Controversial procedure colors lobotomist's legacy
By Lauren McSherry, Town Crier Staff Writer
 The late Dr. Walter Freeman, a former Los Altos resident and the father of lobotomy, is the subject of the book “The Lobotomist” by Jack El-Hai. The book chronicles the controversial career of Freeman, who pioneered lobotomy. Freeman developed tools for his methods, including a modified ice pick that he inserted under the eyelid of patients to access the brain. |
He’s been called a huckster, a monster, a maverick and a medical genius. The man who helped found El Camino Hospital and operated a small clinic on Main Street in Los Altos was a doctor with a notorious reputation.
Known among the medical establishment and public as the ice-pick lobotomist, Walter Freeman spurred controversy by propelling a surgical procedure dubbed barbaric, criminal and a circus act. But as Jack El-Hai discusses in his recent biography “The Lobotomist,” Freeman’s legacy is not that black and white.
“He was truly an innovator, not a charlatan or a kook,” El-Hai said. “But all of his flaws contributed to his undoing in the end.”
According to El-Hai, in the context of the time - when more than half a million Americans endured terrible conditions in state mental institutions where doctors and nurses despaired of helping them - Freeman was justified in trying out a procedure that could send patients home and relieve some of their symptoms. Freeman went wrong, though, in continuing to use lobotomy past reason, when new treatments and drugs were proving more effective.
The man behind the myth
El-Hai describes Freeman as a man incredibly driven to make his mark in the medical profession. The grandson of the nation’s first brain surgeon, William Keen, one of the best known doctors of the turn of the century, Freeman sought to set himself apart as a great doctor seizing as his vehicle to fame a radical brain operation that involved severing connections between the brain’s frontal lobes and the thalamus. From the mid-1930s to the ’60s about 50,000 lobotomies were performed with varied results. Of those, Freeman performed nearly 3,500.
After experimenting with several methods that took hours, Freeman developed a fast, simple operation called a transorbital lobotomy. The only problem was that he needed the right instrument. In his kitchen, he grabbed hold of a tool that would be strong enough and sharp enough with a few taps of a surgical hammer to penetrate past a thin bony plate behind the eye socket to the frontal lobes. It was an ice pick, later called a leucotome, and it immediately became part of Freeman’s surgical toolbox.
Freeman’s sons were occasionally allowed to join their father in the operating room. His son Frank recalled for the Town Crier the first transorbital lobotomy he witnessed:
“It was in June 1952, and I was invited to tag along with my brother Paul. …My brother and I got into hospital gowns. We washed our hands very carefully. They brought the (patient) in, and they helped her get up on the operating table. My father used electroshock as a form of anesthesia for these procedures. He attached electrodes to the woman’s head. We all sort of laid hands on her arms and legs to hold her down. My father threw the switch and she had convulsions. She was knocked cold. … He got out the leucotome. This one was surgical steel, specially calibrated. It was put in at the tear duct and tapped in through the orbital plate. Just tap, tap, tap. It was levered in on both sides to a depth of about 2 inches and then withdrawn. It took just 10 minutes. That’s what frightened people - it was quick and it was easy.”
Freeman took to the lecture circuit and traveled hospital to hospital, attempting to rally support for his new procedure from colleagues and the press.
The medical establishment remained wary of Freeman who doggedly continued to extol lobotomy’s merits. Some of his exhibitions - such as when he performed 25 lobotomies in a single day or used both hands to sever nerve tissues in both of a patient’s eye sockets - caused even more suspicion. And his aggressive use of the press earned him the reputation of a huckster.
“It amused him to find out how easy it was to get publicity and to use the media to put forth ideas,” his son Paul recalled. “They used him and he used them. It had been considered not quite right for doctors to promote themselves in newspapers and magazines. He had a certain impatience with the way medicine was being conducted … and part of it was educating the general public about something he thought was important they know about.”
Among Freeman’s most famous patients were the violin prodigy Violet Silver and Rosemary Kennedy, John F. Kennedy’s sister, who died Jan. 7. Silver, a schizophrenic, returned to earning her living through violin performances after her operation; Kennedy was not so lucky.
“There were some cases in which the result was terrible,” El-Hai said. “In Rosemary’s case she wasn’t able to live independently and required full care for the rest of her life.”
It is rumored that Freeman performed a lobotomy on film actress Frances Farmer - whose battle with mental illness was made famous through the 1982 movie “Frances” starring Jessica Lange. But El-Hai found no record among Freeman’s meticulous psychosurgery files indicating that was true. Frank speculated that the file might have been stolen from the archives at George Washington University, Washington, D.C.
It is also rumored that Freeman carried gold-plated ice picks in his medical kit and lost his license to practice medicine. These myths, according to El-Hai, are untrue.
Freeman’s fall from grace
Maligned by psychoanalysts, fellow doctors and some of his colleagues at George Washington University, Freeman, 57, left the medical school where he had taught for 25 years to move to California in 1954.
From San Jose, he and his wife, Marjorie, chartered a pilot for a bird’s-eye view of the Bay Area, where four of their children resided. They chose Los Altos for its seclusion and lack of development. Freeman looked forward to hiking the nearby foothills.
Frank maintains that his father left Washington, because he was nearing 60 and wanted to be closer to the family. El-Hai believes Freeman had painted himself into a corner in academia and it was time to get out.
Turning his back on academia and perhaps realizing how difficult it would be to obtain a new position at a medical school or clinic, Freeman opened a small private psychiatric practice on Main Street as a solo practitioner. Paul, also a psychiatrist, filled in when Freeman was away from the office.
“It was like a dental office - a little reception room, a treatment room and of course a study where he had a desk and a couple of chairs,” Frank remembered. “He was quite active in doing his lobotomies around here. He was really quite happy.”
Later Freeman moved the practice to Grant Road.
Around the same time, despite his reputation as the ice-pick lobotomist, Freeman was asked to become the first chairman of a new hospital to be built in Mountain View. It would be called El Camino Hospital and would be one of the first general hospitals offering community psychiatry.
“Whether or not they approved of lobotomy, everyone recognized this was a man of great energy,” El-Hai said. “When there was the need to get the hospital off the drawing board, he was a good person to fill the role.”
“I think he realized lobotomy was not going anywhere at that point,” Paul said. “He had been involved in the design of George Washington Hospital in D.C. and he had a desire to see strong psychiatric units in general hospitals.”
Among the design elements Freeman added to El Camino’s psychiatric ward were a pastry kitchen and a croquet green. His idea was that patients benefited from homelike surroundings and that self-absorption made patients worse.
Freeman never received approval to perform lobotomies at the hospital. He continued to operate and lecture throughout California and the United States.
Beyond the lobotomy
In the last years of his life, Freeman roamed the United States following up on the welfare of his thousands of patients. He remained a Los Altos resident until his death in 1972.
“I guess it was sheer luck that he was able to find a procedure that he felt others could be trained to do outside of a full-scale hospital,” Paul reflected, “but large numbers of people are not going to accept major surgery on the head being done by nonsurgeons.”
Despite Freeman’s reputation as a misguided psychiatrist, a criminal and a brain mutilator, his innovative lobotomy continues to influence medicine. Brain surgery is now considered only as a last resort for treating mental illness, with bilateral cingulotomy replacing lobotomy as a more precise treatment for bipolar disorders and major depression.
Despite Freeman’s “arrogance, egotism and stubbornness,” faults that El-Hai said contributed to his downfall, Freeman continues to be regarded as a brilliant innovator by some, a view still held by his sons.
“I prefer to see him as someone who rattled the chains,” Paul said. “He was basically a pretty conservative man who saw social and medical injustices that needed to be changed.”
“We were all darned proud of him for being the man in the arena,” Frank said. “He was a wild man in a way. … He was in the face of constant opposition. He really had a lot of guts.”
