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?