The Man Who Championed Lobotomies: Separating Man from Monster

Walter Freeman, the American neurologist and psychiatrist who devoted his career to championing lobotomy as a treatment for psychiatric disorders, died thirty-five years ago. His reputation was then at a low ebb, and it has not since risen appreciably. It is tempting to write off Freeman as a fringe figure in American medicine — an aberrant doctor who somehow managed to get his hands on 3,400 psychiatric patients so that he could treat them with his infamous ice pick and leave them much worse for the experience. We now consider lobotomies abominable and possibly criminal, so why attach much significance to Freeman’s work?

I began researching Walter Freeman’s life a bit cynically, with exactly that point of view. I guessed that if I ever published anything about him, it would be a chronicle of the doctor’s misdeeds. Eleven years of research and my publication of a biography of Freeman, however, have led me to change my opinion of him, largely because of the effect of a particular kind of information: context. Historians love context, but it always seems in short supply when we make judgments about controversial figures — especially notorious ones.

I first felt the weight of this context early in my research, when I faced the abundance of documents that Freeman left in the wake of his long career. These papers fill boxes in the archive at George Washington University, where Freeman taught neurology for a quarter-century. I spent many days paging through Freeman’s diaries, correspondence, and files. I was surprised to find hundreds of letters and Christmas cards that he received from his lobotomy patients. I hadn’t realized that these people could pick up a pencil or operate a typewriter after their surgeries, much less write eloquently about their lives. In many cases, they praised Freeman for his work, regarded him as a member of their extended family, and considered themselves lucky to have been treated by him.

The cynic in me felt suspicious of their gratitude. Were they simply trying to please their doctor? Had their lobotomies addled their judgment?

Later in the archive I turned up a collection of photographs that, in retrospect, seems to have awaited me in ambush. The photos were contained in an unmarked three-ring notebook, completely ordinary looking on the outside. Inside was shocking evidence.

The photos showed front, rear, and side views of dozens of dead patients from St. Elizabeth’s Hospital in Washington, D.C., where Freeman worked during the 1920s as director of laboratories. In these images, nude and wasted bodies, young and old, horrifying to see, dangled from hooks. Years before he performed his first lobotomy, Freeman had photographed these corpses to determine whether various physical abnormalities accompanied mental disorders.

Initially, these photos hardened my abhorrence of Freeman and sickened me. They seemed proof of an appalling disrespect for the dead. I left the archive to gulp fresh air and think. Did I really want to write a book about this man? How would I tolerate spending years documenting a career that seemed to jump from one horror to another? Could anyone stand to read about such a doctor?

When I returned to the archive and resumed my seat among the fragments of Walter Freeman’s life, I felt highly aware of my surroundings. I noticed the flicker of the overhead lights, the texture of the papers, and the tangy smell of aged documents and moldering photographs. A shift was occurring in my thinking. For a moment, I stopped pondering the awfulness of Freeman’s deeds. My thoughts turned to the doctor himself. I wondered what it was like for him to work among hanging corpses and surgical ice picks.

In his writings, Freeman admitted that he found aspects of his work grisly and repellent. Then why engage in such work? The moment I asked that question, I transformed from cynic to biographer. The cynic criticizes motivation, while the biographer tries to understand it. From then on, I focused my research on Freeman’s motives and character — a far more rewarding pursuit than documenting his apparent transgressions. What accounted for this undeniably gifted physician’s attraction to lobotomy? Why did he stubbornly remain faithful to the procedure for so long?

I found answers in the state of psychiatric medicine before the mid-1950s. Patients could choose few effective treatments for serious psychoses. Many patients faced years, sometimes decades, spent warehoused in abysmally run state institutions. The doctors treating them were overwhelmed and dispirited. Lobotomy grew not only out of Freeman’s intense drive, born in childhood, to attain great heights in medicine, but also out of the desperation of an entire medical specialty. Many lobotomies turned out badly; some benefited patients. Freeman’s advocacy of the operation — an atrocity to the casual observer today — makes sense in the context of the whirlwind of his career and personal life.

As a cynic, I could not have entertained that possibility. But as a biographer who had entered the world that surrounded Freeman as he invaded the brains of those 3,400 patients, I could distinguish the man from the monster.