Filmmakers Barak Goodman and John Maggio have teamed up to make American Experience programs including The Boy in the Bubble (2006), Kinsey (2005) and The Fight (2004). In over a decade of producing documentaries, Goodman has received every major industry award: the Peabody, duPont-Columbia, National Emmy, and an Academy Award nomination. Maggio's Emmy-award-winning work has screened around the world, and he was nominated for an Independent Spirit Award in 2000.
Here, Goodman and Maggio describe making their film, Dr. Walter Freeman's character, lobotomy patients and their families, and more.
What was your first reaction to the story?
Maggio: At the start of this project, I didn't know anything about Dr. Freeman, and I had a vague idea about what a lobotomy was. Like most people, I thought he took out the actual frontal lobe of the brain. When we got Jack El-Hai's book, I thought it was very descriptive, both in terms of the process and the outcomes. Not all of these people became zombies. And Freeman came off as a very flawed individual who started off with good intentions and then went off the rails. It made the story very complex and interesting to me.
Goodman: I was very encouraged when I first learned the story. We had just finished The Boy in the Bubble, which of course is also about medical ethics, and I was excited by the idea of continuing that exploration with this story. When is it ethical to intervene in hopeless situations with very imperfect medical knowledge? That's essentially the question in both stories.
Goodman: I think universally the reaction I got was barely disguised distaste. People kind of winced when I mentioned it. "Eeew!" But then they'd follow with, "really?" They would be fascinated, but there was always the "ick" factor to get past.
Maggio: The term "lobotomy" conjures up such Frankenstein images.
Goodman: People love to look at car accidents. It is always an attraction and repulsion, at the same time.
Maggio: Everyone kind of had an idea about what lobotomy was, but they didn't know the real facts of the story.
Maggio: We both wondered, "how are we going to depict how lobotomies are done?" The visual material exists -- Freeman made films of his lobotomies. We felt like, at the point at which he was going to put the instrument into the eye cavity, that was about all we could take. No one was comfortable looking at that footage.
Goodman: Yet the gory aspect of the operation is part of the story. Freeman was a guy who had incredible detachment from the consequences of his actions. We even learned that other medical professionals found this too much to take. We needed to show a little bit of his distance or indifference. You hear his voice, the clinical tone of his voice -- the detachment that he has. It was integral to the story to show this side of Walter Freeman.
Maggio: Yeah, he did recognize that his patients were suffering, but at the same time had this indifference to the barbarity of this procedure. He was a complex character.
Goodman: It's never a good idea to simply to stake out a cynical point of view about the characters you're trying to depict. It's always more complex than that. We took a page out of Jack El-Hai's book, which very much tries to humanize this guy and to understand him. We learned early on that he was motivated by a complex set of ambitions. He was egotistical and ambitious, of course, but he also had a very idealistic view of medicine and what it could accomplish. As John said, he lost sight of the humanity of the people he was working with. He lost sight of the casualties. It took medicine a long time to figure out that it wasn't worth the human casualties to continue the procedure he created.
Maggio: He was very much a man of the Victorian era. He thought he could apply his trade to a problem, and solve that problem.
Goodman: We expected Freeman's sons, especially Walter, who's an eminent neurologist, to be more protective of his legacy. But they are actually quite critical of him. While Walter admires his father's motivations, drive, idealism, he believes he went too far. He attributes that mostly to ambition. That surprised us, that he would be able to say that publicly.
We actually see it as even more complex than that. A lot of our story is about how the field of medicine allows a person like this free rein. He had charisma, and there were not safeguards in place to check his experiments.
Maggio: The idea that he could walk into a hospital and say, "line up your chronic psychosis patients, and I'll take care of them" -- it boggles the mind that he was allowed to do that with so little consent.
Goodman: His original patients were well-heeled people in his private practice. When lobotomy became a mass production, then he was operating on the poorest patients, in state hospitals.
Maggio: I think there's even more to that story -- it's incredible that the state would hire someone to come in and relieve them of the economic burden of providing even the most basic care for patients through this surgery. Something was really wrong in our society when we allowed that to happen.
Goodman: As historical filmmakers we always have to balance what we're saying against the reality confronted by people in the film. We try to make it clear that the problems these asylum psychiatrists were facing were so large, and the solutions were so few. It was really desperation. Everything you say about lobotomy has to be put in that context: the horrors these people faced. It's still an open debate for many: was the net effect of lobotomies negative or positive? We have to remember that at the time, doing nothing was also a horrible outcome for these people.
Maggio: Freeman saw the suffering that a lot of people didn't see. I think it's important to make the distinction that the actual results from the icepick lobotomy were somewhat less destructive than the early prefrontal procedure -- some would have multiple icepick lobotomies. Some patients could leave the asylum and go home, though they would be a little slower. For Freeman, that was a worthwhile trade-off.
Goodman: I found the families to be so moving. Their anger was right on the surface, even if the operation was 30 or 40 years ago. One of them, Christine Johnson, has devoted her life to this issue. A lot of patients and families are still very upset about it. Here these families are who have been outraged, and held on to that anger, and made it very real for us.
Maggio: A neuroscientist we interviewed, Elliot Valenstein, said, "if this was your mother, and she had a look of terror on her face every day, what would you do?" That to me is the essential question. When you can't reason with someone -- what do you choose to do to help them? Mental illness is so sinister, and it's hard on the family members. When we met the families, it brought the complexities of the story home, because they suffered so much. It's so difficult.
Maggio: I have a feeling that we're going to look back at our own time and wonder, "What were we thinking? Children as young as two on antidepressants?"
Goodman: Yes, I think the whole psychopharmaceutical industry is a perfect example of repeating history. We don't understand the dynamics of these very powerful drugs. I am told by the people I've interviewed that with these drugs we are shooting in the dark as much as we were with lobotomy. We're monkeying with the brain in ways we don't fully understand. The public assumes that if a drug is approved by the FDA, and approved by doctors, we're going to be okay if we use it. People are not skeptical enough of medicine. It's not a process of inexorable progress, marching forward into the future. It's a lot of trial and error, and blind alleys, and failures -- fits and starts. People have to be wary of what they're told, to be their own advocates. I am much more skeptical about doctors than I used to be, as a result of these films.
Maggio: I am not sure how much further along we are in understanding the brain. That's a really important point to understand, going forward. Pills are prescribed with such ease -- granted, it's not an ice pick going into your brain... but we still don't know very much about these drugs and what the long term side effects may be.
Goodman: What makes psychopharmaceutical therapies more sinister today is the marketing. Freeman was a master of manipulating the press. Think about the marketing machines behind drugs today -- if he had had that, imagine how widespread lobotomy might have been.