Assignment Prompts

The Orbitoclast_ Patient Safety and ethics in the medical world

Introduction to Lobotomies

Orbitoclast and Hammer

1946, The year Walter Freeman went from driving ice picks into ice cubes to utilizing them to impale human eye sockets. Once regarded as a breakthrough in mental health care, lobotomies have cast a dark shadow across medical history. When lobotomies were first developed, doctors believed they could be used as a cure for severe mental illness. However, after they were used widely across the nation, many patients were left with lifelong injuries. After World War II psychiatric hospitals experienced overcrowding due to the shortage of employees and the growing demand for mental treatment. In response to overcrowding, doctors were desperate to get patients out of asylums. It was around this time when Walter Freeman introduced his simplified version of the prefrontal lobotomy, the Transorbital Lobotomy. The surgery involved driving an ice pick through the eye socket and into the frontal lobe of the brain to destroy tissue. Freeman’s lobotomy did not require an operating room or a professional neurosurgeon, making it an extremely risky procedure, this also made it easier to perform, causing it to spread quickly around the globe. In this essay, I will explore the factors that allowed Lobotomy to become so popular and widespread. I will discuss the stigma toward mental illness that plagued the 1900s and argue that the acceptance of lobotomies reflects societal values. The responsibility for the disaster of lobotomies lies not only on Walter Freeman but on society as a whole for allowing this to unfold.

Historical context

Before we discuss Walter Freeman’s Orbitoclast we must first set the scene and address the historical context which allowed for something like this to unfold. In the mid-20th century, the study of psychology and neurology was still in its developmental stages and there was little knowledge about mental illness and its origins. People dealing with mental illness were often ostracized from society and sent away to psychiatric institutions, sometimes for the rest of their lives. The general stigma around mental illness was based on fear, and society saw these people as violent or unpredictable. Phelan et al., (2000), analyzed multiple surveys and studies on the public perception of mental illness, concluding that society had a narrow view of mental illness and often rejected people dealing with these issues. Nunally found in 1961 cited by Jo C. et al., (2000) that “people were more likely to apply a broad range of negative adjectives such as “dangerous,” “dirty,” “cold,” “worthless,” “bad,” “weak,” and “ignorant” to a person labeled as “insane” or “neurotic” than to an “average” person”. (Phelan) It is evident that society was not accepting of the mentally ill and had little respect for them which would explain the lack of value for their safety as patients and why they were treated the way they were.

Ancient Psychosurgery

In many ancient cultures when there was no knowledge of psychology mental illness was often thought to be caused by evil spirits and demons. The mentally ill were feared and believed by many to be possessed. One of the oldest known treatments for mental health was discovered In medieval Europe and dates back to 5000 BCE. The medieval lobotomy, also known as Trephining Involves making a hole in the top of the head using stone tools to release demons from the patient’s head (Charka). Sometimes priests would attempt exorcism or torture the “spirit” which was really the person, sometimes this would result in execution. Many religions also believed that mental illness was a God-given punishment: “The Hebrews as well as the ancient Persians believed that illnesses were inflicted by God as a punishment, a punishment for your or your ancestor’s sins.” (Charka). Some of these beliefs are still thought to be true by some today and although we have come far from ancient times, we still deal with powerful stigmas that play a role in the way mental health is viewed today.

Emergence Of Lobotomies

Before and After Lobotomy Photo

Psychosurgery was first performed in 1890 by Gottlieb Burckhardt, a Swiss psychiatrist who performed the surgery on six patients with schizophrenia. Burckhardt went about the surgery by removing parts of the patient’s brain and observing their behavior after. Despite one of the patients dying and others experiencing seizures, Burckhardt reported that the subjects were calmer after the surgery (Stone). When Burckhardt reported his findings his idea was rejected and he was shunned by the medical community, his attempt at psychosurgery was seen as inhumane and had no research to support it. In 1930 Burckhardt’s idea was revisited by Antonio Egas Moniz a Portuguese neurologist who would work with his colleague Almeida Lima to create the leucotomy. Moniz’s leucotomy would go down in history as the first lobotomy as it began to gain popularity in Europe (West). The leucotomy was done by making a hole in the head and using a metal loop-shaped wire to remove the cores of the brain from the frontal lobe. The first lobotomies had severe side effects but continued to be done.

Walter Freeman And The Transorbital Lobotomy

The lobotomy would first be performed in the U.S. in 1936 by American neurologist Walter Freeman and neurosurgeon James Watts. 10 years later in 1946 Walter Freeman modified the European leucotomy making the surgery less invasive and more simple. This modification of the original lobotomy was known as the Transorbital Lobotomy, It used the Orbitoclast which was modeled after an ice pick and would be hammered through the eye into the frontal lobe to separate tissue. This new method of doing lobotomies made them much easier and they didn’t require a sterile setting or even a proper surgeon. Due to the unsafe and unprofessional work conditions, James Watts stopped working with Walter Freeman in 1947 (Torkildsen). Freeman traveled the States performing lobotomies on thousands of people as young as 12 years old with no certified training as a surgeon, he would teach other non-professionals to perform the surgery making it even more accessible. In just the year 1949 a total of more than 5,000 lobotomies had been done and by the time Freeman died in 1972, he had performed 3,439 lobotomies alone (Torkildsen). The impact Walter Freeman had on the medical world as one man is unfathomable, His methods of popularizing lobotomies and advertising them led to the destruction of thousands of lives. “An estimated three out of every 10 people died from Freeman’s transorbital lobotomies. Many more came out of the procedure with permanent brain damage that left them physically and/or cognitively impaired” (Pressman). The fact that the outcome of the Lobotomy procedure was so risky and yet people still brought their loved ones to undergo surgery is shocking. Today, Walter Freeman is often labeled as an antagonist, but can he be worse than the society that enabled him?

Society’s Burden

1900’s Mental Hospital

While Walter Freeman’s ideas may seem outlandish to us now, at the time he was praised by society and perceived as a hero, the Lobotomy was thought to be a medical breakthrough just like anesthesia. Considering the positive responses and approval Freeman got from society it isn’t surprising that he truly thought he was helping people. While his surgery may have been invasive and inhumane, he was responding to a problem already created by society. In the 1900s Stigma around mental health had been growing and instead of coming up with ways to help these people it was considered acceptable to lock them up in prison-like mental hospitals and cast them from society. This response to the “issue” of mental health is what I believe was the true catalyst for the spread of the lobotomy. Asylums were extremely crowded and understaffed due to WWII “In the 1950s, there were only 26 U.S. cities whose population exceeded the aggregate population of public psychiatric institutions. The two largest hospitals each had a census that exceeded 16,000 patients.” (Geller). The large number of patients made treating any patients individually nearly impossible, not to mention that doctors had little knowledge of treating mental health to begin with. Life in asylums was not only overcrowded but patients would be treated as prisoners and abused by staff. “In 1887, journalist Nellie Bly agreed to go undercover in a mental asylum to record the conditions inside. She reported horrific treatment from doctors, including hair pulling and solitary confinement.” (Carlton) The majority of patients in the 1950s were admitted into the institutions against their own will by family. One woman, Emily Packhartd found herself sitting in an asylum for simply practicing another religion than her husband, situations like this happened often due to laws allowing people to commit their family with little evidence (Carlton). People who in today’s world could be functioning members of society had years of precious life stolen from them all because they didn’t fit the social norms of our society and we didn’t know or care enough to help them better.

Decline Of Lobotomies

In the 1950s opinions on lobotomies began to shift as the media exposed them to be harmful and unethical. “In the famous work One Flew over the Cuckoo’s Nest by Ken Kesey (1935–2001), lobotomy is portrayed as a form of treatment that completely extinguishes a patient’s personality and free will. It is likely that the portrayals of Lobotomy in fiction played an important part in changing views on the treatment in the media and among the general population.” (Torkildsen). Along with One Flew over the Cuckoo’s Nest, other media and books would continue to shed light on the behind-the-scenes horrors of the procedure. Howard Dully’s book, My Lobotomy is a memoir written by one of Walter Freeman’s youngest patients, in the book, Howard explores his past and aims to learn everything he can about the surgery he underwent and understand why it happened to him. Dully’s memoir exposes the cruelty of Lobotomy and what it means to him, he helps the reader understand what it may be like to be the victim of such a large-scale medical disaster. An important factor in the downfall of Lobotomies was the advancement of science in the medical world. When the antipsychotic medication for schizophrenia, chlorpromazine (Thorazine) was introduced patients were able to treat mental illness in a much safer and less invasive way. In the 1960s more medical advancements were made and Lobotomy finally became a thing of the past. The last Lobotomy performed in the U.S. was by Walter Freeman in 1967 and resulted in the death of the patient.

Reflection

In today’s world, we look down on Walter Freeman and anyone who had a part to play in the creation and spread of lobotomies. We ask ourselves how something like this which seems so obviously wrong could have even been allowed, and like humans usually do, we point fingers instead of taking the blame ourselves. We villanize anyone who did what we were too oblivious and naive to realize was wrong. In the case of lobotomies, it is evident that responsibility lies on the shoulders of society as a whole rather than one man. Although it may feel nice to pin the lobotomy on one man and take some of the guilt away we must acknowledge what we as humans are capable of. The fact that we watched lobotomies emerge and spread through the world like wildfire without taking a second to question the ethical implications, speaks numbers on how we feel about the mentally ill. The acceptance of lobotomies also reveals how quick we are to forget about those who are different and how we treat them as lesser. We may have come far from the ice pick but many of the same stigmas that enabled Walter Freeman are still prevalent today and continue to affect anyone dealing with mental illness. Lobotomies will forever be a reminder of the cruel capabilities of human society and the
importance of ethical consideration in medical care.