Moniz provided an almost perfect demonstration of how not to do science. He undertook operations without having any idea what damage they might do or what the outcomes would be. He conducted no preliminary experiments on animals. He didn’t select his patients with particular care and didn’t monitor outcomes closely afterward. He didn’t actually perform any of the surgeries himself, but supervised his juniors—though freely took credit for any successes. The practice did actually work up to a point. People with lobotomies generally became less violent and more tractable, but they also routinely suffered massive, irreversible loss of personality. Despite the many shortcomings of the procedure and Moniz’s lamentable clinical standards, he was feted around the world and in 1949 received the ultimate accolade of a Nobel Prize.
In the United States, a doctor named Walter Jackson Freeman heard of Moniz’s procedure and became his most enthusiastic acolyte. Over a period of almost forty years, Freeman traveled the country performing lobotomies on almost anyone brought before him. On one tour, he lobotomized 225 people in twelve days. Some of his patients were as young as four years old. He operated on people with phobias, on drunks picked up off the street, on people convicted of homosexual acts—on anyone, in short, with almost any kind of perceived mental or social aberration. Freeman’s method was so swift and brutal that it made other doctors recoil. He inserted a standard household ice pick into the brain through the eye socket, tapping it through the skull bone with a hammer, then wriggled it vigorously to sever neural connections. Here is his breezy description of the procedure in a letter to his son:
I have been…knocking them out with a shock and while they are under the “anesthetic” thrusting an ice pick up between the eyeball and the eyelid through the roof of the orbit actually into the frontal lobe of the brain and making the lateral cut by swinging the thing from side to side. I have done two patients on both sides and another on one side without running into any complications, except a very black eye in one case. There may be trouble later on but it seemed fairly easy, although definitely a disagreeable thing to watch.
Indeed. The procedure was so crude that an experienced neurologist from New York University fainted while watching a Freeman operation. But it was quick: patients generally could go home within an hour. It was this quickness and simplicity that dazzled many in the medical community. Freeman was extraordinarily casual in his approach. He operated without gloves or a surgical mask, usually in street clothes. The method caused no scarring but also meant that he was operating blind without any certainty about which mental capacities he was destroying. Because ice picks were not designed for brain surgery, sometimes they would break off inside the patient’s head and have to be surgically removed, if they didn’t kill the patient first. Eventually, Freeman devised a specialized instrument for the procedure, but it was essentially just a more robust ice pick.
What is perhaps most remarkable is that Freeman was a psychiatrist with no surgical certification, a fact that horrified many other physicians. About two-thirds of Freeman’s subjects received no benefit from the procedure or were worse off. Two percent died. His most notorious failure was Rosemary Kennedy, sister of the future president. In 1941, she was twenty-three years old, a vivacious and attractive girl but headstrong and with a tendency to mood swings. She also had some learning difficulties, though these seem not to have been nearly as severe and disabling as has sometimes been reported. Her father, exasperated by her willfulness, had her lobotomized by Freeman without consulting his wife. The lobotomy essentially destroyed Rosemary. She spent the next sixty-four years in a care home in the Midwest, unable to speak, incontinent, and bereft of personality. Her loving mother did not visit her for twenty years.
Gradually, as it became evident that Freeman and others like him were leaving trails of human wreckage behind them, the procedure fell out of fashion, especially with the development of effective psychoactive drugs. Freeman continued to perform lobotomies well into his seventies before finally retiring in 1967. But the effects that he and others left in their wake lasted for years. I can speak with some experience here. In the early 1970s, I worked for two years at a psychiatric hospital outside London where one ward was occupied in large part by people who had been lobotomized in the 1940s and 1950s. They were, almost without exception, obedient, lifeless shells.*4
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The brain is one of our most vulnerable organs. Paradoxically, the very fact that the brain is so snugly encased in its protective skull leaves it susceptible to damage when it swells from infection or when fluid is added to it, as with a bleed, because the additional material has nowhere to go. The result is compression of the brain, which can be fatal. The brain is also easily injured by being dashed against the skull by sudden violence as in a car crash or fall. A thin layer of cerebrospinal fluid in the meninges, the brain’s outer membrane, provides a bit of cushioning, but only a bit. These injuries, known as contrecoup injuries, appear on the opposite side of the brain from the point of impact because the brain is flung against its own protective (or in this case not so protective) casing.
Above all, the brain is vulnerable to its own internal storms. Strokes and seizures are peculiarly human frailties. Most other mammals never suffer strokes, and for those that do, it is a rare event. But for humans, it is the second most common cause of death globally, according to the World Health Organization. Why this should be is something of a mystery. As Daniel E. Lieberman observes in The Story of the Human Body, we have an excellent blood supply to the brain to minimize stroke and yet we get strokes.
Epilepsy likewise is a perennial mystery, but with the additional burden that sufferers have been shunned and demonized throughout history. Well into the twentieth century, it was commonly believed by medical authorities that seizures were infectious—that just watching someone have a seizure could provoke a seizure in others. Epileptics were often treated as mental defectives and confined to institutions. As recently as 1956, it was illegal in seventeen U.S. states for epileptics to marry; in eighteen states, epileptics could be involuntarily sterilized. The last of these laws was repealed only in 1980. In Britain, epilepsy remained on the statute books as grounds for annulment until 1970. As Rajendra Kale put it in the British Medical Journal some years ago, “The history of epilepsy can be summarised as 4,000 years of ignorance, superstition and stigma followed by 100 years of knowledge, superstition and stigma.”
Epilepsy isn’t really a single disease but a collection of symptoms that can range from a brief lapse of awareness to prolonged convulsions, all caused by misfiring neurons in the brain. Epilepsy can be brought on by illness or head trauma, but very often there is no clear precipitating event, just a sudden, frightening seizure from out of the blue. Modern drugs have greatly reduced or eliminated seizures for millions of sufferers, but about 20 percent of epileptics do not respond successfully to medications. Every year about one epileptic in a thousand dies during or just after a seizure in a condition known as sudden unexpected death in epilepsy. As Colin Grant noted in A Smell of Burning: The Story of Epilepsy, “No one knows what causes it. The heart just stops.” (An additional one in a thousand epileptics dies tragically each year from losing consciousness in unfortunate circumstances—in the bath, say, or by striking their head badly in a fall.)