My Lobotomy: Howard Dully's Journey (2005)
npr.org
npr.org
Freeman was undoubtedly a cowboy, but his poor practice has warped our understanding of psychosurgery. Freeman didn't invent the lobotomy and was widely condemned by many of his contemporaries, including his former surgical partner James Watts. We overlook the extraordinary suffering caused by severe mental illness and forget just how few treatments existed prior to the great pharmaceutical revolution of the 1950s. Freeman's more conservative contemporaries were, for the most part, responsible clinicians trying to do their best for patients who were experiencing unbearable suffering and had no better options.
Joanna Moncrieff makes this explicit in her book, "The Bitterest Pills". Also elaborated on here: https://www.psycovery.com/images/Postpsychiatrys-challenge-O...
We're still doing the same thing, just without knives (and, as the comment noted, often also WITH knives).
These are real people, in great suffering, and we still don't have answers for many of the diagnostic codes found in the DSM.
Modern psychiatry and neurology may never substantially improve in addressing these disorders, as the human brain is the most complex object known to exist, perhaps beyond comprehension.
DSM-IV definition of mental disorder:
A: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual.
B: Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
C: Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one).
D: A manifestation of behavioral, psychological, or biological dysfunction in the individual.
E: Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.
Other considerations
F: No definition adequately specifies precise boundaries for the concept of ‘mental disorder’.
G: The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations.
https://medium.com/the-dot-and-line/we-need-to-talk-about-bo...
Another atrocity is the reason a Freeman colluded with a controlling and abusive step-mother to lobotomize her son.
> According to Freeman's notes, Lou Dully said she feared her stepson, whom she described as defiant and savage looking. "He doesn't react either to love or to punishment," the notes say of Howard Dully. "He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it he says 'I don't know.' He turns the room's lights on when there is broad sunlight outside."
I cannot possibly imagine a physician being so incompetent. It really feels like he was the contrarian Ivermectin proponent of his time. This is an interesting read: https://en.wikipedia.org/wiki/Walter_Jackson_Freeman_II#Medi...
Yes, reading the article makes me gasp with the information and experience that is enabled by a century of neuroscience, but people in that period had no such option.
The particular subject of the article, a normal child who was lobotomized by a "wicked stepmother" (who later rendered him homeless), was enabled by profound medical malpractice. The surgeon cannot have doubted that the child was completely normal, and the procedure uncalled-for, equivalent to performing a triple bypass on a healthy heart.
Even in modern epilepsy, there is sometimes recourse for "resective surgery" in the hope of quelling seizures, but this is far more informed and exact than the subject of this article.
Unfortunately, it had to start somewhere.
Other methods were not available, the broader medical community did not seem to object, the medical standards were less developed, it was more acceptable for physicians to experiment and learn as they went, some good came out of it, and Freeman did seem to believe in the efficacy of the procedures.
Some of these arguments are stronger than others. Freeman's showmanship (including a death of a patient for a photo-op in the middle of a surgery), and refusal to wear sterile gloves were against medical standards at the time. The broader community was misinformed, as anecdotal evidence of successful procedures was spread by supporters of the procedure, while the atrocious consequences of it were under-reported. Freeman believing that the procedures were effective is difficult to disprove, but we know that such an assumption depends on veracity of a man who has shown to not be a trustworthy professional, and we do know that Freeman knew that the majority of his procedures had significant negative consequences. Some good came out of not only Freeman's work, but also work of the regime-aligned Nazi scientists, especially in the fields of birth control, medical imaging, and aerospace; and this very extreme case illuminates that invention doesn't always justify the means. The argument about the evolution of medicine in the US is more convincing - indeed, the current evidence-based medical approach evolved over time from a much more experimental one. This can be seen in the change of Hippocratic oaths medics would take throughout history. The argument for no better treatment being available is also a strong one - we have a framework around compassionate use or compassionate access to experimental treatments when nothing else is available today. But overall, the arguments, except for a few, are weak with hindsight.
It is important to acknowledge that Freeman faced no repercussions for his actions while he was alive - neither legal nor the widespread moral condemnation he is associated with today. People truly did not know what to make of it. But I ask - if a crime against humanity is committed but it takes humanity some time to recoil and it goes unpunished, is it not a crime?
It's definitely a very interesting topic. I personally don't believe that Freeman didn't know what he was doing, or that he had no reason to know his work was unethical. A man of his age and education shouldn't be as naive. It's more difficult to blame the families, though in this case, the memoir and other recollections do say that the stepmother was probably motivated by a hatred for her son.
It seems there was quite a bit of controversy between Freeman and the more scientifically conservative medical community. James Watts, who originally partnered with Freeman and shared a practice with him, left "in disgust" due to the irresponsible application of lobotomy. Other professionals, like John F Fulton, have criticized Freeman's procedure for its lack of precision and broad collateral damage.
In the mid 1950s, the whole field was changed fundamentally by the introduction of the first antipsychotic drugs. Yet Freeman continued to perform his operation well over a decade after that.
> Freeman faced no repercussions for his actions while he was alive
He did eventually lose his medical license in 1967 and lived to see his views fall out of favor with neurologists/surgeons and patients alike (but not for long, he died a few years later).
I agree that it's a fascinating part of our recent history. I wish there was some way to get insight from the future about which of our currently accepted treatments will be seen as inhumane or counterproductive or simply bizarre in 50 years.
As for repercussions, it seems like Freeman was specifically told by some authority not to perform these procedures anymore in Feb 1967, but his license to practice as a physician was not revoked.
Yes, indeed, medicine is evolving rapidly. I’m betting that our diet fads will look very barbaric in 2050, when we should have much better metabolic agents, not unlike Semaglutide. Transplanting donor organs that would be rejected will hopefully also fall out of fashion. And, I would hope, our reactive, emergency-based approach to healthcare will be replaced by preventative efforts. Nevertheless, I don't think we’re doing anything that will be seen in 50 years to be quite as barbaric as we see lobotomies now.
I very much admire your questions, and the mind behind them.
> But I ask - if a crime against humanity is committed but it takes humanity some time to recoil and it goes unpunished, is it not a crime?
You must admit that crime is subjective. Let us consider leaded gasoline and freon:
https://en.m.wikipedia.org/wiki/Thomas_Midgley_Jr.
This man is a supervillain of the environment. He was a hero of his day. Accolades are subjective.
>But overall, the arguments, except for a few, are weak with hindsight.
We must escape from many things, to escape from our past.
Are you sure that you know them all?
Pride, wrath, sloth, lust, greed, envy, and gluttony.
To pursue:
Humility, meekness, zeal, chastity, generosity, charity, and temperance.
In both cases, the men have committed a severe injustice to society. And in both cases, it seems like they knew better than to do it, but chose to do it, anyways. I don't know if I can absolve Midgley of his moral duties to society in my mind, similar to Freeman.
What's a crime is a bit subjective, but different frameworks give us different definitions. Legally, a crime is something that breaks a norm enshrined in law. It is not unlikely that these men have not committed crimes in that sense. Morally, a crime is a deliberate injustice that harms others. With this definition, I think that these men have committed crimes.
And in some ways, it would be easier to forgive them, if they would admit to having committed a crime or an injustice. There's a very interesting talk by Elizabeth Bruenig on this [0], and she is much more articulate in philosophy than I will ever be. But I do think that once we can say that "if this person just admitted their wrongs, society could heal", that is some evidence of a moral crime having been committed.
> Pride, wrath, sloth, lust, greed, envy, and gluttony
I am not a religious man, but I think this is a good framework to judge the actions of Midgley and Freeman through. I would also add callous, ruthless ambition to that list. Allowing men like this to succeed is certainly nothing to be proud of for us as society.
In a way, it's comforting to know that newspapers back in the 1950's were as susceptible to BS as modern day TikTok influencers.
Maybe the technology / form factor isn't the underlying issue afterall.
fixed it.
Imagine the despair of a mind unable to express itself through voice or other action.
"After a suicide attempt she spent eight years in mental hospitals in New Zealand, receiving 200 electroshock treatments. She was about to have a lobotomy when a hospital official read that she had won a literary prize. She was released.
Later, a panel of psychiatrists determined that she had never had schizophrenia.. she was not mentally ill, just different from other people."
https://www.nytimes.com/2004/01/30/books/janet-frame-79-writ...
Her book Faces in the Water describes the experience, it's chilling.
I went through a few rounds myself in modern day America where we pride ourselves in not being barbarians. The first time I did not even consent, my spouse did it for me (in the 80s). To this day I never fully recovered. And yet if I complain people will just point to "studies" that say it works. Guess what, such studies also existed for lobotomy.
However, 2500 surgeries, some of them with great results, some of them resulted in deaths and many in between. It's a game of chances, not a science. Seems like this dude did not understand what is it exactly he is doing and randomly poked holes in people hoping it would work.
It would have been interesting to read a journal of someone who had the procedure.
https://www.skepdoc.info/ian-harris-on-surgery-the-ultimate-...
If you’ve had a lobotomy surgery, you have a huge tendency to believe it maybe did something positive. An interesting study would have been just tell people that they had a lobotomy. If I had to guess, I bet the success rate would be much higher that actual lobotomy.
This makes me think that something akin to electroconvulsive therapy would have caused remission.
My grandma received it several times...to try to deal with her emotions about my abusive alcoholic grandfather.
For as much as older generations criticize Millennials and Gen Z for being "snowflakes," I'm not sure my grandma's "Greatest Generation" actually handled things better.
https://www.healthdirect.gov.au/electroconvulsive-therapy-ec...
Effects don't last that long (long enough though to get someone out of debilitating depression or mania and time for proper treatment) and need repeated courses to sustain.
There are still issues with memory, where one looses maybe a few days, but also could loose years.
It’s not generally done like in One Flew Over the Cuckoo’s Nest. The pulses, voltages, and currents are apparently small and precise.
More recently, “transcranial magnetic stimulation” has been reported similarly effective and seems to be considered something of an evolution beyond ECT, using magnetic fields instead of electric current, and avoiding the need for sedation etc.
I don’t fully understand it all, and I gather there are still a lot of questions about the exact mechanism. The research done so far is said to support some beneficial outcomes in hard-to-treat cases.
As with so many mental health issues, however, doing rigorous double blind studies for example is difficult or impossible.
Anyway, better practice is no longer to just strap people in and shock people in the brain.
https://www.google.com/books/edition/Coercion_as_Cure/hYdLS6...
Walter Freeman coined the term "surgically induced childhood" and used it constantly to refer to the results of lobotomy. The operation left people with an "infantile personality"; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the "personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist." He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behaviour, Freeman advised a system of rewards (ice cream) and punishment (smacks).
AFAIK, we are pretty unsure how many medications actually work in the mental health field instead only seeing if they return 'results' similar to what we are originally aiming for.
With chemotherapy, we have literally have so much empirical evidence that the benefits far outweigh the risks. We understand the mechanism of action of chemotherapy enough to assess its risk profile.
With lobotomies, we understand enough about the brain now to know that the risk profile is extremely bad. Additionally, empirical evidence has shown that outcomes are pretty bad anyway! We have better tools and ways to understand the brain now to not give people a brain-destroying "treatment" that is basically a random, low chance of success. Would you reasonably prescribe getting shot in the head as a treatment if it had worked on one person?
It's kind of why I wanted to know more about the stories of the people the procedure worked for, just in case there really is some evidence it provides a benefit in some niche category. Though, yeah, I'm not betting on it.
You should genuinely read the wikipedia page on this topic: https://en.m.wikipedia.org/wiki/Lobotomy it will answer your questions and reveal the horror of what you are asking about and why people respond the way they do.
To sum up though; the procedure was mostly performed on women and children, who were also frequently not aware of what was being done to them (not consenting), on men it was mostly performed on homosexuals. The best case outcomes came at the cost of 'decreased psychic complexity', a sort of 'permanent childhood'. The worst cases don't bear repeating here.
I would also like to caution you, when reading on this, note whose voice is present; is it ever the subject who reports positive outcomes?