The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness

  • Jack El-Hai
John Wiley & Sons, 2004 368 pp, hardcover, $27.95 ISBN 0471232920 | ISBN: 0-471-23292-0

History can be written from many points of view. It can be a trick, as Voltaire quipped, that the living play on the dead, aimed at justifying a status quo. Or the historian can assume that people in other times and places were no less rational than we are, and that we could easily repeat whatever they did. Such a history might try to help the reader to understand Germany in the 1930s by painting that world so that Hitler's nomination for a Nobel Peace Prize in the same year as Gandhi made sense.

In the case of a controversial and discredited figure like the neurologist Walter Freeman, biography will tend to steer toward the latter mode, especially if the biographer is sympathetic to his or her subject. Jack El-Hai states he developed a sympathy for Freeman as he dug into the material surrounding lobotomy. Freeman had an acerbic wit, and a vast collection of case histories and other materials. Given this, it comes as little surprise that this is a book heavy on detail. But El-Hai also became close to Freeman's family, and so there is far more detail about Freeman's grandfather and about the food served at certain meals than many might have expected—and much less detail than some might have wished about the infidelities that seem to have compromised his marriage, his nervous breakdowns and the lobotomies he undertook on children.

These comments should not be taken as the prelude to a review, if by review is meant some assessment that would encapsulate the book in a way that might substitute for reading it. I found it almost un-reviewable in this sense: I was non-plussed rather than either captivated or appalled. Freeman was not a surgeon, but he operated on hundreds or perhaps thousands of people, initially with a colleague James Watts, by severing the links between the rest of their brains and their frontal lobes, and later alone by inserting ice picks up through the orbital plate and cutting the fibers leading from the basal ganglia to the frontal lobes. He subsequently crisscrossed the United States by car during the 40s, 50s and 60s, covering hundreds of thousands of miles as he followed up the outcomes of his operations over decades. Many of these patients seem to have seen him as genuinely solicitous for their well-being, and in many cases it seems likely that he was. He appears to have been an unequalled showman when it came to lecturing to students or presenting his findings to his peers. This was a singular career.

Singular though Freeman's career appears to have been, the reader cannot settle back and contemplate this as the story of something that could not happen again, in that a range of brain interventions such as deep brain stimulation are once again in fashion, and children from several months old are being placed on cocktails of psychotropic drugs with even less justification than was once offered for lobotomies. Our thirst for definitive solutions in the behavioral domain appears to be as alive and well as it ever was when Walter Freeman offered to slake that thirst with lobotomies and leucotomies.

It is rarely if ever the place of a biography to attempt to analyze what it was about the times that made a figure such as Walter Freeman possible, and certainly not to analyze whether there is something comparable between then and now that might provide the basis for a modern recurrence of the Freeman story. But in giving the account of a career, a good biography can stop us in our tracks, and perhaps force us to ask such questions. This biography certainly does that and in addition resonates on many other levels. People who have wondered about the relation between their brain and themselves, about whether they would be the same person if they had a stroke, for instance, are likely to find themselves pausing for thought at many points in this book. And who among us can easily answer the question as to whether it is better to let someone vegetate in an asylum rather than have them return to a productive life, even if it does mean trimming back on their conscience by virtue of the disinhibition that these operations produced. What do we say in response to the husband or children who claim that a wife or mother was happier after her operation than ever before? For those who think there are good answers to such questions, this book provides what may be a timely chance to exercise those answers, given all the indications that these questions will come into play again in the not-so-distant future.

The book ends with Freeman's ghost hovering outside the door to modern neuroscience. Most of us inside can see no connections between what he did and what is happening now, and we are dead against asking him in. Who needs the complexity? El-Hai suggests we should accept the connections between what we do now and what we did then, rather than lobotomizing neuroscience by severing them. Me—I'd like to hear more about how Freeman responded to his wife's final years of unhappiness and alcoholism and a lot more about how he or anyone could justify operating in this way on children as young as three or four.