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1/27/09

Walter Freeman, Ice Picks, & Brain Surgery

Walter Freeman, Ice Picks & Surgery

Okay, Relax
Now, This Will Only Hurt A Little Bit. I'm Just Going To Poke This Ice Pick Into Your Brain

Randle Patrick McMurphy, where are you now that we need you?
Your free spirit and rebellious nature has become an icon of the 1960s. But then they had to do it to you. Nurse Rached couldn't stand your antics, your failure to respect her authority. She had you lobotomized. She transformed you into Randle Patrick McZombie, and now you and the 1960s are both gone.

In his One Flew Over The Cuckoo's Nest, novelist Ken Kesey takes McMurphy from a prison work farm and writes him into a mental hospital as a happy-go-lucky guy. Sent up for a battery charge, McMurphy fakes insanity for an easier way to serve out his sentence--in the hospital. He hadn't counted on Nurse Rached.

Kesey knew about mental hospitals. He had worked in one and saw what they did to patients. So, too, in his book The Lobotomist, Jack El-Hai describes a man named Richard, a 1930s mental patient who was lobotomized because he didn't cooperate with hospital staff. El-Hai's book is about a physician, Walter Freeman (1895-1972), who discovered the fine art of ice-picking in order to calm troubled people.


Freeman had heard of António Egas Moniz (1874-1955), a Portuguese, who did the first lobotomy in 1918. Moniz found that the procedure helped many of his patients, although not all. It resulted in severe personality changes, or even mental retardation, often done on unwilling subjects. In 1939, one of his patients shot him several times, though Moniz recovered.


Freeman didn't like the term ice pick. It has a rather unseemly ring to it. He redesigned it and called it a leucotome.

Dr. Freeman was not a surgeon. He had no real surgical training. He was not certified in surgery. For the era he did have a good knowledge of brain anatomy, and because of his interest he hired a young neurosurgeon, Dr. James Watts. After gaining experience with Watts, Freeman entered a solo practice.

I should point out that neither Moniz nor Freeman were regarded by colleagues as mad scientists. They had a credible hypothesis, that severing connection to the thalamus gave relief to schizophrenics and depressives. Credible, though not widely accepted, and Freeman's own behavior was not always cautious. I will also say that opinions about him changed. Radically.

Leucotomy, or lobotomy, severs connections in the prefrontal cortex (prefrontal lobe) or simply destroys it. The surgery can leave a person placid, listless, and without deep interests in anything. As you might guess, it is a practice not without controversy.

Back in 1936, Alice Hammatt at 63 became the first American to receive a lobotomy. She was not, shall we say, altogether willing. After the procedure had been described to her, she didn't like the idea of an ice pick in her brain. She withdrew her consent, but Freeman went ahead anyway. Freeman recorded her last words as "Who is that man? What does he want here? What's he going to do with me? Tell him to go away. Oh, I don't want to see him." Then she screamed.

Alice's husband was quite happy with the results. Before the operation she had moods of suicide and depression. Afterward, he had a sweet marriage until she died five years later. We do not know Mrs. Hammatt's opinion--that is, if she had one. She lost initiative, spontaneity, and was what we today call a couch potato.

Word spread among Freeman's colleagues and with it controversy. Then came Thorazine in about 1950. Though still practiced, today lobotomy is out of favor, largely because of relatively effective antipsychotic drugs. The ethics of the procedure is also a serious issue. As Freeman's son said, "You could never talk about a successful lobotomy. You might as well talk about a successful automobile accident."

Freeman had become a true believer, a crusader for his practice. He performed almost 3500 lobotomies and in 23 states. He traveled the country in his van which he called the Lobotomobile. Pulling up to state-run institutions, he would demonstrate before doctors working there. With a stage presence, he would try to impress them. With a leucotome in each hand, he would "ice pick" both of a patient's eye sockets at one time. By this time, he was a showman of his skill.

Moniz served as a deputy in the Portuguese parliament, as ambassador to Spain, as foreign minister, and as delegate to the 1918 Paris Peace Conference.

If you want to know, António Egas Moniz is remembered for a Nobel Prize for medicine. Walter Freeman is also remembered, although in a different way.

Click here to read from Jack El-Hai. Or here for The American Experience program transcript. Or this one: Lobotomized at 12, Howard Dully has always wondered if something is missing from his soul.


My post is on Walter Freeman, and is not about lobotomy itself. Lobotomy today has been reserved for special cases, and is used judiciously. Bear in mind that operations also turn out well. Read Patricia Moen's account of her lobotomy.

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