Patient H.M. (38 page)

So he didn't need to invite that reporter to his office. But he wanted to. He had some things to get off his chest. Psychosurgery, he knew, had been getting a bad rap in the media.

Now, my grandfather told the
Courant
reporter, he wanted to “show the other side.”

He began by conceding that Thorazine and other new antipsychotic medications had eliminated the need for lobotomies in some cases, and he'd also come to see that there were a variety of mental conditions beyond the reach of psychosurgery. For example, he thought it was useless to operate on “psychopaths genetically or constitutionally born without a sense of moral obligation to society, and totally lacking in feelings of guilt or sympathy toward their fellow creatures.” He also hesitated to operate on “spoilt children” and “social rebels.” Regarding these latter types, he said, “they never warrant psychosurgery because they are not mentally ill but rather are reacting against an unfortunate environment.”

Nevertheless he believed there was still an important place for the procedure in the medical armamentarium. “I am more impressed with psychosurgery every year,” he said. “I wonder why more people don't have it done.” He told the reporter that he performed about eight lobotomies a year and that his preferred method remained the orbital undercutting procedure he'd developed decades earlier. Three months prior to the interview, a woman died of a cerebral hemorrhage while he was performing one, but he boasted that this was the only lobotomy-related fatality he'd ever caused. In general, he believed the procedure to be safe and almost harmless, though he conceded that it did somewhat blunt a person's faculties and ambitions. Patients of his might go on to become anything they chose, “even a brain surgeon,” though my grandfather considered it doubtful that these hypothetical lobotomized neurosurgeons could ever become leaders in their field.

Then he trotted out one of his patients, a woman named Mary, for the reporter to meet. She was forty-nine years old, and the reporter described her as “plumpish, grey-haired,” and “bubbly.” She'd spent most of her career working as a secretary. A few years prior, she began to get extremely anxious. “I used to get panicky with worry over the simplest things, over everything,” she said. She described a panic attack triggered by seeing an open window in a nearby apartment: “Knowing a child lived in that apartment, I'd get sick with worry that he'd fall out.” Eventually, her husband sent her to the Institute of Living, where she was institutionalized for ten months. While there, she received intensive psychoanalytic therapy as well as electroshock therapy, among other treatments.

“The psychiatrists gave me hope and helped somewhat,” Mary said, “but it just wasn't enough.”

Institute staff told Mary's husband that a lobotomy was her best option. Her husband, incidentally, was present during the meeting with the
Courant
reporter, and one of the resulting articles described how Mary “furrowed her brow in concentration while being questioned and at times asked her husband for help in answering.”

Three years had passed since Mary's lobotomy.

“My old feelings gradually left me,” Mary said, “and now I feel very happy—all the time.” She mentioned that she'd been able to resume her job as a secretary for a while, “but now I have a longing to stay home, so I quit.” All in all, Mary gave her lobotomy, and my grandfather, a glowing review. “The operation made me realize how wonderful life is,” she said. “Dr. Scoville is the best doctor in the world!”

It is unclear how much of what my grandfather said during this interview can be taken at face value. Certain of the things he said were not true. For example, at one point he said that he'd performed exactly twenty lobotomies in the operating room at the Institute of Living. This is incorrect: I have access to records documenting at least forty-six, and those records are likely incomplete. Whether his untruths were the result of deceit or carelessness is impossible to say.

Maybe some rearview blurriness is just the inevitable by-product of a life of great drive, one spent always moving forward at great speed, rarely pausing to reflect on where you've been. Maybe that, too, explains why the reporter described my grandfather as being “contemptuous” of slower psychoanalytic approaches to the treatment of mental illness. “No man is worth that much of another man's time,” my grandfather told him. “I like fast results.”

The following year, on March 6, 1973, Senator Ted Kennedy presided over a subcommittee hearing meant to explore the current state of psychosurgery in America.

Kennedy called the meeting to order with a brief overview of the issues at hand: “The nature and functioning of the human mind has fascinated scientists for centuries,” he said. “In recent years they have begun to understand that this is the basis of behavior and have developed tools and techniques to modify and control it. There are those who say the new behavioral research will enable us to realize our full potential as a nation and as a people. There are others who believe that the new technology is a threat to our most cherished freedoms….Few areas of biomedical research have been as controversial as the behavioral research we are to hear about today. Some federal scientists recently circulated a petition urging the National Institutes of Health and the National Institute of Mental Health to refuse to sponsor research into psychosurgery. It is our hope that today's hearing will air both sides of the controversy and help us as a society come to understand and master this new technology so as not to become the victims of it.”

Over the course of the afternoon, several witnesses testified before the subcommittee, and most had views about psychosurgery ranging from neutral to positive. When Kennedy asked the director of the National Institute of Mental Health whether psychosurgery was an effective therapy, the director responded like this:

“Do I think it is a valid technique for behavioral disorders? My answer is a crisp ‘maybe.' ”

And when a neurosurgeon from the University of Mississippi was called to testify, he began with a series of five lobotomy success stories, such as one about a twenty-four-year-old man who “had attacks of nervousness and aggression since childhood….Psychosurgery was performed twelve years ago. He no longer has outbursts of aggression, is happily married, and supervises five other workers at his place of employment.”

Others stressed that the psychosurgery of the 1970s was very different from the psychosurgery practiced decades prior, that the modern procedures were much less damaging, much more precise, and could hardly be called lobotomies at all.

Then Peter Breggin took the stand. Breggin was a Washington, D.C.–based psychiatrist who had published a number of books and articles critical of psychosurgery. After Kennedy introduced him, Breggin said, “The psychosurgeons represent the greatest future threat we are going to face for our traditional American values, as promoted in the Declaration of the Independence and the Bill of Rights. This totalitarianism asks for social control of the individual, at the expense of life, liberty, and the pursuit of happiness. It undermines Jefferson's self-evident truths. These men, I believe, are doing nothing more than giving us a new form of totalitarianism….It creates for themselves an elitist power over human mind and spirit. If America ever falls to totalitarianism, the dictator will be a behavioral scientist and the secret police will be armed with lobotomy and psychosurgery.”

After Breggin finished his opening statement, Kennedy began questioning him.

Kennedy: Do you think all psychosurgery ought to be made illegal?

Breggin: Yes. It is not, in my opinion, a medical procedure any more than the mutilation of an arm as punishment of a crime is a medical procedure. The mere fact that a physician performs the mutilation does not make it a medical procedure. That was established at Nuremberg.

Kennedy: It is your position that the government ought to prohibit psychosurgery?

Breggin: Yes. Very definitely yes. I think it falls into the class of atrocities, as defined in Nuremberg. Let me get to the specifics on what is going on at the present time, in regard to lobotomy and psychosurgery….William Scoville, president of the Association of Psychosurgery, is a lobotomist. Do not believe what you have been told today, Senator, about the demise of the lobotomy. There is a great deal of lobotomy going on in this country right now.

Earlier, in a written report submitted to Congress, Breggin had described my grandfather as having “replaced the deceased Walter Freeman as the nation's spokesman for lobotomy and psychosurgery.” Now, on the Senate floor, Breggin painted a bleak picture of the procedures my grandfather was a spokesman for, describing a “permanently mutilating operation” that destroyed “spiritual and emotional responsiveness.” Breggin highlighted Hartford, and Hartford Hospital, as important centers for psychosurgery, though he warned that nearly every city in the country had at least one active lobotomist. After Breggin spoke for several minutes, Kennedy appeared to grow impatient.

Kennedy: Doctor, did you ever think that they might be right and you might be wrong?

Breggin: Senator, all I can do…

Kennedy: I am sure you are familiar with other examples from medical history: Dr. [Ignaz] Semmelweis saw childbirth defects caused by bacteria transmitted by surgeons; and he was ostracized, and he turned out to be right. Dr. Morton was ostracized because of his beliefs about ether. He was right. Copernicus thought the earth was not the center of the universe. And he was given a very hard time. Now, why do you think you're right, and they are wrong?

Breggin floundered, thrown off-balance by Kennedy's barbed questions. He told Kennedy that he considered
himself
to be much more like those medical mavericks Kennedy mentioned than the lobotomists were. The lobotomists, he pointed out, were almost all high-ranking members of the medical establishment.

“The anti-psychosurgeons are the ones likely to be burned at the stake,” Breggin said, “not the psychosurgeons.”

Breggin ended his testimony then. After the hearings, Kennedy co-sponsored a bill that created a national commission intended to examine, among other topics, whether psychosurgery should be permitted to continue in the United States.

On February 25, 1984, my grandfather and his second wife, Helene, set out from their home in Farmington, Connecticut, to the birthday party of his brother-in-law in New Hope, Pennsylvania.

He was seventy-seven years old and still a practicing neurosurgeon, maybe the oldest in the country. He had no intentions of ever stopping—he'd once written that he was “not intending to retire until stricken by God or man”—despite the fact that age had caused his skills to slip. Over the previous few years, there had been a great deal of tension between him and the management at Hartford Hospital. They worried about the mistakes he might make, and their consequences. Not long before, while in the operating room, he'd been working on a patient's spine, leaning over the incision, using his custom tools to move away the layers of fat and muscle. Then he paused and glanced at one of the nurses.

“Which way is the head?” he asked. Nobody was sure whether he was joking.

The director of the neurosurgery department was now a younger neurosurgeon named James Collias, whom my grandfather had hired two decades before. The hospital put Collias in the awkward position of attempting to control the damage his mentor and former boss might do, increasing the amount of supervision he received and limiting the number and types of procedures he performed. Collias and my grandfather had a series of meetings, and then Collias sent my grandfather a letter on Hartford Hospital letterhead laying out the new rules:

1. Surgical privileges restricted to disc and carpal tunnel procedures, without exception.

2. Allowed to schedule no more than one elective operative case per day, and only during regularly scheduled surgery hours.

3. Not to start any scheduled elective surgery after 5:00 p.m.

4. Never to perform any surgery without neurosurgical house staff or attending assistance at all times.

5. To refer all stat and emergency cases (including complications of scheduled surgery) requiring night (after 5:00 p.m.), weekend (Saturday and Sunday), or holiday surgery to neurosurgical attending on call, or of choice.

6. Not allowed to schedule elective Saturday surgery.

These restrictions will be reviewed periodically by the Department Director and additions, deletions or modifications made at his discretion at any time. Any breach of the above restrictions by William B. Scoville, M.D., will result in the immediate revocation of all surgical privileges.

My grandfather submitted to all the restrictions, though eventually Collias discovered that he had secretly obtained full neurosurgical privileges at another nearby hospital to be able to continue to perform brain operations.

It's unclear whether he was still performing lobotomies in 1984. The International Society for Psychiatric Surgery had disbanded the year before, but in many ways that was because there was no longer a need for its boosterism. In 1977, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, which Kennedy had launched after his 1973 Senate hearings, completed its report. Rather than declare that psychosurgery should be banned, as Breggin and other activists had hoped, the commission instead “determined unanimously that there are circumstances under which psychosurgical procedures may be appropriately performed” and that “psychosurgery should not be prohibited.” The single most important item leading the commission to this conclusion was a federally funded investigation spearheaded by MIT, which looked at hundreds of lobotomy patients in an attempt to determine “the possible side effects of these operations.” This was the largest survey of its kind ever conducted, and it had been accelerated at the request of the commission, which received advance notice of its findings. Those findings were, to many, a shock. After taking a close look at “the neurologic and psychologic sequelae” of the lobotomy patients, the MIT researchers failed to find “any obvious ‘costs' of the intervention.”