Neurologist Walter Freeman introduced the lobotomy to the United States in 1936, but over the next three decades, the controversial procedure left an estimated 490 of his patients dead and permanently disabled many others.
The procedure was simple.
The doctor would first administer a local anesthetic, leaving the patient conscious and alert for what was to come (if the patient didn't respond to anesthesia, doctors would use electroshock). Next, the doctor would position a sharp steel pick of seven or so inches with its point underneath the eyelid and against the bone atop the eye socket. Then, with a swing of a mallet to the butt of the pick, the doctor would drive the point through the bone, past the bridge of the nose, and into the brain.
Once the point was about two inches deep into the frontal lobe, the doctor would rotate it, severing the connective white matter between the prefrontal cortex — the executive center that makes decisions, informs personality, and makes you who you are — and the rest of the brain.
The entire procedure took the doctor less than ten minutes, and the patient would never be quite the same again.
The doctor, much of the time, was Walter Freeman and the procedure was the transorbital lobotomy.
Walter Freeman's Upbringing And Education
Walter Jackson Freeman II was an American neurologist born on Nov. 14, 1895, in Philadelphia, Pennsylvania, into a family with a strong medical background. His grandfather, William Williams Keen, was a renowned surgeon who served during the Civil War, and his father, Walter J. Freeman, was also a distinguished physician. Growing up, Freeman was naturally inclined to follow in their footsteps.
In 1912, Freeman attended Yale University, pursuing undergraduate studies and graduating in 1916. Shortly after, he went on to study neurology at the University of Pennsylvania Medical School, during which he was particularly influenced by the work of William Spiller, a pioneer in the emerging field of neurology.
Freeman was so impressed with Spiller's work, in fact, that he applied to work alongside Spiller in Philadelphia. Unfortunately, Freeman's application was rejected, but this setback didn't deter him for long.
After completing an internship at the Hospital of the University of Pennsylvania, Freeman sought to broaden his expertise even further, studying for a time in Paris and Rome. In 1924, he relocated once again, this time settling in Washington, D.C., where he became the city's first practicing neurologist, as well as the Director of Laboratories at St. Elizabeths Hospital. He also began teaching at George Washington University as a neurology professor in 1926.
He remained at St. Elizabeths until 1933, but during his time there, the profound suffering of mentally ill patients started to weigh heavy on him. It was this experience that eventually led him to seek out an effective method of treating mental patients — and he found his treatment in Portugal in 1935.
Inspired By European Neurologists, Freeman Attempted To Refine The Lobotomy
António Egas Moniz, a Portuguese neurologist, introduced the prefrontal leucotomy in 1935 as a treatment for severe mental disorders. His initial procedure involved drilling holes into the patient's skull and injecting alcohol into the frontal lobes to destroy white matter, aiming to disrupt problematic neural pathways associated with mental illness.
Dissatisfied with the precision of this method, Moniz later designed a surgical instrument called the "leucotome," which featured a retractable wire loop to cut small cores of brain tissue. This refinement allowed for more controlled lesions within the white matter of the frontal lobes. Moniz's work gained international attention, and in 1949, he was awarded the Nobel Prize in Physiology or Medicine for "his discovery of the therapeutic value of leucotomy in certain psychoses."
Wikimedia CommonsA portrait of Moniz at the University of Coimbra.
Before that, though, Freeman first encountered Moniz's research at the Second International Congress of Neurology in London in 1935, where Moniz presented his findings on cerebral angiography. Freeman felt that Moniz's work had potential but needed refining. As it was, it was time-consuming, required an operating room, and necessitated the involvement of a neurosurgeon.
Freeman wanted to make the procedure more accessible, particularly in under-resourced psychiatric hospitals.
Upon his return to the United States, Freeman contacted neurosurgeon James Watts and the two began collaborating to perform the first prefrontal lobotomy in America in 1936. Although they initially adhered to Moniz's method, they soon developed their own approach, known as the "Freeman-Watts standard prefrontal lobotomy," which involved more extensive severing of connections between the frontal lobes and deeper brain structures.
However, the procedure still wasn't quite as efficient as Freeman had imagined.
Then, around 1945, Freeman caught wind of the work being done by Italian psychiatrist Amarro Fiamberti, who had, like Freeman, dedicated himself to the study and treatment of mental illnesses. Fiamberti had notably been developing his own technique for accessing patients' frontal lobe, penetrating the thin orbital bone at the top of the eye socket.
Public DomainTwo surgeons in Sweden performing a lobotomy in 1949.
Once access was achieved, he would then inject substances like alcohol or formalin to disrupt the white matter connections of the frontal lobes — a technique that was considered less invasive than Moniz's approach. More importantly, for Freeman, it also did not require an operating room or general anesthesia, but he still felt there was room for improvement.
Freeman ditched the thin tube and the alcohol, believing he could get more effective, faster results with a simpler tool — an ice pick, effectively. Freeman dubbed this new technique the transorbital lobotomy — most people, however, referred to it as the "ice pick" lobotomy — and in January 1946, he was ready to put it to the test.
Walter Freeman's Evangelical Promotion Of The Lobotomy
On Jan. 17, 1946, Freeman performed his first transorbital lobotomy on a 29-year-old housewife named Sallie Ellen Ionesco in his Washington, D.C., office — a notable change in how and, more importantly, where such a procedure had been performed.
Freeman believed that this new version of the lobotomy was simple enough that it could be done in a more informal environment than a surgical setting, and thus he embarked on a nationwide tour, demonstrating the procedure to other medical professionals and the public.
During the tour, Freeman often performed multiple lobotomies per day, often in equally informal settings like hotel rooms or makeshift clinics. He used the media coverage to garner attention for the procedure, regarding the lobotomy as a quick fix for mental illness.
Public DomainCoverage of Freeman and the lobotomy from the Saturday Evening Post in 1941.
His charisma and dogmatic language, and the apparent effectiveness of the procedure, eventually led to the widespread adoption of the transorbital lobotomy across the United States.
But just as Freeman has long been history's most infamous lobotomist, the transorbital lobotomy remains the most infamous of its kind. Moreover, the lobotomy in its many forms remains among the most infamous medical procedures in all of human history.
And why exactly the lobotomy, despite its use for just 30 years over half a century ago, retains such infamy and morbid fascination comes (at least in part) because of its barbaric simplicity.
The Rise And Fall Of The Lobotomy As A Mental Health Treatment
Archivist Lesley Hall of London's Wellcome Collection of medical history told the BBC of the procedure, "It's not rocket science is it?" Another doctor described the lobotomy to the BBC as "putting in a brain needle and stirring the works."
Indeed, it is at once baffling and horrifying to comprehend that a trained medical doctor of the not-so-distant past would treat the most sophisticated part of the body's most sophisticated organ by simply jamming an ice pick into it.
Yet, from the mid-1930s into the mid-1960s, that is precisely what Walter Freeman did — over 3,400 times.
Despite its 14 percent fatality rate and the fact that Freeman had no formal surgical training, Freeman and the procedure rose to prominence across the United States where some 50,000 procedures were performed, and Europe, which saw at least as many.
Some of these procedures involved Freeman's transorbital method, while many others involved the prefrontal method of drilling holes into the skull, at which point doctors could destroy the brain's white matter with either the injection of alcohol or the twist of a leucotome, a sharp tool ending in a wire loop that could essentially scoop out cerebral tissue.
These two methods were the ones initially preferred by Moniz.
But why? Why did Moniz develop the lobotomy, why did Freeman follow in his footsteps, and why did countless other doctors follow in Freeman's? Moreover, why would this be allowed for the patients who were subjected to it unwillingly or unwittingly, and why would the remainder of the patients undergo it voluntarily?
What, in other words, was the point of the lobotomy?
The definitions of when the lobotomy should be used were just as graceless as the procedure itself. Doctors would perform lobotomies on patients diagnosed with everything from mild depression and anxiety to severe psychiatric disorders like schizophrenia.
In short, medical experts at the time viewed it as a "surgery for the soul," one which could treat everything from mild depression to schizophrenia.
This simplicity helped propel the procedure into the mainstream and the public consciousness, with Freeman receiving spreads in the Saturday Evening Post and traveling the country to evangelize on behalf of his procedure.
But just as this public awareness encouraged some people to volunteer for the procedure, it also invited backlash.
The public took note that while the lobotomy often did calm the anxious mind, it sometimes took things too far. "I was in a mental fog," said Howard Dully, who underwent a lobotomy at age 12 in 1960 and wrote a book about it in 2007, of the aftermath of his procedure. "I was like a zombie."
For some, that feeling dissipated with time. For others, it didn't.
Such cases, like that of Rosemary Kennedy, the sister of John F. Kennedy, became cautionary tales and informed the legacy of the lobotomy in ways that persist to this day.
John F. Kennedy Presidential Library and MuseumRosemary Kennedy, sister of U.S. president John F. Kennedy and one of the most infamous cases of a lobotomy.
Rosemary had suffered from developmental disabilities ever since birth, when the doctor wasn't available right away and the attending nurse instructed Rosemary's mother to keep her legs closed and the baby inside until the doctor arrived. Rosemary's head stayed inside the birth canal for two hours, depriving her of oxygen and leaving her disabled for life.
While that life would last a full 86 years, the last 60 would be spent inside various institutions with Rosemary a shell of her former self. In 1941, following years of seizures and violent outbursts amid what was otherwise a fairly normal existence, Kennedy patriarch Joseph took his 23-year-old daughter to Walter Freeman.
She was never the same again. In fact, she was far worse: Rosemary lost the use of one arm, one of her legs, her speech became largely unintelligible, and she had "the mental capacity of a two-year-old."
Although there are indeed records of successful, or at least incident-free, lobotomies in as many as two-thirds of cases, the ones like Rosemary Kennedy's or actress Frances Farmer's (which may not actually have happened) or Randall P. McMurphy's (which only happened in novel and film) are the ones that we remember.
The very simplicity and inexactitude of the procedure meant that sometimes it indeed brought disaster — live by the ice pick, die by the ice pick.
And that's precisely how it went with Walter Freeman.
Walter Freeman's Final Surgery And Controversial Legacy
In February 1967, Watler Freeman performed his last transorbital lobotomy. The patient's name was Helen Mortensen, a long-term patient now undergoing her third procedure by Freeman's hand. Unfortunately, it did not go as smoothly this time around.
Shortly after the operation, Mortensen died from a brain hemorrhage, and Freeman was stripped of his surgical license. Moreover, by that point, both psychiatry and psychopharmacology had obviated the need for psychosurgery like the lobotomy.
Its heyday was over.
Stanford University Medical Center RecordsWalter Freeman with his wife Marjorie.
Yet, the lobotomy's place in the public imagination would only grow, and darken, as true stories like that of Rosemary Kennedy's came to light and invented stories like those in One Flew Over The Cuckoo's Nest and The Bell Jar fascinated readers.
Today were thus left with a twisted albeit incomplete view of a procedure whose legacy isn't as simple as the procedure itself ever was — nor is Freeman's legacy quite so simple. Despite the controversial outcomes of the procedure, it seemed as if Freeman truly did believe he had dedicated his life to helping the mentally ill.
Walter Freeman died on May 31, 1972, certainly having left a mark on the world. Whether that was for better or worse, though, is still up for debate.
After this look at Walter Freeman and the history of the lobotomy, read up on tragic actress Frances Farmer, one of history's most infamous disputed lobotomy recipients. Then, discover five bizarre, grotesque historical "cures" for mental illness.
