Few words conjure up more gruesome connotations than "lobotomy"--surgically severing the brain's frontal lobe in an attempt to relieve intractable psychiatric symptoms. And yet these operations--first performed in the U.S. in 1936 by psychiatrist and neurologist Walter Jackson Freeman and neurosurgeon James Winston Watts--continued for more than 40 years. In that time, Freeman, the procedure's champion, cut the brains of 3,500 people.

Biographer Jack El-Hai chronicles lobotomy's reign through Freeman's quest to treat mental illness surgically. The tale follows this son and grandson of prominent physicians from his youth in Philadelphia during the early 1900s through his rise and eventual fall in national prominence. Freeman emerges not merely as a maniacal devotee of radical "psychosurgery" but as an earnest advocate of potential treatments for otherwise intractable mental illness. Most of Freeman's work took place when state psychiatric hospitals overflowed with seemingly untreatable patients, many of whom suffered relentlessly. Effective psychiatric medications were not yet available, and lobotomy became a measure of last resort. El-Hai describes how neurosurgeons experimented to transform the complicated prefrontal lobotomy into the simpler transorbital lobotomy--nearly an outpatient procedure in which a physician entered a patient's brain through a region above the eye with an ice-picklike tool. A skilled practitioner could perform a transorbital lobotomy in minutes.

Surprisingly, many of Freeman's lobotomies were reported as successful, not only by Freeman but also by some patients and their families, who sent hundreds of letters expressing gratitude. Of course, many surgeries failed; Rosemary Kennedy, the sister of President John F. Kennedy who suffered "agitated depression," was left "inert and unable to speak more than a few words," as El-Hai says, and was ultimately institutionalized. In 1950 Freeman and Watts reported that of 711 lobotomies they had performed, "45 percent yielded good results, 33 percent produced fair results, and 19 percent left the patient unimproved or worse off." Not surprisingly, many patients remained confused, disconnected, listless and plagued by complications such as seizures. With the emergence of effective drugs during the 1970s, physicians halted lobotomies altogether.

The tale of lobotomy's rise and fall entails far more than one man's quest to spearhead a dubious surgical method. It is a story of desperation among thousands of patients, families, clinicians and policymakers struggling to manage a population seemingly crippled by illnesses for which there was no help. It is also a worrisome account of physicians groping for solutions to problems that they could not adequately address. In this sense, El-Hai's treatment of this medical saga is also poignant and illuminating. --Richard Lipkin

This article was originally published with the title Mind Reads.

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