Walter Freeman was a nice looking, well educated, upper-class sort of guy. He was born in Philadelphia, one of seven children, into a family that traced its roots back to the Mayflower. (According to Freeman’s biography, the excellent The Lobotomist by Jack El-Hai, one ancestor got drunk and fell off the Mayflower, and was saved by a boat hook.) Freeman’s grandfather was a surgeon who had operated on President Grover Cleveland, and who became the first American surgeon to remove a brain tumor. (He did it with his fingers, without benefit of X-rays, in an operating theater that had no electric lighting. The patient lived another thirty years.) Freeman’s father was a gifted surgeon as well.
Freeman grew up surrounded by money. He was tutored in dancing and riding, and cared for by a governess who spoke French, German, and Spanish. As a boy, he was called “Little Walter Wonder Why,” because he was curious about everything.
His father was cold and strict. When Walter got in trouble at school, his father took out a leather whip—and beat himself with it for being a bad father. When Walter was given a gold coin for winning a prize at church, his father praised him—and then made him put the gold coin in the collection plate.
Freeman’s mother was strict, too. Freeman later said that he admired her, but he never loved her.
Freeman attended Yale, where he was a dandy and dressed strangely. A friend remembered meeting him for the first time. Freeman was wearing a wide Mexican sombrero and swinging a cane. He studied poetry, and used his grandfather’s limousine and driver to take him and his friends to school dances. He decided to study medicine as a senior, and after Yale enrolled at Pennsylvania Medical School. He became fascinated with the brain.
After medical school, Freeman left America to study neurology and psychiatry at universities in Europe. He visited asylums in London and Paris, and worked with psychiatrists in Vienna and Rome. He came home depressed because he saw no real treatment for the insane. He wrote, “I looked around at the hundreds of patients and thought, ‘What a waste.’” When he came back to America he opened a private practice and joined the faculty of George Washington University as a professor of neurology.
It was an exciting time in neurology. Millions of servicemen had been wounded in World War I and returned to England, Germany, France, and the United States with brain damage. In earlier wars, because there was no penicillin, soldiers like that would have died from their wounds. Now many of them came home alive, but brain-damaged. So scientists had this gigantic group of wounded men to study.
At the same time, there were huge advances in the new field of psychotherapy. Sigmund Freud had published his groundbreaking theories on the workings of human emotions. Those theories were beginning to find widespread acceptance.
But Freeman wasn’t interested in Freud or psychoanalysis. He thought that approach could actually be dangerous: “When we realize, really get to know what stinkers we are, it takes only a little depression to tip the scales in favor of suicide,” he wrote. Freeman believed instead that there were biological explanations for depression and schizophrenia, and that there had to be surgical treatments for them.
Over the next decade, attached to George Washington University, and working with George Washington Hospital and St. Elizabeth’s Hospital, Freeman experimented on mental patients with a variety of radical new treatments. He subjected them to massive doses of insulin and the stimulant drug Metrazol, or hit them with giant volts of electroshock.
As a doctor he wasn’t very successful. But as a teacher he was a big hit. His university lectures were like vaudeville shows, and drew huge audiences of medical students. Among other things, Freeman liked to write notes on the blackboard using both hands simultaneously.
He had a great sense of humor—even if it was sometimes a little weird. When he was a young doctor, he was asked to treat a young man whose girlfriend had placed a gold ring around his you-know-what. The young man got excited. Then he couldn’t get the ring off his you-know-what, which started to turn blue. Freeman had the ring cut off, but then told the young man it would have to be kept as a “specimen.” Freeman had the ring repaired and engraved. He wore it for years afterward, hanging from his watch chain, using it as a conversation starter.
Other doctors at the time were using many strange methods to treat patients who were depressed or mentally ill. Psychiatrists used electrotherapy, where they ran varying amounts of electricity through people’s brains and bodies. They used hydrotherapy, where they gave their patients baths, douches, wet packs, steam, spritzers, and shots from hoses. Most of these were with cool or cold water, but another doctor used heat—hot baths, hot air, infrared lightbulb cabinets, and electric “mummy bags.” A German psychiatrist developed something called the “electric shower.” The patient was fitted into a helmet that gave his brain a “shower” of electricity.
One doctor used something called the “rest cure.” That involved “isolation from family, quiet, diet, and massage.” Another doctor used “sleep therapy.” He would induce a deep sleep, almost a coma, and keep the patient there—for four to six weeks!
Some of the treatments were brutal. With hydrotherapy, doctors sometimes packed their patients in ice water, hoping that the freezing temperature would shock them into recovery. The insulin and Metrazol “therapies” caused such violent convulsions that patients broke their arms, legs, hips, and even jaws.
Some of the treatments seem just plain crazy now. One nut believed all mental illness was caused by infections. He said all psychotic patients had infected teeth. He started his campaign against mental infection by having all his patients’ infected teeth removed. Then he decided to go further, and have all the other teeth removed, too. Then he started in on their tonsils. He was quoted at the time as saying that if all children had their tonsils removed, mental illness could be eliminated in a single generation. When the tonsillectomies didn’t solve the problem, he started removing the colon, the cervix, and the uterus. He didn’t cure any mental illness, but 30 percent of his patients were killed by the surgeries. He sounds like a guy who should have been locked up himself. Instead, he was the director of the New Jersey State Hospital in Trenton.
These doctors weren’t just doing experiments in dark basements somewhere, hidden from the American Medical Association, or from the public eye. They were the subjects of articles in magazines and newspapers that applauded their efforts. Time, Newsweek, Scientific American, Science Digest, and Reader’s Digest all published stories about the success rates of doctors working with insulin, hydrotherapy, and electrotherapy. (Most of them left out the details, like the stuff about the broken legs and fractured jaws.)
In 1935, visiting London, Freeman witnessed a presentation on chimpanzees whose frontal lobes had been operated on. No one knew why exactly, but the monkeys all became passive and subdued after the operation.
Another doctor attending the presentation was a Portuguese neurologist named Egas Moniz. He returned to Lisbon, and in late 1935 began performing similar frontal lobe experiments on human beings. Moniz called the process “psychosurgery.” He drilled holes in his patients’ heads, and made cuts in their frontal lobes, using a tool he called a “leucotome.” He called the procedure itself a “leucotomy.”
Moniz believed this was a promising treatment for mental illness. He published a paper stating that patients suffering from severe anxiety or depression seemed to respond best. Patients suffering from schizophrenia, he said, didn’t respond at all.
Freeman read about Moniz’s experiments in a French medical journal, and decided this was the answer. He contacted the company that supplied Moniz’s leucotomes and ordered some for himself.
When the instruments arrived, Freeman and his partner, a surgeon named James Watt, began practicing on cadaver brains from the George Washington Hospital morgue. Watt was surprised to find that the human brain had the consistency, under a knife, of “soft butter.” Shortly after, Freeman performed his first leucotomy. He and Watt drilled six holes into the shaved head of a sixty-three-year-old Kansas woman who had insomnia and fits of hysteria. Freeman and Watt used a coring tool to sever the connections between the body of her brain and its frontal lobes. The last thing the patient said before the anesthesia took hold was, “Who is that man? What is he going to do to me? Tell him to go away. Oh, I don’t want to see him.” Then she screamed and passed out.
The doctors said the surgery was a success. The patient lived only another five years, but Freeman said they were the happiest years of her life.
Over the next six weeks they did five more surgeries. After the first or second, Freeman proposed changing the name of the procedure from leucotomy to lobotomy. A month later, Freeman presented his findings at a psychiatry conference in Baltimore. In all of his patients, Freeman told his audience, there had been “worry, apprehension, anxiety, insomnia, and nervous tension.” Now the patients were “more placid, content, and more easily cared for by their relatives.”
He didn’t tell his audience that his first patient, that Kansas woman, was comatose for a week after her surgery. For a week after that she couldn’t speak, and for a week after that couldn’t say her own name. A month later, she could recite the days of the week. Freeman reported that her “symptoms” were all gone. She wasn’t hysterical, or frightened. She was looking forward to going home, he said.
Later, when asked about patients whose brains appeared to be damaged by the surgery, Freeman had this optimistic spin: “Maybe it will be shown that a mentally ill patient can think more clearly and constructively with less brain in actual operation.”
Freeman started, with his first surgery, not quite telling the whole truth about his patients. He would continue to do this for the rest of his career. He often visited patients after their surgeries and pronounced them “cured” or “improved” because their worst symptoms had disappeared. But he made these visits four or five days after the surgery, when they were still barely conscious. Many of them would experience a complete return of their anxiety, or their hysteria, or their depression, but Freeman wouldn’t know that, or wouldn’t make note of it in his published papers or presentations at medical conventions.
Encouraged by the Kansas woman’s surgery, Freeman and Watt conducted many more prefrontal lobotomies. In that early period, Freeman’s statistics said that out of his first 623 surgeries, 52 percent of the patients received “good” results, 32 percent received “fair” results, and 13 percent received “poor” results. The remaining 3 percent died, but they weren’t included in the “poor” results category. Freeman would later get closer to the truth when he admitted that his fatality rate was almost 15 percent.
The surgeries sometimes went badly. A Washington, D.C., police officer hemorrhaged after his lobotomy and became a vegetable. Leucotomes broke off in patients’ heads. One patient died on the operating table when Freeman stopped, mid-surgery, to take a photograph.
This was part of Freeman’s routine. He would always stop twice in the middle of the procedure to take his pictures. He’d stop once after he administered the electroshock, to take a “before” photo. He’d stop again in the middle of the lobotomy itself, to get a “during” photo. He’d sometimes take an “after” picture, too.
Later in his career, after another patient died during the photography session, Freeman started asking an assistant to hold the leucotomes for the “during” photograph, or he’d hold them himself and have someone else take the picture. But he never stopped documenting the procedure this way.
Many of Freeman’s patients were so damaged by the surgery that they needed to be taught how to eat and use the bathroom again. Some never recovered. One of Freeman’s most famous patients was Rosemary Kennedy, sister of future president John F. Kennedy. Rosemary was born slightly retarded, but she lived an almost normal life until she was twenty-three. Then Freeman went to work on her. He performed a prefrontal lobotomy in 1941. Rosemary wound up in a Wisconsin mental hospital, where she stayed until her death more than sixty years later.
Another famous lobotomy patient—but not one of Freeman’s—was the actress Frances Farmer. She was a troubled woman but a great talent and a great beauty when she was hospitalized in Washington State for schizophrenia. She never acted again.
And she may never have had a lobotomy at all. The movie about her life, Frances, which was based on a book about her life, said she did. But I’ve read that her biographer admitted that he fictionalized many parts of her life. There is no record of her undergoing a lobotomy during her time as a mental patient.
The funny thing is, during all these surgeries, no one really knew why the lobotomies were successful. They only knew that for some reason interrupting the flow of energy in the brain seemed to interrupt the progression of anxiety or depression. They didn’t know why. And they didn’t know why it worked in some patients and not in others.
In an attempt to learn more about what happened during a lobotomy, Freeman tried performing them with the patient wide awake, under local anesthesia. During one of these procedures, Freeman asked the patient, while cutting his brain tissue, what was going through his mind. “A knife,” the patient said. Freeman told this story with pleasure for years.
Many in the medical community weren’t convinced that Freeman and Watt were on the right track. When Freeman asked William White, superintendent at Washington’s St. Elizabeth’s Hospital, for permission to conduct lobotomies there, he was told, “It will be a hell of a long time before I let you operate on any of my patients.”
White had several objections. One of them, he said, was that mental patients often were not competent to agree to the surgery. They didn’t understand what they were agreeing to. And the relatives who could agree to the surgery on their behalf didn’t always have the patients’ best interests at heart. “These sick people cause them a lot of trouble,” White told Freeman. “In the back of their heads…relatives not infrequently desire the death of patients in hospitals.”
Another colleague protested, when Freeman presented a paper on his first surgeries, “This is not an operation but a mutilation.” He pointed out that many of the great men and women of history had suffered from depression, but still made enormous contributions to science and the arts. He asked Freeman, “What will be left of the musician or the artist when the frontal lobe is mutilated?”
Freeman got a mixed reaction from the medical community, but he always impressed the media. He was a real showman, and he courted the press. He often called reporters a day or two before he was going to make a presentation at a medical convention and asked them, “Do you want to see history made?” His partner, Watt, complained that Freeman was “like a barker at a carnival.” On the medical convention floor, Freeman would set up a booth and use a clicker to attract a crowd. Then he’d begin talking about the lobotomy like it was some snappy new kitchen appliance.
He even had reporters attend lobotomies, and showed off for them while conducting the surgeries. One time, to demonstrate the simplicity of the procedure, he replaced the standard operating-room hammer with a wooden carpenter’s mallet. Sometimes he performed a simultaneous two-handed lobotomy, severing both lobes at the same time with a flourish—just like he had impressed his students by using two hands to write on the board at the same time.
The news coverage was universally positive. Freeman’s lobotomy was celebrated with headlines like PSYCHOSURGERY CURED ME, WIZARDRY OF SURGERY RESTORES SANITY TO FIFTY RAVING MANIACS, and NO WORSE THAN REMOVING A TOOTH.
This wasn’t the tabloids. The New York Times ran a story applauding Freeman’s success rate, which their reporter put at 65 percent, under the headline FIND NEW SURGERY AIDS MENTAL CASES.
Freeman’s lobotomy might have gotten popular without the support of the press. America’s hospitals were flooded with mental patients. By the late 1940s, there were more than a million mental cases in hospitals or asylums. More than 55 percent of all patients in American hospitals were mental cases. One study reported that the population of mental patients in American hospitals was growing by 80 percent a year.
There was no real treatment for these people. They were often drugged, shackled, kept in straitjackets, or locked in rubber rooms. Doctors were able to keep them from harming themselves or others, but they had a cure rate of about zero.
Besides, keeping them in hospitals was expensive. Freeman offered a solution. His motto was “Lobotomy gets them home!” Directors of mental institutions heard that loud and clear. One of Freeman’s colleagues said that a procedure that would send 10 percent of mental patients home would save the American taxpayer $1 million a day. Freeman claimed a success rate well above 10 percent. Most hospitals and institutions welcomed him and his lobotomy.
Freeman was sort of like the Henry Ford of psychosurgery. He didn’t invent the procedure, but he turned it into an assembly-line process, streamlining it so it could be done more efficiently, more cheaply, more quickly, and on more patients.
By the early 1940s Freeman was a successful doctor. He was famous. He had married and produced a big family. He and his wife, Marjorie, had six children, one girl and five boys. Freeman liked family vacations. Every summer he’d take his family on long drives to lakes and rivers for hikes or camping expeditions. He might have just enjoyed life and coasted on his reputation as the American father of the prefrontal lobotomy. But he was ambitious.
In the early 1940s Freeman heard about an Italian surgeon who was trying to refine the prefrontal lobotomy by entering the brain without drilling or cutting the skull, through the thin bone at the back of the eye socket—known as the orbit. Freeman read up on this procedure, and in early 1946 conducted America’s first transorbital lobotomy. He used an ice pick on his first patient. (He saved the ice pick. It’s in Washington, D.C., with his archives. It says “Uline Ice Company” on the handle.)
The patient’s name was Sally Ellen Ionesco. She was twenty-nine, and she had suffered years of depression and manic behavior. She sometimes became violent with her young daughter, or with herself, and had tried to jump out a window.
Freeman went into her brain through the eye socket on one side, and had her come back a week later to do the other side.
The surgery was apparently successful. After a rough period of adjustment, the patient found that her violent outbursts were gone. “It was like, ‘Thank God, it’s over,’” her daughter later told Freeman’s biographer. “There was peace.” Although she required a private nurse for a while, Sally Ellen Ionesco gradually became well enough to take care of her daughter, to help her husband in the family business, and later to be licensed as a practical nurse and get work as a nanny.
To Freeman, the new transorbital technique represented an incredible improvement. Without cutting and drilling, lobotomies could be done in doctors’ offices. There would be no surgeon, no anesthesiologist, no hospital stay, and almost no recovery time. Freeman thought he could send his patients home an hour after the procedure.
He began doing lobotomies in his office. He stretched the patients out on a table, knocked them out using electroshock, punctured the skull using his Uline ice pick, and swung the ice pick back and forth across their frontal lobes. He waited for the bleeding to stop, then sent the patient home, sometimes in a taxi cab.
When nothing went wrong, the patients were left with no visible damage except for a pair of very blackened eyes. Freeman was funny about this—in an insensitive way. He said, “I usually asked the family to provide the patient with sunglasses rather than explanations.”
But things did go wrong. The fourth transorbital patient hemorrhaged during the procedure. Freeman couldn’t stop the bleeding. The patient was rushed to a hospital and saved, but suffered from epileptic fits for the rest of his life, which he spent selling newspapers on a street corner.
On another occasion, Freeman stopped mid-surgery to set up the camera and document the procedure. For some reason the ice pick began to slide down into the patient’s brain. He died without ever regaining consciousness.
James Watt refused to assist with the transorbital procedure, which he said was unprofessional and unsafe. Other colleagues agreed. A hospital medical director, one of Freeman’s earlier supporters, wrote to him and said, “What are these terrible things I hear about you doing lobotomies in your office with an ice pick? Why not use a shotgun? It would be quicker!”
Freeman was not bothered by these reactions. He was sure he had found a fast, cheap, and effective way to treat hopeless mental patients. To prove it, he began touring the country and visiting mental institutions. He would perform transorbital lobotomies and, in the process, teach the resident psychiatrists how to do the operation themselves.
He worked hard at it, and he did it practically for free. He charged large institutions twenty-five dollars a patient to perform the lobotomy at a time when, as a private physician, he could have charged thousands. In one year he visited hospitals in seventeen states, and also made presentations in Canada, Puerto Rico, and South America. On one five-week driving tour of America, he visited eight states and performed 111 lobotomies.
He made these tours driving a specially outfitted car that he called “The Lobotomobile.” The first one was a custom-fitted Lincoln Continental. Later he would drive a van. Whatever the model was, he carried in it photographic equipment, to make records of the surgeries and the patients, a card catalog of patients’ records, a portable electroshock machine, a Dictaphone for taking notes while he drove, and his surgical instruments.
One summer he logged 11,000 miles in his Lobotomobile. He kept a diary of his work. The entries alone make you tired.
29 June, Little Rock, Arkansas, 4 patients
30 June, Rusk, Texas, 10 patients
1 July, Terrell, Texas, 7 patients
2 July, Wichita Falls, Texas, 3 patients
9 July, Patton, California, 5 patients
14 July, Berkeley, California, 3 patients
State hospitals tended to be more willing to try the treatment than private ones, because state hospitals were overcrowded and underfunded and would do almost anything to send a few patients home. The Stockton State Hospital in California had more than 4,000 patients when it started doing lobotomies, and between 1947 and 1954 did 232 of them. Most of the lobotomy patients were women. The author Joel Braslow, in his book Mental Ills and Bodily Cures, said almost the same number of patients died from the operation as were sent home by it—21 percent were killed, and 23 percent were cured.
Freeman was ready to do the surgery whenever, wherever. One of his surgical assistants—Jonathan Williams, who replaced James Watt after Watt refused to go along with Freeman’s plan to do lobotomies in his office, without a surgeon present—later told a story about a patient who had been brought to Freeman for a lobotomy. The day before the surgery, though, he’d gotten cold feet and refused to go through with the operation. He locked himself in his hotel room. Freeman, contacted by the patient’s family, drove to the hotel and convinced the patient to let him in. Using a portable electroshock machine he had designed and built for himself, he administered a few volts to the patient to calm him down. According to Williams, “The patient was…held down on the floor while Freeman administered the shock. It then occurred to him that since the patient was already unconscious, and he had a set of leucotomes in his pocket, he might as well do the transorbital lobotomy then and there, which he did.”
Williams said that, over time, the portable electroshock device began to fall apart. First the dial for setting the voltage broke. Then the timer broke. In the end, Freeman would simply connect the patient to the machine, plug it in, and flip the switch—relying on his own instincts to guess how much juice was going into the patient, and how long to leave it running.
There’s all kinds of evidence that Freeman did not have much patience for standard medical practice, and that he preferred to get right to work without taking the ordinary precautions. Sometimes this resulted in Freeman breaking off the ends of the leucotomes while they were still in the patient’s skull. On more than one occasion, Williams had to open the skull the old-fashioned way and surgically remove two or three inches of broken-off steel from behind the eye sockets, cleaning up after Freeman had made a mess.
Williams said that Freeman hated wasting time on creating a sterile environment for the surgery. He wasn’t worried about what he called “all that germ crap,” Williams said. “I often had to assert myself, insisting, ‘Walter, at least let me drape the patient.’”
Freeman’s cross-country campaigns spread the lobotomy far and wide, and fast. Dozens of doctors trained by Freeman began performing their own surgeries. There are no official numbers on this, but some estimates say Freeman did more than 5,000 lobotomies in his career. People taught by him may have done 40,000 more.
Freeman’s lobotomy began falling out of favor. By the early 1950s it was still a common surgery, but its long-term benefits were beginning to be questionable. Then, in 1954, the Food and Drug Administration approved use of the chemical compound chlorpromazine, which was sold under the name Thorazine. Freeman dismissed it as “chemical lobotomy,” and thought it was inefficient. The patient would have to continue taking the drug forever, while the lobotomy required one procedure for life. But the medical community embraced Thorazine, and many other drugs developed afterward. They were easy to administer, required no training to administer, didn’t have fatal side effects, and could be stopped at any time without permanent damage.
The lobotomy passed into literature and legend—Ken Kesey’s One Flew Over the Cuckoo’s Nest, and the bar joke “I’d rather have a bottle in front of me than a frontal lobotomy”—and became increasingly unpopular as a medical procedure. (I’ve heard it was Tom Waits who made up the line about the bottle. Kesey had a job at a mental hospital—maybe the Veterans Administration hospital in Palo Alto—where he saw firsthand the results of lobotomy and other mistreatment.)
The lobotomy may have become passé, but Walter Freeman never stopped believing in it, promoting it, or performing it.
In 1954, he left Washington, D.C., for the West Coast. He was fifty-eight. It was clear to him that he could go no further professionally in the medical establishment. His work was too controversial for him to ever be head of the American Medical Association or run a major psychiatric institution. Besides, he had always hated the weather—too cold in winter, too muggy in summer. He moved to California.
There were personal reasons, too. Two of his children had finished their university educations, married, and settled in the Bay Area. And in California he could be closer to the places he loved to walk and hike—Yosemite, the Sierras, the Grand Canyon.
In addition, his wife was a heavy drinker, and that had become a problem. A fresh start for him would be a fresh start for her, too.
Freeman, being Freeman, didn’t just move. He moved with style. He knew he wanted to live somewhere around Palo Alto, but he wasn’t sure which community was best for him. So he hired a private plane, and spent half a day having a pilot fly him over the area. Some guys would’ve just looked at a map and talked to some real estate agents. Not Freeman. By the end of the day, he settled on green, leafy, high-class Los Altos. He and his wife bought a house in the foothills.
Freeman was sort of a celebrity in the medical world, and he was welcomed by the local medical community. But his lobotomy was not. Freeman set up offices at 15 Main Street, right in central Los Altos, but no hospital in Los Altos would allow him to operate. He had to go all the way to Doctors General Hospital, on the outskirts of San Jose, to perform his procedure.
This was more than a medical decision. Los Altos was a nice place. It wasn’t supposed to have problems like mental illness. Los Altos had manicured gardens and clean sidewalks and showcase homes. It didn’t have crazy people. Even though Freeman was an educated and cultured man, erudite and charming, the people of Los Altos probably thought his medical procedure was low-rent and tacky. It was for people in loony bins, and there weren’t any loony bins in Los Altos. The local attitude was, “We just don’t do lobotomies here.”
I don’t think my stepmother was shopping for a lobotomy the first time she met Freeman. But she was fed up with me, that was certain.