First, Do No Harm
April 17, 2017
ARCHIVAL (CLIP FROM THE MOVIE 'FRANCES,' 1982):
I will perform trans orbital lobotomy on ten patients within an hour.
NARRATION: In the 1930s, a new brain surgery like the one portrayed here in the movie Frances, was brought to the United States – the lobotomy.
ARCHIVAL (CLIP FROM THE MOVIE 'FRANCES,' 1982):
Only a little more dangerous than operating to remove an infected tooth.
NARRATION: It was performed on mentally ill patients all over the country.
ARCHIVAL (CLIP FROM THE MOVIE 'FRANCES,' 1982):
Lobotomy gets ‘em home!
NARRATION: Hailed by the media as a miracle cure.
JACK EL HAI (AUTHOR, “THE LOBOTOMIST”): Life magazine, The New York Times, Time magazine. They loved it.
BARRON LERNER (MEDICAL ETHICIST): Lobotomy was felt to be mainstream science. It wins the Nobel Prize.
NARRATION: But more than 40,000 surgeries later the brutal truth about lobotomy would come to light.
BARRON LERNER: They were basically going in and mushing around brain tissue. And, unfortunately in many cases leaving patients worse off.
NARRATION: Seven decades later, a look back at the lobotomy story shows how far our understanding of the brain has come . . . and how far we still have to go.
NARRATION: In the early decades of the 20th century people struggling with mental illness had few options.
BARRON LERNER: Families were at their wits-end, didn’t know what to do with people who had lots of mental symptoms. Institutions were very overcrowded. And the treatments were very, very difficult. Like Hydrotherapy where people would be immersed in water. Insulin Therapy where the doctors would make the patient’s blood sugars go down to zero and they would have seizures.
NARRATION: In 1936 a new surgical technique called lobotomy began to be used. The experimental procedure, which partially severed the frontal lobes from deeper parts of the brain, was said to calm and even cure those struggling with mental illness.
KATE CLIFFORD LARSON (AUTHOR, “ROSEMARY: THE HIDDEN KENNEDY DAUGHTER”): Dr. Walter Freeman and Dr. James Watts, who was a neurosurgeon were claiming that they had great success, that they were restoring a good life to people who had been suffering. And they had become famous.
JACK EL HAI: One of Freeman’s many gifts, skills, was cultivating the media. And they reciprocated with a lot of very favorable coverage. Miracle cure to the brain. Cutting the brain cures the soul. The media was all over it.
NARRATION: In 1941, Joseph P. Kennedy, the patriarch of that prominent political family, read about the surgery and contacted Freeman and watts about his eldest daughter rosemary.
KATE CLIFFORD LARSON: Rosemary was slower to walk and talk. As she grew, it became more and more obvious that Rosemary could not really move beyond say a third or fourth grade educational level.
ARCHIVAL (A&E, 1987):
ROSE KENNEDY: Being at the table, she wasn’t up to the complicated conversation we had or the political discussions.
KATE CLIFFORD LARSON: In her early 20s, her mental health issues were really becoming a problem. The tragedy is many other doctors at the time recommended against this procedure. They agreed that it was too experimental.
NARRATION: But at the age of 23 Rosemary Kennedy was lobotomized. The surgery did not go well.
KATE CLIFFORD LARSON: They cut too deeply into the brain fibers and Rosemary became disabled.
JACK EL-HAI: She did eventually regain her ability to walk and talk, but she lost a lot of what was in her personality. It should have been a terrible setback for lobotomy. It wasn’t.
NARRATION: With Rosemary Kennedy’s failed surgery hidden from the public, Freeman would ultimately break with his surgical partner and take the procedure even further.
ARCHIVAL ("TRANSORBITAL LOBOTOMY," 1949-1950):
DR. WALTER FREEMAN: The simpler approach to the frontal lobe through the roof of the orbit.
NARRATION: Inspired by an icepick from his kitchen drawer, Freeman would use a surgical pick to enter the brain through the patient’s eye socket. He claimed that this could be done by anyone, anywhere in a matter of minutes. And to prove it, he took his new procedure on the road.
BARRON LERNER: These things that were being done were nothing like what we might think of as modern evaluation of treatments like a randomized control trial. These were just patients who were sick with mental illness who got a lobotomy.
NARRATION: And it would be used for a whole host of ailments.
JACK EL-HAI: Hallucinations, obsessive behaviors, feelings of depressions and suicide. Soldiers returning from the theater of war with anxiety and behavioral problems. People suffering for what was then called intractable pain.
NARRATION: Arguably, one of those patients was Anna Ruth Channels. Channels had suffered from severe headaches for several years and Dr. Freeman was sure that a lobotomy was the cure. Carol Duncanson is Anna Ruth’s daughter.
CAROL DUNCANSON: Walter Freeman promised. She would just be happy. Everything would be fine. And who wouldn’t go rah-rah for that when you’re hurting so badly?
NARRATION: Dr. Freeman lobotomized Anna Ruth when Carol was three months old. And in a cruel twist of fate, her headaches were gone, but so was almost everything else.
CAROL DUNCANSON: When they brought her home, she did not know how to do the activities of daily living. Even the most basic things like toileting and bathing. My aunt taught her, from the very beginning. She wasn’t the mother that I would ever describe as being motherly.
NARRATION: Carol says, because her mother was unable to care for her, that she and her sister would spend part of their childhood living in a series of foster homes.
CAROL DUNCANSON: I’m told that Doctor Freeman went to West Virginia and interviewed my mother after the lobotomy. And that he’d consider her outcome excellent. That’s probably the most insulting thing I’ve ever heard.
NARRATION: In the mid 1950’s treatment for the mentally ill would begin to change dramatically as antipsychotic drugs came on the market.
BARRON LERNER: They weren’t perfect. They had a lot of side effects. But they worked for a lot of people, which left lobotomy in an interesting place. I mean, why would I burrow into someone’s brain if I don’t have to? But, some still felt that lobotomies were indicated. One of those people was Walter Freeman.
JACK EL-HAI: There was a number of children who received lobotomies at Freeman’s hands. He recommended a lobotomy for a young boy who was having trouble in his family, getting along with his stepmother.
NARRATION: In 1967, Freeman would be forced to stop performing lobotomies when one of his patients died while having her third operation. In all he had done more than 3500 surgeries in three decades. He died in 1972, but his radical procedure had taken hold in popular culture.
ARCHIVAL (SUDDENLY LAST SUMMER, 1959):
There’s only one little operation they perform here. It’s on the brain it’s called a lobotomy!
BARRON LERNER: I think the way culture has dealt with lobotomy might be in sort of a simplistic way. Evil doctors experimenting on patients and creating all this havoc and disruption. A great legacy of lobotomy would be to understand why lobotomy was so exciting at the time. People were enormously upset about the mental illness that they saw that they couldn’t treat otherwise. They were excited about the possibilities of new technology. I think we can see how many of those factors are still in play today.
NARRATION: While people struggling with mental illness now have more choices, from new medicines to the more unconventional – like the use of LSD for Post Traumatic Stress Disorder, for some the treatments still don’t work.
But with the BRAIN Initiative, scientists are hoping that advancing technology will help them understand the brain in ways once thought unimaginable.
ARCHIVAL (KTVU, 4-3-13):
JULIE HAENER: President Obama unveiled a 100-million-dollar initiative today that seeks to map the brain in unprecedented detail.
DR. EMAD ESKANDAR (PROFESSOR IN NEUROSURGERY, HARVARD MEDICAL SCHOOL)): We probably know about one percent of what the brain is doing. The brain is incredibly complex. It has a hundred billion neurons, untold trillions of connections. So, particularly when it has to do with higher cognitive functions like feelings and thinking and emotion, we really do not have a very good understanding of that.
NARRATION: At Massachusetts General Hospital, doctors are using a surgical technique called Deep Brain Stimulation - or DBS for short - on patients with untreatable psychiatric disorders, including a severe form of OCD.
DR. ALIK WIDGE (TO PATIENT): What do you feel?
PATIENT: A seven.
DR. ALIK WIDGE: A seven, okay, can you put an adjective to it?
PATIENT: It’s a happiness.
NARRATION: While surgery is not without risks, doctors say DBS is largely reversible. A pacemaker-like device is implanted with wires that send electronic pulses into targeted areas of the brain. It has successfully controlled tremors in Parkinson’s patients, and has been tested on patients with untreatable depression.
DR. DARIN DOUGHERTY (DIRECTOR OF DIVISION OF NEUROTHERAPEUTICS, MASSACHUSETTS GENERAL HOSPITAL): When I first met Liss, her affect, or the way her face looked, was just very blank, very sad, even had trouble making eye contact.
NARRATION: Liss Murphy’s anxiety and depression had become so debilitating that one day she just got up and left her job.
LISS MURPHY: Walked out, and I never went back to the office. And just went off the grid totally. I was just in complete shutdown.
NARRATION: In 2006, Murphy became one of the first patients to undergo Deep Brain Stimulation surgery for depression. The surgery lasted 8 hours. Once the electrode was implanted and turned on, the doctors delivered a small amount of electrical stimulation.
LISS MURPHY: Then finally, I felt something and, it was it was remarkable, actually. Within two to three months, I started walking my dog again. Being able to get out of bed in the morning and getting showered and dressed, and they sound like small things, but I didn’t do those things very well.
DR. EMAD ESKANDAR: Our goal is to make very sick patients better. So, if we have a safe therapy that takes someone that is so depressed that they can never leave the house, and give them their life back, how can you say no to that?
NARRATION: While Liss Murphy was helped, some other results for depression have been less promising. Doctors are now in the early stages of experimenting with a new, more advanced device that responds to each patient’s mood.
DR. DARIN DOUGHERTY: We realize we’re on the cutting edge of these treatments for psychiatric illness and because of that we’re extremely careful. There is a dark history of psychiatric neurosurgery. It’s now been almost a century ago, but it’s still overhangs our field, but I really want to emphasize how far we’ve come.
BARRON LERNER: Our challenge, I think, as a medical community is to not get over involved in the fact that it’s psychosurgery. Let’s try to evaluate it scientifically as best we can.