Lobotomy Doctor - Miracle Maker or Monster

From the Friday, January 18, 2008, Toronto Star, Living section, page L2, an article about a documentary about the doctor who started using lobotomies in dealing with mental illness:

Ice Pick Surgery

A MIRACLE WORKER OR A MONSTER?

Documentary looks at legacy of doctor who pioneered lobotomies to treat mental illness

Stuart Laidlaw
Faith and Ethics Reporter

With ambition blinding him to both critics and his own failures - including patients who died on the operating table - Dr. Walter Freeman inserted an ice pick into the skulls of almost 3,000 people, swished the cold steel instruments about "like a windshield wiper" and earned a reputation as the world's top lobotomist.

A new PBS television documentary looks at the legacy of the man hailed as an angel of hope by some, but as a monster by most.

"This is a man who believes he is born to medical genius," Andrew Scull, University of California sociology professor, says in the PBS documentary The Lobotomist airing Monday evening.

The story might have taken place decades ago in post-war America, filmmaker Barak Goodman says, but it is a reminder of how easily things can go astray when overzealous researchers combine with a press hungry to report the next miracle cure, and with families desperate to alleviate a loved one's suffering.

"It's a really great cautionary tale," Goodman says in a phone interview. "The dynamic that was at play then is something that we need to be wary of today."

Freeman was able to do his work at a time when patients did what doctors told them. There was little in the way of informed consent before doctors prescribed procedures, leaving doctors great freedom to try new techniques.

Today, patients must be told of the risks before they agree to treatment, and ethics boards at both hospitals and research facilities keep an eye on the work being done. If you've ever wondered why such things are needed, The Lobotomist offers a chilling answer.

Freeman, grandson of pioneering brain surgeon William Keen, was driven to make his own mark in the medical world. After stumbling onto an obscure study by Portuguese neurologist Egas Moniz in 1936, he knew he had his answer.

Working at one of the U.S.'s largest mental hospitals, St. Elizabeth's in Washington, D.C., Freeman expanded on Moniz's work severing neurological links in the brain to completely detach the frontal lobe from the rest of the brain.

It came to be known as a lobotomy. At first, he had to work with a neurosurgeon named James Watts in a lengthy and complicated procedure that involved operating rooms, specialized equipment and full surgical staff. Freeman would sit on a stool directing the action.

He later came up with a method to reach into the brain through the eye cavity, and no longer needed Watts. For years, he was hailed as a hero, feted by the medical establishment, the press and the families of his patients for offering a simple solution to great suffering.

Freeman simply pulled back the eyelid, inserted an ice pick above the eye, tapped it with a hammer to get it into the brain cavity, swerved it back and forth and pulled it out. The same was then done to the other eye, and the patient was sent home within hours - wearing sunglasses to mask the two black eyes.

"The first ice picks came out of our kitchen drawer," recalls Freeman's son, Franklin.

The procedure could be done anywhere; an examination room, an office, or surgical theatre. Freeman once went to a hostage taking, performing a lobotomy at the scene as police held the suspect down. Patients were often awake during the procedure, and told by Freeman to perform mental tasks such as reciting the alphabet or the Lord's Prayer so he could measure his progress.

"He had kind of a perverse need to shock people," Elliot Velenstein, a neuroscience professor at the University of Michigan, says in the film.

Freeman had his ticket to fame. He toured the U.S. teaching others, sure to have the local press on hand to write stories about him and his work. Deemed "surgery of the soul" by The New York Times, reporters hailed the lobotomy as a miracle cure for mental illness.

"The next thing you know, you have this story out there not of damaging the brain, but of plucking madness from the brain. And it's such a story of promise," Robert Whitaker, author of Mad in America, says in the film.

Families, including the Kennedys, flocked to him and those he taught for help. Freeman himself lobotomized more than 2,900 people, including a 4-year-old. But by the late 1940's, more than 5,000 ice pick lobotomies were being performed across the U.S. annually.

As criticisms began to mount that the cure was worse than the illness and not as safe as heralded, Freeman bullied on, convinced of his discovery's importance even as the evidence built up against it.

By the late 1960s, with drugs becoming the preferred treatment for mental illness, lobotomies fell into disrepute, taking Freeman's reputation with it. He died in 1972, still trying to prove the effectiveness of the procedure. Goodman says the story, however, is far from over.

"What's really interesting is why the wider community allowed it to happen. What was the failure there? Why was there no oversight? And that's what we can learn from," Goodman says.

"There will always be Walter Freemans. The key is how to prevent Walter Freemans from getting their hands on too many patients."

The Lobotomist airs Monday, 9 p.m., PBS.

Schizophrenia

From the World Health Organization, http://www.who.int/en/, information about schizophrenia, http://www.who.int/mental_health/management/schizophrenia/en/:

SCHIZOPHRENIA

What is schizophrenia?
Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity.

Facts
Schizophrenia affects about 24 million people wordwide.

Schizophrenia is a treatable disorder, treatment being more effective in its initial stages.

More than 50% of persons with schizophrenia are not receiving appropriate care.
90% of people with untreated schizophrenia are in developing countries.

Care of persons with schizophrenia can be provided at community level, with active family and community involvement.

There are effective interventions (pharmacological and psychosocial) available and the cost of treatment of a person suffering from chronic schizophrenia is about US$2 per month; the earlier the treatment is initiated, the more effective it will be. However, the majority of the persons with chronic schizophrenia do not receive treatment, which contributes to the chronicity.

Pilot programmes in a few developing countries (e.g. India, Iran, Pakistan, Tanzania, Guinea-Bissau) have demonstrated the feasibility of providing care to people with severe mental illness through the primary health care systems by:

* appropriate training of the primary health care personnel;
* provision of essential drugs;
* strengthening of the families for home care;
* referral support from mental health professionals, and
* public education to decrease stigma and discrimination.

Do You Know the Warning Signs of Suicide?

Knowing these facts may help you to help yourself or family members or friends or coworkers to get help when needed in dealing with thoughts about suicide.

From the American Association of Suicidology, http://www.suicidology.org/displaycommon.cfm?an=2, here is an article about understanding the warning sides and what to do to help.

UNDERSTANDING AND HELPING THE SUICIDAL PERSON

Be Aware of the Warning Signs

Are you or someone you know at risk of suicide? Get the facts and take appropriate action.

Get help immediately by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral should you witness, hear, or see anyone exhibiting any one or more of the following:

Someone threatening to hurt or kill him/herself, or talking of wanting to hurt or kill him/herself.

Someone looking for ways to kill him/herself by seeking access to firearms, available pills, or other means.

Someone talking or writing about death, dying or suicide, when these actions are out of the ordinary for the person.

Seek help as soon as possible by contacting a mental health professional or calling 1-800-273-TALK (8255) for a referral should you witness, hear, or see someone you know exhibiting any one or more of the following:

Hopelessness
Rage, uncontrolled anger, seeking revenge
Acting reckless or engaging in risky activities, seemingly without
thinking
Feeling trapped - like there's no way out
Increased alcohol or drug use
Withdrawing from friends, family and society
Anxiety, agitation, unable to sleep or sleeping all the time
Dramatic mood changes
No reason for living; no sense of purpose in life

Here is an easy mnemonic to remember these warning signs:
IS PATH WARM?

I Ideation
S Substance Abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood Changes

What To Do

Here are some ways to be helpful to someone who is threatening suicide:

Be direct. Talk openly and matter-of-factly about suicide.
Be willing to listen. Allow expressions of feelings. Accept the feelings.
Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.
Get involved. Become available. Show interest and support.
Don’t dare him or her to do it.
Don’t act shocked. This will put distance between you.
Don’t be sworn to secrecy. Seek support.
Offer hope that alternatives are available but do not offer glib reassurance.
Take action. Remove means, such as guns or stockpiled pills.
Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Be Aware of Feelings

Many people at some time in their lives think about completing suicide. Most decide to live because they eventually come to realize that the crisis is temporary and death is permanent. On other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and thoughts they experience:

Can’t stop the pain
Can’t think clearly
Can’t make decisions
Can’t see any way out
Can’t sleep, eat or work
Can’t get out of depression
Can’t make the sadness go away
Can’t see a future without pain
Can’t see themselves as worthwhile
Can’t get someone’s attention
Can’t seem to get control

If you experience these feelings, get help!

If someone you know exhibits these symptoms, offer help!

Contact:

A community mental health agency
A private therapist or counselor
A school counselor or psychologist
A family physician
A suicide prevention or crisis center

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