Steve Doyle

Madness!

The pioneer has his place in medical research. . .On the other hand it is important in medicine to recognize fully the responsibility with regard to those who follow voluntarily, that is physicians; to those who follow blindly, that is lay people; and to those who are forced to follow, that is patients.

—Oskar Diethelm (1939)

Is the quieting of the patient a cure? Perhaps all it accomplishes is to make things more convenient for the people who have to nurse them.

—Nolan Lewis (1949)

I

New York City, 1935

“We're lost, aren't we? I know it. We're lost! You got us lost! Can't you do anything right!?”

Wipers slapped away in vain at relentless torrential rain. Theodore squinted through cascading sheets into the glare of blurry lights. Buildings towered over the little Ford as he navigated through narrow streets choked with traffic. He had never seen so many automobiles, or buildings for that matter. Theodore was indeed far from home. Beside him, his wife squirmed in her seat and wrung her hands between outbursts.

“I can't believe you got us lost. But then I can. I should have expected it. You can't do anything right. Oh, God, where are we? We're never going to get there you know. We should have let Archibald drive us, but no, you didn't want to arrive too early! Now we're going to miss his talk and it's all your fault. Our son-in-law's big chance to impress the big-shot city doctors and we're not even going to see it. I never should have married you! What was I thinking?”

Used to such haranguing, Theodore pursed his lips and kept his own mouth shut, but resolved to speak with Archibald. He'd been thinking about it for some time, even had an occasional opportunity, but let it pass because he dreaded the discussion. However Alice was getting worse and it was becoming more and more obvious that something had to be done. Her anxiety, insomnia and depression had worsened; she had even mentioned suicide. They'd come to New York to attend a conference and hear their son-in-law, a well-respected physician back home in Kansas, present a paper. Theodore decided that afterwards he would brooch the deplorable subject, the only course he believed open to Alice. Institutionalization.

II

Washington, D.C., 1936

“Thank you for seeing me, Doctor Freeman. My son-in-law speaks very highly of you.”

The two men, both slightly over six feet tall, shook hands. “Archie's a good chap. He tells me your quite concerned about your wife. Please, have a seat and tell me about it.”

The older man removed his charcoal gray fedora and sat down. “Alice is the youngest of five girls. Her parents seem to have spared the rod and spoiled the children. She learned early on to throw tantrums in order to get her way and she continues to use such childish behavior to this day. She will fly into a rage at the smallest nuisance and the slightest inconvenience absolutely infuriates her. Her anxiety drives her to distraction and her fussiness distresses me. But the thing that worries me above all is her recent talk of suicide.”

“Suicide?” The neurologist raised an eyebrow and shifted in his leather seat. “That is very serious indeed. Please elaborate on that.”

Theodore slumped in the chair and rubbed his forehead for a moment with his fingertips. “Three years ago my brother killed himself. Alice has brought that up and suggested he's probably better off.”

“I see. Is she currently taking any medication?”

“For more than a decade she's been using sedatives to help her sleep, but lately they haven't been giving her any relief.”

“Archie tells me you're exploring the option of having her committed.”

Theodore's eyes dropped to focus on his hands, fingers nervously traversing the wide brim of his hat. “I've been married to Alice for more than thirty years. I've grown used to her constant badgering and rapidly shifting mood swings, but her erratic behavior has become more than I can bear. One day she stood in front of a mirror and actually urinated all over the floor.”

Dr. Freeman stroked his goatee and nodded. “Hmmm.” He lay his pencil down atop the yellow notepad and leaned forward, mousy eyes fixed on his visitor. “A year ago the mental hospital would be her fate, surely. But today there may be an alternative, no doubt the reason Archie has sent you to me. There is a new procedure which has been used with some success in Portugal to treat people who exhibit the same symptoms as your wife, namely agitation and depression.”

Theodore blinked. The clock on the wall ticked away seconds.

Dr. Freeman waited for his guest to say something. When he didn't the neurologist continued. “It's called prefrontal leucotomy^* and it involves surgery whereby we cut the nerve fibers connecting the frontal lobe to the rest of the brain.”

Theodore blinked again.

“Let me explain. Alice suffers from distractions caused by fixed ideas that interfere with her normal thinking. Now, these thoughts which have become stuck, are maintained by nerve pathways. When we sever these connections, we free the brain to establish new, clean ones.”

“You're going to actually cut into her brain?”

“I know it sounds frightening, but it's really no different than any other part of the body. People once scoffed at the idea of surgery and who knows how many poor souls suffered and even died because no one dared attempt to remove a ruptured appendix?”

“Do you think it will help Alice?”

“I believe Alice is an ideal candidate. And consider the alternative is permanent placement in an institution where there are more patients than beds. A place where she would be neglected at best and possibly abused. Her situation would be hopeless. Moreover, her condition would continue to deteriorate. On the other hand, this new procedure holds forth the hope of giving her at the very least a chance to keep her freedom.”

“Okay, Doctor Freeman.”

“I'd like to have you bring her in for an examination. The receptionist can make an appointment.”

“Thank you, Doctor.” The men rose from their seats and shook hands again.

III

The thin woman stood with arms crossed and foot tapping, head tilted slightly to one side. “My husband says you can help me sleep. The bromide isn't working.”

Dr. Freeman ran a hand over his balding head. “Your husband and I have discussed a possible treatment for your insomnia as well as your anxiety and depression.”

“What sort of treatment? I just told you my sedatives aren't working. Theodore, he's not listening.”

“Listen to what he has to say, Alice. He's a doctor.”

She raised her already high-pitched voice. “Don't tell me what to do! You're always telling me what to do!”

Theodore and Dr. Freeman exchanged a quick glance. The neurologist offered the couple seats. “Would you mind telling me if you suffer from anything other than the symptoms I've already mentioned? What is the state of your general health?”

“What? Why are you asking me that? What does that have to do with anything?”

“In order to treat you effectively I need to know all that ails you, don't you agree?”

Alice clasped and unclasped her hands, eyes drifting up to the ticking clock. She lowered her voice to a whisper. “Sometimes my stomach hurts.”

Theodore nodded. “She suffers from ulcers.”

Alice turned on him, arms flailing. “I was going to tell him! I know about my own health! I can talk to him you know, he's only a doctor!”

“It's all right,” Dr. Freeman said. “Do you feel your emotions often dictate your actions?”

Alice shook her head vigorously. “No more than anybody else. Tell him, Theodore, I'm no more emotional than anybody else.”

Dr. Freeman smiled at Theodore's raised eyebrows. “Do you feel like you worry a lot?”

“Oh yes, I worry about all kinds of things. My hair; I'm constantly worrying about my hair, especially how it looks in back. And Theodore; I worry about him all the time. If he's late from work I get anxious. I mean he may be out looking for someone younger. I'm sixty-three you know.”

“I wouldn't have guessed that. You look much younger.”

“It's my hair. I take very good care of my hair. I've always had luxurious curls.” Alice primly patted the top of her thinning scalp.

“Do you know why you worry so much?”

The woman shook her head slowly. Dr. Freeman tapped one side of his forehead. “It's up here. Right here in the front of your brain is a worry center. Everyone has one but yours is working overtime. Worse, it's causing you to have some very dangerous thoughts.” Alice looked down quickly, breaking eye contact. Dr. Freeman continued. “What we need to do is make it stop; to separate your emotional brain from your rational brain, so you can get on with your life without so many distractions, so many worries.”

Alice resumed eye contact with the doctor. “There is nothing wrong with my brain. Theodore, tell this man there's nothing wrong with my brain.”

Dr. Freeman smiled. “Think of an apple. It may look appealing, delicious even, but still be wormy at the core. The operation I'm proposing is very much like coring an apple. We go in and cut out the bad parts, leaving the rest intact. And it will heal with time. It's just like extracting a tooth.”

“I don't want you to cut up my brain. Theodore, tell this man I don't want him cutting up my brain.”

The doctor shook his head. “I'm afraid a mental institution may be in your future if we don't do something now to stop your bad thoughts from getting worse. If you wind up in one of those hospitals you will be helpless and your situation will be hopeless; there's a good chance you would be there for the rest of your life.”

Alice's eyes welled up with tears and she wailed. “I don't want to be helpless! Theodore, don't leave me helpless!” She leaned over and sobbed into his shoulder.

Theodore gently patted her back. “It'll be all right, Alice. We'll listen to the doctor and everything will be okay.”

“My diagnosis is that you're suffering from agitated depression. I'd like to check you into the George Washington for observation. Then, if you both still want to proceed, we'll go ahead with the operation and you'll be able to go home after about two weeks.”

Alice continued sobbing. Theodore nodded his assent. “Whatever you think is best, Doctor.”

IV

George Washington University Hospital, 1936

Nurse Nutt looked up from the front desk to see the neurologist coming through the glass door. “Thank God you're here, Doctor Freeman. Your latest patient has really been putting us out.”

“Really, how so?”

The nurse hung her head. “I don't mean to complain, Doctor, but she's a difficult one, she really is.” She raised her face again. “Why, some of the girls want to sedate her and be done with it. But I wouldn't let them, no sir. I said, ‘Doctor Freeman said we are to observe her and we can't do that very well if she's asleep all the time’.”

“Very good. Well done, Nurse Nutt.”

“She hardly sleeps at all, but alternates between laughing hysterically and crying uncontrollably. She struggles so much when we try to take her blood pressure or check her pulse that it takes several members of the staff to hold her still.”

“She's—” A shrill cry interrupted Dr. Freeman's question.

“What?! Nobody told me that! You can't do that! I want to see Doctor Freeman, right now!”

Nurse Nutt nodded in the direction of the yelling. “Guess who.”

Dr. Freeman hurried to the end of the hallway but walked calmly into the room. A nurse holding shears stood apprehensively in the corner. Alice was sitting up in the bed, hands on top of her head. She looked to the neurologist, her eyes ablaze with fury. “My hair! My hair! You never said anything about cutting off my hair! You can't do it! I'll be ugly! Forget about this operation, I can't do this!” She began rocking and sobbing.

“It's all right. It's all right. I'll tell you what, you can keep your hair and we can still do the operation. We'll just work around it; you'll wake up with all your curls intact.”

She looked at him with red-rimmed eyes and sniffed. “Really?” He nodded. “Okay. I'll do it then, but don't cut off my hair.” She wagged a warning finger at him.

Another man entered the room and exchanged greetings with Dr. Freeman. The nurse in the corner said, “Boy, am I glad to see you.”

Alice's eyes narrowed to slits. “Who is that man? What does he want here? What's he going to do to me? Tell him to go away.”

The man held up a large needle. To Dr. Freeman he said, “Avertin,” at which the neurologist nodded. He approached Alice's bedside. “This is just a little anesthetic so you don't feel anything during the operation.”

She focused on the needle, eyes wide as saucers, and she began to struggle. “No, no, no, no!” A pair of orderlies, on standby in the hallway, rushed into the room. Their strong arms held her so she could barely wiggle and the anesthesiologist plunged the needle into her buttock. In combination with nitrous oxide gas, the drug soon rendered her unconscious. Her hair was sheared off to the line of her ears.

In the operating room, Doctors Freeman and Watts prepared for the surgery, the first of its kind to be performed in the United States. “This is groundbreaking. We are pioneers in the field of psychosurgery,” Freeman said.

With a shake of his head, Dr. Watts replied, “People generally think of me as conservative; this is going to change that for sure. I'm about to operate on a physically normal brain. I can't believe I'm doing this. It's radical.”

They took up positions on each side of the patient. Working on the right, Dr. Freeman chose a scalpel and cut into Alice's scalp while Dr. Watts did the same on her left. After stopping the bleeding, the men employed drills to bore into her skull. Into the hole they inserted a leucotome, a knife-like instrument, to a depth of about four centimeters. Dr. Freeman pushed a button on the end of the tool, causing a wire loop to protrude at the other end. He slowly rotated the leucotome, allowing the loop to cut a swath through nerve fibers. Once it had gone full circle, he retracted the loop, backed the tool off about a centimeter, and cut again. He backed off a third time and cut yet another core. Satisfied, the neurologist extracted the leucotome, re-inserted it at a different angle, and began cutting three more cores.

“Like a knife through butter.” Dr. Freeman risked a glance at Dr. Watts. Everything was going smoothly until red liquid gushed up onto his hands. The loop had caught and severed a blood vessel. Frantically, Dr. Freeman untangled the instrument and hurried to stem the crimson flow. After a harrowing moment, they were able to stabalize the patient and her vital signs returned to normal. The surgeons stitched up her scalp and bandaged her head. The operation had taken one hour.

Several hours later Alice awoke to find the neurologist standing beside her bed. “Feeling better?”

“Yes, Doctor, much better, thank you.” She rubbed a paper handkerchief over her face.

“Do you know where you are?”

“George Washington University Hospital.” She rubbed her arms, then her face again.

“Are you happy?”

“Yes.” She rolled the handkerchief into a ball, then unrolled it.

“Do you remember being upset when you came in here?”

“Yes, I was quite upset, wasn't I?” She rubbed the kerchief over her face.

“What was it all about?”

“I don't know. I seem to have forgotten. It doesn't seem important now.”

The doctor beckonned and Theodore entered the room. “Hello, Doctor. Hello, Honey.”

Alice smiled peacefully and offered her hand. “Hi. I've been having an adventure.”

Dr. Freeman said, “We'll be keeping a very close eye on her for the next few days.”

Alice giggled and wagged a finger toward the doctor. “And I'll be keeping a very close eye on them, too.”

Over the next several days, Alice continued to improve. She slept well and showed no signs of anxiety. She read magazines and demonstrated an ability to discuss the articles she'd read. Dr. Freeman checked on her daily. A week after the surgery he spotted Nurse Nutt in the hallway. He told her he was on his way to see Alice.

The nurse accompanied him. “Since her operation I haven't heard a single complaint from any of the girls. She's docile as a lamb. She lets us check her vitals with no trouble at all, in fact she smiles the whole time. Where before every little thing upset her, now nothing does.” Nurse Nutt put a finger to her chin. “We have had to teach her to eat with a spoon, though. It's as if she'd forgotten how. Oh, and if she doesn't like the taste of something, she doesn't complain like she did before, she just spits it out.”

They walked into her room and Dr. Freeman gave her a greeting. “Good morning. How are you today?”

Alice returned a blank stare. “How you who you say?”

“I asked how you were.” Dr. Freeman eyed her apprehensively.

“Who you were were who?” She knitted her brows and seemed to be trying very hard to concentrate.

A look of concern cast a pall over the doctor's features. “Alice, how are you feeling?”

“You who you were you say too?”

“Do you know where you are?” Dr. Freeman removed a retinoscope from his shirt pocket and leaned in to examine Alice's pupils.

“You who woo woo?”

Nurse Nutt stood frozen. “What's wrong with her?”

Dr. Freeman frowned. “I suspect she's suffering the effects of swelling, or possibly hemorrhaging, in her brain. I want you to keep her head elevated.” He wheeled around and rushed from the room.

“Right away, Doctor,” she called after him.

“Ooo who ooo,” came out of the patient.

Days drifted by and Alice slowly returned to “normal.” She could once again carry on light conversation, though she would not initiate any dialog and had to be prompted. Her stuttering disappeared. She could not write legibly, but Dr. Freeman thought time would heal that deficiency also. Her personality was completely altered and in some respects her maturity had reverted to that of a child, she would need to be toilet trained for instance, but her anxiety and depression, including her suicidal tendencies, seemed to have vanished. Dr. Freeman considered the results of her surgery a complete success. “Spectacular,” he wrote.

Ten days after her operation Theodore came to collect her and bring her home. She smiled at him. “Hi! I'm all better. See, they cut my hair.” She turned her head to show him. “I'm mostly bald now, isn't that silly?”

Epilogue

Five years after her surgery, Alice contracted pneumonia and died in 1941. She was sixty-eight years old.

Between 1936 and 1952, tens of thousands of these mutilations were performed in countries around the world, leaving seriously damaged people in their wake. In 1950 Doctor Freeman announced he would no longer recommend the prefrontal lobotomy he and Dr. Watts had developed and performed on Alice, but not because he'd given up on psychosurgery. Instead, he'd become an advocate of transorbital lobotomy, a method whereby the frontal lobes are accessed through the eye sockets, where the bone is much thinner and can be punctured by a sharp point rather than a drill. Contrary to a standard lobotomy, which took an hour, a transorbital lobotomy took about ten minutes. Dr. Freeman began performing these operations in his office as an outpatient procedure, prompting one colleague to write, “What are these terrible things I hear about you doing lobotomies in your office with an ice pick? I have just been to California and Minnesota and heard about it in both places. Why not use a shotgun? It would be quicker!”