Focus 580; The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness

This morning in this first hour focus 580 we will look back to the life of a man who is among the most scorned physicians of the 20th century. His name was Walter Freeman and the reason for that scorn is his association with one of the most controversial medical procedures ever developed. He is a man who is known for refining and promoting the low bottom E a surgery that today is to say the least considered barbaric but for a time from the late 1930s through the mid 1950s it thrived in the mainstream of psychiatric practice. Our guest for the program is Jack al-Haj who has authored a biography of Walter freighted. Freeman The title of his book is the bottom assts a maverick medical genius and his tragic quest to rid the world of mental illness that's the subtitle It's published by Wiley. Our guest has worked for more than 20 years as a freelance writer of books essays and articles he's contributed to publications including The Atlantic Monthly American heritage The Washington Post Magazine the History Channel magazine. He currently serves as executive vice president of the American Society of journalists and authors and he's joining us this morning by.

And as we talk questions are certainly welcome from people who are listening the only thing we ask of people who call in is that they are brief in their questions or comments just so that we can keep our program moving but of course anyone listening is invited into the conversation. The number if you're here in Champaign-Urbana where we are 3 3 3 9 4 5 5 we do also have a toll free line and that was good. Anywhere that you can hear us if you're listening around Illinois in Indiana or on the internet as long as you're in the United States use the toll free That's eight hundred to 2 2 9 4 5 5 again here in Champaign Urbana 3 3 3 9 4 5 5 and toll free 800 to 2 2 9 4 5 5. Jackie O Hi hello. Hello. Thank you for having me. Well thank you for talking with us we appreciate it. Probably the place to start. There may be some people listening who are who don't know what the lobotomy is or was or maybe they have only a vague idea so probably right here at the

beginning which could explain what this procedure is. A lobotomy was a brain operation designed to blunt the symptoms of various symptoms of different mental disorders. And so it was used. It was performed on people who had what today we call schizophrenia chronic depression obsessive compulsive disorder and a whole host of other problems. And what the operation involved was and what Walter Freeman was very much interested in doing was severing some of the neural connections between two different regions of the brain the frontal lobes and another region called the Salomon Freeman. And some of his contemporaries believed that. People who who showed symptoms of certain symptoms of mental illness suffered from an over active. Now in this they're Stalinists Freeman believe was sending overly strong overly urgent signals to the frontal lobes and those signals they received

were received by the frontal lobes expressed themselves as feelings of anxiety suicidal feelings hallucinations and those other symptoms that we associate with mental illness. So Freeman was not interested in cutting out sections of the brain he was interested in every neural connection. So that's what he began doing later on he developed other kinds of low bottom is that accomplished that indeed in different ways. Also we ought to place this in medical history at least a little bit and mention the fact that there had been different people doing experiments doing surgery on the brain as a way of trying to treat mental illness before this. So there there is indeed some history of this kind of approach to traveling trying to help people or deal with people who had psychological or emotional disturbances or you're right and it and the bottom erodes that at a very interesting and fertile time and in

psychiatric history as you mentioned. There had been various neurologists and psychiatrists who had tried treating the brain to treat mental illness before Freeman as early as the 18 and late 1880s. But these people did worked on very small number of patients and were working really on the fringes of medicine. But then in 1035 a Portuguese neurologist named got its money. Began performing a significant number of brain operations on his patients in Lisbon and at first he was injecting alcohol into the brain and in his attempts to to change these neural connections and then he began cutting with surgical tools. And and Freeman and Monique were were more acquaintances. They became good friends later on and Freeman took up the cause the following year and performed the first of these operations in the United States. If

Freeman and his neurosurgeon partner James Watts coined the term bottom emojis had been calling them new Kadhimiya and all this was happening at a time when there is a battle beginning to brew between people like Freeman who believe that there is a biological basis to psychiatric illness and people who are followers of Sigmund Freud who believe that or are. Mental problems arose from our environment and from our upbringing and a whole host of other causes. So all of this was happening at a very interesting time in psychiatric history. And again just to make the point as I did at the beginning that while today we think very very very negatively about the procedure about lobotomy and doing this kind of crude sort of brain surgery as a way of treating mental illness. There was a time when people believed that this this could hold great promise and in fact that the man that you mentioned it was monies actually got a Nobel Prize for his work

in this area. He did in 1949. Right. And it's one of the truthfully one of the things that attracted me to writing about Walter Freeman was that I could not figure the man out. I could not understand what what drove this clearly talented gifted physician to become attracted to this brain mutilating procedure and I also didn't understand why he stayed with it for so long and it was very important in the course of all my work to place his work his work in a context. And what I learned was that these were times of great desperation in psychiatric medicine that the psychoactive medications effective ones did not start coming out until the mid 1950s. So in 1036 When Freeman performed his first lobotomy there were very few other treatments available to seriously ill patients in the hospital. There were various shock therapies that were just beginning to appear at that time. Electric

shock and shock by insulin coma and by a chemical convulsion. These were treatments that patients were very afraid of because they were terrible to go through. And then there is the alternative of just keeping patients confined and hoping that they would get better on their own which did happen sometimes but not very often. Meanwhile. You know tens of thousands of patients were piling up in state government psychiatric hospitals and they were becoming very despairing of ever getting better in their care givers were becoming despairing of the same thing. And it was in that environment that Freeman began his work and began getting support for lobotomy. Freeman comes from a medical family. His father and his grandfather were both physicians. And it's interesting though that he went on to be a doctor because he when he first went to college went to Yale. He didn't have a promising start and wasn't thinking about medicine and his father actually actively discouraged

him from taking up medicine as a career. Yeah so he he had these these two medical model is ahead of him. His father and his grandfather his father the one who discouraged him from going into medicine. Freeman viewed him in a very poor light. He didn't think very highly of his father as his father was in frame in mind a medical Drudge. He you know he went to his office every day and treated the patients. But then at the close of the day that was it. Freeman's father never contributed papers to medical publications never attended medical conferences never did anything beyond what he had to and Freeman's father didn't enjoy being a physician. On the other hand there was his maternal grandfather William Williams Keen who was a physician of a much different kind. He was probably the most famous surgeon in the United States and at that turn of the century he was America's first brain surgeon. He had operated on United States presidents he

was a president of the American Medical Association and he was more important he was endlessly curious and endlessly accomplished and I think Freeman as he was growing up seeing these two doctors at work in his family really came to think that there that he had a choice that if he chose to become a physician himself he could follow in his father's footsteps or in his grandfather's in this grandfather's footsteps. His grandfather's trail that path of accomplishment. And renown was much more appealing to him. Our guest in this part of focus 580 is jack high and we're talking about his book The Bottom ist It's a biography of Dr. Walter Freedman a man who perhaps more than any other individual here in the United States promoted popularized and refined the operation which he came to call the bottom E which was as I mentioned beginning of the program although this is something now that that we think of as a barbaric thing a crude and barbaric thing at one point

was a mainstream treatment at a time when there weren't a lot of alternatives for people who were trying to for physicians and others who were trying to help people who were mentally ill. If you're interested in reading the book it's a it's published by Wiley here. There is also a website by the way for a book for the book which is the bottomless dot com Either you can go there directly or you can go. We've set up a link on our website. You can go there that way or you can just go down to the bookstore and take a look at the book if you're interested. 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5. He as I mentioned he he did not for when he first went to college went to Yale and didn't really get off to such a great start for his university education he wasn't really thinking about studying medicine. But then when he did go that way he really took to it. It would seem. How did he end up choosing neurology as something that he wanted to focus on. From from the very start of his medical school he was interested in the brain and he was also very

interested in the lab work and very good at the lab work. And I think I think that that combination led him to follow your neurology as his specialty and he also had some teachers who encouraged him. But initially Freeman when he left medical school he went into neuro pathology and he spent a year in Europe in Italy and in France studying neuro pathology and it was as a pathologist as a laboratory worker that Freeman got his first job in the United States at St. Elizabeth's Hospital in Washington D.C. and this was still is a large federal hospital at that time it was primarily for the insane. And Freeman was the director of laboratories there he was not he was not dealing with patients he was dealing with cadavers and lab specimens. But from from his time at Saint Elizabeth Freeman certainly

saw that there were thousands of patients in that hospital at that time and he was greatly impressed by what he saw as a waste of tremendous human potential. And that's what I think what sparked his drive if he was going to follow in his grandfather William King footsteps and be the innovator and be this renowned physician he thought that treating the mentally ill could be a way for him to do it. It's interesting here again the involvement of his grandfather because he Freeman got that job at St. Elizabeth's because of through the efforts of his grandfather so you know one wonders if if somehow things had gone differently that if he didn't find himself doing work at this hospital for the mentally ill that maybe the work in his career might have gone in some different direction. Oh I think it could have gone in in much much more productive directions. He clearly had the potential for it and you know I began all this like many people I think would thinking a freeman as a monster. What I knew of

the bottom E's came from reading One Flew Over The Cuckoo's Nest and seeing movies like Francis about the actress Frances Farmer in which lobotomy was shown really not as a treatment for mental illness but as a as a way to subdue patients and sometimes that's a way to punish patients. For non-conformist behavior and so I thought that anyone who would advance this kind of treatment had to be a monster. As I got into it though as I got deeper into my research and deeper into my writing about Freeman I saw that things were not so black and white that there were a lot of shades of grey in here because Freeman clearly cared about his patients. In his way he was not a warm gregarious kind of man but there's no doubt that he cared about his patients and he had a lot of talent. I think you're right that had this idea of of treating mentally ill patients by

surgically treating their brains had not arrived. I think he could have gone in a great direction. That's I guess that that seems to be an important part of the story that you're telling is that well. Well however we might fault him for what he did and how he did it and particularly for sticking with. Well the bottom E long past the point where. It seemed not to make any sense anymore particularly with the advent of psychiatric medications that things like. Thorazine that was the the very first one and then there were others that we all all of that is true. I mean you can you cannot deny any of that. Yet at the same it seems though that in in large part his basic motivation was that he did indeed want to help people he saw all these people that he believed were suffering and that at that time medicine didn't really have a lot to offer and he thought perhaps this surgery that he came to be introduced to and then practice and and make his own sort of adjustments

to you really believe that that could indeed help. Right and but I don't want to give the impression that Freeman was a man without flaws. He was highly flawed very colorfully flawed which was one of the things that made him a good subject for a biography too I came to think of him as kind of a King Lear in medical garb because he had all of these flaws and defects in his character and was unaware of them. And I suppose most people are oh there are flaws in their character. But it was these flaws not only accounted in part for the downfall of the bottom me after the introduction of these medications in the 1980s but also his own personal downfall and he took he took a big crash himself because. He continued advocating Labiatae me long after the time that effective medications became available really until his dying day and 1072 he performed his last lobotomy in 1967

and is his life crumbled around him. His marriage his relationships with his children as it were as a result of his is really unimaginable. Focus on the procedure he really invested himself heavily in the bottom and that was one of the things that and treat me a great deal. The SU will explain a little bit ago the procedure it was called something different but essentially it was developed by this a Portuguese neurologist Gus monies who was actually doing it at that time the way he was doing it involved opening the skull. You had to get in there to get at the brain and was doing this surgery and then what happened. Freeman came along. And later develop a different way of doing it that we can talk about. But how did Freeman How did he become acquainted with Mondays and his work and then how did he become acquainted with the man himself.

Freeman and monies met in 1035 at a medical conference in London and this was a very important conference because there was a presentation there that may or may not have to have had an effect on the development of psycho surgery. One of the presenters at the conference was a a researcher from Yale named Carlyle Jacobson and he presented his research on to chimps that he had been experimenting on at Yale who had had large portions of their frontal lobes removed and that Jacobson was interested in the changes in behavior how these chimps reacted differently to solving problems dealing with aggravation and frustration. Once they had their frontal lobes removed and there was no clear cut answer that Jacobson could could supply one of the chimps grew more frustrated after the removal of that part of her brain and the other grew less. But.

But there are some accounts that maintain that moonies listen to Jacobson's presentation and they are at that moment got the idea for doing something similar on human beings to treat them for their psychiatric problems. Money is denied this. His whole career he said that he had come up with the idea for looks to me long before arriving in London several years beforehand. But but at any rate Freeman and Monique and monies were both at this conference and in fact we were both exhibiting in the exhibitors hall next to each other and and got to know each other and once Freeman once monies began doing his the economies in Lisbon. The two began corresponding and it became as I said close friend Freeman had a part in getting money its first publication in the United States and Freeman was a big supporter of monies getting the Nobel Prize.

Later on in the late 1940s I think I actually did did not ask Freeman if he Freeman would nominate him for the prize. Yes he did it for the money and had been nominated before that not for his work with me but he was the developer of a procedure called cerebral angiography which allowed doctors to to get a look inside the brain. I'm using various dyes in and cerebral fluid. And so money had been nominated before but that had been some time before and with some embarrassment money did write Freeman letters asking him to suggest him to the Nobel Committee and Freeman happily did it and Freeman was hoping that he could ride on Money's his coattails in fact and perhaps get a prize at the same time. After being at St. Elizabeth's for him and went into academic research he went to

George Washington University and there he met a neurosurgeon named James Watts who became a professional partner for Freeman. Perhaps you might talk a little bit about watts and his contribution to the work. They were opposites in many ways as a as I guess a lot of good partners are sometimes. Why was this very soft spoken quiet serious surgeon who who had studied it at Yale and studied in Germany and had a very high professional standing even though he was he was somewhat younger than Freeman Freeman on the other hand was. This was the boisterous in-your-face kind of guy who was a showman who loved when he was teaching at George Washington University love to amaze his students by doing things like using both hands to write on the chalkboard each hand writing something completely different at the same time and doing very

graphic demonstration for his students comparing his hairy leg with the hairy leg of a female patient who had a glandular problem that made her very hairy things like that and it and the way they worked together initially was that Freeman was the brain anatomy expert and one was the surgeon for the Freeman had no credentials at all and no training at all as a surgeon. And so when they did their early operations in 1036. For the most part what did the cutting and Freeman did the guiding. But after a while Freeman began to do more of the cutting and it became more of an even partnership as far as the surgery part of it went in til later on. Freeman began to feel that he was qualified and capable of working solo as a brain surgeon and he and he ended up working that way on many hundreds of patients.

The initially what they were doing was they were they were doing the surgery by opening the skull of the individual which was complicated which required obviously required sterile conditions you had to have a modern operating room. It was not something that everybody could do. It was extremely expensive. And Freeman had this feeling that if the procedure could somehow be simplified there that that would be a way then that more people and in his in his mind more people could benefit. From it and that is how he ended up developing the trans orbital bottom ie the one that you've been just now describing it sort of makes my head hurt and probably I imagine anybody has the same reaction it's sounds like a grit to say the least a really grizzly thing I can't I can't really even imagine watching somebody do it. But of course a lot of people did watch him do it.

A lot of good people didn't watch it but a lot of people who watched it even seasoned physicians fainted when they watched it it was a terrible procedure to behold. But what Freeman had in mind when he developed the transorbital lobotomy was the was that those masses of patients in the St.. Thank you Patrick Hospital. And even though these places were called hospitals of course they didn't have operating rooms that couldn't accommodate the earlier procedure the pre-frontal lobotomy procedure that Freeman and Watts worked on together. And so that so that that's what prompted pre Freeman Freeman to start tinkering with other ways to access the brain besides burning cutting burn holes in the sides of the skull. And he found that there was a much simpler approach and that was through the eye or a bit of the skull. And so what transorbital lobotomy is involved. If if you're on your list that will bear with me it is grisly but he had a sharp

instrument that he called a look at Tom which I have one of his look at Holmes It really looks like a stiletto. And he he placed the tip of that instrument beneath the eyelid of the patient the patient was was unconscious. Having been made so by electric shock and so it placed the tip of the Lucasfilm beneath the eyelid and then above the eyelid above the eye the eyeball itself was not harmed in any way. But then he would press the instrument all the way back in till it hit the back in the upper roof of the pit which is a very thin part of the skull and then with a few taps of the hammer Freeman could breach that bone and access the parts of the brain that he was interested in. But Freeman saw this as really an outpatient procedure. The patient was was unconscious but only briefly. Five to 10 minutes from the electric shock machine and once the patient awoke the patient would have. Terrible black eye and probably a

terrible headache but could often walk away with assistance from the table and to go back to their ward in the hospital if that's where they were or if they were not a hospital patient could go home the same day and that did happen. And Freeman saw this is a way to bring the bottom into the masses is a portable method of Labatt a me so to speak. And by far the 30 400. The bottom line is that he performed in his career by far the majority were the kind of the bottom of the transorbital procedure which he did in hospitals all around the country about 25 different states. How did James Watts feel about this. What objected to the procedure but not for the reasons that a lot of people may think want to believe that a brain operation of any brain operation should be the province of a of a neurosurgeon and should be done in a general hospital. Under the

conditions that he and Freeman had done their previous Labatt meets with an anesthesiologist present with sterile draping and all the sterile conditions and all of that. Freeman I believe that all of these things were hindrances obstacles things that would keep the bottom E's away from the people who needed it most. And so walk himself did performed transorbital lobotomy is not a lock. I think fewer than 50 but he did them. He did them in hospital and he didn't he did not support Freeman going around doing these in thank Antrix hospitals not wearing gloves not using sterile draping. Not using the electro shock as a form of anesthesia all of that was subjected to and it contributed to the break up of their partnership which happened in the late 1940s. We are a little bit past the midpoint of this part of focus 580 I guess I would like to introduce once again our guest Jack high. He is the author of the

biography that we're talking about here the biography. Dr. Walter Freeman the title of the book is the bottom ist and it's published by Wiley Jack al-Haj is currently the executive vice president of the American Society of journalists and authors and he has been for a long time been a writer freelance writer of books essays and articles. He's contributed to various publications including The Atlantic Monthly American heritage Washington Post Magazine. He's also received a number of honors and awards for his work among them the June Roth Memorial Award for medical journalism. He's joining us this morning by telephone and as we continue to talk of course questions are welcome. 3 3 3 9 4 5 5. We do also have a toll free line go to anywhere that you can hear us. And that is 800 to 2 2 9 4 5 5. Lot of people over this period that we're we're talking about say from the mid 30s to the mid 70s did the surgeries. Certainly Freeman was not the he did many but only a small number of those that were done. And as you point out in the

book some of the leading names in neuroscience did them and also many of them were done in V.A. hospitals. Right. How does anyone have a number of do you have a number to put on how many people have had lobotomies in the United States and their number was somewhere between 40000 and 50000 worldwide it was closer to 100000 there were a lot of the bottom is done in other countries especially in Scandinavia in the U.K. in Japan and elsewhere so you can see from those numbers that total about thirty five hundred is a very thin piece of the pie. But his influence is much greater than those numbers might suggest because he really was the internationally known advocate for the procedure he did demonstrations in other countries. He did transorbital lobotomy in France and in Germany and and elsewhere and he corresponded with with

other psycho surgeons around the world he organized a psycho surgery. Conference or symposium in Portugal in 1988 and so he was really at the center of things. But he found after the 1950s when his base of support fell out from under him and in the bottom he was no longer a mainstream procedure. He found himself very much alone aside from a small number a handful of supporters and that was a very lonely position for him to be in. What even at the time when the bottom he was considered to be a mainstream procedure it was controversial and there were people who argued against it. Can you talk a little bit and give us a sense of what kind of debate went on within the medical community. Unity about whether or not this was a good procedure an appropriate procedure should be done. A lot of that debate came out of the conflicts between

psychiatry's who had a psychoanalytic orientation and those who had a biological orientation like Freeman. And so the psychoanalyst and at that time psychoanalysis was mainly performed by psychiatrists and and talk therapies were not done as they are today by psychologists and licensed social workers and others that the psychoanalytic Lee oriented psychiatrists very much objected to the idea of operating on healthy brain tissue because even Freeman didn't didn't maintain that there was anything wrong with the tissue that he was cutting operating on that healthy tissue in an attempt to treat the psyche what they regarded as a problem of the psyche which to them was absurd that an operation could accomplish anything. Freeman always had a ready response to their criticisms which was show me how psychoanalysis can accomplish something better especially with a

severely psychotic patient. And at that time there wasn't an answer to that to that response. And then another direction that it that the criticisms against Labatt of me came from were from neurosurgeons who believed as Watts did that that this was their area. This is their territory. Freeman wanted to train wanted to train psychiatry's to perform transorbital lobotomy in the state hospital setting and they did not like this at all they didn't like the idea of anybody. Physicians are not who had no surgical training meddling with with cutting devices inside the brain. We have a caller here would welcome others 3 3 3 9 4 5 5 year in Champaign-Urbana toll free 800 to 2 2 9 4 5. Color is in white teeth. It's on one number one. Well no.

Well I don't think the most he has talked about the real reason that people objected to Nevada me and now as I recall it it wasn't because of a debate between the biologist and the psychoanalyst or what have you was because some people are a lot of people seem to get turned into semi vegetables as a result of this operation. And yet others didn't. Could he talk about the way various patients reacted and how how they reacted to the what was the outcome from this operation for. And what is the range and we know it's kind of confused about it when I read about it. Thanks. Well excellent question. It is a good question. Well as Vic is the caller suggested there was a range to these outcomes and that that was because there were variations in brain anatomy. Freeman was operating blind. He could not see what he was doing and so he was using landmarks in the skull and landmarks in the brain to orient himself and to and to try and determine from those where to do his cutting. So there were patients who emerge from their lobotomies as

I suppose you could call them semi vegetable. There are certainly worse off than they had been before their operation. But before I began my research I had the impression that the majority of the bottom ie patients came out as barely barely aware drooling. People who could not do much of anything. And I think that was the outcome in only a very small number of cases more commonly what happened was the patient came out with a what they called what Freeman and Watts called a distant emotional aspect of it but they were they could not express themselves emotionally and after all that was the purpose of the operation to to silence some of the emotional signals from the foulness and it certainly worked in that sense. There were patients who did not experience extreme happiness or extreme

sadness that they were just following kind of a groove down the middle and even more of a problem they emerged very childlike in the infant tile. Sometimes they had to be re taught how to behave how to walk how to use the toilet how to do all kinds of things and their behavior was inappropriate often the straight laced patients may come out of the operation with an urge to tell dirty jokes. They so there were a lot of outcomes like that in addition to incontinence and seizures and all kinds of problems like this. So there were objections based on those outcomes. Freeman by his estimation about a third of his patients were better off after their lobotomy is about a third were neither worse nor better often than the other third were worse off including a small number who died directly or as a result of their lobotomy. And there were and much to my surprise when I went through Freeman's papers at George Washington University I

found letters and Christmas cards from patients who believe they owed their lives to Him who had returned to their families after their Labatt amazement had returned to their jobs as teachers or in some cases physicians or musicians and certainly believe themselves better off they were in nobody's opinion were they the same people that they had been before their operation. But they were able to get along they had traded the symptoms of frontal lobe damage for the symptoms of their mental illnesses. And in some cases they believe that those symptoms were were easier to manage and easier to get by. So Freeman had did have a group of patients that he could point to as a success who they themselves would say that they were better off. At the same but that's offset against perhaps two thirds of the number of people that he did the procedure on who either were no better off or fur or worse off that doesn't. That said to me that doesn't sound like a very good record right a 33 percent success

rate doesn't sound like a very good record but Freeman compared that 33 percent to zero percent or 2 percent who he believed would get better without any treatment and so he you know he was on a salvage mission and that's what he called it. Sometimes he was trying to salvage the talent and potential that he believed could be salvaged through this operation. And you know a lot of people have assumed that that my book the low bottom as you know is a an apology for Freeman's career or for a way to excuse his outcomes or his methods. And that's not the case at all I think anyone who reads my book will get a very generous sampling of everything that Freeman did wrong and what his faults were. But I very much did want to understand him and to find out what his motivations were and what kind of man he was so that I think really is the main job of the biographer and that's what I was after.

Let's talk with another caller. Someone listening this morning and f ing him this is lie number one. Hello. Yes the case I'm most familiar with is the case of Francis farmer the how Hollywood star. One question I have is did Freeman have anything to do with that case and my my other comment is it seemed like she was in a lot of torment before she had the lobotomy operation. But then the way the way I read about it in the way it was portrayed in the movie is that the bottoming operation was portrayed as a kind of a fascist method of controlling the free spirit and that afterwards she was a very flat personality. So what would be your commentary on Frances Farmer. I was of very interested in Frances farmers case because it sounds like you have seen the movie Frances and yes that that film has a scene in it a very disturbing graphic scene in which a doctor who looks

exactly like Walter Freeman. Give Frances Farmer a transorbital lobotomy and in fact spout the dialogue that directly from Freeman's textbooks on the bottom E. And so I did a I did a lot of looking into what Freeman's relationship with Francis farmer was and I concluded for certain that Freeman had nothing to do with Francis farmer there's no record of her in in his papers and I think there would have been if she had been his patient because although Francis farmer didn't come out of her hospitalization a changed and probably still it and ruined person. She did have a career afterwards she hosted a television show and in Indianapolis and did act in the movies afterwards and I think Freeman would have claimed her as a success had she been his patient but but even more importantly I came to the conclusion that Freeman didn't know that Francis farmer didn't

have a lobotomy at all. I have found some. The papers are written by the doctors at her hospital Western State Hospital in Washington state in which they they gave case histories a complete list of patients. Up through the early 1950s that had received the bottom means they were of course patients aren't named but they are described by age and sex and diagnosis and when they were released from the hospital and none of those patients matches Frances Farmer. And in addition a farmer's sister to her dying day maintains that the family had prevented Frances Farmer from having a lobotomy. Fred farmer never said that she had a lobotomy as well and you know it all goes back to a book called shadow land a written record of the. Yeah ran around 1900 by a writer named William Arnold he was the first person to mean to to put it out there that Francis farmer

had a lobotomy but he later admitted that he had fictionalized aspects of that book and and I believe the fiction lines that part of it. You know in the movie The one comment that the doctor made that really kind of angered me was I was full of anger the psychoanalyst at the time to read the piece. Trans orbital whatever you call it as it gets I'm going to get from out of here and get some great. I think he says gets them home or says something like that which which is something that Freeman often said was kind of a swashbuckling type of statement to me you know arrogant but I suppose at the time they were all mired in fact no analytic approaches and they didn't they weren't having much success you know full well Freeman Freeman was arrogant he was a cowboy and he was impervious to criticism he did not listen to others and he wasn't interested in listening. I mean getting in he

did volatility parallel to our current president. I'm not going there but I think you're right I think oh well you know there is as the caller points out there is this sort of association at least in. An urban legend with Francis farmer. There was someone who was a sort of celebrated individual in a sense or a famous case that he did operate on and that was Rosemary Kennedy John Kennedy's sister right. Yes she was JFK the oldest sister. And there's there's no question that Walter Freeman and James Watt performed in the bottom E on her and it was a terrible outcome because before her lobotomy Rosemary Kennedy wished she was different from the other Kennedys. She may have suffered from some severe learning disability or maybe some some brain damage that came out of birth trauma in the family Kennedy family

has long maintained that Rosemary Kennedy was mentally retarded I don't believe that was the case. But. There's no question that after her lobotomy she was a very severely handicapped person and was then unable to live her life with anything remotely approaching independence and in fact had to be cared for full time and am in a convent home in Wisconsin for a half century so that Rosemary Kennedy's story I do go into in in my book how it happened. It's a terrible preamble and outcome. It's a terrible story all around. We have about 10 minutes left in this part of focus 580 And again our guest is Jack. He's author of the book The Labatt a must It's published by Wiley and it's a biography of Dr. Walter Freeman Freeman a man who is known for having refined the procedure known as the bottom and perhaps and was at one time

arguably maybe the best known the leading proponent of the procedure. Did them many of them for a long time. If you're interested in reading more you can look for the book also questions here welcome 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5. We talk a little bit about the fact that at at one time that this was considered to be a mainstream procedure and a lot of well-known people knew or scientists were doing them. What happened was eventually perhaps this was by about the mid 1950s the procedures started to decline and declined I guess pretty rapidly as more and more psychoactive medications came along that made possible to treat more effectively to treat mental illness and the first one was Thorazine that was introduced in 1954 and then others followed other better ones followed. But Freeman himself just would not let go of the bottom E and continued to do them and I

think you said he did his last one in the seventies 1967 67. So he believed so so much in this procedure that long after probably he should have stopped after any. He should've stopped and I think that the bottom has continued to be done into the 70s. How do you account for that. How do you account for his in ability to realize that what at one point might have seemed promising was considered to be a mainstream sort of procedure was no longer. Why wouldn't he give it up. Well if there is a a surface reason I think a surface answer to that question and a deeper answer to that question the surface answer is that Freeman believed or said he believed that the that the pharmaceutical treatments and coming out were worth fats that they wouldn't last that they would be shown not to be effective in the long term or would be

shown to have so many debilitating side effects on patients that that they would be discontinued and there's a lot of irony now looking back and hearing Freeman say that say this because of course the main criticism criticisms against the bottom itself was that it was a fad and that it had terrible permanent side effects on that on many of the patients who had it. But I but going a little deeper I think by by the 1000 50s Freeman had it. It sunk his whole career. He had placed his entire life really behind Labatt of me and he did. He couldn't give it up. I think no matter what happened by that point he couldn't give it up to the extent that in 1954 Freeman left very comfortable a teaching position he had a George Washington University and went out to California and

into started really in a new medical life there in private practice as a neurologist in psychiatry. And he was feeling as an academic as if a teacher in a medical school that he wasn't getting enough respect and that his field wasn't getting enough respect. And so his allegiance his main allegiance was to the to the bottom E. And so he left so that he could continue doing that in and of what he thought would be a better environment. And another very interesting thing about Freeman's life is that he spent much of his last 10 years going around the country following up on his lobotomy patients finding out what happened to them how they were doing. And I don't think there is another physician of the 20th century or maybe of any times who so extensively followed up on the faith of his patients. I mean you could assume from that that you know he had a general interest or genuine interest and

curiosity and how his patience turned out but I think there's something more to it and I think that it's that he was trying to justify his work to others and to himself every time he saw the bottom the patient who was getting along at home. That made him feel better and made him believe that he had done the right thing. So this is a very complicated man who who did things for reasons that were not always logical. You know one of the things I found myself wondering going back in the story to the point where he became interested in psycho surgery as a way of treating mental illness. How much of that was on the one hand his motivated by his desire his genuine desire to help people and on the other is genuine desire to make a name for himself. Well he was it was a mix. It was both. And I don't think he was aware of the extent to which his ego was playing into all of this.

But. But I do believe that when he came upon money as his work and got the idea to do the bottom means unself he was thinking at some level of his thinking. One thing that was going on was this is how I can make my mark. This is what my career can be built on and of course that is the consideration that doctors should not should not weigh very heavily when they're making decisions on treating patients. But doctors are people flawed people and they do it. Well there we must leave it with our thanks to our guest Jack Al-Haj the book is the low bottom of a maverick medical genius and his tragic quest to rid the world of mental illness published by Wiley it's in the bookstore Now if you want to read it. And thanks very much for talking with us. Thank you David I enjoyed it.