The most controversial Nobel Prize of them all?

Hammering a glorified icepick through the top of the eye socket to poke around the brain reads like an act of medical barbarism from a time long since passed (a sister surgery to the ancient act of trepanning, perhaps) yet operations were performed routinely as late as the 1960s with the majority falling between the late 1940s and early 1950s – not even an average lifetime ago (Tartakovsky, 2019). In fact, one of the youngest, at 12 years old, and most notable recipients of the procedure, Howard Dully is still alive today having written a memoir of his experiences in 2007.

To declare: a detailed account of the practice or indeed the wider history of psychosurgery will be beyond the scope of this article. I myself do not, by any means, claim expertise or even any developed knowledge beyond select trivia. This writing serves as much as a personal learning experience as it does a more formal commentary.

Disclaimers aside, as I delved deeper into the procedure’s controversial history, I was drawn repeatedly to the nature of the patients themselves. Who was chosen and why? A 2017 article in Nature (Terrier, Levêque, & Amelot, 2017) reveals that “84% of 1,340 subjects of the surgical procedure were female patients”, when considering lobotomies in France, Switzerland, and Belgium in the period 1935-85. Similar findings are apparent in records from other countries.

One journal from Sweden (Ogren, Sjöström, & Bengtsson, 2000) states that “the majority of the 704 patients who underwent lobotomy at Umedalen Hospital were women”. In the United States, “a 1951 study of the nation’s hospitals found that nearly 60% of patients subjected to lobotomy were women” (Johnson, 2014). When analysing Stockton State Hospital in California, 85% of lobotomies performed there were upon women – despite male patients outnumbering female patients during that time.

Neurologist and lobotomy advocate Walter Freeman himself had identified supposedly ideal candidates for his transorbital lobotomy – namely African American women. Freeman spoke of “the greater family solidarity manifested by these people” and provided a chilling anecdote as to the supposedly improved condition of twenty African American patients a short while after he operated upon them (El-Hai, 2016). Furthermore, seventeen of Freeman’s first twenty psychosurgical patients were women.

What was the general rationale behind this demographic skew? Jack El-Hai, author of The Lobotomist, writes that “a preponderance of women suffering from depression and other affective disorders may be partly responsible, but agitated and boisterous behaviour in women was less acceptable to doctors of Freeman’s time than the same behaviour in men” (El-Hai, 2016). The Nature article (Terrier, Levêque, & Amelot, 2017) cites the inferior status of French women stemming from the Napoleonic Code of 1804 as a possible factor. Jennell Johnson’s book American Lobotomy: A Rhetorical History provides explicit detail as to the psychiatric treatment women received in comparable cases to men (Johnson, 2014).

From an observer’s perspective, it appears that lobotomies were utilised as another tool against the oppressed and non-consenting – women, African Americans, and even children being the frequent subjects of this procedure. When coupled with archaic attitudes towards mental health and the readiness to perform inhumane procedures, the results were often devastating. As Howard Dully himself said: “Walter Freeman’s operation was supposed to relieve suffering. In my case it did just the opposite. Ever since my lobotomy I’ve felt like a freak – ashamed.” (‘My Lobotomy’: Howard Dully’s Journey, 2005)

Ben Himsworth is a Niche analyst

Contact Ben.Himsworth@nicheconsult.co.uk