Walter Jackson Freeman II By: Cody Kriewald

Significance to Psychology Freeman was an american neurologist who is regarded as the single most important cause of lobotomies becoming so popular from the late 1930s to the mid 1960s.

Early Life and Background Born on November 14th, 1895 Raised in Philadelphia, Pennsylvania Family was a wealthy one with a history of medical practitioners in its ancestry Grandfather was William Williams Keen, Jr.

William Williams Keen, Jr. Civil war surgeon Worked with several presidents Including secretive work Credited as first american brain surgeon Keen was a famous surgeon of the Civil War, he worked with several presidents (including secretly removing Grover Cleveland’s jaw tumor), and is credited as the first american brain surgeon. He developed several brain surgery techniques, including the first successful removal of a brain tumor.

Biography (cont.) Attended Yale College from 1912 to 1916 Continued at Perelman School of Medicine at the University of Pennsylvania Studied the works of William Spiller during his work there Freeman attended Yale College (not “University,” as it wasn’t one yet) from 1912 to 1916. After finishing his undergraduate education there, Freeman continued on to the Perelman School of Medicine at the University of Pennsylvania. He studied the work of another aspired neurobiologist William Spiller while he attended Perelman.

William Spiller Credited by many psychologists as the father of neurology Freeman tried to get hired working with him, but failed Not to be confused with British man whose remains were used as a TV stand, Spiller had begun formal scientific study of the brain and its workings. Freeman idolized this work, but when he finished his graduate education and attempted to find work alongside Spiller, he was rejected.

Biography (cont.) Moved to Washington D.C. in 1924 Began work at St. Elizabeth’s hospital Saw suffering of those with mental ailments Inspired to continue work in neurology Finished his PhD in neuropathology Hired at George Washington University Only preceded his “entrepreneurship” Shortly after failing to obtain work with his idol (1924), Freeman moved to Washington D.C. and began work as a neurologist at St. Elizabeth’s Hospital. Seeing the suffering of the patients with psychological ailments, he continued his work in neurology. After earning his PhD in neuropathology, he began work as the head of the neurology department of George Washington University. This, however, was simply a stepping stone for his involvement in one of the most grisly trends to strike America in the 20th century.

Psychosurgery: Origins Less focus on curing physical ailments as on correcting behavioral abnormalities Credited to Gottlieb Burckhardt Far different from his grandfather’s removal of abnormalities such as brain tumors, the oldest form of psychosurgery sought to cure behavioral dysfunction through physical intervention. The person most commonly credited with the first formal work with psychosurgery was the Swiss psychiatrist Gottlieb Burckhardt.

Burckhardt’s Work First performed between 1880 and 1890 Worked on same principle of lobotomy Removed parts of patients’ brains to alleviate symptoms of mania, dementia, or paranoia Between the early 1880s and 1890s, he performed what could be called a precursor to lobotomy by removing parts of the frontal, temporal, and parietal lobes of six patients who all suffered from irreconcilable symptoms of mania, dementia, paranoid delusion, auditory hallucinations, and psychosomatic symptoms.

Burckhardt (cont.) Spectacular failure One patient died within 5 days and another committed suicide Two were unchanged, and the last two became quieter Psychosurgery largely taboo for the following couple of decades His first attempts proved less-than-encouraging. One of the patients died within 5 days of the surgery after suffering from epileptic seizures; another recovered, but then committed suicide shortly after; two more exhibited no change from the surgery, which indicated a completely failed procedure; and the last two displayed some of the negative symptoms associated with lobotomy (aphasia, motor weakness, and general lethargy). While some would argue that the negative symptoms exhibited by the last few were a partial success, these results simply equated to them essentially becoming vegetative. Because of these results, practice of psychosurgery was largely taboo for the following couple of decades.

Egas Moniz True inspiration for Freeman’s lobotomies Labeled his surgery the “leucotomy” Took cores from patients’ frontal lobes Some blame him for the development of lobotomy While Burckhardt’s experiment might have been the closest to the first formal psychosurgery operation, he was an inexperienced surgeon. Egas Moniz, on the other hand, was both an accomplished Portuguese neurologist and physician. Additionally, he commanded more experienced surgeons under his guidance so that he didn’t have any hand in the actual operation himself. His operation, which he titled “leucotomy,” involved taking cores of patients’ frontal lobes - a slightly less destructive version of a lobotomy. While some condemn him as the developer of a barbaric operation, others caution that he was searching desperately for a cure which nobody else was able to produce at the time - a topic which will come up again at the end of this presentation.

Lobotomies Begin Changed procedure to separate frontal lobes from thalamus Employed James Watts as partner First lobotomy one year after leucotomy Within the next two month, worked 20 more cases With Moniz as his guide, Freeman developed his own procedure - the lobotomy. His procedure, instead of simply taking material from the frontal lobes, sought to sever the connection between the frontal lobes and the thalamus. Because he was unlicensed to perform the surgery himself, though, he employed the help of neurosurgeon James Watts. Exactly one year after the first leucotomy, on September 14th, 1936, Freeman directed Watts in performing the first ever lobotomy on Alice Hood Hammatt, a Topeka, Kansas housewife. Within the next two months, they had opened cases for 20 more patients, and over 200 within the next 6 years. (Picture features traditional prefrontal lobotomy, performed through a hole in the top of the skull)

Transorbital Lobotomy Pick is tapped through eye socket and moved back and forth Separates the prefrontal cortex and the frontal lobes Anesthesia provided by electroconvulsive shock In about 1946, Freeman became aware of an Italian doctor who was performing lobotomy through the eye socket instead of from the top of the head down. He quickly developed the transorbital lobotomy from this context, which led to the development of the infamous “icepick lobotomy.” It is named so because Freeman originally used an icepick from his own freezer to perform the operation. Eventually, he developed a tool to replace the icepick, but what he switched to was essentially different only in name, not function. Once he got it through the thin bone at the back of the eye socket (which is what made this procedure so appealing), he simply swished the pick back and forth in order to destroy some of the connections within the prefrontal cortex. Anesthesia was provided by an epileptic seizure induced by electroconvulsive shock similar to the ECT that is occasionally used for the treatment of extreme bouts of depression.

Lobotomy Becomes a Fad No longer required a surgeon Performable outside of operating room Watts leaves due to overuse With the advent of transorbital lobotomy, neither a surgeon or an operating room is required to perform it (although how it is still not considered a procedure requiring a medical license is beyond me). With this, Freeman begins performing it extensively, basically handing it out as if it’s candy. This leads to Watts leaving, as he found this drastic overuse of the procedure to be inhumane and unnecessary. Unfortunately, this didn’t stop Freeman in the slightest, as before mentioned, he no longer required the aid of a surgeon. (Watts, pictured right - because I hadn’t put him in yet)

Popularity Spreads Almost solely spread because of Freeman Drove around in his “lobotomobile” Within his 40 years of “entrepreneurship,” he performed nearly 3,500 Out on his own, he drove through 23 states over the next 40 years of his life in his “lobotomobile,” lobotomizing everybody from 4-year-olds to JFK’s sister, Rosemary. He didn’t have a surgical license or any formal surgical training, but he only charged $25 per lobotomy and believed it could be the cure for things so simple as teenage hormonal disturbances. He even encouraged other medical practitioners that he met with along the way to use the procedure in a similar way to his, further popularizing lobotomy. Within his 40 years performing the operations, he treated nearly 3500 patients (2500 of which were icepick procedure).

One Personal Account Howard Dully received a lobotomy at age 12 Given on the direction of his stepmother Wrote his account “My Lobotomy” Howard Dully was given a lobotomy at the age of 12 because his stepmother found him to be “unbelievably defiant,” which Freeman responded to with what you’d expect - give that boy a lobotomy! He took decades to recover from the surgery, and became alcoholic, incarcerated, and at times homeless during the recovery process. His recollection of the experience was summarized in his book “My Lobotomy,” which described the horrors associated with such an oversimplified procedure.

All Things Come to an End Last lobotomy performed on Helen Mortensen Her 3rd lobotomy, as she was a long-term patient She died on the operating table Freeman was finally banned from performing surgery when Helen Mortensen, a long term patient of his, died on the operating table (as had about 100 other of his patients). He was already a decade and a half retired from his position at George Washington University, so he simply retired to his loss. He died 5 years later in 1972.

To Counter the Controversy Jack El-Hai tries to show a more civilized side Works to portray Freeman similarly to some of Moniz’s more moderate critics He was only trying to help people since no other treatment existed at the time https://www.youtube.com/watch?v=_0aNILW6ILk Jack El-Hai, in his book “The Lobotomist,” catches readers off guard. He chooses to portray Freeman, instead of as a narcissistic madman, as someone who legitimately cared about his patients. El-Hai argues that Freeman simply got too caught up in the idea that he had found a physical panacea - that lobotomy was the key to curing all mental ailments. What you choose to believe is up to you, though.

Discussion Questions Do you think Freeman had his patients’ best interests in mind, or was he simply a great salesman? Keep his showmanship in mind. Can you think of any benefits that may have come from this mistake? Is this really such a special failure? What about the popularity of trepanation in the past?

Sources Dully, H., & Fleming, C. (2007). My Lobotomy: A Memoir. New York: Crown. Hai, J. (2005). The lobotomist: A maverick medical genius and his tragic quest to rid the world of mental illness. Hoboken, N.J.: J. Wiley. http://drs.library.yale.edu/fedora/get/mssa:ru.0657/PDF http://www.npr.org/templates/story/story.php?storyId=5014576&ps=rs http://listverse.com/2009/06/24/top-10-fascinating-and-notable-lobotomies/ http://projects.wsj.com/lobotomyfiles/?ch=two