The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness (review)

The medical journalist Jack El-Hai provides a very readable, engaging, and often riveting account of the life of Walter Freeman (1895–1972). The history of Walter Freeman is a cautionary tale that deserves our closest attention. Freeman is infamous as the psychiatrist who, with his neurosurgical colleague, James Watts, introduced leucotomy into the United States, and who became its most famous practitioner and advocate. Ten years after its introduction, in 1946, Freeman stepped well beyond the pale with his invention of the reviled procedure that he called transorbital lobotomy. This operation was designed to be performed by psychiatrists who, like Freeman, lacked neurosurgical qualifications. In place of anesthesia, Freeman often stunned his patient with electroconvulsive therapy. He then pushed an ice pick through the orbital plate into his or her frontal lobe to destroy nerve pathways. The operation was "blind" in the sense that he could not see where his instrument was cutting. Freeman performed thousands of these operations across the United States between 1946 and 1967.

As El-Hai asserts, Freeman is a biographer's dream. Freeman was the ultimate self-promoter and showman. He was a prolific writer, correspondent, and recorder of events and opinions. It is fortunate for his biographer that Freeman's contemporaries have provided reams of material that allow corroboration or contradiction of Freeman's perspective. For example, the circumstances surrounding the crucial episode when his loyal colleague, James Watts, found Freeman performing a transorbital "ice-pick" lobotomy in their shared offices, were very fully—but differently—described by Freeman and by Watts. El-Hai has made good use of material provided by Freeman's family and by archivists of the George Washington University to provide detail and balance. El-Hai quotes and refers respectfully to his predecessor historians Valenstein, Pressman, Shutts, and Shorter.

El-Hai seems to agree with Freeman that his story may be divided into three phases. The first phase, childhood and education, was played out in Philadelphia. Freeman's father was a physician, and his grandfather, William Williams Keen, was an illustrious Philadelphia surgeon who treated and advised several American presidents. Freeman venerated his grandfather and craved his fame and standing. Freeman found the perfect stage to enact his main dramas when he arrived in Washington in 1924. He labeled the second phase (1924–1954) a period of accomplishment. At St. Elizabeth's Hospital, he performed autopsies and aligned himself firmly with biological approaches to psychiatric treatment. In 1935, the Portuguese physician Egas Moniz invented leucotomy. In September 1936, Freeman and Watts performed the first leucotomy in the United States. Close to fifty thousand lobotomies were performed in America during the following decades, several thousand by Freeman himself. The third phase, that of decline, commenced with Freeman's move to California in 1954. El-Hai aligns these phases in Freeman's life with the history of lobotomy's birth, triumph, and decline. However, El-Hai also divides Freeman's story around the pivotal year of 1946. In that year, Freeman invented transorbital ice-pick lobotomy, fell out with Watts, and abandoned any semblance of acceptable psychiatric practice. Also in that year, Freeman watched helplessly as his son, Keen, fell to his death in an accident at Yosemite. El-Hai vividly portrays these events in the chapter titled "Waterfall." The synchronicity of these professional and personal dramas is astounding.

In his prologue, Jack El-Hai promises to address two "central questions": "What accounted for Freeman's attraction to this drastic and damaging form of psychiatric treatment?" and "Why did he stay with it for so long, even after most other physicians had abandoned it?" (pp. 3–4). A coherent response to these excellent questions deserves a chapter of systematic analysis. Instead, El-Hai's answers are scattered and piecemeal. El-Hai explains Freeman's quest for medical achievement and fame by reference to...