Patient H.M. (10 page)

And so it went.

The broken illuminated the unbroken.

Among brain scientists, this approach, teasing out the functions of different areas of the brain by studying individuals who lacked those areas, became known as the lesion method, and by the middle of the twentieth century, it had become predominant. The notion that different areas of the brain corresponded to different functions was no longer controversial; it had become universally accepted dogma. Bit by bit, area by area, scientists were plotting out a functional map of the human brain.

But that map still contained immense expanses of uncharted territory.

For example, scientists might have succeeded in pinpointing a dime-size portion of the brain's superior temporal plane as necessary for the in-the-moment perception of sounds, and labeled it the primary auditory cortex, but they had no clue what part of the brain was responsible for our ability to recall and recognize a specific sound at a later date. Or, for that matter, how it could do the same for past sights or tastes or touches or smells or the multisensory stews that constitute human experience.

The brain was slowly giving up some of its secrets, its ancient functions coming to light, but memory, which more than anything else defines us, remained a dark mystery.

In the basement of the library, right before I took the elevator up to the fifth floor and stumbled on Phineas Gage, I read one of the earliest letters from my grandfather to Fuller Albright. In it he described some of his long-range goals.

“I have done no animal or experimental work since being a medical student in physiology and helping a little in the experimental surgery department,” he wrote, “but my chief hobby is mechanics, so the technical side of research appeals to me strongly.”

He wrote the letter in 1936. Within a decade, he would find a way to unite his passion for tinkering and his interest in experimental surgery.

And, in the back wards of asylums around the country, he would discover a nearly limitless source of material.

H
e drove the twenty miles from Hartford to Middletown in his new Buick convertible, top up to shield him from the approaching New England winter, following the highway alongside the Connecticut River due south and pulling off just before the river veered southeast toward the ocean. Middletown was once the largest and most prosperous city in Connecticut, a bustling port where traders made fortunes provisioning the Caribbean colonies with goods and slaves. Once the business of slavery declined, the residents found new purpose, building factories to assemble Colt firearms and Royal typewriters, and founding Wesleyan University, a liberal arts college on the west side of the city. Wesleyan was the city's most well-known institution, but on the opposite side of town was a second institution, built around the same time and almost double its size. That's where my grandfather was heading. It was November 14, 1946. He could see the redbrick and wrought-iron gate of the asylum on a hill in the distance long before he got there.

As he passed through the gate, my grandfather might have noted some similarities between Connecticut State Hospital and his wife's asylum, the Institute of Living. Both made good first impressions, and although the grounds at the asylum in Middletown weren't designed by Frederick Law Olmsted, they too were beautiful. The largest building, Shew Hall, towered at the head of a sloping circular drive and looked reminiscent, in architecture and scale, of Paris's Élysée Palace, the residence of the French president. This was the asylum's administration building, and from his office on the top floor the superintendent, Dr. Edgar C. Yerbury, could gaze west over all of Middletown, while the vast grounds of his institution sloped gently down toward the river to the east.

The Connecticut State Hospital was the largest public asylum in the world. It occupied 906 acres, 406 of which were taken up by the asylum's farm, with its piggery, chicken coops, and verdant rolling pastures full of cows. Although the patients worked the farm for free, and the profits could be considerable—the previous year more than fifty thousand dollars of asylum-sourced milk was sold to the local community—the asylum as a whole was struggling. The problem was this: There were too many inmates. Every year the asylum was tasked with feeding and sheltering and protecting—from each other and from themselves—growing numbers of mentally ill men and women, but its resources had not kept pace. This pattern had been repeated all over the country in the 1940s as state asylums filled to overflowing. The cause of this insanity epidemic was a mystery. Some argued that it had to do with all the disturbed soldiers coming home from World War II. Others believed that the lingering anxieties and uncertainties provoked by the Great Depression had finally come home to roost, or that Americans were simply less willing and able to care for their disturbed relatives at home, as was once the norm, and had become accustomed to the idea of turning them over to the state.

Regardless of the reasons, state asylums nationwide were in crisis. And while conditions had been deteriorating for years, the general public had become aware of this deterioration only recently. In May 1946,
Life
published an exposé, “Bedlam 1946,” that hit newsstands with the force of an explosion. The text of the article painted a vivid picture of inmates being fed a “starvation diet” in “hundred-year-old firetraps in wards so crowded that the floors cannot be seen between the rickety cots.” But the text was nothing compared to the photographs. A man named Jerry Cooke had spent weeks in a state asylum in Ohio and emerged with a horrific portfolio of images straight out of a Hieronymus Bosch painting. On one page, a group of naked men huddled together against a wall, some hiding their faces in shame while others gazed hollow-eyed into the lens. On another page, an old woman, also naked, sat neglected and withered on a dilapidated wooden bench. To the American public, just emerging from World War II, the photos were both shocking and shockingly familiar. State mental hospitals, the country's most popular magazine declared, had become “little more than concentration camps on the Belsen pattern.”

The article provoked not just outrage but action. Congressional hearings were held in Washington, and within two months of the magazine hitting newsstands, President Truman signed the National Mental Health Act, which provided federal funds for psychiatric research. There was broad consensus that the current conditions were untenable and that something had to be done to ameliorate them, although opinions varied widely about the best strategies for doing so. Was it a question of throwing more money at the asylums, increasing their carrying capacities? Or should more outpatient facilities be built, allowing potential patients to remain in their homes?

Or perhaps there was a simpler, quicker solution.

Perhaps there was a solution that took aim, with surgical precision, at insanity itself.

My grandfather parked his Buick in the visitors lot in front of Shew Hall, and no doubt Superintendent Yerbury came down to greet him. The day's visit was a momentous one and had been almost a half year in the making. In June, just weeks after “Bedlam 1946” was published, Connecticut's Joint Committee of State Mental Hospitals held a meeting in Hartford. The committee was an agency composed of the governing bodies of the state's three public asylums: Connecticut State Hospital, Norwich State Hospital, and Fairfield State Hospital. While the
Life
exposé had not dealt specifically with these particular asylums, the article's clear implication was that the horrors it depicted applied to state asylums nationwide, and the joint committee knew that it was in no position to rebut that view. The Connecticut state asylums, the committee would admit, were “seriously overcrowded, which, with the bad housing facilities, made it extremely difficult to render the best of service to our mentally ill patients.” Any measures that might reduce the numbers of inmates had to be examined, and it was clear that the time for action had arrived. At the meeting, Yerbury suggested that one solution might be for the three state asylums to adopt a “coordinated program of neurosurgery.” His peers agreed, and two months later, in August, representatives of all three state asylums met again to begin working out the details. That second meeting took place at the Institute of Living.

Although the Institute of Living, as a private asylum catering to the wealthy, didn't face the same problems of overcrowding as its public counterparts, the latter had always looked to the former for guidance on the implementation of novel psychiatric treatments. The Institute of Living's forward-looking superintendent, Charles Burlingame, presided over the meeting. He had already introduced the lobotomy on a limited scale at his asylum several years before, and my grandfather, as the Institute of Living's chief consulting neurosurgeon, had performed the majority of them. In fact, my grandfather and several other neurosurgeons also attended that August meeting of the Joint Committee of State Mental Hospitals and “signified their willingness to be added to the state hospitals as consultants.” A third meeting was held a month later, on September 18, 1946, and this time several researchers from Yale attended. A general way forward was agreed upon: My grandfather and the other neurosurgeons would begin operating on patients at all Connecticut asylums, public and private, at least twice a week. Asylum personnel, overseen by researchers from Yale, would meanwhile keep tabs on the patients' postoperative progress.

A vote was taken, and passed, and the Connecticut Cooperative Lobotomy Study was born. The next day, the
Hartford Courant
heralded the event, declaring that “Connecticut thus becomes the first state to undertake a scientific, controlled study and practice of the brain operation known as prefrontal lobotomy.” The article also noted that the widespread promulgation of the lobotomy in Connecticut was “expected to ease the load on mental hospitals, both operational and financial.”

And then, on that brisk November day, there at the mammoth Connecticut State Hospital with its hundreds of cows and pigs and chickens and its more than three thousand human inmates, the project was finally getting under way.

Most of the workers at the asylum referred to the operating room by its number: 2200. Because 2200 was not as well equipped as the OR at Hartford Hospital, my grandfather had brought along all the tools he needed. He also brought a crowd. A large group of the asylum's nursing and medical personnel, as well as its superintendent and administration officials, squeezed inside to watch the first lobotomy ever performed there.

The patient was a thirty-one-year-old man who had been at the asylum since he was fifteen. During his time there, he had often shown “periods of excitement and disturbed states.” He also, despite coming from a poverty-stricken family, continued to express his belief that he was in fact a nobleman. Orderlies led the man into 2200 and strapped him down to the operating table. My grandfather laid out his tools, scrubbed up, pulled on his mask, and put on his loupes, the special glasses that magnified everything he looked at. The patient received several injections of a local anesthetic in the flesh of his temples, and then the operation began. The musty smell of bone dust filled the crowded room.

The clinical director of the asylum was a psychiatrist named Dr. Benjamin Simon, and as my grandfather began to slice the nerve tracts connecting the frontal lobes with the posterior parts of the brain, Simon leaned in and began to interview the patient so everyone could hear.

“Are you feeling any pain?”

“No, Doctor.”

“What do you think of all this? What are they doing to you?”

“Well, he is doing some kind of operation on my head.”

“What do you think it will do for you?”

“I want to be able to go back and work.”

“Why can't you do that now?”

“I don't know. There is something the matter with my mind….Oh, I felt something then!”

“What did you feel? Was it a pain?”

“No, it didn't hurt. It did something to the pressure.”

“What do you mean by that?”

“It stopped the tension.”

Simon stopped the questions then and let my grandfather finish the procedure. At the end, the patient, appearing “relaxed and somewhat sleepy,” was wheeled off to a recovery room and another inmate took his place. After the second operation, my grandfather gathered his tools and returned to his Buick, and the crowd dispersed.

Like the Institute of Living's
Personews,
the Connecticut State Hospital had its own in-house newsletter that was distributed to the staff every two weeks. The one there was called
The Scribe,
and its next edition, which had a seasonally appropriate cover illustration of Christmas candles, would note “the ‘Grand Central Station' atmosphere that 2200 assumed on last Tuesday, November 14th to be exact. ‘Lobotomy' has become a sacred word all over the place, but to the people who were in the O.R. I doubt if even ‘Webster' could find a proper definition for the word. It is a pity that a talking movie was not made of the day's events. Haw!”

No movie was made, but the events that took place in 2200 that afternoon were recounted a few months later, on March 31, 1947, during the next meeting of the Joint Committee of State Mental Hospitals. Benjamin Simon gave a vivid account of the day and of his odd operating-room interview, while Superintendent Yerbury declared that the patient in question was “now on the road to recovery.” After hearing their testimony, the committee agreed that their experimental “program for study and furtherance of such neurosurgery in the state's mental hospitals” appeared to be bearing fruit and voted to continue funding the Connecticut Cooperative Lobotomy Study.

Three days after the meeting, my grandfather again loaded his surgical tools into his Buick and made what was becoming a familiar drive back to the Connecticut State Hospital. In the four months since his first visit, he'd gone back at least four times and made a similar number of visits to the two other state asylums. The lobotomy project was well under way by then, and its pace was picking up. My grandfather—always so good with his hands—was becoming increasingly skilled at performing the procedure. More fluid, more confident, faster. On that particular spring afternoon, he would end up lobotomizing three inmates in room 2200, not just two.