When Rosemary Kennedy died on January 7, we lost a promising life and one of our last survivors from the era of lobotomy. Between 1936 and the 1970s, 40,000 to 50,000 Americans received psychosurgeries in government hospitals, private institutions, and doctors' offices. The news of Kennedy's passing will revive images of that dark time in the history of psychiatric medicine: the filthy back wards in mental hospitals, sick people in restraints, sharp instruments violating the brain, the vacant eyes of permanently damaged patients.
I'm familiar with these images because they haunted me during the early months of my work on a biography of Dr. Walter Freeman, the lobotomist who operated on Rosemary Kennedy in 1941 along with his neurosurgeon partner, James Watts. I began my research thinking of Freeman as a monster at worst and as a seriously misguided physician working at the fringes of medicine at best. Rosemary Kennedy's case in particular seemed to blast Freeman's morals, ethics, and abilities. Here was a beautiful young woman, the product of a spirited family, who suffered from mood swings. Whether her emotional difficulties were caused by birth trauma, learning disabilities, or an inborn brain defect -- her exact disorder remains unclear -- her behavior disturbed her father. By some accounts, Rosemary's behavior grew increasingly volatile after 1939, and there are stories of her smashing objects and even kicking her grandfather. Outbursts of anger and bouts of depression may very well have been her response to her sense that she did not belong in her family and that her parents felt dissatisfied with her as she was. Her father could only see Rosemary's behavior as a threat to the political aspirations he held for his sons.
He soon turned to Walter Freeman, who had performed the first U.S. lobotomy in 1936 at George Washington University. Freeman agreed to undertake the surgery. The nightmarish result was a woman inert and unable to speak more than a few words. Kennedy eventually regained the ability to walk but permanently lost the initiative and mental capabilities she needed to live with even partial independence. Significantly disabled, she lived for more than fifty years at a convent school in Wisconsin.
This was an undeniable disaster and a blot on Freeman's reputation and medical judgment. As I began investigating his life, I had to wonder whether I really wanted to immerse myself in the life of a man who could perform such an operation in the guise of medical healing. But over time, as I absorbed the content of the mountain of journals, memoirs, correspondence, articles, books, and patient records he left in the wake of his long career, I started to see Freeman differently.
Kennedy's lobotomy may well have been unacceptable even under Freeman's own standards for surgery. (His partner Watts, however, did diagnose Kennedy with "agitated depression," one of the strongest indications they used for psychosurgery.) Yet I soon came to recognize the shades of gray that surrounded the advent and promotion of lobotomy as a treatment for mental disorders during the middle decades of the twentieth century.
Before the mid-1950s, psychiatric medicine offered patients few treatments other than psychotherapy -- largely ineffective for patients with serious psychoses -- and shock therapy by electricity, insulin coma, or chemically-induced convulsions (Editor's note: Treatment with pharmaceuticals has become common). Many patients faced years, perhaps decades, warehoused in abysmally run state institutions. The doctors treating them were overwhelmed and dispirited. Lobotomy, I saw, was not simply Walter Freeman's aberrant passion, but a justifiable option in times of desperation -- and a treatment that sometimes returned patients to their lives as parents and family members and even as doctors, teachers, and musicians. In the lobotomy cases that Freeman considered successful, patients traded suicidal feelings, deep depression, and obsessive behaviors for indolence, lack of foresight, and other more manageable consequences of severed frontal lobes. (Freeman's lobotomies did not remove sections of the brain, as has frequently been reported.)
One other factor brought some 3,400 Americans, Kennedy among them, under Freeman's knife. It was the potent mixture of his strengths as a scientist and his fascinating flaws. He combined brilliance with arrogance, compassion with egotism, and determination with stubbornness. He worked tirelessly to advance lobotomy even as his personal life collapsed around him. Most new medical therapies fail to improve the lives of patients in the long run, and Freeman's brand of psychosurgery has proven no exception.
The era of lobotomy ended long ago, and Freeman died in 1972. Rosemary Kennedy's spirit and membership in a dynamic family ensures that she will be remembered for more than her lobotomy. There is one lesson we can learn from her life that has nothing to do with a young woman's psychiatric problems, a father's misplaced faith in the curative powers of a new medical treatment, or a physician's drive to be seen as an innovator. It is that the healthiest families guide children toward happiness and independence by appreciating and cultivating the qualities they already have. Rosemary was born into a family that wished her to be something different, and that added to her suffering.
Jack El-Hai is the author of The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness, published this month by John Wiley & Sons. The book s website is at http://lobotomist.com.