"The Lobotomist" Review

The Seattle Weekly reviews "The Lobotomist"

As Freud recedes in importance in our age of Prozac and Paxil, psychopharmacology and neuroscience having rendered him a 20th-century crank, we ought to remember that there are limits to the mechanistic view of the brain. No fan of talk therapy, psychiatrist Dr. Walter Freeman (1895–1972) set out to debunk Freud by ridding patients of their mental problems by operating directly on the brain—never mind that he was not, in fact, a trained surgeon. That he eventually simplified his technique to hammering ice picks in above the eye socket (hence transorbital lobotomy), often in a nonsterile clinical setting, has only contributed to his horrific reputation and legacy. To those who even recognize his name, it's associated more with Dr. Frankenstein or Dr. Moreau than with legitimate medical practitioners.

That's why The Lobotomist, though not so brilliantly organized or told by author Jack El-Hai, is still an important book. "Psychosurgery," as Freeman helped to coin the term, is actually making a comeback (though under a different name). Thanks to supercomputers and modern imaging, plus the most delicate of surgical techniques (some of them noninvasive, using gamma knives and the like), surgeons are again operating on people with profound brain disorders. In a sense, since brain maladies like schizophrenia are organic and not neurotic, Freeman paved the way, but he also polluted it as he went. (Incredibly, his mentor, a Portuguese doctor named Moniz, won a 1949 Nobel Prize for originating psychosurgery.)

Freeman was involved with some 3,500 lobotomies in the decades following 1936 (when he helped perform the first such operation in the U.S.). El-Hai makes depressingly clear that the surgery's popularity coincided with the huge and costly increase in the number of institutionalized mental patients, most of whom could not give Freeman their informed consent for the procedure. (The boom ended with the advent of antipsychotic drugs like Thorazine, which Freeman ironically opposed because it only masked the root causes of mental illness, rather than treating them.) This is the climate that also gave rise to electroshock therapy and One Flew Over the Cuckoo's Nest; Freeman's own daughter called him "the Henry Ford of psychiatry." Indeed, he took an assembly-line approach to the surgery, often driving around the country—including a stop at our own Western State Hospital—in search of patients. Of one road trip, he wrote, "I left a string of black eyes all the way from Washington [D.C.] to Seattle." (Black eyes resulted from the ice-pick procedure, which patients generally didn't remember afterward.) Among his patients were Rosemary Kennedy and the sister of Tennessee Williams; bafflingly, El-Hai skims over these sad episodes.

He also fails to integrate much current medical knowledge as he tells Freeman's bizarre saga. Since Freeman surgically violated the brain's frontal lobes, he often succeeded in abating the symptoms of mental illness without addressing their cause; the procedure amounted to "salvage, not rescue," one contemporary noted. Yet El-Hai doesn't really address why the medical establishment went along with lobotomies for so long—despite any evidence-based studies on their efficacy.

Still, there's a great story in here. Freeman is like a dark doppelgänger to Kinsey—well-intentioned, more banal than evil, and a bit of a showman. While performing a prefrontal lobotomy on a conscious patient under local anesthetic, he asked, "What's going through your mind?" On the operating table, the patient replied, "A knife." BRIAN MILLER