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The Nation | COLUMN ONE

Psyche's Torn Curtain

Now seen as misguided butchery, lobotomies were once the treatment of choice for mental illness. Doctors, patients confront a dark past.

May 18, 2004|Benedict Carey | Times Staff Writer

SANTA CRUZ — He is a big man with a sweep of white hair who lives in a small apartment by the sea, not far from the San Jose hospital where a doctor gouged his brain with a steel wand more than 40 years ago.

The doctor had recommended the operation, and Howard's parents agreed to it. They thought it was the only way to relieve their 12-year-old son's "adolescent anxiety," to subdue his anger, to set his life straight.

It didn't work out that way. Howard made far more mischief after the operation than he had before. He has struggled with anxiety, fits of anger and moodiness for much of his life. Eventually, he found a kind of peace. Today, at 55, he has a job, a wife who loves him, a sense of humor and a view of Monterey Bay from his easy chair.

Yet the operation still haunts him. He fears that discussing it publicly could jeopardize his job at a transportation company, and with it the small comforts that have taken a lifetime to find. He agreed to be interviewed only if his last name would not be published.

"It horrifies people when I tell them what happened," he said.

More than half a century after a Portuguese neurologist won the Nobel Prize for inventing the lobotomy, doctors view the procedure as little more than misguided butchery. About 50,000 Americans had the surgery between 1936 and 1960. An estimated several hundred, perhaps several thousand, are still alive.

Silenced for decades by fear or shame, a handful have begun to speak out. Their children and grandchildren are speaking out too, as they struggle to understand the operation's effects on their own upbringings.

"It's like we were all supposed to slink into the shadows, as if it never happened, as if doctors never cut into the brains of people we loved," said Christine Johnson, 34, a medical librarian in Levittown, N.Y. She is writing a book about her late grandmother, who was lobotomized in 1954. Johnson also hosts a website, www.psychosurgery.org, devoted to memorializing people who underwent the procedure.

A new film, "A Hole in One," offers a fictionalized exploration of the lobotomy era, inspired by a patient's account. A book-length treatment of the subject by poet Penelope Scambly Schott, based on a relative's experience, is due out this year.

Some psychiatrists say it is important for the profession to confront this chapter of medical history because doctors today are pursuing increasingly aggressive, brain-altering treatments, from implantable electrodes to powerful drug combinations.

"We as a profession had one generation of humility after the era of lobotomy, but it's gone," said Jeffrey Schwartz, a research psychiatrist at UCLA. "We're now back to a point where the elite of our society believe that the most sophisticated way to treat mental illness is with drugs, magnetic fields, a knife or radiation beam. It's especially important that we hear the rest of the lobotomy story from people who were there."

To fathom why lobotomy was once widely accepted, an understanding of the state of mental healthcare half a century ago is required. Overwhelmed by sheer numbers, many mental institutions in the U.S. were chaotic warehouses. Patients screamed in the hallways or lay chained to their beds. Drugs to control hallucinations or quiet imaginary voices were not widely available.

Egas Moniz, a neurologist in Lisbon, had reported in 1935 that he "cured" a paranoid patient by destroying a portion of her prefrontal cortex, behind the forehead. Independently, several leading brain researchers in the United States found that an injury to the prefrontal region subdued aggressive behaviors.

The frontal lobes help primates strategize, solve problems and manage emotions. In a lobotomy, nerve fibers leading to and from the region are severed. Typically, this flattens emotional responses and induces a kind of apathy.

The idea of purposely damaging the brain was appalling to many doctors. Yet the procedure seemed to offer hope to thousands of deeply disturbed men and women who otherwise were likely to remain institutionalized.

Some top psychiatrists and neurosurgeons began performing lobotomies in the late 1930s and found that their patients emerged calmer and easier to manage. Many were able to return home. Soon, news accounts reported that doctors had devised a "surgical cure" for mental illness. By the mid-1940s, lobotomy was viewed as the most advanced treatment psychiatry could offer for severe mental illness. In 1949, Moniz was awarded the Nobel Prize in medicine.

"In the context of that time, control of behavior became paramount, and any treatment that achieved that control was seen as therapeutic," said Joel Braslow, a UCLA psychiatrist who has written a history of the era, "Mental Ills and Bodily Cures."

"The illness was being defined by the physician, and the outcome -- whether it succeeded or failed -- was also defined by the physician. The end result was placing the illness only in people's brains, rather than in the context of their lives."

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