gray women/in the long dayroom/of the long ward/don't think they are bored/Who would believe/Jean can still grieve?/Whenever she starts/looking down/the attendants send her/to have her hair/dyed brown/again/and again/and curled/as if the world/or a hot comb/or curlers/could ever re-furl/those severed fibers."

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School in Worcester.