Junkfood Science: When science was forgotten — The Lobotomist

January 23, 2008

When science was forgotten — The Lobotomist

This historical medical film is one of the hardest and most uncomfortable films you’ll ever watch. That is also why it is one of the most important films to watch.

Some readers may be old enough to remember when the press heralded this medical procedure as “one of the greatest surgical innovations of this generation” and a miracle cure. Hospital administrators and doctors deemed it a milestone of modern medicine and it was widely accepted. Nurses and doctors flocked to auditoriums to learn about it and watch it performed. The procedure was done by the tens of thousands at the most elite medical institutions in the country and the doctor who developed it was awarded a Nobel prize. Among patients and families, it offered hope and was accepted uncritically.

This is a story about how popular science went terribly wrong, while the truth never spoken. Healthcare professionals didn’t speak out, few criticisms were recorded in medical journals or mentioned to the public, the AMA and FDA were complicit despite the scientific data refuting it, and no one stopped it ... for decades. This experimental procedure and its many untested variations, with no scientifically valid evidence for safety or efficacy, were done on the healthy organs of tens of thousands of people who, it was believed, had no other options.

But it wasn’t a cure or a treatment. The Hippocratic Oath — First, do no harm — was abandoned. It was an era when the science wasn’t understood and such measures were justified by the perceived need to do something, regardless of the costs. This crude procedure left the lives of the vast majority of its victims, those who survived, permanently devastated by horrible side effects and took away joys of human social existence. It became fashionable as a result of fraudulent promotional claims spread by advocates with prestigious medical credentials and positions of authority.

Here are excerpts of the full transcripts of the program, The Lobotomist, available through PBS. As you read these and the evolution of this procedure and its acceptance, think of what it can teach us today.

I think Dr. [Walter] Freeman believed and I think the public believed this was going to be a magical cure... He was an apostle, he was a crusader. He was genuinely convinced of the effectiveness of what he was doing... Physicians were seen as demigods in white... He gave you hope...

It was clear in those days... There would be no treatment because there's nothing seriously that anyone could do... He was repelled by what he saw. He was almost nauseated by what he saw. He saw 5,000 people whose lives were going nowhere, would go nowhere. And he wanted, I think, right away to try and do something about it... Freeman believed that physical defects in the brain caused mental illness... But they had still not found the locus of mental illness, and were nearly powerless to treat it... These shock therapies often worked by the standards that they were operating on at that time, not a cure for the disease, not making someone completely better, but reducing some of the symptoms. And...at a cost...

He wanted to be a great figure in American medicine. So this is a man who is convinced that he's born to medical greatness, desperate to achieve it, looking for a route forward.... he faced few obstacles. Neither the government, nor the medical profession, nor patients themselves were likely to stand in his way. Patients accepted treatments completely uncritically... Freeman and Watts did six or seven other operations and reported good results. But it wasn't too much long after that, maybe only three or four months that these patients began to relapse. What looked like a cure, or a significant alleviation of their symptoms, seemed to disappear. So they did a second operation, sometimes even a third... By the time he'd operated on a dozen patients, Freeman was ready to pronounce lobotomy a success. But he had to admit that even those with the most favorable outcomes had troubling side effects... they were incapable of carrying on normal social life. They were usually demobilized and lacking in energy. And they were that on a permanent basis.

When the inventor first presented his new operation at a medical conference, he couldn’t explain the scientific mechanisms for why it might work, and there was resistance.

Some of [the doctors] were simply astonished that he would even try such a thing, and a few were outraged that he would try an untested procedure like this. Freeman begged his audience for time. It would take months, even years, he argued, to properly evaluate the progress of lobotomy patients. Meanwhile, he promised, lobotomy would remain ‘an operation of last resort.' But Freeman knew that ultimately it didn't matter how much other doctors might oppose him; their disapproval would never reach the outside world. At that time, it was considered unethical to publicly criticize another physician. So people didn't write critical articles, they may have talked among themselves, they may even have raised critical questions at a meeting. But they did not write anything that would stop him from continuing his work.

Aware of the power of public relations, Freeman aggressively courted the press. Soon he was receiving glowing reviews in major publications. The Washington Star called lobotomy “One of the greatest surgical innovations of this generation." The New York Times called it “surgery of the soul," and declared it “history making."

We think of science as having this sober sort of process, something is introduced, it goes to a medical journal, it's peer-reviewed there. Freeman sort of bypassed that process because he in fact knew he was going to get a lot of resistance and he brings the press into it right from the beginning. And the press — they're always eager for miracle surgery, it sells papers and so, next thing you know, you start having this story out there, not of damaging the brain, but of plucking madness from the brain, and it's such a story of progress....

As popularity for the procedure and demand for it grew, he needed a version which could enable “a kind of production line lobotomy,” and another experimental variation, the ice pick lobotomy, was born:

The whole thing would take three or four minutes. This patient came to the hospital this morning after breakfast and she will leave tomorrow afternoon... Freeman forged ahead. He was convinced this was an operation which could be replicated very easily. As he put it, “Any damned fool, even a hospital psychiatrist could learn it within an afternoon." Eager to train others in his new technique, Freeman barnstormed the nation's state hospitals in the mid-1940's. Typically, Freeman would arrive to great fanfare. And then, often with the press and photographers around, he would perform his operations...

To hundreds of beleaguered asylum doctors and administrators, though, Freeman's new procedure seemed a godsend. “I felt somehow that we were in the presence of one of the milestones of modern medicine," gushed one physician. “I've seldom been more stirred."... the number of lobotomies performed annually soared from 150 in 1945 to over 5,000 in 1949. Despite the known side effects, there seemed to be an endless supply of willing patients. This was an era in which the doctors and patients and their families were interested in making tradeoffs. [The] failures were barely noticed. By decade's end lobotomy had won the acceptance of mainstream medicine. Lobotomies were being performed at Johns Hopkins, Mass General Hospital, the Mayo Clinic, and other elite medical institutions. And in 1949 lobotomy received its highest endorsement when Egas Moniz was awarded the Nobel Prize... In his early days, Freeman had called lobotomy 'an operation of last resort.' By the early 1950s, it was an operation he would perform anytime, anywhere.

Decades after they had begun, the reality of the horrors of the side effects were finally being more widely reported in the medical journals:

[A]nd it's really starting to harder to justify this as a miracle surgery, just cause we see these long-term results. Many who had once supported lobotomy began to disavow it. “It is inconceivable," reported the American Medical Association, “that any procedure that effectively destroys the brain could possibly restore the patient to a normal state." Lobotomy, one former supporter declared, was really no more subtle than a gunshot to the head...condemned lobotomy as a brutal assault on the brain. But Walter Freeman had little patience for his critics....

And even few patients and their families could bring themselves to publicly admit the horrors of the side effects:

If you've agreed to allow this sort of procedure on somebody near and dear to you, you want to believe that you've made the best possible decision for that person, and what you would have a very hard time living with I suggest is the notion that you've inflicted rather than a cure on somebody you care for, permanent damage...

Freeman decided to move to Los Altos, California to resurrect his career. Far from the reproachful Eastern medical establishment, he could try to bring lobotomy to new categories of patients. If housewives found their early 1950s existence too depressing for words, why Freeman had a solution that would get them through their day happy as little clams. If children were misbehaving, conditions we might now see being called hyperactivity disorder, why they might need a lobotomy... In all, Freeman lobotomized 19 children under the age of 18, including a four year-old... [Before his last lobotomy in 1967].

Ultimately, lobotomy began grew out of favor after the introduction of thorazine in 1954. But it continues to be done in hospitals around the world “in rare cases of obsessive-compulsive disorder.”

“Progress, far from consisting in change, depends on retentiveness. Those who cannot remember the past are condemned to repeat it."
George Santayana (1863-1952)

The author at From Another Dimension explained the importance for each of us to face horrible atrocities like these, our responsibilities in them, and remember what philosopher George Santayana tried to warn us:

Americans should...be memorializing... the imprisonment of Japanese-Americans during WWII, My Lai, slavery, or the genocide of American Indians. The Japanese should memorialize the Rape on Nanjing and other past wrongs. The Germans should be remembering the Holocaust more than the Jews.

Each society should take its worst wrongs, and examine them carefully, so as to remember what truly must be remembered, what is of paramount importance: that although I see myself as a good person and my country as a good nation, the fact remains that horrible atrocities can happen by my hands; that my nation, my people, my community, my family — that I, can be responsible for these things. Even if I believe myself to be right. Even when I feel my cause is just. See? It happened before. It can happen again...

This understanding helps us know why it's so important for each one of us to have the factual information and evidence on medical interventions — not passively accept the grandiose marketing claims, regardless of whether they come from glowing patient reviews, the media, or prestigious credentialed professionals. We are destined to repeat the past if we fail to understand it and our part in making sure things like this don’t happen again.

But, speaking out and standing up against the groupthink is hard. From Another Dimension wrote: “Not only do we avoid asking if we are in the wrong, we fear asking, and we fear even more saying that aloud in public, because we know others will become wrathful, attacking our ideas and even ourselves.”

And it is unconscionable that anything like lobotomies could ever happen again.

But many who saw The Lobotomist saw the parallels with bariatric surgeries being done today on the healthy organs of fat people, but feared saying it aloud just as people in the past had. These experimental procedures are similarly lauded in the media and by advocates in the medical community, while the reality of the aftermath for most patients and the scientific evidence isn’t readily acknowledged. They target socially undesirable genetic differences in certain people and treat health problems for which there are safer and more effective options. One day, the AMA will say about these, too: “It is inconceivable that any procedure that effectively destroys a healthy GI tract could possibly restore the patient to a normal state.”

The Lobotomist is available for viewing here. The historical films make the reality even more distressing. Dr. Freeman would peel open the person’s eyelid and insert an ice pick between the eyeball and the lid. He would tap the ice pick with a surgical hammer — or a carpenter's mallet, if he was performing for a crowd and wanted to shock them — and break through the orbital cavity of the eye to the prefrontal lobe. He would wiggle the ice pick like a swizzle stick through brain matter to sever the frontal lobes and “cure psychosis, depression or troublesome behavior.” How something like lobotomies crept into mainstream acceptance is a riveting and important story.

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