Lobotomies

(Nov. 16) - The case files of mental illness are filled with half-baked theories and their drastic advocates. Wilhelm Fleiss, for example, believed that sexual hang-ups stemmed from irregularities in the nasal cavity and that a little judicious snipping could set everything straight. In 1895 he famously botched an operation on Sigmund Freud's patient Emma Eckstein, absent-mindedly leaving a yard of surgical gauze stuffed in her head and almost causing her to bleed to death.

Sound Portraits ProductionsHoward Dully, age 12, is shown before, during and after his transorbital lobotomy. Now 56, he has made a documentary about it.
Dr. Walter J. Freeman, a central figure in "My Lobotomy," a radio documentary that will be broadcast this afternoon on the National Public Radio program "All Things Considered," believed that the source of many mental disturbances was the thalamus, in which overabundant emotions tended to congregate. The solution, in his view, was simply to sever that part of the brain from the frontal lobes.
In the late 1930's, Dr. Freeman was one of the first Americans to perform a transorbital lobotomy, in which holes are drilled in the patient's head. In 1946 he devised a faster and more efficient procedure, the prefrontal, or "ice pick," lobotomy, in which a spike is driven beneath the lids of both eyes and then swirled around in a sort of eggbeater motion to scramble the neural connections. He had some positive results, as in the case of Ann Krubsack, who today says she believes that the operation greatly helped her schizophrenia, if not entirely curing it, and enabled her to raise a family and hold down a job she liked.
But because the procedure was used indiscriminately, Dr. Freeman had at least as many poor and even tragic results. He nevertheless became a champion of the operation and to publicize it gave virtuoso demonstrations in which he sometimes used a carpenter's mallet instead of a surgical hammer and sometimes wielded two hammers at once, cracking both eye sockets simultaneously. The whole process took less than 10 minutes.
The operation was originally intended as a last resort for intractable patients, especially those in mental institutions before the advent of drugs like Thorazine made such patients easier to manage. But Dr. Freeman eventually expanded his practice to include patients who suffered from nothing more than migraine or postpartum depression. All told he performed some 3,000 lobotomies, including some on children as young as 4 , whom he believed to be suffering from the early onset of schizophrenia.

Sound Portraits ProductionsDespite his ordeal, Dully describes himself as "at peace" today.
His most famous patient was President John F. Kennedy's sister Rosemary, whom he lobotomized in 1941 when she was 23 and who required full-time care until her death this year. In 1960, when the ice-pick procedure was already becoming obsolete, he lobotomized a crew-cut 12-year-old Californian named Howard Dully. If the purpose of a lobotomy is to deaden the patient's emotions, then that operation, too, was a failure. Today Mr. Dully, a huge, barrel-shaped 56-year-old, is warm, expansive and full of feeling. He has been married three times - twice happily - and has a grown-up son and a job he likes, driving a tour bus. Except for his family and a few close friends, no one knew he had been lobotomized, and on meeting him no one would ever guess it.
But a couple of years ago, feeling, as he puts it, as if some part of him were missing, Mr. Dully began to look into what had happened to him.
In the course of his research he crossed paths with Dave Isay, a producer of radio documentaries, who encouraged Mr. Dully to make a documentary of his own. A result was "My Lobotomy," a 22-minute piece that includes archival recordings of Dr. Freeman (he has one of those deep 1950's newsreel voices), as well as of his son, Frank, who talks about his father's "magnificent obsession," and an interview with Ellen Ionesco, the first patient to undergo the ice-pick procedure. The most compelling voice, though, is Mr. Dully's own gravelly rumble as he tries to come to terms with what amounts to a second-rate fairy tale. (The documentary had its premiere on Monday evening in an auditorium at Bellevue Hospital Center.)
He was lobotomized, it turns out, for no other reason than that he didn't get along with his stepmother, whose long list of complaints about him included sullenness, a reluctance to bathe and that he turned on the lights during daytime. Mr. Dully's father signed off on the procedure, without seeming to take much of an interest in it, and the most dramatic moment in the documentary comes when, after 40 years of silence on the subject, Mr. Dully asks him why. "I got manipulated pure and simple," the father says. "I was sold a bill of goods." But he quickly adds that "nobody is perfect" and that in any case he doesn't like to "dwell on negative ideas." "You shaped up pretty good," he says to his son.

Dr. Robert Lichtenstein, a neurosurgeon who assisted Dr. Freeman in lobotomizing Mr. Dully, attended the Bellevue gathering, along with Ms. Krubsack and the relatives of some people who had been lobotomized, and he, too, had an upbeat view. After all these years, he said, he was pleased to meet Mr. Dully and to see that the procedure had had such a "positive outcome."
For his part, Mr. Dully cried a little but also grinned and said that the best part of the process was merely being able to talk about the operation with his father and say that he still loved him. Ever since the lobotomy he had felt like a freak, he says at the end of the documentary, but now he knows that the operation "didn't touch my soul." "For the first time I feel no shame," he adds. "I am, at last, at peace."
Jack El-Hai, who has written a well-regarded biography of Dr. Freeman, was also at the premiere, and afterward he said of him: "Was he a nut job? I don't think so. He knew more about brain anatomy than just about anyone, and I think he did care about what happened to his people. But he was stubborn, he was impervious to criticism, and he had a loner quality that in the long run caused both him and his patients great harm. I think of him as King Lear in medical garb."