Gracefully Insane (13 page)

McLean doctors like to say they never evinced much enthusiasm for lobotomies, and statistics back them up. Between 1938 and 1941, no more than two patients received the operation each year. At its peak, in 1947, fourteen patients—all women—out of a census of around two hundred were lobotomized. (Two-thirds of McLean’s patients at the time were women, and their average length of stay was much longer than the men’s. Nationwide, doctors lobotomized twice as many women as men.) That peak may be partially explained by the upgrading of McLean’s surgical facilities. Patients no longer had to be driven under guard into downtown Boston for surgery at the Massachusetts General Hospital. Now surgeons were only too happy to avail themselves of McLean’s refurbished operating room. “With surgical fees running as high as $600 an operation,” writes medical historian Jack Pressman, “psychosurgery had become a lucrative side-specialty.”

Pressman obtained access to the case files of all McLean’s lobotomy patients to write his 1998 history,
Last Resort: Psychosurgery and the Limits of Medicine.
On the one hand, he accepted the prevailing wisdom, articulated by acting psychiatrist-in-chief Paul Howard at a 1950 staff conference, that lobotomies were indeed “a last resort” for those long-term patients who had already failed to respond to less radical treatments. Howard allowed that the surgery may “take away something from the personality” but felt that it also held out the hope of relieving a life of suffering. But Pressman could not help but note how effortlessly the lobotomy option slid into the psychiatrists’ checklist of possible cures. Initially envisaged as an option for patients who had lingered in the wards for more than two and a half years, it soon came to be discussed much earlier in the treatment cycle. “After a preliminary
period of observation, electric shock and or insulin shock should be tried,” one doctor noted in the file of a new arrival. “However, the prognosis in either therapy with this patient is not good and she may become a candidate for lobotomy.” Pressman concluded, “For patients whose combination of age, sex, diagnosis, and mental history placed them in the pool of possible candidates, the meter was ticking as to the eventuality of receiving a lobotomy—a race between improving enough to be discharged from the hospital and being brought before a staff conference at which they would be recommended for surgery.” At one such staff conference, a McLean doctor let slip that “we usually do a lobotomy to quiet people down.”

Here is a transcript of a 1945 staff conference concerning the advisability of lobotomy for a male patient. The doctors’ names have been changed.

At the end of the conference, the doctors voted not to lobotomize the patient in question.

At a small, well-staffed hospital like McLean, the doctors knew most of the patients personally. So when a patient like “Sarah Worthington” was lucky enough to make dramatic strides with the help of a lobotomy, every doctor knew about it. Worthington, a housewife and mother in her midforties, had been admitted to McLean in 1947 following a suicide attempt. The initial diagnosis was neurotic depression. At the hospital, she became aggressive and paranoid and again tried to commit suicide. She was given electroshock therapy, which depressed her even more. Five years of intense psychotherapy “might or might not help,” opined one doctor, for “there is nothing to go back to in her case.” About ten months after checking in, Worthington was lobotomized.

Her improvement was dramatic. She appeared at a rare postoperative staff conference and displayed “pleasure and spark.” “The patient seems to have derived a good deal of protection from the overwhelming accumulation of her depressive feelings,” her doctor noted. “It seems justifiable to say that the lobotomy has given her a chance to solve these problems in a way which no previous therapy had succeeded in doing.” Her IQ was measured at 134—higher than before her surgery—and she was soon discharged home. Worthington found a job demonstrating merchandise to women’s clubs and was promoted to a supervisory job after several years. She continued to meet her doctor for weekly psychotherapy and wrote him a grateful note several years after her surgery:

Of course, the doctors drew heart from Worthington’s recovery. But the statistical analysis was less forgiving. Of the first eight women operated on, seven were still in McLean five years after the surgery. At the 1950 staff conference, Paul Howard noted that about half of the sixty patients lobotomized by then had been discharged from the hospital but still needed varying levels of care. Those remaining in the hospital showed some improvement. When I interviewed Howard almost fifty years later, even the distant memory of lobotomies sent a chill up his spine. “It’s a horrible thing to think of, someone reaching into your brain and cutting it with a knife.” He still remembered the approximate range of outcomes. “Our statistics showed that one-third of the patients got a little better—these were people who had been in the hospital for three or four years and probably weren’t going to get out—one-third got much better and one-third remained unchanged.”

McLean’s flirtation with lobotomies ended in 1954. The newly appointed director, Dr. Alfred Stanton, had a strong psychotherapeutic background and zero interest in psychosurgery. Also, antipsychotic drugs were becoming available to the psychiatric profession. Perhaps more importantly, the operation was developing an unsavory reputation. The irrepressible Walter Freeman had decided to become the Henry Ford of psychosurgery, and he was barnstorming the country to promote his gruesome “ice-pick” lobotomies. Instead of using anesthesia, Freeman, sometimes operating alone in his office in downtown Washington, electroshocked
his patients into unconsciousness. Then he hammered an ice pick (initially from the Uline Ice Company; later he used a surgical tool) through the bone above the eye and more or less randomly wiped out frontal lobe tissue. At the 1950 staff conference, Howard related a “probably fictitious story” about patients visiting Freeman’s office for electroshock and emerging with two black eyes resulting from an impromptu lobotomy. Given Freeman’s increasingly erratic conduct, it is possible that the story was true.

But there is another reason that lobotomies ground to a halt at McLean: Virtually every patient who might qualify for a lobotomy had already received one. Eighty-five percent of the lobotomized patients were discharged within eighteen months of having the operation. The rest hung around, taking up the few remaining beds for chronic sufferers. By 1954, McLean was already trying to admit younger patients, who held out more hope of being cured. “The salvageable deadwood had been logged out,” Jack Pressman explained at the end of his study of psychosurgery at the hospital.

In a bizarre coda to McLean’s history with lobotomies, Walter Free
man drove his specially outfitted Cortez camper-van onto the property in 1968 and parked it outside of Upham Memorial Hall, then a geriatric ward. Freeman had converted his van into a mobile record room and carried hundreds of his own case files with him. He had even mounted an X-ray viewer inside the Cortez; Freeman was on a cross-country tour, seeking out former patients for the purpose of monitoring their progress and updating his files. (He had stopped performing lobotomies the previous year.) “He came on a weekend, and he wanted to be let in and have access to our records,” recalls Dr. Paul Dinsmore, who was running Upham at the time. “I told him he couldn’t just show up there off hours, and expect us to open our files.” Freeman drove off, and did not return.

Freeman died in 1972, at the age of seventy-six.

FREUD AND MAN AT MCLEAN

Great Doctor, are you savant or charlatan?

 

 

 

T
he Boston medical establishment, meaning the Harvard medical
establishment, of which McLean was a part, did not leap to embrace Freudianism. This was somewhat ironic, given that Harvard doctors had played a key role in bringing Sigmund Freud’s ideas to the United States. It was philosopher and psychologist (and putative McLean patient) William James who twigged onto Freud’s work and discussed his ideas in his famous Gifford Lectures of 1901-1902, later published as
The Varieties of Religious Experience.
And McLean historian Silvia Sutton notes that Harvard neurologist James J. Putnam—the same Putnam who admitted Stanley McCormick to McLean—published the first paper in English on the clinical use of psychoanalysis in 1906 and “put Freud on the
American psychiatric map.” Like many practitioners dipping their toes into the infant science of psychotherapy, Putnam’s endorsement was tentative at best. His paper concluded “not that the ‘psychoanalytic’ method is useless, for I believe the contrary to be the case, but that it is difficult of application and often less necessary than one might think.”

It was Putnam and Clark University president G. Stanley Hall who invited Freud, Jung, and Ernest Jones to Worcester, Massachusetts, to deliver a series of lectures at the university’s twentiethanniversary celebration in 1909. The event quickly acquired mythic proportions. Even the political agitator Emma Goldman, who had heard Freud speak in Vienna, attended the lectures; she had once operated an ice-cream parlor in Worcester with two anarchist colleagues. Freud himself called it “the first official recognition of psychoanalysis.” It also proved to be Freud’s only North American visit; to have appeared in the famous group photograph taken after the sessions was tantamount to immortality in the psychoanalytic pantheon. McLean was represented by F. Lyman Wells, a young assistant in pathological psychiatry, who told Hall he was entirely unimpressed. (James, too, was underwhelmed by Freud; “a man obsessed with fixed ideas,” he reported.) Thomas Bond, a third-generation McLean psychiatrist, remembers his grandfather Earl telling him of his decision not to go to Worcester. “He thought Freud had no relevance to what they were doing at the asylum, and in a way he was right,” his grandson said. Many McLean patients, then and now, were psychotically disturbed and deemed to be beyond the reach of Freud’s intellectual “talk therapy.”
¹¹

Freud’s inroads into the psychiatric establishment came slowly. The first psychoanalyst hired by Harvard’s Massachusetts General
Hospital, of which McLean was part, was stashed away in a cubbyhole under a flight of stairs, and his name was effaced, Sovietstyle, from the hospital’s official history. Starting in 1924, Freudian psychoanalysis begins to appear in the clinical section of McLean’s annual report. In 1928, the director, Frederick Packard, wrote that “a special attempt has been made to find out what, if anything, in the Freudian methods is practical of application in the psychoses.”