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The Lobotomy Letters

The Lobotomy Letters: The Making of American Psychosurgery

Mical Raz
Volume: 25
Copyright Date: 2013
Published by: Boydell and Brewer,
Pages: 184
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  • Book Info
    The Lobotomy Letters
    Book Description:

    The rise and widespread acceptance of psychosurgery constitutes one of the most troubling chapters in the history of modern medicine. By the late 1950s tens of thousands of Americans had been lobotomized as treatment for a host of psychiatric disorders. Though the procedure would later be decried as devastating and grossly unscientific, many patients, families, and physicians reported veritable improvement from the surgery; some patients were even considered cured. The Lobotomy Letters gives an account of why this controversial procedure was sanctioned by psychiatrists and doctors of modern medicine. Drawing from original correspondence penned by lobotomy patients and their families as well as from the professional papers of lobotomy pioneer and neurologist Walter Freeman, the volume reconstructs how physicians, patients, and their families viewed lobotomy and analyzes the reasons for its overwhelming use. Mical Raz, MD/PhD, is a physician and historian of medicine.

    eISBN: 978-1-58046-794-0
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Note on Archive Material and Patient Records
    (pp. xi-xii)
  5. Introduction
    (pp. 1-8)

    On a typical morning in a modern psychiatric hospital, patients receive a variety of treatments, ranging from pharmacological, psychodynamic, and behavioral therapies to electroconvulsive therapy, occupational therapy, and music therapy. The results of these therapeutic interventions are interpreted by both members of the treatment team and by the patients, their families, and their friends. Some patients will be seen as improved. Others will be seen as needing additional therapy or a different therapeutic approach. Medical students learn to look at patients, interpret the entirety of their situation, and sum it up succinctly: Is he good? Is she better? To claim...

  6. Part One: Lobotomy as Modern Medicine

    • Chapter One From French Neurology to American Lobotomy
      (pp. 11-25)

      In June 1923 Walter Freeman arrived in Paris to work at the Salpêtrière under the patronage of the famed neurologist Pierre Marie. Freeman’s grandfather, the distinguished surgeon William W. Keen, had written to Pierre Marie on Freeman’s behalf, enabling the young medical graduate to study the classic neurology of the Salpêtrière, headed by Charcot’s student and successor.

      Many American medical students and young physicians trained in Europe. Paris was the primary destination until the mid-nineteenth century, known as the “French period” in American medicine.¹ In the late nineteenth and early twentieth centuries, German medicine became preeminent, eclipsing the popularity of...

    • Chapter Two Locating Holism
      (pp. 26-43)

      Lobotomy was closely tied to changes in the neurological profession, first performed by a Portuguese neurologist and later popularized by an American one. As we have seen, the French neurological tradition as well as the growing competition between the fields of neurology, neurology, and psychiatry set the ground for the procedure’s development. Changing perceptions of brain function in the early decades of the twentieth century contributed to neurologists’ willingness to experiment with a surgical intervention for mental illness. The intellectual basis of a procedure designed to disrupt neural pathways connecting the frontal lobes and other cerebral area was based on...

    • Chapter Three Between the Ego and the Ice Pick
      (pp. 44-66)

      Psychosurgery and psychoanalysis enjoyed a surprisingly close relationship in the 1950s. While it might seem inevitable that two radically different approaches would hold distinct and opposing views of psychosurgery, I argue that this was not the case. Psychodynamically oriented psychiatrists and psychosurgeons crafted a common, eclectic discourse on psychosurgery containing elements from both theories. This discourse had far-reaching effects on therapeutic practice. Both psychosurgeons and psychodynamically oriented psychiatrists and psychoanalysts endorsed various forms of psychotherapy before and after psychosurgery. For certain psychoanalysts, psychosurgery was a means by which to obtain more effective analyses. Many patients also viewed psychosurgery and psychotherapy...

  7. Part Two: Interpreting Lobotomy

    • Chapter Four An Active Docility: Reconstructing the Clinical Encounter
      (pp. 69-100)

      Why did patients and their family members agree to or even seek out a lobotomy? Why did physicians choose to perform this procedure, today viewed as damaging and abusive? To answer these questions, in this chapter I reconstruct the personal stories and experiences of lobotomy patients and their families. From correspondence between Walter Freeman and his patients and their families, as well as the medical documentation available in the patient case files, I re-create the context in which lobotomy was perceived and examine how it came to be viewed by patients and families as a legitimate treatment for mental illness.¹...

    • Chapter Five A Surgically Induced Childhood
      (pp. 101-117)

      In 1947 Freeman answered a letter from a frustrated father of a lobotomy patient. The father complained that his daughter was often uncooperative and childish, and that he and his wife experienced considerable difficulties in caring for her at home. “The best means of controlling such behavior,” Freeman advised, was “a rapid change from one type [of activity] to another around the house and frequent outdoor activity, lots of affection and once in a while a good old span[k]ing if she does not behave herself.” On this point, Freeman cautioned, “It may take two of you to get her down,”...

    • Chapter Six Lobotomized, in Good Working Condition
      (pp. 118-133)

      Employment status was a key factor in evaluating the patients’ postoperative condition and in determining whether the operation was successful. Restoring the ability to lead a useful and productive life was, for Freeman, one of the main goals of the operation. However, it was not only the work ethic and values of the physician that emphasized the importance of employment and productivity. The capacity for work and productivity defined patients and family members’ perceptions of individual health and well-being.

      Adolf Meyer, the Swiss-born American pathologist and psychiatrist, developed a theory of maladjustment to replace the primacy of the discourse of...

  8. Conclusion
    (pp. 134-140)

    Wilma Rogers wrote Walter Freeman this letter at the end of 1954, the same year chlorpromazine entered American psychiatric practice. She had tried many different medications, including various barbiturates, reserpine, chlorpromazine, as well as a trial with stimulants. She had briefly attempted psychotherapy with at least six different psychiatrists, and had undergone prolonged therapy with the renowned psychiatrist Lothar Kalinowsky.² Freeman had performed her first transorbital lobotomy in early 1954. A few months later, Wilma wrote Freeman that she felt as though she was “a spectator, watching a never ending scene of human life, which I am prohibited from ever...

  9. Notes
    (pp. 141-162)
  10. Index
    (pp. 163-166)
  11. Back Matter
    (pp. 167-167)