Cut it out

The Lobotomist: a maverick medical genius and his tragic quest to rid the world of mental illness

Rosemary Kennedy was the most famous victim of lobotomy. When the prettiest but mentally retarded daughter of Joseph P Kennedy showed signs of agitated depression in 1941, the Boston millionaire bought the latest treatment available. It left his daughter unable to care for herself, confined from the age of 23 to an institution in Wisconsin, an embarrassing footnote to her famous family's history. None of them even visited her until 1958, when Senator John F Kennedy, campaigning in Wisconsin, stopped by.

Hindsight is the bane of biography, and nowhere is its lens more distorting than in medicine. Knowing what we know today, how is it possible that "they" - the people of the benighted past - could have done what they did? Whenever Dr Walter Freeman, the subject of Jack el-Hai's fascinating book, picks up his ice pick, you want to scream: "Stop him!"

Freeman, an American neurologist, was the most ardent proponent and practitioner of the surgery that aimed to cure mental illness by cutting it out. From the mid-1930s until well into the 1950s, "psycho-surgery" was presented as a miracle cure. This was at a time when America's mental hospitals were crow-ded with patients who had no hope of recovery or release. Popular films such as The Snake Pit (1948) pricked the public into awareness of the torments - electric shocks, straitjackets, solitary confinement - suffered by the condemned souls in what were really no more than psychiatric warehouses.

Freeman, a graduate of Yale and the University of Pennsylvania Medical School, was a rising star of neurology when, in 1936, he adapted a technique designed by Egas Moniz, the Portuguese neurologist. Freeman performed his first "lobtomy" at George Washington University Hospital in co-operation with a colleague, the neurosurgeon James Watts. Boring two holes in the front of the skull, they made incisions in the brain (it was "the consistency of warm butter", writes el-Hai) and cut several round cores of neural fibres. The theory was that severing the neural connections in the prefrontal regions of the brain would cause new neural pathways to form, resulting in a change in behaviour.

The procedure was used on schizophrenics, depressives, hyperactives, even children, and seemed to work - on some. The first patient's husband reported that the remaining five years of her life were her happiest. However, eight out of the first 20 patients relapsed, and there were many reoperations. Yet the stories of success - of patients who went back to work, married, raised families - encouraged the practitioners to persevere. Even if some, such as Rosemary Kennedy, were left inert or listless, what was the alternative?

The most horrifying passages in el-Hai's book describe Freeman performing his magic trick with an ice pick. As a cheaper and easier alternative to the original procedure, Freeman developed the "trans-orbital" lobotomy, which he hoped would be used on the patients flooding America's mental hospitals after the Second World War. An unlicensed surgeon who was indifferent to antiseptic techniques (he did not believe in "all that germ crap"), Freeman would first anaesthetise patients with an electric shock, then insert his ice pick into the space between the patient's eyeball and eyelid, and make a lateral cut.

The lobotomy was adopted by the highest bastions of American medical respectability - the Massachusetts General Hospital, Johns Hopkins and Columbia University Hospitals and the Mayo Clinic. It also caught on internationally - in Japan, New Zealand and South America. In Britain, Wylie McKissock of London had performed more than 1,300 lobotomies by 1950. The US racked up more than 40,000 over four decades, with Freeman himself taking part in nearly 3,500. Something of a showman, he liked driving around the country giving demonstrations. Although Freeman was diligent in his efforts to collect follow- up statistics, the overall record is still unclear. It is thought that a third of his patients showed improvement, while only a few died.

At the end of 1954, Freeman left George Washington Medical School and moved to California. There, to his dismay, his lack of surgical credentials was noticed and he was received as "the ice-pick lobotomist". Besides, psychoanalysis was now in vogue, especially on the west coast, and had become the treatment of choice for depression. The fashion for psychoanalysis was followed by the anti-psychiatry movement, which held that sick minds were caused by a sick society; and, in turn, by the advent of drugs for treating mental distress. Freeman, with his moustache, Hemingwayesque baggy trousers and passion for cutting and hunting, became a man out of his time, treated as not so much a charlatan as a has-been.

This book is an important and disturbing contribution to the history of psychiatry. El-Hai makes the point that lobotomy was not just one man's hobby (even Freeman used it only as a last resort), but a response to a public health crisis. The reader might wish for a few more hard statistics and international comparisons. None the less, The Lobotomist is a reminder of the optimism of the post- war era, when psychosurgery, like the United Nations, was seen as an answer to mankind's ancient miseries.

Brenda Maddox is writing a biography of Ernest Jones

This article first appeared in the 13 June 2005 issue of the New Statesman, G8 protest: how far should you go?

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Bohemian rhapsody: Jeanette Winterson’s “cover version” of The Winter’s Tale

 Jeanette Winterson's The Gap of Time is full of metaphorical riches.

Shakespeare – that magpie plunderer of other people’s plots and characters – would undoubtedly have approved. The Hogarth Shakespeare project invites prominent contemporary writers to rework his plays in novelistic form and this is Jeanette Winterson’s reimagining of The Winter’s Tale. Like the original, it shuttles disturbingly between worlds, cultures and emotional registers. It has never been an easy play, for all its apparent focus on reconciliation, and Winterson handles the gear-changes with skill, moving between the offices of Sicilia, a London-based asset-stripping company, and New Bohemia, a New Orleans-like American urban landscape (with interludes in both a virtual and a real Paris).

Her Leontes is a hedge-fund speculator, Polixenes a visionary designer of screen games (the presence of this world echoes the unsettling semi-magic of Shakespeare’s plot). They have a brief and uncomfortable history as teenage lovers at school and Polixenes – Xeno – has also slept with MiMi (Hermione), the French-American singer who eventually marries Leo.

The story unfolds very much as in the play (though Winterson cannot quite reproduce the effect of Shakespeare’s best-known deadpan stage direction), with Leo using advanced surveillance technology to spy on Xeno and MiMi, and Perdita being spirited away across the Atlantic to the US, where her guardian, Tony, is mugged and killed and she is left in the “baby hatch” of a local hospital – to be found by Shep and his son and brought up in their affectionate, chaotic African-American household. Perdita falls in love with Zel, the estranged son of Xeno, discovers her parentage, returns to London and meets Leo; Leo’s PA, Pauline, has kept in contact across the years with MiMi, a recluse in Paris, and persuades her to return secretly to give a surprise performance at the Roundhouse, when Leo is in the audience, and – well, as in the play, the ending is both definitive and enormously unsettling. “So we leave them now, in the theatre, with the music. I was sitting at the back, waiting to see what would happen.”

That last touch, bringing the author into the narrative in the same apparently arbitrary way we find in a text such as Dostoevsky’s Demons – as a “real” but imperfect witness – gently underlines the personal importance of the play to this particular author. Winterson is explicit about the resonance of this drama for an adopted child and one of the finest passages in the book is a two-page meditation on losing and finding: a process she speculates began with the primordial moment of the moon’s separation from the earth, a lost partner, “pale, lonely, watchful, present, unsocial, inspired. Earth’s autistic twin.”

It is the deep foundation of all the stories of lost paradises and voyages away from home. As the moon controls the tides, balances the earth’s motion by its gravitational pull, so the sense of what is lost pervades every serious, every heart-involving moment of our lives. It is a beautifully worked conceit, a fertile metaphor. The story of a child lost and found is a way of sounding the depths of human imagination, as if all our longing and emotional pain were a consequence of some buried sense of being separated from a home that we can’t ever ­remember. If tragedy is the attempt to tell the story of loss without collapse, all story­telling has some dimension of the tragic, reaching for what is for ever separated by the “gap of time”.

Winterson’s text is full of metaphorical riches. She writes with acute visual sensibility (from the first pages, with their description of a hailstorm in a city street) and this is one of the book’s best things. There are also plenty of incidental felicities: Xeno is designing a game in which time can be arrested, put on hold, accelerated, and so on, and the narrative exhibits something of this shuttling and mixing – most effectively in the 130-page pause between the moment when Milo (Shakespeare’s Mamilius, Leo’s and MiMi’s son) slips away from his father at an airport and the fatal accident that follows. In the play, Mamilius’s death is a disturbing silence behind the rest of the drama, never alluded to, never healed or reconciled; here, Milo’s absence in this long “gap of time” sustains a pedal of unease that has rather the same effect and the revelation of his death, picking up the narrative exactly where it had broken off, is both unsurprising and shocking.

Recurrent motifs are handled with subtlety, especially the theme of “falling”; a song of MiMi’s alludes to Gérard de Nerval’s image of an angel falling into the gap between houses in Paris, not being able to fly away without destroying the street and withering into death. The convergence and crucial difference between falling and failing, falling in love and the “fall” of the human race – all these are woven together hauntingly, reflecting, perhaps, Shakespeare’s exploration in the play of Leontes’s terror of the physical, of the final fall into time and flesh that unreserved love represents.

A book of considerable beauty, then, if not without its problems. MiMi somehow lacks the full angry dignity of Hermione and Leo is a bit too much of a caricature of the heartless, hyper-masculine City trader. His psychoanalyst is a cartoon figure and Pauline’s Yiddish folksiness – although flagged in the text as consciously exaggerated – is a bit overdone.

How a contemporary version can fully handle the pitch of the uncanny in Shakespeare’s final scene, with the “reanimation” of Hermione, is anyone’s guess (the Bible is not wrong to associate the earliest story of the resurrection with terror as much as joy). Winterson does a valiant job and passes seamlessly into a moving and intensely suggestive ending but I was not quite convinced on first reading that her reanimation had done justice to the original.

However, weigh against this the real success of the New Bohemia scenes as a thoroughly convincing modern “pastoral” and the equally successful use of Xeno’s creation of virtual worlds in his games as a way of underlining Shakespeare’s strong hints in the play that art, with its aura of transgression, excess, forbidden magic, and so on, may be our only route to nature. Dream, surprise and new creation are what tell us what is actually there, if only we could see. Winterson’s fiction is a fine invitation into this deeply Shakespearean vision of imagination as the best kind of truth-telling.

Rowan Williams is a New Statesman contributing writer. His most recent book is “The Edge of Words: God and the Habits of Language” (Bloomsbury). The Gap of Time by Jeanette Winterson is published by Vintage (320pp, £16.99)

Rowan Williams is an Anglican prelate, theologian and poet, who was Archbishop of Canterbury from 2002 to 2012. He writes on books for the New Statesman

This article first appeared in the 01 October 2015 issue of the New Statesman, The Tory tide