It was hailed by the New York Times as "surgery of the soul," a groundbreaking medical procedure that promised hope to the most distressed mentally ill patients and their families. But what began as an operation of last resort was soon being performed at some fifty state asylums, often to devastating results. Little more than a decade after his rise to fame, Walter Freeman, the neurologist who championed the procedure, was decried as a moral monster, and lobotomy one of the most barbaric mistakes of modern medicine.
American Experience presents The Lobotomist, the gripping and tragic story of an ambitious doctor, the desperate families who sought his help, and the medical establishment that embraced him. From award-winning producers Barak Goodman and John Maggio (The Boy in the Bubble, The Fight), this one-hour film features interviews with Dr. Freeman's former patients and their families, his students, and medical historians, and offers an unprecedented look at one of the darkest chapters in psychiatric history.
"The precipitous rise and fall of lobotomy raises important questions about medical innovation," says filmmaker Barak Goodman. "At what point do interventions meant to alleviate suffering begin to conflict with essential human qualities?"
In 1924, twenty-eight-year old Dr. Walter J. Freeman arrived at St. Elizabeth's in Washington, D.C. -- one of the nation's largest hospitals for the mentally ill, and home to thousands of patients suffering from agitated depression, dementia, and psychosis. "He was repelled," says Jack El-Hai, author of The Lobotomist, on which the film is partially based. "He saw 5,000 people whose lives were going nowhere, would go nowhere. And he wanted to do something about it." Freeman embarked on a bold experiment: to discover a physical abnormality in the brain that caused mental illness. He was "convinced that he was born to medical greatness, desperate to achieve it, looking for a route forward," says sociology professor Andrew Scull in the film.
In 1936, Freeman came across an obscure monograph by Portuguese neurologist Egas Moniz detailing the results of a radical new operation on the brain's frontal lobe that he performed on a group of twenty mental patients. Moniz asserted that after surgery, one third of his patients were cured of their symptoms. For Dr. Freeman, the operation promised hope not only for the treatment of mentally ill patients, but also for his own personal future.
Freeman recruited a young neurosurgeon named James Watts to assist him in performing the first prefrontal lobotomy in the United States, on a patient suffering from anxiety, insomnia, and depression. Pushing beyond Moniz's operation, Freeman directed Watts to sever the frontal lobe from the thalamus -- the seat of human emotion in the brain -- where Freeman believed the symptoms of mental illness originated. Four hours later, the patient awoke alert and manifested no anxiety or apprehension. Freeman and Watts pushed forward and performed dozens of prefrontal lobotomies, despite mixed results and outrage from some in the medical community.
In 1945, as shell-shocked GIs began to overwhelm state mental hospitals, Freeman adapted his procedure, creating the so-called "ice-pick" lobotomy, a portable and inexpensive method as horrific as it was convenient. Freeman believed that anyone, even a hospital psychiatrist, could be taught to perform this new operation in just one afternoon, and began traveling the country's mental hospitals on what he called "head hunting" expeditions in search of more patients.
"Typically, Freeman would arrive to great fanfare," says El-Hai, "and then with the press and photographers around, he would perform his operations, sometimes one right after the other." "He had kind of a perverse need to shock people," adds Elliot S. Valenstein, a professor of neuroscience at the University of Michigan.
As Dr. Freeman persisted on his crusade to make lobotomy the preferred treatment for mental illness, he enlisted the power of the press to bolster his image. Major publications across the country hailed lobotomy as a miracle surgery, one not damaging the brain, but "plucking madness" from it.
By 1949, the number of lobotomies performed in the United States using Freeman's method soared to 5,000 annually, up from just 150 in 1945. Before his death in 1972, Walter Freeman would go on to personally lobotomize more than 2,900 patients in 23 states, including nineteen children under the age of eighteen. But as long-term studies on the after-effects of the operation began to emerge, many proponents of lobotomy began to abandon it. For many patients the procedure resulted in a vegetative state, or reduced them to a childlike mental faculty.
"It's fascinating to wonder why mainstream medicine would go along with Walter Freeman," says American Experience executive producer Mark Samels. "Ultimately, he was not a monster but a tragic figure, incapable of understanding the consequences of his own imperfections."