Changing Medical Technology

I just finished reading My Lobotomy by Howard Dully and Charles Fleming.  Howard Dully received a transorbital lobotomy (also known as an “ice-pick lobotomy”) when he was 12 years old.  The doctor who performed the lobotomy was the king of transorbital lobotomies, Walter Freeman.  The book chronicles Dully’s life as well as his search, more than 40 years after the lobotomy, for answers as to why this surgery was performed on him.  It’s a harrowing story, especially because by almost all accounts, Dully was a normal kid.  The problem in his life seems to have been his step-mother who for some reason just didn’t like him and was probably afraid of him because he was a big kid.

Antonio Egas Moniz was the pioneer of the lobotomy and in fact, received the Nobel Prize in Medicine in 1949 for his work in this area.  By the late 1950’s, with the introduction of drugs that worked far better than lobotomies, the procedure fell out of favor in the mainstream medical community.   In fact, some have characterized the lobotomy as the biggest mistake ever made by mainstream medicine.  My favorite quote about the lobotomy comes from Norbert Weiner who is the father of cybernetics.  He said on page 148 of his book Cybernetics, “…prefrontal lobotomy …has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier.”

Reading My Lobotomy is an eye-opening experience.  Throughout the entire book, I wondered where the authorities were.  Surely there were adminstrators at the hospitals where Freeman worked who realized that his methods for diagnosing patients as having major psychoses were problematic.  Why did they let him continue to practice for so long?  What about all those doctors that Dully’s step-mother took him to who said he was a fine, normal kid?  Why did none of them recognize that she was going to continue in her pursuit until she found the diagnosis she was looking for?  The problem, of course, is that at the time, a lobotomy could be prescribed for conditions as mundane as “youthful defiance” or even just “moodiness.”  There is no doubt that Howard Dully was a defiant youth.  Reading the book, I get a portrait of him as a really smart kid who was bored in school and who probably had attention deficit disorder as well as an incredible amount of stress as a result of being an abused child.  But the kind of trouble he got into was normal kid stuff and probably could have been dealt with by someone paying a little bit of attention to him and maybe challenging him a little more in school. 

The other question that kept popping into my head was whether things are better now.  Could this sort of thing happen today?  Obviously, there are not a lot of lobotomies performed today but kids are put onto serious psychotropic medicines all the time.  What kind of safeguards do we have in place to protect kids (or adults for that matter)?  Do we require multiple physicians to look at a kid before he or she is diagnosed as schizophrenic or bipolar or whatever?  My guess is that we don’t.  Although it seems like the effects of taking drugs for these conditions would not be permanent in the same ways that having a lobotomy would be permanent, some of the stigmatization that Dully describes would be present and very damaging simply with a diagnosis of schizophrenia or some other serious mental disorder.

One of the most moving parts of the book is the afterword to the paperback edition of the book.  Dully is contacted by two brain researchers to have a detailed MRI taken of his brain to determine the kind of damage that was done by the ice picks.  The researchers suspected they would find little damage because Dully seemed so normal, too normal for someone who has had a lobotomy.  What they found was brain damage that was so significant that if it had been done to an adult, that person would be a vegetable.  But because Dully had the surgery when he was 12, his brain was still maleable.  It adapted to the damage so that after 40+ years, he was a normally functioning adult.  Dully then says that he had always felt burdened by the lobotomy, like something really bad had been done to him as a child.  After the MRI, he realized that he actually was quite lucky that he had the lobotomy at such an early age.  If it had been done even five years later, he probably would never have left the institutions he grew up in.  He would never have had a life with a wife and kids and a job.  So he now sees his life as lucky.  It’s an inspirational shift in perspective, I think, and I’m not sure how many of us would be able to make that shift. 

From a technology standpoint, this story reminds me that we have developed lots of tools that we can use in a variety of situations.  But having the tools doesn’t mean that we should actually use the tools.  And when we do use the tools, we need to put into place significant checks and balances to avoid abuses of power and to protect the powerless as much as we can.  I don’t think we’ve really learned these lessons yet.

By the way, National Public Radio did a 22-minute documentary about Howard Dully back in 2005.  Here’s that story–I strongly encourage you to listen to it by clicking on “Listen Now” in the upper left corner of the page.