In 1949, Portuguese neurologist Egas Moniz was awarded the Nobel Prize in Medicine for "one of the most important discoveries ever made in psychiatric therapy." The discovery was that surgically removing part of a person's frontal lobes could relieve symptoms of mental illness. During its heyday in the 1940s and '50s, prefrontal leucotomy, or lobotomy, was performed on more than 40,000 people in the United States and 10,000 in Western Europe.
Yet even at the time at least one critic observed that lobotomy could turn patients into unresponsive "zombies." In hindsight the procedure looks just short of barbaric.
So how did drilling holes in a patient's skull, inserting a blade, and waggling it around to destroy brain tissue become an acceptable "cure" for mental illness? Janet Sternburg explores this question in her memoir "White Matter," a cultural and personal history that relates how not one but two of her relatives were lobotomized — at her family's request — at the height of the procedure's popularity.
First her Uncle Bennie, then 10 years later her Aunt Francie. Bennie was schizophrenic and prone to violent outbursts; Francie had become suicidally depressed. Doctors told Sternburg's four worried aunts that if their sister did not have the procedure she would "weep for the rest of her life."
"This is the story of a family," Sternburg writes, "who made choices based on imperfect knowledge — of the world, and of themselves — and had to live with their consequences."
She could be describing any of us, though for most of us the stakes are not so high.
For some patients, lobotomy actually seems to have offered relief. They "were able to be aware of their situations, even to compare them with the past and say how much better they were."
Others emerged more like Bennie, who did not speak for most of his adult life and lived at home under constant supervision. Or like Rosemary Kennedy, the willful, moody and sometimes violent sister of John F. Kennedy, who was lobotomized (at her father's request, without her mother's knowledge) at age 23. She spent the rest of her life in an institution, incontinent and unable to walk or speak.
The doctors who championed lobotomy believed they were helping individuals and society. Freudian analysis did little for patients in the grips of mania or schizophrenia. Psychiatric institutions were overcrowded and underfunded. Sternburg writes, "Lobotomy kept costs down; the upkeep of an insane patient cost the state $35,000 a year while a lobotomy cost $250, after which the patient could be discharged."
Walter Freeman, a protégé of Moniz who was hugely influential in popularizing lobotomy, believed so fervently in its benefits that he developed a faster and more portable procedure: stick an icepick (yes, an icepick) through the patient's eye socket and into their brain (perhaps you've seen "Jessica Jones") and agitate it to destroy tissue. Freeman criss-crossed the country in a van he dubbed the "Lobotomobile," his icepick at the ready.
In small towns across America, families brought out their unruly and unwell. One quick stab of the icepick later (he got it down to seven minutes), the patient was returned docile and "at ease." His slogan: "Lobotomy sends them home."
For families like Sternburg's, lobotomy offered a last resort that tugged on the tangled heartstrings of compassion and self-preservation, love and fear. It was not always clear whose interests were served when a patient was lobotomized. "When a person has undergone a vast trauma and been left with intolerable anguish, is there a saving grace in the loss of one's self?" Sternburg asks. "Would a life without feeling be preferable to one spent in torment?" In its best moments, this book raises questions about the uncertain contours of compassion. As one cousin considering Francie's lobotomy suggests, "it was her or them."
Sternburg is at her most astute when she can hold sometimes contradictory truths in mind, but she is prone to slipping into a more brittle moralism. "They must have thought they were doing the right thing. ... What was wrong with them?" Of Freeman she writes, "One cannot reckon with or reconcile this man; believe me, I've tried." As if a person were an account to be settled. As if we were rational creatures whose motives and desires were ever anything other than a hopeless jumble. Empathy is not the same thing as understanding, and Sternburg is sometime caught in the quandary of trying to write her way in both directions at once.
Today, lobotomy is no longer practiced on the mentally ill, but other types of psychosurgery are an option for people with severe epilepsy, as seizures can cause irreparable brain damage and even threaten a patient's life; removing brain tissue can stop seizures from happening.
But cures for mental illness remain elusive. The 1950s saw the rise of the biochemical model of brain function, as researchers noticed that tuberculosis patients became euphoric on Iproniazid (thus was discovered the first antidepressant) and that drugs like mescaline could produce mental states similar to psychosis. Pharmaceutical companies seized on the idea that mental states are controlled by chemicals, ushering in the era of the "chemical imbalance" theory of mental illness. In recent years, however, this model has largely been discredited by researchers who have shown that chemicals help mediate brain function, but a chemical imbalance doesn't actually cause complex mental illness (no, serotonin levels don't cause depression); and researchers have yet to replace it with a better model or more effective treatments. So while drugs can offer relief, many of the mentally ill and their caregivers are still, like Sternburg's family, making choices with imperfect knowledge and living with the consequences.
White Matter: A Memoir of Family and Medicine
Hawthorne Books: 238 pp, $18.95