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The Lobotomy Was SO Much Worse Than You Think

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The Lobotomy Was SO Much Worse Than You Think

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0:00

Rosemary Kennedy was a bright young

0:02

woman. Once she could read and write,

0:07

she would play with her siblings and

0:09

keep a diary. She engaged in social

0:11

events, traveled the world, and took

0:13

part in public life. Not without

0:16

difficulty. She'd been born with an

0:18

intellectual disability, and everyday

0:20

things were harder for her than for

0:22

other people. But she was otherwise a

0:24

regular, healthy woman, and above all,

0:28

she was happy.

0:30

But all of that changed after the

0:33

operation. Once out from under the

0:36

knife, Rosemary could no longer talk

0:38

intelligently. She struggled to walk.

0:40

She was incontinent. She was left with

0:42

the mental capacity of a young child,

0:44

and she needed around the clock care.

0:47

She was institutionalized shortly after

0:50

and so would spend the rest of her life

0:52

more than six decades in hospitals and

0:55

special schools. Her father never

0:58

visited her again. Her mother didn't for

1:00

20 years. You might have assumed this

1:02

was the result of some terrible accident

1:05

like from a harsh fall or perhaps a

1:07

major medical event like a stroke or

1:09

perhaps the operation was botched. But

1:12

it wasn't. Doctors did it on purpose and

1:17

called it progress. But we know it today

1:19

by a different name entirely,

1:22

the labbotomy.

1:24

And Rosemary wasn't the only one. Once

1:27

lorded as a breakthrough in mental

1:30

health medicine and neurology, tens of

1:32

thousands of labbotoies were performed

1:34

on people in the United States alone.

1:37

People celebrated it so much that the

1:39

man who pioneered it would receive a

1:41

Nobel Prize. So, how did it come to

1:44

this? How were thousands of people

1:47

irreversibly changed by a practice seen

1:49

as compassionate and scientific? Why did

1:54

it seem like a reasonable solution at

1:56

the time? And was it ever as black and

1:58

white as history remembers it? This is

2:02

the story of the labbotomy. how it

2:04

spread, who it hurt, and what it reveals

2:07

about medicine, mental health,

2:10

authority, and desperation.

2:17

Now, to understand how the labbotomy

2:19

came to dominate mental health

2:21

procedures for decades, we need to

2:23

understand some historical context of

2:24

the time during which it was developed.

2:27

And to do that, we need to go back to

2:29

the early 20th century. At this time,

2:31

new mental health conditions were being

2:33

officially medically categorized. Due to

2:37

the horrors of the First World War,

2:38

psychiatry and psychology was given a

2:41

new purpose as soldiers came back with

2:43

so-called war neurosis, resulting from

2:46

the stress and trauma of fighting the

2:48

most industrialized campaign ever

2:50

fought. Soldiers had been stood in soggy

2:53

trenches for four years, watching their

2:56

friends get blown to bits and shot to

2:58

pieces, resulting in severe

2:59

psychological conditions like

3:01

post-traumatic stress disorder, what

3:03

they called shell shock at the time.

3:06

Others suffered from brain injuries from

3:08

bullets and shrapnel that fundamentally

3:10

changed people's personalities or left

3:12

them permanently disabled. At the same

3:14

time, other conditions were gaining

3:16

mainstream attention in the medical

3:17

world, like schizophrenia for the very

3:19

first time, ushering in questions about

3:22

how to help those with such conditions.

3:24

Many in the Western world agreed that

3:27

mental health care was becoming an

3:29

increasingly important part of medicine

3:31

and that some of these people were

3:33

seriously unwell and needed looking

3:35

after. And this is how the asylum system

3:38

came to be. facilities that could hold

3:41

mentally unwell people for treatment.

3:43

But those treatment options were

3:45

limited. To put it nicely, psychiatry at

3:48

the beginning of the 20th century was

3:50

helpless in comparison to the modern

3:52

methods and medicines that we have

3:53

today. The asylums quickly became

3:56

overcrowded with patients, and drugs

3:58

like anti-depressants, antiscychotics,

4:00

and mood stabilizers just hadn't widely

4:03

been rolled out yet. If people were a

4:06

danger to themselves or others and they

4:09

were prone to violent outbursts, then

4:12

the only options at the time were pretty

4:14

barbaric. Straight jackets and other

4:17

restraints were common. Isolation,

4:20

electric shock therapy, insulin coma

4:22

therapy, and chemical shock therapy were

4:25

all heavily utilized in an attempt to

4:27

try and curtail people's conditions.

4:30

They were just unwell people but often

4:34

treated more like animals. Believe it or

4:36

not, asylums were seen as the kindest

4:39

option at the time. If people were

4:42

dangerous through no fault of their own,

4:44

say through mental illness, then they

4:46

couldn't simply be put in the workhouse

4:48

or in prisons like they had been before.

4:51

And so asylums were supposed to be

4:53

society's answer to keep both them and

4:56

the general public safer. But in

4:59

practice, this was of course rife for

5:02

abuse. Some psychiatrists were all too

5:05

eager to claim success for unproven

5:08

experimental treatments like some of the

5:11

ones we mentioned. But the asylums

5:13

quickly became full as people were

5:15

turfed inside for all kinds of reasons.

5:17

And there was pressure from above to see

5:20

them emptied. But mental health issues

5:22

were often seen as incurable and

5:24

degenerative because the science was

5:27

just so underdeveloped. The result was

5:30

asylons and hospitals buckling under the

5:32

sheer number of patients. In 1946, for

5:35

example, in the United States, nearly 1/

5:37

half of all public hospital beds were

5:40

devoted to what they called the mentally

5:43

ill. So, not only were psychiatrists

5:46

coming up with new experimental and

5:49

often harmful treatments, but there was

5:51

also a massive incentive from the system

5:54

to double down on these treatments. At

5:57

the time, there was this belief that

5:59

mental health issues were a result of

6:01

physical neurological problems that

6:04

could be solved or cured. Like with

6:06

other physical injuries, if you can cure

6:09

a faulty heart or lungs with surgery,

6:12

why not the brain? Of course, brain

6:15

surgery was a very new and highly

6:17

experimental idea at the time. Could

6:20

anyone pull it off and find the solution

6:24

to these problems?

6:26

Well, as it turns out, one man could.

6:31

But you're not going to like the answer

6:32

that he came up with. Meet highly

6:35

respected Portuguese neurologist Egazmon

6:37

Mones. Highly experienced in his field,

6:40

he was at a neurology conference in

6:42

London in 1935 when he first came up

6:44

with an idea for an experimental new

6:47

kind of psychosurgery. And in 1936, he

6:50

published his first report on what he

6:52

believed was a procedure that could

6:54

seriously alleviate the mental harm

6:56

people were facing. And here we actually

6:58

need to stop and talk about a few

7:00

different kinds of psychosurgical

7:02

procedures as well as medical theories

7:04

at the time that would inform the

7:05

process that monies would develop. Now

7:08

whilst neurology and brain surgery were

7:11

relatively new in terms of their

7:13

sophistication in medicine, some things

7:16

about the brain were known. For

7:18

instance, it was widely understood that

7:19

the frontal lobe was important for

7:22

emotional regulation. And it was also

7:24

known that damage to the frontal lobe

7:27

sustained by people wasn't always

7:29

immediately fatal like with other parts

7:31

of the brain. Even by the 1930s, the

7:34

famous story of Fineas Gage was

7:36

wellknown. He was a railway worker who

7:39

had a railway spike launched at high

7:41

speeds through his head and frontal

7:43

lobe. He survived, but his personality

7:45

was forever changed afterwards. So it

7:48

was understood that if there was

7:49

anywhere in the brain you were going to

7:51

cut a few sinapses out of, it should

7:53

probably be at the frontal lobe for the

7:55

lowest chance of death. Now, as we said,

7:58

this front part of the brain is really

8:00

important for emotional regulation, but

8:02

also things like reasoning, speech, and

8:05

executive functions like impulse

8:07

control, voluntary muscle movements,

8:10

social understanding, and even recalling

8:12

information. Moners didn't know much

8:15

about the frontal lobe at the time.

8:17

Nobody did. His theory around mental

8:20

illness was wrong but internally

8:23

logical. He believed that mental illness

8:25

was a physical issue caused by fixed

8:28

pathological circuits in the brain. That

8:31

literal physical white matter connected

8:33

together caused certain unhealthy

8:36

psychological loops, thoughts and

8:38

behaviors. If you could sever those

8:41

physical connections, then it should

8:43

stop the psychological loop of thoughts

8:45

that Mones believed contributed to

8:47

insanity, obsession, and compulsion.

8:50

This, according to Monise, could be

8:52

effective for agitated states, anxiety,

8:55

depression, and things like OCD as well.

8:57

What Manise was advocating for was a

8:59

procedure called a lucottomy. A

9:02

lucottomy's aim was to surgically cut

9:05

white matter connections in the frontal

9:07

lobe. The procedure would involve small

9:10

holes being drilled into the skull. Then

9:13

a lucatome, which is a surgical tool

9:15

with a wire loop on the end, would be

9:17

inserted to destroy the targeted brain

9:20

tissue. This differed from a lobectomy,

9:23

which is a really uncommon treatment

9:25

that included removing a portion or all

9:27

of the frontal lobe or any lobe on any

9:29

part of the body for that matter. John

9:31

Fton, a professor at Yale University,

9:33

experimented on chimps with lobectomies

9:36

to study effects on their behavior after

9:38

watching frontal lobe injury victims

9:40

during World War I. And it would be his

9:42

work on chimpanzees that would inspire

9:44

Mones at that 1935 London conference. A

9:48

labbotomy as we know it today wouldn't

9:50

come around until later. And whilst it's

9:53

described as a specific procedure later

9:55

on, it started out as more of a kind of

9:57

catch all term for psychosurgical

9:59

procedures performed on the frontal

10:01

lobe. Mones wasn't ignorant to the idea

10:05

of his lucottomy potentially being able

10:08

to fundamentally alter people's brains.

10:11

But the way he saw it, cutting those

10:13

connections in the frontal lobe, even

10:14

allowing for some behavioral and

10:16

personality deterioration,

10:18

outweighed the debilitating effects of

10:21

severe psychiatric illness. In other

10:24

words, the trade-off was seen as worth

10:25

it because it could help reduce the

10:27

numbers in asylums and genuinely

10:30

alleviate anguish for people, allowing

10:32

them to live relatively normal lives

10:34

with their families, even if their

10:37

faculties were slightly impaired. Now

10:40

there were issues with the lucottomy as

10:42

an idea. They were relatively limited in

10:45

scope and had to be done under general

10:47

anesthetic in a surgical setting which

10:49

made them long, timeconuming and

10:52

expensive. The procedure was seen as

10:53

somewhat controversial from the very

10:56

beginning and results were mixed. For

10:59

many lucottomies offered low

11:01

expectations of improvement among

11:02

certain mental conditions and especially

11:04

amongst those whose conditions had

11:06

deteriorated significantly. Mones

11:08

himself accepted that they would be

11:10

unlikely to benefit much from the

11:12

operation, but he considered the results

11:14

acceptable for the first and second

11:15

series of trials done on a few dozen

11:17

patients. It wasn't like the surgery had

11:20

no positive effects whatsoever.

11:22

According to Maners, of the patients in

11:25

the second group of 18 people, all

11:27

schizophrenic, three were categorized as

11:29

almost cured and another two also had

11:32

become much better. His conclusion was

11:35

that a preffrontal lucottomy is a simple

11:38

operation always safe which may prove to

11:42

be an effective surgical treatment in

11:44

certain cases of mental disorder. And

11:47

that's actually not entirely outrageous

11:49

to say. The dottomy was in theory and if

11:52

done right most of those things despite

11:55

the trade-off in a person's personality

11:57

that may result. But there's also reason

11:59

to believe that Mones's findings were

12:01

somewhat flawed. Mones almost never

12:03

performed the surgeries himself and

12:05

early trials were quite small, poorly

12:07

controlled and with no patient follow-up

12:10

to actually assess the effects that it

12:11

might have on a person over the long

12:13

term. Outcomes could also be seen as

12:16

vague and subjective where a patient

12:18

would appear calmer and less distressed

12:21

in general after the surgery. But it's

12:24

hard to know if this is because the

12:25

procedure worked as intended or just did

12:27

significant damage to make it so. In

12:30

that sense, the side effects of the

12:32

surgery could be reframed as successes.

12:34

If it left you bedbound for weeks during

12:37

recovery, then you would be calmer. It

12:41

wasn't necessarily about what was good

12:42

for the patient in total terms, but

12:44

their impact on society and their

12:46

immediate surroundings. Yes, I'm afraid

12:50

you're bedbound, but you are calmer and

12:52

easier to be around. Of course, this

12:54

sounds bad, but then it gets worse. You

12:58

see around this time an American doctor

13:00

by the name of Walter Freeman saw the

13:02

lucottomy and thought h not bad but what

13:05

if we could make this more efficient and

13:07

this is where the lobotomy officially

13:10

came to be as well as where its true

13:12

horror would also arise. Freeman pushed

13:14

for a widespread quick version of the

13:17

nuctomy which we know now today as the

13:19

labbotomy and the details of how they

13:21

were done is pretty horrifying. An

13:24

icepic like instrument would be inserted

13:27

into the patient's eye socket above the

13:29

eye before then being hammered through

13:32

the thin orbital bone to reach the

13:34

frontal lobe where the tool would be

13:36

swept left to right to sever connections

13:39

in the frontal lobe completely. This was

13:42

not the delicate white matter cutting

13:46

like Monese's lottomy, but instead a

13:49

complete mashing of the frontal lobe

13:52

from the inside, indiscriminate and

13:54

total. The transorbital lobotomy, as it

13:58

was known, already sounds like a ghastly

14:00

and barbaric procedure, but the extra

14:02

details make it even more grizzly. These

14:05

were done often outside of a sterile

14:08

operating theater, completed in mere

14:10

minutes, and were often done without a

14:12

surgeon or any anesthesia whatsoever.

14:14

All factors that differ significantly

14:18

from Monise's method. It would also be

14:21

repeated until the desired result was

14:23

reached. This allowed Freeman to mass

14:26

industrialize labbotoies across the

14:29

world because they were so quick and

14:31

cheap and easy to perform. By

14:34

comparison, he would perform assembly

14:37

line labbotoies at state mental

14:39

hospitals and asylums where

14:41

psychiatrists would identify patients

14:43

for the procedure and have them ready

14:44

for him when he arrived. On one

14:46

occasion, he labized 228 patients over

14:49

12 days for the West Virginia Labbotomy

14:52

Project. That's 19 people per day across

14:56

an 8hour day. That's faster than one

14:58

every half an hour. Hardly very long to

15:01

perform such a dangerous and complex

15:04

procedure. And to be honest, no one

15:06

knows if he even took that long. The

15:09

other scary part was the creeping scope

15:11

of the labbotomy as well. As its

15:13

popularity widened and spread across the

15:16

world from Freeman's methods, many were

15:18

subjected to it with a whole wide range

15:20

of differing conditions. At first, it

15:22

was mainly for people experiencing major

15:25

schizophrenia or a dangerous form of

15:27

psychosis that made them a threat to

15:29

themselves and others and in

15:31

considerable distress. But soon the

15:34

lobotomy would be seen as a kind of cure

15:36

all among doctors to conditions like

15:39

depression, anxiety, PTSD, ADHD, OCD,

15:44

and epilepsy. Some of you may even have

15:47

these conditions today. And if you were

15:49

alive back then, you might have found

15:51

yourself staring at Walter Freeman's

15:53

icepic a little too closely. Eventually,

15:56

labbotoies were even considered useful

15:58

procedures for people seen as having

16:00

behavioral problems like women and

16:02

children who were seen as difficult,

16:04

hysterical, or otherwise exhibited

16:06

inconvenient behaviors. In fact, later

16:09

studies would suggest that the majority

16:11

of those who were given the procedure

16:14

were women. But what actually happens to

16:17

them when a patient got a transorbital

16:20

labbotomy? What was their life like

16:22

afterwards? Well, across the board, the

16:26

results weren't good. The effects that

16:28

labbotoies had on patients were far more

16:31

expansive than Monese's lucottomy. Even

16:33

Freeman himself admitted that every

16:35

patient probably loses something by this

16:37

operation. Some spontaneity, some

16:40

sparkle, some flavor of their

16:42

personality. He also stated that the

16:45

best possible option for some patients

16:47

was to turn them into a veritable

16:49

household pet in utilizing the

16:52

procedure. British psychiatrist Maurice

16:54

Partridge, who conducted a follow-up

16:56

study of 300 patients, said that the

16:59

treatment achieved this effect by

17:00

reducing the complexity of psychic life.

17:03

But negative effects on patients were

17:06

recorded as early as the late 1930s.

17:08

Labbotoies left patients with reduced

17:10

responsiveness, self-awareness, and

17:13

self-control, which makes sense given

17:15

that these are the things regulated by

17:17

the frontal lobe. Other side effects

17:19

included disorientation, strange

17:22

behaviors, flattened emotions. Surprise,

17:25

surprise. Some suffered personality

17:28

irerasia, others incontinents, some had

17:31

seizures, some people ended up with a

17:33

childlike dependency, and some people

17:35

just died. Dr. JL Hoffman wrote in the

17:39

New England Journal of Medicine in 1949

17:41

that quote, "These patients are not only

17:44

no longer distressed by their mental

17:46

conflicts, but also seem to have little

17:48

capacity for any emotional experiences,

17:51

pleasurable or otherwise. They are

17:53

described by the nurses and the doctors

17:55

over and over as dull, apathetic,

17:58

listless, without drive or initiative,

18:00

flat, lethargic, placid and unconcerned,

18:04

childlike, dosile, needing pushing,

18:07

passive, lacking in spontaneity, without

18:10

aim or purpose, preoccupied

18:13

and dependent. In so many cases, it

18:15

effectively turned people into mindless

18:18

zombies. Were people's symptoms reduced?

18:22

Yes, but only because their very

18:24

capacity to feel such symptoms were

18:26

taken from them alongside large aspects

18:29

of their individual personalities. The

18:32

result was some ending up as

18:34

unrecognizable to those who cared for

18:36

them. In 1948, Swedish professor of

18:39

forensic psychiatry Gusta Rylander

18:41

reported that a mother said about her

18:43

daughter who underwent a lobotomy that

18:45

quote, "She is my daughter, but yet a

18:48

different person. She is with me in

18:50

body, but her soul is in some way lost.

18:54

Freeman's public demonstrations of the

18:56

labbotomy also sometimes went

18:58

disastrously wrong, including people

19:00

losing their lives during the procedure.

19:03

Stabbing an ice pick into someone's

19:05

brain and then sloshing it around is

19:08

bound to have some adverse effects. It

19:11

was inevitable with the less careful,

19:14

less surgical method that some people

19:16

would suffer and others would die.

19:19

Monese's lucottomy wasn't perfect.

19:22

But it wasn't this. And yet, asylums and

19:26

hospitals loved it. Patients became

19:29

quieter and easier to manage, which made

19:32

them cheaper to house, as well as making

19:34

it possible for patients to be cared for

19:36

safely at home. It helped empty the

19:38

asylums and hospitals. But those that

19:41

left certainly weren't the same people

19:43

who arrived for all the worse reasons.

19:46

And then you have the ethical questions

19:48

about intent, authority of medical

19:51

professionals, and desperation. In cases

19:54

where patients had families, doctors

19:56

would pressure them into going along

19:58

with a labbotomy as a last resort

20:00

because it offered them a chance of

20:01

being discharged over a lifetime of

20:04

institutionalization.

20:05

Families were often desperate to get

20:08

their members back home, and so they

20:10

reluctantly agreed, assuming that the

20:12

psychiatrists knew best. Between having

20:14

a mentally unwell and potentially

20:17

violent person at home, or seeing them

20:19

be locked away in an asylum for life,

20:23

the risk of having them turned into a

20:25

benign household pet, as per Freeman's

20:29

words, may have been the least bad

20:32

option. Let's remember there were no

20:36

good options in cases where somebody had

20:39

no advocate or next of kin. The state

20:41

then took the executive decision-making

20:43

role when a patient was deemed not to

20:45

have decision-making capacity for

20:47

themselves. This makes the question of

20:49

medical consent murky and semicoerced at

20:51

best and really not even considered at

20:54

worst. After all, it's an ethically

20:56

dubious treatment if carried out against

20:58

a patient's wishes. But this is a

21:00

difficult question in severely psychotic

21:02

patients who lack insight about their

21:04

condition. It's almost inevitable that

21:06

some people were fully conscious of the

21:08

fact that they were getting a labbotomy

21:10

against their will as it happened. And a

21:14

lot of these people weren't left happier

21:16

or healthier as a result. A few actually

21:19

were. This can't be ignored, but most

21:22

were just seen as easier to deal with,

21:25

especially in terms of schizophrenic

21:26

cases where the labbotomy was originally

21:28

believed to provide some relief. It

21:31

appeared to show very little marked

21:33

improvement for the majority of

21:34

patients. The mortality rate was between

21:37

0.8 8 and 2.5% which aren't great odds

21:40

and 10% of those who underwent

21:42

operations were known to have some

21:44

problems with epilepsy afterwards making

21:46

seizures a frightening new reality for

21:48

many. In the end over many countries

21:51

tens of thousands of patients would

21:53

undergo labbotoies and lucottomies with

21:55

varying levels of success in their

21:57

treatment. Many underwent multiple

21:59

operations. Freeman himself did

22:02

thousands. But even despite the invasive

22:05

surgery, major risks, and lack of

22:07

understanding around the long-term

22:08

consequences, the scientific community

22:11

were sufficiently impressed. In the end,

22:13

Mones was awarded the 1949 Nobel Prize

22:16

in Physiology and Medicine for his

22:18

development of the lucottomy, even if it

22:21

eventually led to Freeman's brutal

22:24

icepic variant. All of this brings us

22:27

back to Rosemary Kennedy, the woman with

22:29

whom we opened this story. She is

22:32

perhaps the most famous case of anyone

22:34

who underwent a lobotomy. She was the

22:37

daughter of Joseph Patrick Kennedy and

22:39

Rose Elizabeth Fitzgerald and she was

22:41

the older sister of the future United

22:43

States President John F. Kennedy. When

22:46

Rosemary was born at home in 1918, her

22:49

mother was told to hold her legs closed

22:51

for two extra hours as there were no

22:53

doctors available to help deliver the

22:55

baby. Hospitals were overwhelmed with

22:57

the outbreak of the Spanish flu which

22:59

left them short staffed for home visits.

23:02

This starved Rosemary's new brain of

23:05

oxygen and resulted in her developing an

23:07

intellectual disability of which there

23:09

was and still is major stigma. She

23:13

learned to walk and talk somewhat slower

23:16

than her siblings, but still grew up

23:17

managing her disability into a

23:19

well-adjusted young woman. She was happy

23:22

and healthy. She enjoyed shopping for

23:24

clothes, going to dances, and spending

23:26

time with her friends. Her mother stated

23:28

that she was quote an affectionate,

23:31

warmly responsive, and loving girl. She

23:34

was so willing to try to do her best, so

23:37

appreciative of attention and

23:38

compliments, and so hopeful of deserving

23:41

them. As Rosemary grew older though, her

23:44

care, education, and life circumstances

23:47

all got more demanding. She was sent to

23:49

several private boarding schools and

23:51

moved around a lot as a young adult,

23:53

including to the UK when her father was

23:56

the US ambassador to Britain between

23:58

1938 and 1940. Her parents tried to find

24:02

schools that offered special support for

24:03

students with intellectual challenges,

24:06

which were limited given the standards

24:07

of the time. And so Rosemary found

24:10

education understandably difficult. And

24:13

being a Kennedy, she wasn't like the

24:16

other kids. The Kennedys were a

24:18

political dynasty even back then with

24:21

social obligations to make and

24:23

appearances to keep up. The Kennedy

24:25

parents had high expectations of their

24:28

children, and as a result, the siblings

24:30

could be very competitive. This

24:32

frustrated Rosemary as she struggled

24:33

with the challenges of this very

24:35

different lifestyle that just didn't

24:37

suit her as she was unable to live up to

24:39

the accomplishments of her siblings. Not

24:42

to mention the fact that the instability

24:44

of moving around all the time likely

24:46

wouldn't have helped her settle

24:47

anywhere. Her behavior started to get

24:50

troubling after she returned home from

24:52

the UK in 1940 at the age of 22. She

24:56

suffered from convulsions and was prone

24:57

to violent outbursts which did sometimes

25:00

injure those around her. She was

25:02

expelled from a summer camp in

25:03

Massachusetts and moved around a few

25:05

more schools before being placed in a

25:07

convent school in Washington DC. Once

25:10

there, Rosemary started sneaking out at

25:12

night which alarmed the school and her

25:14

parents. The nuns were worried that she

25:16

might become sexually active which would

25:19

put her at risk of a disease or

25:20

pregnancy. Her father, on the other

25:22

hand, was more worried that her

25:24

daughter's behavior could jeopardize the

25:26

political ambitions of his other kids

25:28

through scandal. Father of the year. In

25:31

1941, at 23 years old, Joseph Kennedy

25:34

arranged for a pair of doctors to

25:36

perform a labbotomy on his daughter in

25:38

the hope of curing her. He did not

25:41

notify the rest of the family. One of

25:44

the doctors was

25:46

Walter Freeman. The other doctor was

25:49

James Watts, who'd been present through

25:50

much of Freeman's work that we've

25:52

discussed up to this point. Dr. Watts

25:54

later recalled the procedure. Quote, "We

25:56

went through the top of the head. I

25:59

think she was awake. She had a mild

26:01

tranquilizer. I made a surgical incision

26:04

in the brain through the skull. It was

26:06

near the front. It was on both sides. We

26:08

just made a small incision, no more than

26:11

an inch." As Watts operated, Freeman

26:14

asked Rosemary to do things like recite

26:16

the Lord's Prayer, sing God Bless

26:19

America, or count backwards. Watts

26:21

explained, "We made an estimate on how

26:24

far to cut based on how she responded."

26:27

When Rosemary's speech dissolved into

26:29

total incoherent gibberish, they

26:32

considered it job done. It quickly

26:34

became clear after the fact that the

26:36

operation was a disastrous failure.

26:40

Rosemary had lost most of her ability to

26:42

walk and to talk. Her personality was

26:46

permanently altered. She was left

26:48

physically disabled, incontinent, and

26:50

whilst having high functioning capacity

26:52

before, she could no longer look after

26:55

herself with something more akin to the

26:57

mind of a young child or a toddler. She

27:00

was institutionalized shortly afterwards

27:02

for the rest of her life, and the whole

27:04

story was kept under wraps until 1987.

27:09

She would ultimately recover the ability

27:11

to walk with a limp, but never regained

27:13

her ability to speak coherently. She

27:15

eventually died at the age of 86 in

27:17

2005, surrounded by her siblings. She

27:20

was reconnected with her family by then,

27:23

but let's not forget it was her parents'

27:25

actions who' taken this bright,

27:27

confident young woman who needed help

27:30

and completely erased the person she

27:32

used to be. As we said in the intro, her

27:35

mother didn't visit her for 20 years,

27:36

and her father never did, dying in 1969,

27:40

almost 30 years later. Her siblings

27:43

treated her better, especially her

27:44

younger sister, Ununice Kennedy, who

27:46

acted as Rosemary's advocate for a large

27:48

portion of her life. She even started

27:50

the Special Olympics, what we now call

27:53

the Parolympics, in her honor in 1968.

27:56

But the reality was Rosemary didn't need

27:58

to be cured. She needed help managing

28:01

her condition in a less demanding and

28:04

stressful environment. Eventually, the

28:06

labbotomy would fall out of fashion. By

28:09

the 1950s, the first antisycchotic drugs

28:11

were coming onto the market that

28:12

provided better outcomes than an

28:14

experimental and invasive brain surgery.

28:17

They proved to be decisive as public

28:19

criticism, personal shame from the

28:21

psychiatric field and Freeman's

28:23

dwindling public perception all slowly

28:26

spelled the end for this gruesome

28:28

procedure that robbed so many of being

28:30

able to live a semi-normal life. But

28:33

then, of course, the damage had been

28:35

done. Tens of thousands of people were

28:37

already permanently affected by the

28:39

procedure, which was, let's not forget,

28:41

completely irreversible. You can't just

28:44

stitch brain matter back on and have

28:46

people go back to the way they were

28:48

before. And that leaves a few loose ends

28:51

to tie up with the main one being Monise

28:54

who received that Nobel Prize for his

28:57

work on the dotomy.

28:59

After all, should he have received that

29:03

prize? There have been calls for the

29:05

Nobel Committee to formally withdraw his

29:07

prize after you take into account the

29:09

harm he caused both directly through the

29:11

lucottomy but also indirectly through

29:14

the later widely established

29:16

transorbital labbotomy. If anything,

29:19

Mones should have gotten the Nobel Prize

29:20

for a different medical technique he

29:22

developed entirely, agography. Mon

29:25

realized back in the 1920s that if you

29:27

injected a contrast agent containing

29:30

iodine into certain blood vessels that

29:32

supplied the brain, you could X-ray

29:34

someone's head and reveal both brain

29:36

tumors and vascular deformities. Before

29:38

this technology, there was really no way

29:40

to know exactly where a brain tumor

29:42

could be within someone's head. This

29:44

development has undoubtedly saved

29:47

countless lives in the decades since,

29:49

and it's still utilized to this day in

29:52

modern medicine via angiograms. But his

29:55

prize wasn't for that. It was for the

29:57

lucottomy. Some might argue he made a

29:59

groundbreaking step forward in neurology

30:02

that was later tainted by Freeman and

30:03

Watt's despicable practices. But others

30:06

say he created something not based in

30:08

scientific merit and rushed ahead with

30:10

his findings leading to significant

30:13

harm. But it's always not quite so cut

30:16

and dry. Statistics appeared to show

30:18

that lucottomies and even labbotoies in

30:21

some cases did help people in particular

30:24

treatment resistant cases of certain

30:25

conditions. Ultimately though the

30:27

evidence was weak, harm was

30:29

underestimated and patients simply being

30:32

seen as more compliant and dosile was

30:35

attributed as a positive even if it

30:37

actually wasn't. The procedure also

30:40

opened the door to cases of catastrophic

30:42

misuse and abuse like in the case of

30:44

Rosemary Kennedy and many others. Lots

30:47

of people had procedures performed

30:49

against their will and people trusted

30:51

the doctors because of their

30:52

professions. Ultimately, even if we're

30:55

being generous, monies being awarded the

30:57

Nobel Prize was premature until it was

31:00

possible to learn the long-term

31:01

consequences of what psychosurgery could

31:03

do for a person's quality of life, not

31:06

just for the ease of hospitals as a

31:09

cost-saving measure. As for Freeman and

31:12

Watts, they should have gone to jail for

31:14

the harm they caused and propagated

31:16

throughout the medical community. But

31:19

arguably,

31:20

all of this wasn't just for nothing,

31:23

which is the one shred of good from the

31:25

story. Not only did these procedures

31:28

eventually lead to the better

31:30

understanding of neurology that we have

31:31

today, but also the development of

31:33

safeguarding practices in medicine as

31:35

well as the creation of systems to work

31:37

out complicated questions like what

31:40

actually is capacity and consent in a

31:43

medical context. It helps us on the

31:46

journey of better understanding mental

31:48

health and hopefully puts us on the path

31:50

as a species to work out how to treat

31:53

certain psychological conditions with

31:55

greater compassion and understanding.

31:58

One could argue it's hard to judge

32:00

historical medicine by modern standards,

32:02

but this wasn't medieval plague doctors

32:04

putting leeches on people's wounds to

32:06

balance the humorus. These were people

32:08

who were being lobtomized less than a

32:10

century ago. In 100 years time, people

32:14

may well look back on the medical

32:15

practices we undertake today and think

32:18

much the same as we do of the labbotomy.

32:21

But the systems we have in place now are

32:24

designed to value change and are more

32:27

mature at putting the patients care and

32:29

quality of life first. Today, the idea

32:33

of the lobotomy in a medical context

32:35

isn't completely gone. Nowadays, heavily

32:38

regulated versions of the labbotomy do

32:39

occur like the kingulotomy and the

32:42

capsulotomy. They're only for treatment

32:45

resistant conditions that are highly

32:46

damaging to a person's life performed as

32:48

a last resort. They're done in fully

32:51

sterile surgical conditions and cut mere

32:54

millimeters of tissue at most with

32:56

overlapping layers of consent being the

32:58

cornerstone of such procedures. Less

33:00

than a dozen take place every year

33:03

across the entire world. Overall, the

33:05

story of the labbotomy is one that shows

33:07

the danger of accepting positions of

33:10

authority for authorities's sake, both

33:12

in the case of patients and doctors, but

33:15

also between doctors and those who ran

33:17

their hospitals and asylums. It shows

33:19

how medicine is often judged by the

33:21

success of the moment, and it's a

33:23

warning that we should be wary of

33:25

so-called miracle cures. Of course, it

33:28

also shows the lack of accountability

33:30

that occurs when the system fails.

33:33

Somewhat ironically, the lobotomy is now

33:36

characterized as a blunt instrument to a

33:38

societal problem that had no solution at

33:40

the time, but arguably only makes things

33:42

worse. But it is important to remember

33:45

that the lobotomy was not born out of

33:47

cruelty or laziness,

33:50

but desperation. And sadly, it was

33:53

rewarded before anyone could truly

33:56

understand the full cost it had on

33:59

individuals.

Interactive Summary

The video details the history and impact of the lobotomy, a surgical procedure performed on the frontal lobe of the brain, initially intended to alleviate mental distress but often resulting in severe cognitive and personality changes. It begins with the story of Rosemary Kennedy, who, despite being born with an intellectual disability, lived a relatively fulfilling life until a lobotomy at age 23 left her with the mental capacity of a child and dependent on constant care. The narrative then expands to the broader context of early 20th-century mental healthcare, characterized by limited treatment options and overcrowded asylums. Dr. Egaz Moniz developed the leukotomy, a less invasive procedure involving cutting white matter connections in the frontal lobe, for which he was awarded the Nobel Prize. However, American physician Walter Freeman popularized a more brutal and efficient version, the transorbital lobotomy, often performed with an ice pick-like instrument inserted through the eye socket. This procedure became widespread, applied to a range of conditions beyond severe mental illness, and often resulted in patients becoming passive, apathetic, and losing significant aspects of their personality. The video highlights the ethical dilemmas surrounding consent, the pressure on families, and the questionable basis for the procedure's initial acceptance and reward, particularly Moniz's Nobel Prize. It concludes by noting the eventual decline of the lobotomy due to advancements in medication and increased public criticism, while acknowledging that highly regulated, minimally invasive versions still exist for extreme cases, and reflecting on the lessons learned about medical authority, patient care, and the dangers of seeking quick cures for complex societal problems.

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