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Aired January 21, 2008

The Lobotomist

A gripping tale of medical intervention gone awry, and one of the most barbaric mistakes of modern medicine.

Film Description

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 Buccle, 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."


Produced and Directed by
Barak Goodman and John Maggio

Written by
Barak Goodman

Edited by
R. A. Fedde

Associate Produced by
Kate Walker

Additional Editing by
John Maggio

Cinematography by
Stephen McCarthy

Music by
Edward Bilous

Senior Consultant
Jack El-Hai

Narrated by
Campbell Scott

Additional Music by
Greg Kalember

Art Direction
Kate Walker

Additional Camera
John Chater
Buddy Squires

Graphics and Animation
R. A. Fedde

Visual Effects
Yorgo Alexopoulos, YA Multimedia

Sound Editor & Mixer
Richard Fairbanks

Additional Music by
Gary Lionelli

Doug Dunderdale
Joe Maggio
Paul Rusnak

Camera Assistant
Mary Ann Janke
Chris Teague

Wally Argo
Michael O'Leary
Benjamin Salley

Ned Hallick

Production Assistants
Brandon Baur
Travis Breitenbach
Kristine Ekman
Mike McClelland
Julia Landau

Assistant Editor
Elyse Hughes

Voice of Dr. Freeman
Lee Wilkof

Family members' voices
Clint Jordan
Joanna Merlin

On camera actors
Richard Biermann
Veronica James
Carl Nubile


Production music provided by APM Music LLC

Special Thanks
Mary Babiarz
Stephen Burke
Barbara Dully
Howard Dully
Janice Ek
Angelene Forester
James Franco
Franklin Freeman
Paul Freeman
Walter Freeman III
Linda Grant
Robert Hager
Sallie Ellen Ionesco
Christine Hamilton Johnson
Dr. Surya Kanhouwa
Emma Ketteringham
Jennifer King
Bob Kolb
Robert Lichtenstein, MD
Julius McLeod
Leslie McPartland
Tom McPartland
Joe Mendillo
Richard Mereand
Harry Merliss, MD
Arnold Moss
Carl Nubile
Chris Payne
Chief Savannis A. Peoples
Dr. Jogues Prandoni
Andy Scull
Edward Shorter
Lyle Slovick
Jerry Starpoli
Garrett Swain, MD
Janice Thomson
DeWitt Thomson
Elliot Valenstein
Blair, Michael, & Kenn Walker
Robert Whitaker

Archival material
American Board of Psychiatry and Neurology
AP/Wide World Photos
Howard Dully
Alfred Eisenstadt/Time & Life Pictures/Getty Images
F.I.L.M. Archives, Inc.
Angelene Forester
Franklin Freeman
Paul Freeman
Walter Freeman III
Herbert Gehr/Time & Life Pictures/Getty Images
Getty Images
Historic Films Archive
Kurt Hutton/Hutton Archive/Getty Images
Christine Hamilton Johnson
Thomas Kirsch, Opacity
Lincoln Journal Star
Lisbon Academy of Sciences
Lawrence Moore
National Library of Medicine
NBC News Archives
New York State Office of Mental Health
Pennsylvania State University Media Sales
St. Elizabeths Hospital
Saturday Evening Post magazine, ©1941, Saturday Evening Post Society
Seattle Post-Intelligencer Collection, Museum of History and Industry, Seattle
Thomas Jefferson University
University of Nebraska Medical Center
University of Rochester
Walter Freeman/James Watts papers, Special Collections and
University Archives, The George Washington University
Washington State Archives
The WPA Film Library
Yale University Library, Manuscripts & Archives

Additional thanks
Babiarz Court Reporting Service
Hudson Heritage CPCR Ventures LLC
Nova Health Systems
Millbrook Vineyards
Reformed Church of Poughkeepsie
Sea View Hospital Rehabilitation Center and Home of
New York City Health and Hospitals Corporation
St. Elizabeths Hospital and the staff of Blackburn Laboratory
Based, in part, on the book 'The Lobotomist' by Jack El-Hai

For American Experience

Post Production
Vanessa Ezersky
Glenn Fukushima
Greg Shea

Series Designer
Alison Kennedy

Online Editors
Spencer Gentry
Mark Steele

Sound Mix
John Jenkins

Production Manager
Nancy Sherman

Molly Jacobs

Jay Fialkov
Janice Flood
Maureen Jordan
Scott Kardel

Project Administration 
Susana Fernandes
Pamela Gaudiano
Tory Starr

Marketing and Communications
Sean Cleary
Jen Holmes
Patrick Ramirez

Project Manager
Lauren Prestileo

Series Manager
James E. Dunford

Coordinating Producer
Susan Mottau

Senior Editor
Paul Taylor

Series Producer
Susan Bellows

Senior Producer
Sharon Grimberg

Executive Producer
Mark Samels

An Ark Media film for American Experience

©2008 WGBH Educational Foundation


The production team would like to acknowledge Jack El-Hai's book The Lobotomist. Consult the further reading page for a list of more books and Web sites related to the program The Lobotomist.

A number of people appeared on-camera or acted as advisors and are listed below. 

On-camera interview subjects

Howard Dully, former patient
Jack El-Hai, writer
Angelene Forester, daughter of a former patient
Franklin Freeman, son of Walter Freeman
Walter Freeman III, son of Walter Freeman
Christine Johnson, granddaughter of a former patient
Janice Jones-Thomson, daughter of a former patient
Robert Lichtenstein, M.D., neurosurgeon
Julius McLeod, former hospital aide
Leslie Jones McPartland, daughter of a former patient
Harry Merliss, M.D., former student of Walter Freeman
Andrew Scull, professor of sociology
Edward Shorter, medical historian
Garrett Swain, M.D., former student of Walter Freeman
Elliot S. Valenstein, professor of neuroscience
Robert Whitaker, writer

Senior Consultant
Jack El-Hai


Narrator: He was an idealistic doctor, hungry for fame, who would champion one of the century's most infamous medical procedures.

Walter Freeman III, son of Walter Freeman: He wanted to solve the problems of psychiatry, and he wanted to do it fast.

Julius McLeod, Former Hospital Aide: I think Dr. Freeman believed and I think the public believed this was going to be a magical cure.

Walter Freeman (archival): Here the skull is thin enough to transmit light and it can usually be perforated easily with a sharp instrument.

Narrator: Hailed by some as an angel of mercy, he was denounced by others as a medical monster.

Edward Shorter, Medical Historian: He was an apostle, he was a crusader. He was genuinely convinced of the effectiveness of what he was doing.

Walter Freeman (archival): The instrument upon removal appears clear and shiny.

Garrett Swain, M.D.: I thought he was the nearest thing to a genius that I had ever met; I also thought he was crazy as hell.

Narrator: Why did mainstream medicine go along with Walter Freeman?

Robert Whitaker, Writer: The lesson here is not how a man can go off the rails, but is how science can go off the rails.

Edward Shorter, Medical Historian: Physicians were seen as demigods in white. They were all lords of the manor. They could all order it be done, whatever they wanted to be done.

Narrator: Was lobotomy a medical breakthrough or a monstrous mistake?

Franklin Freeman, son of Walter Freeman: You could never talk about a successful lobotomy. You might as well talk about a successful automobile accident.

Elliot S. Valenstein, Professor of Neuroscience: Some people did show considerable improvement, and did resume some kind of normal life.

Walter Freeman (archival): He was allowed to go home again and obtain employment as a door-to-door salesman.

Janice Jones-Thomson, daughter: My father said that doctors would operate on her brain and this would take the violence out of her -- that she would be docile after that.

Robert Whitaker, Writer: Is the absence of pain what we should look for? Is the absence of suffering? That's what this raises so much is what do we value about being human?

Title Card: The Lobotomist

Narrator: On a cold January day in 1946, Ellen Ionesco, a 29-year-old housewife and mother, arrived at the Washington, D.C. office of Dr. Walter J. Freeman. With her was her six-year-old daughter Angelene.

Angelene Forester, daughter of patient: My mother always acted a little, sort of aloof. And you just accepted, that's Mommy. Mommy's that way. But it got more and more. And the time came when she was so depressed she would stay in bed for literally days. I remember her pointing up to the ceiling and saying, do you see those wires, that's what they torture me with. Then she started getting more violent and aggressive. And one day she tried to smother me. And finally we took her to see Dr. Freeman.

Reading from a Walter Freeman patient record: Examined Ellen I. this morning. She has suicidal ideas. She became more and more noisy, shouting, "I'm so tired, I'm so tired." I decided she was quite inaccessible and would require immediate treatment.

Angelene Forester, daughter of patient: When we went into his office the whole wall was like windows and sunlight streaming in. It was bright and cheerful. And Dr. Freeman came out and he looked kindly and gentle, very, very gentle and I felt, we're going to be okay.

Narrator: Freeman escorted Ellen to a back room and shut the door.

Angelene Forester, daughter of patient: I had no idea what was going on behind that door. But she changed so radically for the better once he had seen her. She never mentioned suicide again.

Narrator: Ellen Ionesco was the first patient to undergo the procedure Dr. Freeman had perfected only weeks before. He called it "transorbital lobotomy."

Jack El-Hai, Writer: In a transorbital lobotomy, Freeman would first have the patient rendered unconscious through the use of the electroconvulsive shock machine.

Franklin Freeman, son of Walter Freeman: Just before he threw the switch, we all had a laying on of hands. And we went for a little ride.

Walter Freeman (archival): Usually three successive convulsions are necessary but in old people a single one may be sufficient while in a sturdy young person four or even six convulsions may be administered without danger.

Andrew Scull, Professor of Sociology: The patient would then enter unconsciousness for a relatively brief period but several minutes.

Walter Freeman (archival): Now that the convulsion has subsided the nurse holds a towel over the nose and mouth of the patient.

Andrew Scull, Professor of Sociology: Freeman would peel back each eyelid, insert his ice pick and with a hammer tap through the brain, wiggle it about, sever the frontal lobes, withdraw it. And when the patient came to, he or she would be given dark glasses to hide the black eyes they'd been given.

Angelene Forester, daughter of patient: I felt like he had given me a tremendous gift to give my mother back to me. He gave you hope. Everything will be better and it was.

Narrator: Twenty-two years earlier, in 1924, neurologist Walter Freeman arrived at St. Elizabeths in Washington D.C., one of the nation's largest hospitals for the mentally ill. At 28, Freeman was the youngest laboratory director in St. Elizabeths' history. But he confronted an institution in crisis. Like many other state hospitals, St. Elizabeths had seen years of decline. It had become a dumping ground for patients suffering from agitated depression, dementia and psychosis.

Walter Freeman III, son of Walter Freeman: It was clear in those days when you were committed to a mental hospital, this was not a voluntary affair, there was no way out. There would be no treatment because there's nothing seriously that anyone could do. These were warehouses for people that society wanted to forget.

Edward Shorter, Medical Historian: You have this enormous population of patients smearing their excrement on the walls, tearing off their clothes, sitting befuddled on the floor, day after endless day. You say, "How could people live like this? How could they be forced to live like this?"

Narrator: As he wandered St. Elizabeths vast patient wards, Freeman later wrote, he was filled with a "weird mixture of fear, disgust and shame."

Jack El-Hai, Writer: 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.

Walter Freeman III, son of Walter Freeman: He saw the nature of illness not as something that required sympathy but as something that required action. Do something. He wanted to solve the problems of psychiatry, and he wanted to do it fast.

Narrator: Like most neurologists, Freeman believed that physical defects in the brain caused mental illness. Scientists had already shown that the brain was made up of distinct regions, each controlling different physical, behavioral and emotional reactions. But they had still not found the locus of mental illness, and were nearly powerless to treat it.

Edward Shorter, Medical Historian: They would try to treat symptoms. And they couldn't treat all the symptoms. If you were on the verge of suicide, there was nothing that they could do except watch you until you finally recovered spontaneously from your melancholia. And an episode of melancholia could go on for seven or eight months. And that is seven or eight months of hell.

Narrator: In the 1930s, researchers began experimenting with a number of so-called "shock therapies" meant to reroute the circuitry in the diseased brain. Patients were brought to the edge of death through an intentional overdose of the hormone insulin. Others were given Metrazol which triggered seizures so violent they often fractured vertebrae.

Robert Whitaker, Writer: If you look at the patient writings after this, they talked about, "Doctor, why are you torturing me? Are you going to kill me? Please," they would beg, "don't do this to me again." But after people left that table they were quieter, they were more subdued, and they would often go back to their wards and not be bothersome for a period of time.

Jack El-Hai, Writer: 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 yes, the shock therapies achieved that at a cost.

Narrator: For Freeman, shock therapies proved that mental illness resulted from a defect somewhere in the brain, and he wanted to be the one to find it. The scion of a prominent medical family from Philadelphia, Walter Freeman had always believed he was destined for great things. His grandfather William Keen was, for a time, America's most famous surgeon, the first to successfully remove a brain tumor from a living patient. Keen was a showman who loved to perform his complex operations in front of large and admiring audiences.

Franklin Freeman, son of Walter Freeman: He was just one of these men who had just boundless energy and enthusiasm, a pioneer brain surgeon, at one time, a president of the American Medical Association. As a young man my father was determined to be as successful as his grandfather.

Narrator: After graduating from the University of Pennsylvania medical school in 1920, Freeman married Marjorie Franklin, an economist. The couple moved to Washington, DC, where they had four children in as many years. But Freeman was increasingly obsessed with a search for an effective treatment for mental illness.

Andrew Scull, Professor of Sociology: 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.

Narrator: Leaving his growing family behind, Freeman spent long days and nights in St. Elizabeths' basement morgue measuring and photographing the brains of mental patients.

Edward Shorter, Medical Historian: If you take your deceased patients and do an autopsy on their brains, the hope was that you'd be able to see the physical lesion that is causing that illness and that that then would guide you to an effective intervention.

Narrator: But, for all his efforts, Freeman came up empty.

Jack El-Hai, Writer: Throughout all these studies of brains and bodies and nerves and blood, he never found anything that differentiated seriously mentally ill patients from other people.

Narrator: "I recognized that I'd done nothing important," Freeman recalled, "in either explaining mental disorder or treating it."

Robert Whitaker, Writer: He's a man who wants to make his mark, clearly driven with ambition, but he's reached a point where, in essence, he's disappointed. His research hasn't panned out.

Narrator: Then, in the spring of 1936, Freeman made a discovery that would change everything. Just as his own work seemed to reach a dead-end, he picked up an obscure monograph written by a Portuguese neurologist named Egas Moniz. Moniz detailed the results of a radical new operation he had performed on a group of 20 mental patients. By taking small corings of their brains, Moniz asserted, it had been possible to rid a third of these patients of their symptoms.

Elliot S. Valenstein, Professor of Neuroscience: Moniz never really had a good theory of why this operation should work. He simply had a crude notion that people who are mentally ill are sort of obsessed, he called them fixed ideas. And that these fixed ideas probably resided in some way in the frontal lobes.

Narrator: For years, researchers looking for the origins of mental illnesses had suspected the frontal lobes, which, when injured by accident or in battle, had made men calmer, less prone to anxiety or depression.

Andrew Scull, Professor of Sociology: It was apparent that one could damage the frontal lobes and the patients didn't die, but they changed. And the question was what to make of these changes.

Narrator: Until Moniz, few had thought to surgically alter the frontal lobes. For most of mainstream medicine the idea was abhorrent. But not for Walter Freeman.

Jack El-Hai, Writer: Freeman almost went wild with excitement. He thought, 'This may be it.' He saw a vision of the future unfold, not only a future in the treatment of the mentally ill, but his own personal future.

Narrator: As Freeman set about to be the first neurologist in the United States to attempt Moniz' procedure, he faced few obstacles. Neither the government, nor the medical profession, nor patients themselves were likely to stand in his way.

Edward Shorter, Medical Historian: Patients accepted treatments completely uncritically. There was no question of signing permission forms, for example, in those days. The whole concept of informed consent didn't exist. Physicians were kings of their wards, able to do anything they wanted.

Narrator: Lacking a license to perform surgery himself, Freeman hired a willing young neurosurgeon named James Watts. Within months, the pair were ready to attempt their first procedure on a living patient. They chose 63-year old Alice Hammatt who had wrestled for years with insomnia, anxiety and depression.

Jack El-Hai, Writer: Her husband had grown very concerned about her so he brought her in to see Freeman. She was really facing institutionalization. But Freeman had been looking for a patient who had symptoms similar to the most successful of Moniz' outcomes. And so he saw Mrs. Hammatt as that possibility.

Narrator: On a September day in 1936, Freeman and Watts prepared Hammatt for surgery.

Harry Merliss, MD, former student: I remember the patient was on the operating table, everything was aseptic, and Dr. Watts made an incision along the side of the head, and drilled some holes, and put in an instrument like a spatula, approximately a quarter of an inch wide. And Dr. Freeman was sitting on a stool about six feet back and going this way or that way.

Narrator: While conducting Watts' every action, Freeman pushed beyond Moniz' operation. Rather than take corings from the brain, as Moniz had, Freeman ordered Watts to cut the strands of nerves connecting the frontal lobes to the thalamus, a small structure deep inside the brain.

Jack El-Hai, Writer: He believed that the thalamus was the seat of human emotion and that the symptoms we see as signs of mental illness, the hallucinations, the feelings of depression, the suicidal feelings, anxiety, all of those were the result of overly strong emotional impulses reaching the frontal lobes from the thalamus.

Andrew Scull, Professor of Sociology: If they could break those chains of connection those pathological thought patterns maybe these patients could reestablish a more sane reaction to their environment.

Narrator: Four hours later, Alice Hammatt, the first patient to receive a lobotomy in the United States, opened her eyes. "Her face presented a placid expression," Freeman noted, "By evening she was quite alert, manifested no anxiety or apprehension." Excited by their results, Freeman and Watts began to do more lobotomies, acquiring patients from Freeman's private practice.

Elliot S. Valenstein, Professor of Neuroscience: 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.

Narrator: Realizing that they had to refine their procedure, Freeman and Watts began operating on conscious patients, taking cues from their reactions.

Jack El-Hai, Writer: Freeman sometimes ask them to do mental tasks as they were being lobotomized, like count backwards from a hundred by sevens, or recite the names of the presidents, or sing a song, or sometimes he would even ask them, I think very unwisely, to recite The Lord's Prayer.

Narrator: 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.

Edward Shorter, Medical Historian: Freeman's definition of success is that the patients are no longer agitated. That doesn't mean that you're cured, that means they could be discharged from the asylum, but 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.

Jack El-Hai, Writer: After lobotomy they would behave in a very child-like manner. They had to be re-taught how to use the toilet, how to walk. Many lobotomy patients were very uninhibited. Many had problems with over-eating. And so they were definitely not the same person who had received the operation.

Walter Freeman : This is a boy of nineteen. Here he is shown days before lobotomy.

Walter Freeman III, son: My father was very keenly aware not just of these side effects but of the path ahead that would be faced by these individuals and the descent into madness and he was helping them. He wanted to prevent this march of disintegration.

Narrator: As their patient load climbed, Freeman and Watts appeared before a medical conference in Baltimore to report the results of their new operation.

Andrew Scull, Professor of Sociology: Freeman got up to announce that they had a new cure for mental illness. This was a very dramatic and highly charged occasion. There were angry interjections from the audience. There were questions. There were attempts to even shout him down.

Jack El-Hai, Writer: Some of them 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.

Narrator: 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.

Elliot S. Valenstein, Professor of Neuroscience: 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.

Narrator: 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."

Robert Whitaker, Writer: 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.

Narrator: In 1941, Freeman received an unexpected call. Joseph P. Kennedy, the wealthy ambassador to England, had become concerned about his eldest daughter Rosemary. Slow from birth, she had begun acting erratically, throwing fits and running away from the convent where she lived.

Jack El-Hai, Writer: He was getting worried about Rosemary's behavior, worried that she would become pregnant or contract a venereal disease of some kind that would discredit the family and her brothers' political careers.

Elliot S. Valenstein, Professor of Neuroscience: Joseph Kennedy sought the best medical advice in the New England area. And the advice they gave was that she ought to have a lobotomy.

Narrator: That September, at the age of 23, Rosemary Kennedy became Freeman's 66th lobotomy patient. The results were disastrous.

Jack El-Hai, Writer: Before her operation, Miss Kennedy was able to live somewhat independently. But after the operation she was very seriously disabled. And she had to live under almost full-time care for all of her remaining days

Narrator: But Walter Freeman was undeterred.

Andrew Scull, Professor of Sociology: One of the characteristics of an enthusiast, and Walter Freeman was certainly that, is that they are able to overlook everything that contradicts their enthusiasm. And they concentrate on all the things they see that show they're on the right path. So over and over again, we can see Freeman managing to dismiss the casualties of his surgical interventions.

Film footage from "Let There Be Light": The guns are quiet now and the oceans of the earth are filled with ships coming home. In far away places men dreamed of this moment, but for some men, the moment is very different from the dream.

Narrator: With the end of World War II, traumatized veterans returned home and soon overwhelmed already crowded state hospitals.

Film footage from "Let There Be Light": Every man has his breaking point, and these were forced beyond the limit of human endurance.

Narrator: In 1946, Life magazine published "Bedlam," an expose of two state hospitals: Pennsylvania's Byberry and Ohio's Cleveland State. To a country shaken by recent revelations of Nazi atrocities, the pictures were deeply affecting.

Robert Whitaker, Writer: All of a sudden America sees these photos that look like concentration camp photos. You see people huddled naked along walls, strapped to benches, and it really is this descent into this shameful moment and the country did say we have to do something about this.

Narrator: To Freeman, the crisis in state mental hospitals evoked the scenes of misery he had encountered years earlier at St. Elizabeth's. But now, Freeman felt he had a treatment with which to end the suffering and cement his reputation. Before lobotomy could be used on a mass scale, however, it had to be radically simplified.

Jack El-Hai, Writer: It was expensive, it required the services of a neurosurgeon, of an anesthesiologist, an operating room. And these state institutions, even though they were hospitals in name, they didn't have any of those things available.

Andrew Scull, Professor of Sociology: He needs a version of the operation which can become a kind of production line lobotomy.

Narrator: After months of trial and error, Freeman believed he had found a simpler route to the brain.

Edward Shorter, Medical Historian: The eyes are in the orbital cavity okay. I'm putting my fingers now on the, on the bony roof of the orbital cavity. And if you punch up through the roof of the orbital cavity you'll punch up into the pre-frontal lobe.

Walter Freeman (archival): Here the skull is thin enough to transmit light, and it can usually be perforated easily with a sharp instrument.

Franklin Freeman: In our home on Connecticut Avenue, we didn't have a refrigerator, we had an icebox. The first ice pick came right out of our kitchen drawer and it worked like a charm.

Walter Freeman : Turning now to the operation itself, very little preparation is necessary for transorbital lobotomy.

Garrett Swain, MD: The instrument was put in above the eyeball and in the plain of the nose. You could feel it hit the roof of the orbit and then with a tap of a hammer you could knock it through.

Harry Merliss, MD, former student: In that way it was located in the prefrontal area, and he went back and forth like a windshield wiper.

Julius McLeod, Former Hospital Aide: I don't remember exactly you'd cross it then you'd pull it back like a champagne, and it popped.

Garrett Swain, MD: And then it would be returned to where it was. You would hold gauze over the eyeball and withdraw the instrument. The whole thing would take three or four minutes.

Walter Freeman : This patient came to the hospital this morning after breakfast and she will leave tomorrow afternoon.

Narrator: One day, in March of 1946, surgeon James Watts stumbled upon Freeman performing his new procedure in their shared office.

Jack El-Hai, Writer: What he saw was his partner Freeman standing there with ice picks sticking out of both eyes of a patient. And Freeman saw Watts enter and said, quite casually, Jim can you come here and hold the picks while I take a photo?

Garrett Swain, MD: Dr. Watts didn't say anything, he simply turned around and walked out. He felt that it was a major surgical procedure to enter the brain. He felt it should be done in an operating room by a surgeon. And he felt that it should not be done lightly. The next day Dr. Watts and Dr. Freeman didn't share an office any longer.

Walter Freeman (archival): This photograph shows the leucotomy at a depth of seven centimeters from the upper eyelid.

Andrew Scull, Professor of Sociology: 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."

Narrator: Eager to train others in his new technique, Freeman barnstormed the nation's state hospitals in the mid-1940's.

Jack El-Hai, Writer: Typically, Freeman would arrive to great fanfare. And then, often with the press and photographers around, he would perform his operations, sometimes one right after the other.

Elliot S. Valenstein, Professor of Neuroscience: He had a kind of a perverse need to shock people. Sometimes he'd use a carpenter's hammer rather than something that looked like a surgical device.

Andrew Scull, Professor of Sociology: He would get bored doing things right-handed so he would switch off in mid-operation and start doing things left-handed. There are reports which he proudly writes down in his diary about fellow professionals fainting as he proceeds in this or vomiting.

Julius McLeod, Former Hospital Aide: When I walked in that room the first time, and to see this thing, I really wanted to run. I did not want to be there. To see somebody nailing, what I call a nail, through somebody's skull. I just could not see at eighteen years old how that made any sense.

Narrator: 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."

Jack El-Hai, Writer:Freeman had succeeded in coming up with a new kind of lobotomy that was portable, quick, cheap, easy and could be used on an outpatient basis.

Franklin Freeman, son: He did twenty-five transorbitals in one day. He also trained a psychiatrist in Rusk, Texas; that man did seventy-five lobotomies in one day.

Jack El-Hai, Writer: His daughter Lorne once teasingly called him the Henry Ford of lobotomy and he loved it.

Narrator: Spurred on by Freeman, 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.

Jack El-Hai, Writer: This was an era in which the doctors and patients and their families were interested in making tradeoffs. They had to because the option of staying in a hospital for twenty, thirty, forty years wasn't an acceptable option.

Elliot S. Valenstein, Professor of Neuroscience: If this was your mother and you had to choose between someone who was in a state of terror, and that's the way they were all the time, and the alternative was that they would be calm and look calmer, even if they were not maybe as they once were, you might choose that.

Leslie Jones McPartland, daughter: My first memory is going out to Pilgrim State and standing outside on the lawn and looking up to the top floor, it was two floors, and there were bars on the windows, and I asked my father why Mommy was in jail. And he said 'she's not in jail, she's in the hospital and the doctors are going to make her better.'

Narrator: Some time in the late 1940s, Beulah Jones, a young mother from Long Island, began to hear voices and to claim that she was the lost queen of Scotland. Her husband Herbert committed Beulah to Pilgrim State Hospital where her behavior became unruly. Doctors advised that she undergo a lobotomy. Herbert went along.

Janice Jones-Thomson, daughter: He sat us down one day and said that she was going to have a lobotomy, that he had sat down before this board of doctors, and they had told him that this was the best thing to do, and he was desperate, he didn't know what else to do so he agreed to it.

Narrator: Beulah's operation was one of 12 lobotomies performed at Pilgrim State that day.

Janice Jones-Thomson, daughter: My father said that doctors would operate on her brain and this would take the violence out of her, that she would be docile after that. Well, my recollection was there was no change in her behavior other than she lost her higher intellect. She could not sit down and read anymore. She could barely write. She had no long-term memory. It was like everything was right here in this minute.

Christine Johnson, granddaughter: They observed my grandmother for about six months and she was as delusional afterwards as she had been before hand. Once they determined the lobotomy didn't work, they sent her to a ward which was known for the untreatable cases and no one ever bothered with her again.

Narrator: Such 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.

Robert Whitaker, Writer: That's mainstream medicine saying 'this is a great thing. This is an incredible advance.' I think it's Mental Hygiene News adopts as its logo, a light shining into darkness and the light is lobotomy and the past is the darkness. So when you look back and you say, 'How is this monster going around you know introducing this to asylum medicine? He's not that. He's going to places that have been exposed as sort of snake pits and he's bringing this light.

Garrett Swain, MD: I remember one Saturday afternoon, there was a man who had barricaded himself in the bedroom with a hatchet and was going to kill his wife. And someone remembered that Dr. Freeman was this man's psychiatrist. So they called him up at home. He dressed and came out, pounded on the bedroom door and said 'this is Dr. Freeman, John, come out'. And he said to the policemen that were there, 'Hold him down.' And he proceeded to do a bilateral transorbital lobotomy on him.

Narrator: 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.

Edward Shorter, Medical Historian: Freeman could go into a mental hospital and say, line up your chronic psychosis patients and they'd be lined up there on a series of beds. And he would intervene in them one after another. There was no question of asking the patients or their families for permission, no question of consulting the nursing staff. He was literally a little god.

Narrator: At Cherokee state hospital in Iowa, three of freeman's patients died on the operating table, one after freeman's ice pick slipped while he was taking a photograph. Without pausing, he packed up and left for his next demonstration.

Edward Shorter, Medical Historian: It wasn't that he pulled the wool over anybody's eyes. He was an apostle; he was a crusader. What he believed was genuinely effective. Increasingly, Freeman's crusade was aimed at lifers, the poorest and most vulnerable mental patients, abandoned by their families and living for years as wards of the state. In 1952, Freeman embarked on what he called his "West Virginia Lobotomy Project." Over a 30-day period, in one of the nation's poorest states, he would operate on 238 patients, an average of almost eight per day. One of Freeman's favorite stops in West Virginia was the small town of Lakin -- home to the hospital for the colored insane.

Julius McLeod, Former Hospital Aide: Budget was a real problem, supplies were a problem -- didn't have towels for patients, didn't have clothing for patients. We did not have sheets to cover, to give every person a sheet. Poor folks are the ones end up in most of the mental institutions. If you can afford other kinds of treatments, you don't end up there.

Narrator: Unable to pay for its committed patients, West Virginia was threatening to close down Lakin and hospitals like it. Dr. Freeman offered a cost-effective solution. "Lobotomy," he promised, "gets them home."

Walter Freeman III, son: Here he moved off the ground, where he was on very solid grounds for relieving the mental distress of the individual to relieving the state of the burden of the financial and medical care. That I think for very good reasons was the wrong thing to do.

Julius McLeod, Former Hospital Aide: I think Dr. Freeman believed and I think the public believed that this was going to be a magical cure. But when you shoot in the dark, you don't know what you're doing, you just shoot. Hoping it'll come out right some kind of way.

Narrator: By the mid-1950s, the first long-term clinical studies of lobotomy had begun to appear in medical journals. Now, the medical community could assess lobotomy's true impact.

Robert Whitaker, Writer: Some people can't leave the institutions, and they're almost in a vegetative state. Some people go home, but they're just sort of like children around the home. And at best we could see some people that have jobs, but so often they're not motivated really to go to the jobs. So now we have a longer term, we're ten years, twelve years and it's really starting to harder to justify this as a miracle surgery, just 'cause we see these long-term results.

Narrator: 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. Especially vehement were Freudian psychoanalysts, who condemned lobotomy as a brutal assault on the brain. But Walter Freeman had little patience for his critics.

Elliot S. Valenstein, Professor of Neuroscience: Psychoanalysts did not take schizophrenic patients. They couldn't have talking sessions with someone who thought voices were coming out of the toilet bowl. So that if anyone wanted to criticize Freeman at a meeting, he'd say, 'what can you do for a patient like this? What can you do for them?' And they could do nothing.

Walter Freeman III, son: They have no conception of what it's like to be suffering the demons of mental illness. And he was trying to cure them of that, and the fact that they might turn into, let's say, fat slobs afterwards was a small price to pay for the relief from this intense mental anguish. He pointed out repeatedly a very high rate of suicide of these individuals that they can't stand this mental pain and he was helping them.

Narrator: Many of Freeman's patients and their families felt that they had been helped. Once, during a speech in front of an audience of psychiatrists, Freeman was heckled.

Franklin Freeman, son: He reached under the podium, big box of over 500 Christmas cards that he received that Christmas, dumped them on the table and said how many Christmas cards did you get from your patients.

Reading, relative of former patient: Of course you know what my wife went through. She never will be herself fully again. But if she had not got the operation you gave her she probably would not be in shape to enjoy life as she is today.

Reading, relative of former patient two: I want to tell you Dr. Freeman that my brother Abe is still with me just as happy and carefree as a child. May God bless you and yours always for your kind interest in me and my brother.

Andrew Scull, Professor of Sociology: 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.

Narrator: The question of whether lobotomy was a valuable therapy or a medical travesty could not be decided by science alone.

Robert Whitaker, Writer: Is the absence of pain what we should look for? Is the absence of suffering? Is the absence of caring? The absence of anxiety, is that a good thing or is that what makes us human? That, that's really what the core of this is, what do we value about the human mind? He chose not to value certain things. But that's what this raises so much: what do we value about being human?

Narrator: Ultimately, the fate of lobotomy would be settled by a pill. In 1954, a new drug called Thorazine began to sweep through state mental hospitals.

Jack El-Hai, Writer: Thorazine was initially marketed as a chemical lobotomy. This was seen as a selling point, that it produced results similar to lobotomy but without, of course, all the risks of the surgery.

Narrator: With a viable alternative now in hand, the medical community turned decisively against lobotomy.

Robert Lichtenstein, MD: There were people parading at neurosurgical meetings that this was something atrocious. And that nobody should have their brain operated on for the ideas or thoughts or behavior that they're demonstrating.

Narrator: Overnight, Freeman's opportunities to perform lobotomy began to disappear.

Walter Freeman III, son: His office in George Washington University was closed, his teaching assignments were cancelled, his hospital practices at D.C. General were forfeit.

Jack El-Hai, Writer: At this point Freeman couldn't give up lobotomy because to give up lobotomy, I think, meant giving up being Walter Freeman. He saw himself so strongly as the lobotomist, the man who could salvage patients from the dead. To cast that aside, regardless of the arguments for casting it aside, was just too much for him.

Narrator: 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.

Andrew Scull, Professor of Sociology: 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.

Narrator: Howard Dully was 12 years old when he was brought to see the famous doctor. Howard had become disrespectful, his stepmother told Freeman, and occasionally violent at home.

Howard Dully, former patient: My problem with her was that I felt she was trying to replace my mom, and I resented that, which I would feel to be a natural reaction for a kid whose mom died. So acting up is the only way I could show my resentment.

Narrator: Howard's stepmother visited Freeman's office almost a dozen times to have him evaluated, sessions Freeman summarized in case notes.

Howard Dully, former patient: October 26th, 1960. Howard is rather evasive about talking about things that go on in the home. Howard seems to have poor muscular control. He objects to going to bed, but then sleeps well. He does a good deal of daydreaming. He turns the room lights on when there's broad sunlight outside. He hates to wash. He puts on a sweater on the hottest days and goes without an undershirt on chilly ones. I think it would be pretty much of a shame to wish Howard on anybody. I explained to Mrs. Dully that Howard was unapproachable by psychotherapy and that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband. I would have to talk to him and make it stick.

Narrator: Ten weeks later, Walter Freeman lobotomized Howard Dully, former patient.

Howard Dully, former patient: I didn't know it was going to be done. I didn't know it was done until three weeks afterwards when I was told by Freeman. I didn't want to know any more about it because I was concerned that there was might have been some reason that I did deserve this. That's what I was afraid of. What had I had done that I don't know about that one would deserve this?

Narrator: In all, Freeman lobotomized 19 children under the age of 18, including a four year-old.

Howard Dully, former patient: I've always felt that something was taken from me, that there was a piece missing because my life has never gone well. Some of my judgment is not good. I don't have the drive that a normal person has. I've had trouble almost all my life in almost anything I did: work, relationships, money. I wasted my whole life on this one issue, my whole life.

Narrator: By 1967, Dr. Freeman had personally performed more than 2900 lobotomies. In February, at Herrick Memorial Hospital in Berkeley, he performed his last when a patient died of a brain hemorrhage. Freeman was stripped of his hospital privileges and soon retired from his medical practice.

Angelene Forester, daughter of patient: I've heard some things about how he changed into a monster. There were things that I hear he has done that I was incredulous. But I think, by and large he really, sincerely wanted to do something in a time when nobody was doing anything but virtually incarcerating these people.

Jack El-Hai, Writer: I began by thinking that he must have been a monster, or a criminal because, after all, look what he did. But I've come to think of Walter Freeman as more of a tragic figure, blind, not so much to the consequences of lobotomy, but to the consequences of his own faults and failings.

Walter Freeman III, son: To see this excess, this failure of judgment. The excess of ambition, personal ambition, I think tarnished him and that does distress me still.

Dr. Freeman : This is Walter Freeman, MD., PhD. March 9, 1968. I'm 72 years old now and traveling around the country.

Narrator: In his last years, Walter Freeman embarked on one more journey.

Andrew Scull, Professor of Sociology: He's started obsessively criss-crossing the country, searching out his former patients, trying to speak with them, trying to prove to the world that lobotomy hadn't been the great medical catastrophe it increasingly was seen as being.

Walter Freeman (archival): In the past four weeks I've come 7,000 miles chasing up patients that I've operated on and seeing how they are getting along now anywhere from two to 30 years after their operations.

Jack El-Hai, Writer: I think Walter Freeman wanted to feel good about what Walter Freeman had done, and hoping to find, I think, his redemption in what they told him. So, isn't it funny that Walter Freeman is seeking treatment from his patients, the ones he had treated before.

Walter Freeman: I'm pretty much like any other hunter that gets on the trail of something, he loses sense of time and distance. It's such an absorbing preoccupation that mere physical matters don't particularly halt a person in his pursuit.

Slate: Walter Freeman died on May 31, 1972.

Slate: Lobotomy, in a modified form, is still done in rare cases of obsessive-compulsive disorder at hospitals around the world.