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Day 3:
January 23, 2008
When travesties such as these are uncovered can anything be done to rectify the damage?
Did Dr. Freeman lobotomize Frances Farmer?
Do you approve or disapprove of your father's work?
How was Dr. Freeman able to perform lobotomies without consent?
Is there any way one can find out if a lobotomy had been performed on him/her as a youth?
Did having a father who was in the public eye have an impact in your life?
Question:
When travesties such as these are uncovered, what, if anything, is ever done to rectify the damage that's been done or does everyone just walk away shaking their heads?
Howard Dully
San Jose, CA
Answered by Andrew Scull:
Dear Mr. Dully,
Sadly, I think the answer is often even worse than the alternatives you offer. Those who attempt to blow the whistle on these sorts of things are often ostracized or punished by their fellow professionals, who prefer to sweep professional misdeeds under the rug. Here are two examples:
At about the same time that Freeman was experimenting with lobotomy, a substantial number of psychiatrists, here and in Europe, were putting schizophrenics into extended comas by injecting them with insulin. They claimed 70 to 80 per cent cures. The procedure was dangerous, and its inventor claimed it "worked" by starving the brain of oxygen. In 1953, a young British psychiatrist, Harold Bourne, published a paper in The Lancet on "The Insulin Myth," arguing that the treatment was a sham and a failure. His reward, in the weeks that followed, was to be denounced in vituperative terms in the press and in professional journals by the leading lights of British psychiatry. Five years later, an extensive controlled trial demonstrated that Bourne was right. I am not aware that he (or those who had been put into the comas) ever received an apology, public or private.
A decade and a half before lobotomy, the superintendent of the Trenton State Hospital, Henry Cotton, had claimed to cure 85 per cent of his patients by removing the infections that he claimed caused all forms of mental illness. In pursuit of his goals, he removed teeth, tonsils, stomachs, spleens, colons, and uteri, virtually eviscerating many of his patients, and killing almost half of those he subjected to abdominal surgery. Thousands of others were left mutilated by his depredations. (He was every bit as sincere as Freeman, pulling his wife and his children's teeth in an attempt to prevent their going mad -- both his sons subsequently killed themselves -- and arranging to have his own teeth pulled when he himself had a mental breakdown. After which he was allowed to return to Trenton and to operate on many more patients.) America's leading psychiatrist, Adolf Meyer, who had sent one of his protégées, Phyllis Greenacre, to investigate these claims, suppressed her report documenting these disasters, and when Cotton died six years later, wrote an obituary in the American Journal of Psychiatry lamenting Cotton's premature death, and the cutting short of his grand experiment! (The whole travesty is recounted in my book Madhouse for those who are interested.)
Occasionally, after the fact, lawsuits are launched attempting to secure damages for the victims. This occurred in Canada, for instance, after the death of Ewen Cameron, former president of the American, Canadian, and World Psychiatric Associations, and a member of the Nuremberg medical tribunal which had investigated Nazi doctors. Cameron, practicing at McGill University, had experimented with "depatterning" and "psychic driving," extraordinary experiments where, inter alia, he wiped out patients' memories with repeated electroshocks designed to reduce those subjected to them to the status of helpless, incontinent "infants," whose psyches he then purported to rebuild. Cameron at his death was a highly respected figure in his profession. Only after it emerged that much of this work had been secretly supported by the CIA were lawsuits brought, some of which were successful in securing monetary damages for his victims and/or their families. Whether money could ever adequately compensate for what has been done, for suicides and ruined lives, is very doubtful, as I'm sure you would agree. But the legal acknowledgement of the depth of the wrong that has been wrought is, of course, worth something.
Remarkably, scholars writing about such episodes in recent years have adopted a more benign view of these human experiments. They have urged that these doctors' actions have to be seen in the context of their times, and the depth of the dilemmas they confronted. There is merit to these contentions to a point, but I fear they can easily topple over into apologetics. Freeman, Cotton, and Meyer were, in my view, moral monsters -- a judgment that requires more extended analysis than I can give it here. One needs, to be sure, to understand how they came to do what they did, and how they were able to persuade their fellow-professionals of the merits of the approaches they championed. But to understand is not to excuse, and I believe it is important to say so loudly and clearly.
Question:
I'm wondering if Franklin Freeman might care to comment further on the E! Mysteries and Scandals broadcast where he states that his father lobotomized Frances Farmer, now that I have provided the source of the picture he states was of Farmer being operated on (it's actually a 1949 Seattle P-I series where the patient's face is seen in another photo) and also retrieved the complete lobotomy logs from Western State Hospital, which show all lobotomies Dr. Freeman (and those he trained) performed. Frances was not the patient in the photo nor is she in the lobotomy logs (or any surgery logs, for that matter). Thank you for your time.
Jeffrey Kauffman
Portland, OR
Answered by Franklin Freeman:
Many years ago Frances Farmer's file disappeared from the patient's records at Western State Hospital.
Question:
Do you approve or disapprove of your father's work?
A. R.
McLean, VA
Answered by Walter Freeman III:
I strongly approve my father's work developing, applying, and proving the value of surgical intervention to relieve the suffering from otherwise incurable mental disease leading to physical and emotional devastation and often suicide. I also approve the transorbital procedure, because its rates of mortality and postoperative epilepsy are one third those of standard procedures. I strongly disapprove the use of lobotomy to ease the control of aggressive and unruly patients, as appears to have occurred in the cases, under parental pressure, of Rosemary Kennedy and Howard Dully. I disapprove equally strongly the use of this valuable surgical procedure to reduce the cost of mental health care, by my father and by anyone else.
Question:
How was Dr. Freeman able to perform all of these lobotomies without consent from patients or family members?
A.D.
Waukesha, WI
Answered by Jack El-Hai:
Walter Freeman did secure legal consent for most of the lobotomies he performed, at least by the standards of the time. Many of his patients were wards of the state, institutionalized in government psychiatric hospitals. If the hospital administration decided that such patients would benefit from a lobotomy, they got one. In other cases, Freeman obtained consent from patients themselves (if they seemed competent to give it) or from family members and next of kin. In the early years of lobotomy, Freeman was quite scrupulous in gaining familial consent, because he believed that the families had to be on board to provide the extensive recovery care at home that most patients required.
As one anti-lobotomy psychiatrist pointed out in the 1940s, however, families could have mixed motives for approving a patient's operation. Some desperately hoped for a miraculous recovery, but others may have unconsciously wanted to end a patient's burdensome existence. Some chronically ill patients later confessed that they had wanted to die as a result of their lobotomy -- a passive form of suicide.
Question:
Is there any way one can find out for sure if a lobotomy had been performed on him/her as a youth, some fifty years ago? Thank you.
S. Smith
Lake Tahoe, NV
Answered by Barak Goodman:
I would recommend you contact the George Washington University library, where Freeman's papers are kept. If you are a family member of one of Freeman's patients, it's possible you can gain access to his records. beyond this, it may be difficult to find out for certain if a lobotomy has been performed for it leaves no visible physical trace.
Question:
Did having a father who was noticed in the public eye, positively and negatively, have an impact in your life?
Nguyen MyAnh
McLean, VA
Answered by Walter Freeman III:
Unless the parent is a president, governor, or superstar in cinema, sports or music, very little of public fame spills over to the spouse or offspring. In my experience the effect of having a parent who was greatly admired by some and detested by others was limited to the adoption of an attitude toward me that was colored by enhanced friendliness or overt avoidance in social encounters. As far as I can tell, the fame did not carry over to overt preferential treatment in admission to schools or openings for jobs. To the contrary, I was impressed that people who had a negative attitude toward my father were more likely to be scrupulous in visiting that anathema on my head.
Question:
If the chemical treatment Thorazine had not come into use, would lobotomy still be considered an acceptable form of treatment?
Thomas Kohlbrenner
McLean, VA
Answered by Anand Pandya:
Aside from the discovery of Thorazine, there are several other treatments that were developed or refined around the same time and those treatments also have many advantages over frontal lobotomies. These include Lithium, tricyclic antidepressants and electroconvulsive therapy as well as the development of psychosocial interventions such as clubhouses and residential models that empower patients, and cognitive and behavioral therapy. Together, these interventions would likely have displaced frontal lobotomy.
In addition, starting in the sixties, we have had a revolution in society's attitudes about the rights of people with mental illness. It is not acceptable (and, of course, it never should have been acceptable) to ignore the preferences of the person with the illness and their family. Nor is it acceptable to engage in such invasive procedures without offering the patient and their family information about the risks, benefits and alternatives. I believe that these reforms would have reduced the practice of frontal lobotomies even if we didn't develop better treatments. The documentary The Lobotomist vividly shows that lobotomies may have been helpful for some people and were clearly not appropriate for others. I believe that if we did not have modern treatments, we would have at least learned not to use frontal lobotomies only on carefully selected cases. In fact, psychosurgery is still performed on patients with severe cases of OCD but such patients are carefully selected and there is a process for informed consent.
Your question acknowledges that most frontal lobotomies were acts of desperation in a time before medication. In the centuries before frontal lobotomies, there were even more dangerous attempts to treat mental illness such as bleeding. Like bleeding, frontal lobotomies could calm a patient temporarily. When you look back over the course of history, you realize that frontal lobotomies seem like just a step on a long path. Our modern medications are probably just another step. They are far better than a frontal lobotomy but I believe that someday we will have treatments that are far better still.
This doesn't mean that everything is always getting better. The lives of people with mental illness can and has become much worse at times when society is not willing to treat all people with dignity. Hopefully, we can learn this lesson from the tragedies of frontal lobotomies.
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