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This episode was suggested by Sierra and Abby. If you'd like to suggest a topic, you can do so on Facebook and Instagram at Morbid Curiosity Podcast, on Twitter at Morbid Podcast, on our website, www.morbidcuriositypodcast.com, and on the MCP patron Discord server. This episode contains discussions of animal experimentation, mental illness, suicide, non-consensual surgical procedures, and malpractice and abuse in mental health care facilities. If these aren't topics you want to hear about, this may be a good episode to skip.
Humans are fascinated by gore and violence, but even more so the mysterious and unsolved. Interest in these disturbing and unpleasant subjects is called morbid curiosity, and it has gripped millions of people throughout the ages. I am one of those people. My name is Hallie, and this is the Morbid Curiosity Podcast.
The history of medical care for mental health issues is fraught with difficulties. Much harm has been done over the centuries in the name of mental health treatment. For most of recorded history, the mentally ill have been ostracized and excluded by society, placed in crowded hospitals, or committed to insane asylums. Despite the advent of more humane treatment in the late 19th century, mental institutions were not equipped to deal with the medical and social problems associated with mental illness and remained seriously crowded.
Historic examples of the horrific conditions are so prevalent and disturbing that mental health institutions have become commonly used horror tropes. Most horror involving mental institutions includes wards full of both violent patients and the empty husks of those who have undergone some sort of psychosurgery. One of the most infamous psychosurgeries in history is the lobotomy. A lobotomy is a surgical procedure that was developed in the 1930s to treat severe mental health conditions.
The procedure had several variations, but usually involved inserting a sharp instrument into the brain to sever certain neural connections. Today, this procedure is considered barbaric and unethical. However, during its heyday, it was thought of as a miracle cure by those physicians who worked in mental institutions. It was thought to help patients as well as carers in managing them.
This is because a lobotomy is quite effective at altering behavior. However, it was a blunt instrument with unpredictable results. While some patients seemed to improve after the procedure, more suffered severe and irreparable brain damage. The story of the development, use, and decline of the procedure is fascinating, but it's also incredibly disturbing.
The lobotomy wasn't the first procedure involving cutting into the skull. Trephination or trepanation, which is the cutting of small holes in the skull, dates back centuries. Trephined skulls have been found in Europe, Asia, and the Americas, particularly in Peru, from the Neolithic age to the advent of written history. Though anthropologists aren't exactly sure why it was done, it's thought that it had ritual as well as medical purposes.
Amazingly, there's evidence in the form of skeletal healing that proves some people survived the procedure. In ancient Greece and Rome, medical instruments were invented to penetrate the skull. An example was the Roman trephraserata, an instrument that was rolled between the surgeon's hands to bore a hole into the skull. This instrument inspired later medical tools, such as the manual burr hole and the electric drill that neurosurgeons use today for craniotomy procedures.
During the Middle Ages and the Renaissance, trepanation was performed not only for skull fractures, but also as a treatment for madness and epilepsy. Triangular trephines were invented and used to open the skull or elevate pieces that were concaved due to fracture. In more recent history, a freak accident caused an explosion of scientific interest in the human brain. The American Crowbar case, also known as the case of Phineas Gage, inspired many medical and psychiatric professionals to study the brain and human behavior.
In 1848, 25-year-old Phineas Gage, a construction foreman, was helping to construct a railway line near the town of Cavendish, Vermont. A tamping iron, which is a long metal bar measuring 3 foot 7 inches in length and 1 1⁄4 inches in diameter, was accidentally propelled through Gage's head. The 13 1⁄4 pound rod penetrated his left cheek and came out just to the right of the center of the back of his head. Gage survived, but suffered from extreme changes in his behavior.
Before the accident, he'd been a motivated, energetic, capable, friendly, and conscientious worker. Afterwards, Gage was obstinate, irreverent, irresponsible, and socially uninhibited. The changes were noticed by physicians, family, and friends almost immediately after the injury. Gage's physician, Dr.
John M. Harlow, paid close attention to his patient, not just because of the personality changes, but also Gage's survival after such an extensive injury. Dr. Harlow followed Gage's travels across North and South America, Gage taking the tamping iron with him wherever he went.
Harlow published a thorough description of the case 20 years after it occurred, and it became notorious immediately. When Gage died in 1860 near San Francisco, Dr. Harlow retrieved his skull and the tamping iron. The items were donated to Harvard Medical School's Warren Anatomical Museum in 1868.
They're still there today. In the early 1930s, neuroscience and psychology were focused on understanding brain function and its relationship with behavior and mental processes. The frontal lobe of the brain was central to this interest. The frontal lobe is one of the four major lobes of the brain.
Today, scientists know that it plays a critical role in high-level cognitive processes, such as planning, organization, decision-making, problem-solving, impulse control, concentration, task prioritization, voluntary movement, coordination, language production, personality, social behavior, emotional regulation, and the working memory. Given its wide-ranging functions, damage to the frontal lobe can have a significant impact on behavior, cognition, language, and motor skills. John Fulton and Carlyle Jacobson were American neuroscientists at Yale University who conducted a series of experiments exploring the effects of lesions on the prefrontal cortex on behavior using chimpanzees. The chimpanzees were trained to perform specific tasks, and their behavior was observed under different conditions.
During these experiments, it was observed that one chimpanzee, Becky, exhibited intense agitation and emotional distress when she made errors during a task. Fulton and Jacobson performed a surgical procedure to remove part of Becky's prefrontal cortex. Afterward, Becky was significantly less emotional and less reactive to errors. However, her counterpart, Lucy, who had been relatively non-reactive when she made errors, became quite aggressive and prone to tantrums after her frontal lobe was removed.
These experiments were presented at a pivotal meeting of neurologists in London in 1935. During the Second International Congress of Neurology, Antonio Igeles Muniz, a Portuguese neurologist, heard Fulton and Jacobson report their findings. A professor at the University of Coimbra, Muniz was interested in understanding the underlying mechanisms of mental illness. After hearing about the change in Becky's behavior, he believed that similar alteration of the prefrontal cortex could lead to changes in human behavior and alleviate psychiatric symptoms.
Knowing of the inhumane conditions in most mental institutions, Muniz was eager to find new therapeutic methods that could offer hope to those suffering from severe mental disorders. He proposed the term leucotomy, emphasizing his intent to isolate specific connections in the brain and sever them without causing widespread damage. He and his colleague, Dr. Almeida Lima, performed the first leucotomy on a human patient in 1935.
His original technique was adapted by others, but the basic idea remained the same. Surgeons drilled a pair of holes into the skull, either at the side or the top, and pushed a sharp instrument, a leucotome, into the brain. The surgeons swept the leucotome from side to side, slicing into the frontal lobe. Muniz also experimented with injecting alcohol into the brain to sever those connections.
Initial results indicated that some patients exhibited improved behavior and reduced symptoms. This success encouraged Muniz to conclude the technique was a viable treatment for severe mental illness. His work gained significant attention, leading to being awarded a Nobel Prize in 1949. Despite all the good press, there were many early critics of the procedure.
Physicians argued that Muniz was glossing over the adverse side effects. Muniz's leucotomy laid the groundwork for another technique, which developed in the United States. Dr. Walter Freeman, along with his colleague, Dr.
James Watts, was inspired by Muniz's work and performed what they called a prefrontal lobotomy in 1936. Freeman and Watts published their research and promoted this method as a treatment for various psychiatric conditions, such as schizophrenia and severe depression. Unsatisfied that such a helpful procedure required surgery, Freeman developed a new version of the lobotomy that didn't require drilling into the skull. He called it the transorbital lobotomy, and it involved using a hammer to drive a leucotome into the frontal lobe of the brain through the eye socket.
The whole operation took between 5 and 10 minutes. This technique could be performed quickly and did not require specialized surgical settings. Freeman's eccentric appearance, engaging personality, and theatrical demonstrations of his surgical techniques gained him substantial popularity with local and national media. The procedure was offered in hospitals and doctor's offices.
It was used for anything from schizophrenia to behaviors in children that Despite opposition from some doctors, especially psychoanalysts, it became a mainstream part of psychiatry, with more than 1,000 operations a year at its peak. It was used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders. The reason for its popularity was simple. The alternative was considered worse.
The chance of a cure seemed preferable to a life sentence in an institution where straitjackets, padded cells, and physical violence were used to subdue violent patients. The most prolific lobotomist in the U.K. was the neurosurgeon Sir Wiley McKissock, who was based at the Atkinson Morley Hospital in Wimbledon. He would often drive down to smaller hospitals in the country and do lobotomies on the weekends.
Psychiatrist Dr. John Pippard, who was critical of the procedure, followed up with several hundred of McKissock's patients. He found that around a third benefited, a third were unaffected, and a third were worse afterwards. Similar results to the surveys in Japan.
Although he himself had authorized lobotomies, he turned against the practice, uncomfortable putting a needle in the brain and, quote, stirring the works, end quote. Quite quickly after the lobotomy's rise in popularity, ethical controversies arose. Freeman often performed the procedure without sufficient consent or consideration of the risks. Moniz, too, came under fire for the serious ethical and practical concerns surrounding the leucotomy.
The lobotomy also quickly became a method of managing problem patients, even if they didn't have severe mental health issues. This was extremely unethical as it took away the patient's agency, independence, and often their personality. These concerns led to the eventual discreditation and decline of lobotomies in psychiatric treatment. Although some patients appeared to benefit from the procedure, many others experienced severe complications, including cognitive impairment, personality changes, physical disability, and in some cases, death.
The lobotomy was invasive, unpredictable, and administered without sufficient evidence of its long-term effects or consideration for the ethical implications. In 1939, Moniz was shot multiple times by one of his patients. It's unknown if the patient had undergone a lobotomy from Moniz. His mobility now limited, Moniz retired from active medical practice.
He continued to write and research in other areas of neurology until his death in 1955. As public opinion in America turned against the procedure, Dr. Freeman's reputation suffered. Despite this, he continued to perform lobotomies into the early 1960s.
Eventually, he lost his medical license due to ethical breaches. He died due to complications from cancer surgery in 1972. With the development of antipsychotic medications in the 1950s, the lobotomy quickly fell out of favor. Ominous portrayals of lobotomized patients in novels, plays, and films further diminished public opinion of the procedure.
Jack Nicholson's performance in One Flew Over the Cuckoo's Nest in 1975 solidified public perception of psychosurgery as a tool for wielding power over mentally ill patients. In the 1980s, standards were developed to prevent unethical use of psychosurgery. For example, psychosurgery should only be considered after trying less invasive measures. Physicians must consider the patient's ability to provide full consent.
Clinical research studies should be done to confirm the safety and efficacy of the procedures and the risk of adverse side effects should not outweigh the benefit of the treatment. Psychosurgery is still performed today, but is far more humane and less invasive. Procedures such as deep brain stimulation modulate neural function without destroying tissue. Minimally invasive surgeries are also available, such as stereotactic radiosurgery for obsessive compulsive disorder.
In these procedures, small lesions are made on the brain using radiation, freezing, or small cuts. The risk of death or serious damage has lessened, but side effects can still be an issue, including seizures, incontinence, apathy, and cognitive problems. Lobotomy didn't always render the patient a vegetable. Many times, the changes were quite subtle.
It did improve the condition of some patients within the hospital and sometimes permitted them to lead useful lives in society. It's true that most patients who were lobotomized were left at a lower intellectual level. But at the time, physicians felt this was better than spending the rest of their lives in a mental institution. But there were also disastrous, life-changing effects on personality, physical and intellectual functions.
Brain infections, dementia, epilepsy, incontinence, difficulty understanding language and speaking, personality changes, inappropriate social behavior, apathy, obesity, light sensitivity, confusion, chronic headaches, and death were all serious side effects. And it was impossible to predict which of these would occur. The neurosurgeons at the time knew this and didn't publicize it. Walter Freeman's work especially highlights the lack of patient safety, informed consent, and post-operative care that so many people suffered.
I'm going to go into more detail on Walter Freeman, but first, an ad must play. If these ads annoy you, you can get ad-free episodes by joining the MCP Patreon for as little as $2 a month. We also now offer memberships on our Ko-fi page. While he didn't invent the lobotomy, Dr.
Walter Freeman is often seen as the face of this infamous procedure. His almost fanatical support of lobotomy and his work to spread its use in hospitals and doctor's offices across the United States has earned him this role. A lot of the information I'm about to present comes from Jack Elkind's 2005 biography of Freeman called The Lobotomist, a maverick medical genius and his tragic quest to rid the world of mental illness. Freeman graduated from Yale University in 1916, received his medical degree from the University of Pennsylvania in 1920, and by 1924, he was the head of the neurology department at George Washington University in Washington, D.C.
Freeman's theatrical personality was evident early in his clinical experience. One example of this is when Freeman was treating a young man with a metal ring wrapped around his penis. Freeman briskly removed the ring with forceps, and when the patient asked to have it back, Freeman told him it was now a surgical specimen and had to stay at the hospital. However, Freeman had the ring repaired, engraved with his family crest, and then wore it on a gold chain for many years after.
Freeman often kept memorabilia related to his lobotomy patients later in his life. After his internship and residency, Freeman became director of laboratories at St. Elizabeth's Hospital in Washington, D.C. He wasn't sure the job suited him, but after learning that St.
Elizabeth's was a well-regarded institution for the insane, he was intrigued. He quickly developed a reputation for pursuing unconventional treatments for patients with catatonic schizophrenia and depression. His favorite procedure was the cisternal tap, a method of draining cerebral spinal fluid by inserting a needle through the skin and through the arch of the atlas vertebrae into the cisterna magna, the largest pocket of spinal fluid surrounding the brain. Calling it the, quote, jiffy spinal tap, end quote, Freeman favored the procedure due to its speed and efficiency compared to a regular lumbar spinal tap.
Many of his colleagues were more cautious, as the procedure can cause severe neurological injury if performed improperly. Freeman kept detailed written and photographic records of his work and often wrote to other neurologists. Muniz was one of them. Freeman and Muniz became quite familiar over the years.
Freeman referred to Muniz as, dear master, in personal correspondence and nominated Muniz for the Nobel prize in 1949. On September 4th, 1936, Freeman performed the first lobotomy in the U.S. with Dr. Watts.
Their patient was a woman named Alice Hood Hammett who was diagnosed with agitated depression. Hammett almost withdrew her consent the night before due to concerns about her head being shaved, but Freeman promised he wouldn't shave her head. The morning of the operation, she tried to withdraw her consent and struggled as she was being put under general anesthesia. For this procedure, Freeman and Watts acted as co-surgeons.
17 incisions three centimeters in length were made on either side of her forehead. Using an auger, Freeman and Watts created holes in the skull and used a modified version of Muniz's leukotome to remove cores of white brain matter from between the prefrontal cortex and the thalamus. They removed white matter at depths of four, three, and two centimeters, repositioned the leukotome, and removed three more cores at the same depths. This was done on both sides.
The wounds were washed with saline and sutured closed. The procedure had taken one hour. When Hammett awoke, she stated that she was, quote, happy, end quote, and didn't mind that Freeman had shaved her head. Six days after the operation, Hammett began to have language difficulties, was disoriented, and agitated, but she was discharged from the hospital, so Freeman considered the surgery a success.
After his early successes performing frontal lobotomies, Freeman developed his transorbital approach. He used a mallet to tap an orbital clasp, an instrument resembling an ice pick with a wooden handle, through the orbital roof. Following penetration, Freeman would sweep the orbital clasp from side to side, cutting through brain tissue. He was able to perform the procedure in an office setting because he anesthetized patients with a portable electroshock machine.
His decision to perform a lobotomy without a neurosurgeon was met with immediate criticism. The hospital reprimanded Freeman, stating that he was, quote, not a surgeon, and if he wants to operate, he'll have to apply for surgical privileges, end quote. However, because Freeman's transorbital lobotomy didn't require any holes in the skull or general anesthesia, there was nothing to say he couldn't perform the operation by himself in an outpatient setting. After Freeman performed his first transorbital lobotomy on Sally Ellen Ionesco, a In the procedure, Rosemary was unable to function independently and was institutionalized for the remainder of her life.
One of her nurses who observed the procedure found it so horrific that she never worked in the medical profession again. After chloropromazine was approved for use in the U.S. in 1955, things went swiftly downhill for Freeman. His final transorbital lobotomy patient, Helen Mortensen, died three days after her operation in 1967.
It had been her third lobotomy from Freeman. Freeman's medical license was revoked after this incident. Still, he continued to tour the country giving lectures and visiting his former patients. He often took pictures to document their well-being.
It's hard for us to remember that this procedure came from a place of concern for patients and for the staff in mental institutions. Physicians were desperate to provide care for all their patients, and that desperation led to supporting lobotomy. When faced with the choice to leave a patient raving, soiling themselves, and attacking staff, or performing a lobotomy that might help them, most physicians chose lobotomy. However, the consent of the patient was not often acquired.
The healing motives behind lobotomy were overshadowed by the desire for ease of care. This usage and the long-term effects of the procedure were not policed by the medical profession until it was too late. The legacy of lobotomy is a complex one. Much harm came to the people who underwent the procedure.
However, important questions were raised about the ethics, informed consent, and the balance between innovation and patient safety, and the potential harm caused by untested or inadequately researched medical interventions. It's incredibly unfortunate that these questions only surfaced after such pain, but we can make sure all that pain wasn't for nothing by continuing to ask these questions whenever we can. Learning from mistakes, especially painful ones, is for many what drives their morbid curiosity. The Morbid Curiosity Podcast is produced by H.
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