What We Have Come To: Big Pharma, & Psychiatry

Back when my father had heartburn, he drank water, maybe with a little baking soda. Sometimes it went away, sometimes it didn't. If not, he lived with it until he felt better. Commercials nowadays treat it as a medical disorder. First there were Alka-Seltzer ads with somebody groaning "I can't believe I ate the whole thing." Now you are urged to visit your physician who might diagnose your problem as gastroesophageal reflux disease (“Ask your doctor whether you might be suffering from GERD”). Or maybe you are diagnosed as needing Zantac.

Pharmaceuticals have become big business. This is not news. Another change, though, has not been trumpeted. I refer to the medicalization of mood and personality. Today, if you are shy you suffer from a psychiatric disorder. Never mind that shyness is a common personality trait. The psychiatric industry has a new view of normalcy as driven by our aggressive, competitive society. But you find shyness as a virtue among certain American Indian tribes. These Indians think of it as not wanting to steal attention from another.

The psychiatric bible, the DSM, or Diagnostic and Statistical Manual of Mental Disorders, reflects the politics of each era. It once identified homosexuality as "sociopathic personality disorder," but that category has been deleted partly because of pressure from gay-rights groups. Veteran's groups lobbied to have post-traumatic stress disorder included. Self-defeating personality disorder was lobbied against by women’s groups, and was deleted.

Then there is depression. Today, few scientists accept that it is caused by a lack of serotonin. Yet, that is what Big Pharma would have the public believe. Some suspect that Big Pharma cooked the studies to validate antidepressants as safe and effective, and that the Food and Drug Administration has too easily approved them.

At one time melancholy and despair were viewed as existential problems. Sophocles said that wisdom is the residue of suffering. Now an existential dilemma has been pathologized. Take a pill and you'll feel better. Rather like the soma pills in Aldous Huxley's Brave New World. (I acknowledge that some people are depressed profoundly beyond an existential dilemma.) More

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.

Nature V. Nurture II: David Reimer, Ruined for A Concept

Nature Versus Nurture, II: Of David Reimer, and; A Man Who Tampered With A Human Being For The Sake of His Career

David Reimer, 1965-2004

(SeeNature V. Nurture I, 29 May 2004 for the first part.)

The tragic story of David Reimer can be traced to one man, John Money, who put career, ideology, and dogmatism above any real concern for a human being. He wanted to prove that nurture could prevail over nature and used Reimer as his guinea pig, trying to make the boy think like a girl, messing with his mind, and generally making a wreck of the lad. "For Dr. Money, David was the ultimate experiment to prove that nurture, not nature, determines gender identity and sexual orientation—an experiment all the more irresistible because David was an identical twin. His brother, Brian, would provide the perfect matched control, a genetic clone raised as a boy."

John Colapinto: "Just shy of a month ago, I got a call from David Reimer's father telling me that David had taken his own life. I was shocked, but I cannot say I was surprised. Anyone familiar with David's life—as a baby, after a botched circumcision, he underwent an operation to change him from boy to girl—would have understood that the real mystery was how he managed to stay alive for 38 years, given the physical and mental torments he suffered in childhood and that haunted him the rest of his life. I'd argue that a less courageous person than David would have put an end to things long ago. . . ."

"David Reimer was one of the most famous patients in the annals of medicine. Born in 1965 in Winnipeg, he was 8 months old when a doctor used an electrocautery needle, instead of a scalpel, to excise his foreskin during a routine circumcision, burning off his entire penis as a result. David's parents (farm kids barely out of their teens) were referred to Johns Hopkins Hospital in Baltimore, home of the world's leading expert in gender identity, psychologist Dr. John Money, who recommended a surgical sex change, from male to female. David's parents eventually agreed to the radical procedure, believing Dr. Money's claims that this was their sole hope for raising a child who could have heterosexual intercourse—albeit as a sterile woman with a synthetic vagina and a body feminized with estrogen supplements. . . ."

The reality was far more complicated. At age 2, Brenda angrily tore off her dresses. She refused to play with dolls and would beat up her brother and seize his toy cars and guns. In school, she was relentlessly teased for her masculine gait, tastes, and behaviors. She complained to her parents and teachers that she felt like a boy; the adults—on Dr. Money's strict orders of secrecy—insisted that she was only going through a phase. Meanwhile, Brenda's guilt-ridden mother attempted suicide; her father lapsed into mute alcoholism; the neglected Brian eventually descended into drug use, petty crime, and clinical depression. . . ."

"After David's suicide, press reports cited an array of reasons for his despair: bad investments, marital problems, his brother's death two years earlier. Surprisingly little emphasis was given to the extraordinary circumstances of his upbringing. This was unfortunate because to understand David's suicide, you first need to know his anguished history, which I chronicled in my book As Nature Made Him:The Boy Who Was Raised As a Girl."

"For Dr. Money, David was the ultimate experiment to prove that nurture, not nature, determines gender identity and sexual orientation—an experiment all the more irresistible because David was an identical twin. His brother, Brian, would provide the perfect matched control, a genetic clone raised as a boy."

"David's infant "sex reassignment" was the first ever conducted on a developmentally normal child. (Money had helped to pioneer the procedure in hermaphrodites.) And according to Money's published reports through the 1970s, the experiment was a success. The twins were happy in their assigned roles: Brian a rough and tumble boy, his sister Brenda a happy little girl. Money was featured in Time magazine and included a chapter on the twins in his famous textbook Man and Woman, Boy and Girl."

"The reality was far more complicated. At age 2, Brenda angrily tore off her dresses. She refused to play with dolls and would beat up her brother and seize his toy cars and guns. In school, she was relentlessly teased for her masculine gait, tastes, and behaviors. She complained to her parents and teachers that she felt like a boy; the adults—on Dr. Money's strict orders of secrecy—insisted that she was only going through a phase. Meanwhile, Brenda's guilt-ridden mother attempted suicide; her father lapsed into mute alcoholism; the neglected Brian eventually descended into drug use, pretty crime, and clinical depression."

"When Brenda was 14, a local psychiatrist convinced her parents that their daughter must be told the truth. David later said about the revelation: 'Suddenly it all made sense why I felt the way I did. I wasn't some sort of weirdo. I wasn't crazy.' "

"David soon embarked on the painful process of converting back to his biological sex. A double mastectomy removed the breasts that had grown as a result of estrogen therapy; multiple operations, involving grafts and plastic prosthesis, created an artificial penis and testicles. Regular testosterone injections masculinized his musculature. Yet David was depressed over what he believed was the impossibility of his ever marrying. He twice attempted suicide in his early 20s."

"David did eventually marry a big-hearted woman named Jane, but his dark moods persisted. He was plagued by shaming memories of the frightening annual visits to Dr. Money, who used pictures of naked adults to "reinforce" Brenda's gender identity and who pressed her to have further surgery on her 'vagina'."

"When David was almost 30, he met Dr. Milton Diamond, a psychologist at the University of Hawaii and a longtime rival of Dr. Money. A biologist by training, Diamond had always been curious about the fate of the famous twin, especially after Money mysteriously stopped publishing follow-ups in the late 1970s. Through Diamond, David learned that the supposed success of his sex reassignment had been used to legitimize the widespread use of infant sex change in cases of hermaphroditism and genital injury. Outraged, David agreed to participate in a follow-up by Dr. Diamond, whose myth-shattering paper (co-authored by Dr. Keith Sigmundson) was published in Archives of Pediatrics and Adolescent Medicine in March 1997 and was featured on front pages across the globe."

"I met David soon after, when he agreed to be interviewed by me for a feature story in Rolling Stone. He subsequently agreed to collaborate with me on a book about his life, As Nature Made Him, published in February 2000. In the course of our interviews, David told me that he could never forget his nightmare childhood, and he sometimes hinted that he was living on borrowed time."

"Most suicides, experts say, have multiple motives, which come together in a perfect storm of misery. So it was with David. After his twin Brian died of an overdose of antidepressants in the spring of 2002, David sank into a depression. Though the two had been estranged, David had, in recent months, taken to visiting Brian's grave, leaving flowers and, at some point prior to his own suicide, a note."

"David also had marital difficulties. He was not easy to live with, given his explosive anger, his cyclical depressions, his fears of abandonment—all of which Jane weathered for almost 14 years. But with David spiraling ever deeper into sloth and despair, she told him on the weekend of May 2 that they should separate for a time. David stormed out of the house. Two days later, Jane received a call from the police, saying that they had found David but that he did not want her to know his location. Two hours after that, Jane got another call. This time the police told her that David was dead."

"Genetics almost certainly contributed to David's suicide. His mother has been a clinical depressive all her life; his brother suffered from the same disease. How much of the Reimers' misery was due to inherited depression, and how much to the nightmare circumstances into which they had been thrown? David's mutilation and his parents' guilt were tightly entwined, multiplying the mental anguish to which the family members were already prone."

"In some press reports, financial problems were given as the sole motive in David's suicide. While this is absurdly reductive, it is true that last fall David learned that he was the victim of an alleged con man who had hoodwinked him out of $65,000—a loss that ate at him and no doubt contributed to his despair."

"In his final months, David was unemployed—for him, a disastrous circumstance. When I first met him, seven years ago, he was a janitor in a slaughter house—tough, physically demanding work that he loved. But when the plant closed a few years ago, David never found another full-time job. And thanks to me, he didn't have to. I split all profits from the book with David, 50-50. This brought him a substantial amount of money, as did a subsequent movie deal with Peter Jackson, the director of the Lord of the Rings trilogy. With no compelling financial need to work, David was able to sit around his house and brood—a state of affairs for which I feel some guilt".

"In the end, of course, it was what David was inclined to brood about that killed him. David's blighted childhood was never far from his mind. Just before he died, he talked to his wife about his sexual 'inadequacy,' his inability to be a true husband. Jane tried to reassure him. But David was already heading for the door."

"On the morning of May 5, he retrieved a shotgun from his home while Jane was at work and took it into the garage. There, with the terrible, methodical fixedness of the suicide, he sawed off the barrel. Then he drove to the nearby parking lot of a grocery store, parked, raised the gun, and, I hope, ended his sufferings forever."

From Slate Magazine, 3 June 2004, "Gender Gap: What were the real reasons behind David Reimer's suicide?" By John Colapinto.

( John Colapinto is the author of As Nature Made Him: The Boy Who Was Raised a Girl. He is a contributing editor at Rolling Stone magazine where his original story about David Reimer won a national magazine award for reporting. His 2001 novel About the Author is being developed for the screen by Dreamworks.)