The doctor's children sang songs and played I Spy as the family car rolled down America's highways in the late 1940s and '50s. Up front, beside their father, sat a small leather case. Inside were ice picks.
Dr. Walter Freeman was a well-known neurologist and a consultant to the VA and Walter Reed Hospital. He was also the country's loudest salesman for a brain operation he said took about ten minutes and was easy to learn. He wasn't a surgeon.
Holes older than history
People have been cutting into the human head for a very long time. Archaeologists have found skulls with deliberately cut holes, roughly 7,000 years old in at least one case. The practice is called trepanation: removing a piece of the skull. In a 3,500-year-old tomb in Israel, two brothers were buried with signs of leprosy and serious developmental problems. One of them was missing a section of frontal bone, and the missing piece lay in the tomb right beside him. Objects in the tomb show the family had money, which probably explains why the brothers got so much medical care and lived as long as they did. The rich getting better medicine is not a modern invention.
Even in the ancient world, opening the head was a last resort, and in the 20th century it still was. Freeman thought that was the problem.
A promise, and a shaved head
Freeman didn't invent the lobotomy. A Portuguese doctor, Moniz, performed the first one in 1935 on a 63-year-old woman suffering from anxiety, depression, insomnia, paranoia and hallucinations. He destroyed parts of her frontal lobes with absolute alcohol, also called ethanol. He named the procedure a leucotomy, and it won him the 1949 Nobel Prize in Medicine.
Freeman and his partner, neurosurgeon Dr. James Watts, used a tool like the one Moniz invented. It was a metal cylinder that pulled out cores of white matter between the prefrontal cortex and the thalamus. Their patient, Alice Hammatt, had agitated depression. The doctors scooped deeper and deeper, to 2, then 3, then 4 centimeters, and accidentally sliced a blood vessel along the way. She woke up happy, so happy that she didn't even mind that Freeman had broken his promise and shaved her head. Six days later she was struggling with language, agitated and disoriented. The hospital sent her home anyway, and Freeman declared the operation a success. He also gave it a new name, lobotomy, which set his work apart from the Nobel winner's.
Over the next six years the two men performed more than 200 of them. By their own numbers, 14 percent of patients suffered serious harm or died.
A goatee, a hat, and a ring
The press didn't flinch. In May 1941 the Saturday Evening Post ran a glowing profile and hailed the work as "transforming a world full of hatred into one radiant with sunshine and kindness." Freeman looked the part, with a long goatee, round spectacles, a wide-brimmed hat and a fancy walking stick. Around his neck, always, hung a gold ring on a chain. Early in his career he had used forceps to tug that ring off a young patient's penis. When the man asked for it back, Freeman lied and said it was a medical artifact now. Then he had it engraved with his own family crest. He also kept a little souvenir from each of his lobotomy patients.
The San Francisco Examiner told the story of a young woman who fell into muteness and despair after she got engaged. Therapy and electroshock didn't help, so she got a 10-minute lobotomy, and her grateful mother was soon planning a wedding. Maybe what the bride needed was to call off the wedding.
Freeman wanted his operation faster still. He was inspired by the Italian psychiatrist Amarro Fiamberti, who performed the first transorbital lobotomy, done through the eye socket, in 1937. Freeman's son Franklin later confirmed that the first ice pick came straight out of the family's kitchen drawer. It was the same pick they used to punch new holes in their leather belts. Freeman drove it in through the eye socket and swept it sideways, which essentially destroyed the frontal lobes. Instead of anesthesia, he knocked patients out with a portable electroshock machine. Now he could operate in an ordinary office.
Thousands of American brains were operated on with an ice pick from the Freeman family's kitchen drawer, the same one they used to punch holes in their belts. The man doing it wasn't even a surgeon.
Can you lend me a hand?
Watts was horrified. Freeman often didn't wash his hands, rolling his eyes at all that "germ crap," as he called it. The hospital at George Washington University had already reprimanded him for performing surgery without being a surgeon. Watts said he would quit if Freeman kept doing lobotomies in their shared office. Then one day Watts walked in to find a patient unconscious on the table with an orbitoclast, the medical name for Freeman's ice pick, stuck in his eye socket. Freeman glanced up and said: "oh, good, you're here. Can you lend me a hand while I take a photograph?"
That ended the partnership. Freeman took his one-man show on the road, with his children along for the ride. He loved an audience and liked to get a gasp by putting ice picks into both eye sockets at once. At one demonstration a sharp instrument slipped into a patient's brain and the patient died. Freeman moved on to the next patient in line. At Eastern State Hospital in Virginia, the staff said his patients looked like they had been "kicked in the face by a mule." In August 1952 he lobotomized 35 women at Spencer State Hospital in West Virginia. He told their families to offer "lots of loving and just enough punishment to add spice."
The girl who stopped singing
His worst failure had come years earlier. Rosemary Kennedy was the eldest daughter of Joseph and Rose Kennedy. When she was born in 1918, the Spanish flu had doctors stretched thin, and while the family waited for one to arrive, a nurse pushed the baby's head back into the birth canal for two hours. Rosemary grew up with developmental delays, violent outbursts and repeated attempts to run away. Her letters, written in a childish, slanting hand, show a girl trying desperately to win her parents' approval. In 1941, when she was 23, her worn-out father chose a lobotomy to make her more docile. Lobotomy had never been used to treat her condition, an intellectual disability.
She was strapped to the table and wide awake, reciting poems and singing, while the doctors swept a metal spatula through two holes drilled in her skull. Then she went silent. Freeman and Watts realized they had gone too far. Rosemary never walked or talked normally again, and she lived in a facility in Jefferson, Wisconsin, until she died in 2005. Her siblings weren't told what had happened to her. Once they learned, they became activists: Eunice started the Special Olympics, and Ted Kennedy helped pass the Americans with Disabilities Act.
Freeman went on to lobotomize more than 4,000 people, at least one as young as four. His last transorbital lobotomy came in 1967. It was Helen Mortensen's third, and she died of a brain hemorrhage, like at least 100 of his other patients. Only after that was he banned from ever doing the procedure again. Freeman had lost his own 11-year-old son in 1946, when the boy was swept over a waterfall at Yosemite. Fourteen years later, Freeman met Howard Dully, an 11-year-old who would become one of his patients, and suggested the two of them go hiking.
