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Author Podcast: Jack El-Hai

abstract:

Jack El-Hai, prize winning medical journalist and author of The Lobotomist (Wiley 2005) spoke with BookBuffet about the life and times of Dr.Walter J. Freeman—the man who helped pioneer and promote lobotomy as a revolutionary form of psychosurgery in the treatment of patients with schizophrenia and other psychiatric illnesses. What went wrong? Why did this procedure become synonymus with the kind of repugnance and abuse we ascribe to it today?  What can people, the medical community and healthcare policymakers learn from the unique life and career of Walter Freeman? Listen to the interview about The Lobotomist, and find out.

article:

July 06, 2005

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Dr. Walter J. Freeman ranks as one of the most scorned physicians of the twentieth century.  A man widely remembered as a loose canon who worked beyond the boundaries of accepted medical practice to appease his own personal demons. The myths surrounding Freeman and the operation that made him famous, the lobotomy, still persist today. 

 

Yet many of the most important medical figures of the time leant their support of his work, effectively pulling lobotomy into the mainstream of Medical practice, and many of Freeman's patients, some of them speaking with astonishing clarity observed how lobotomy had changed their lives for the better.

 

So how is it that both physicians and patients supported a procedure today that seems outrageous and even barbaric, and why did Freeman remain a forceful proponent of lobotomy even after most physicians abandoned it in terms of new forms of psychiatric treatment?

below)

Interview

Part I of a two-part interview

BB. Mr. El-Hai tell us how you first became interested in the subject of lobotomy and Walter Freeman?

JE: Well the topic really seized me when I met a woman here in Minnesota whose uncle had underwent lobotomy in the state hospital system. Up until then what I knew about lobotomies is probably what most people know about lobotomy.  I believed that lobotomy was not so much a treatment as it was a measure to control patients, or even to punish them, as was shown in books like One Flew Over The Cuckoo's Nest, and in movies like Frances [Her biography, Will There Really Be A Morning]

And I also believed that it was a rare operation that was and done by doctors working far out of the medical mainstream.  So when I heard the story of this woman's uncle's lobotomy, a lot of his story contradicted what I thought I knew about psychosurgery and when I started researching more, I quickly came upon the career of Walter Freeman, and my jaw dropped when I first read about Dr. Freeman. 

 

There were a lot of things I couldn't figure out about him.  I couldn't figure out what a gifted and talented doctor like him was attracted to a mutilating brain procedure.  Then I also couldn't understand why he stayed with it so long; past it seems the point of reason. 

I kept those questions in mind as I continued to work.  I produced a couple of magazine articles about lobotomy and about Freeman's life. As I moved onto do the book, those two questions became the central questions of the book.

BB: Had you had any personal experience with mental illness before writing your book?

JE: No, not really, just a long personal interest in medicine, psychiatry and psychology, but no, I don't have any relatives who have had lobotomies or who have been seriously mentally ill.

BB: How does your book compare or differ from other books investigating Walter Freeman’s life, those of David Shutts, Jack Pressman and Elliot Valenstein?

JE: Those are all good books and they were important sources for my research, but I think The Lobotomist is really the first book to look at Freeman's life as a biographer would.  The other books go into great (and very interesting) depths and detail looking at the history of lobotomy and other kinds of psychosurgery. I was more interested in Freeman himself and his motivations and so I wanted to really find out about the character of this man as much as I could.

I really did come to think of him as a character, in the sense that King Lear is a tragic figure and character.  I began to see Freeman's life in terms of tragedy, that he had these undeniable gifts but he also had great flaws, and he was unaware of his flaws - as most people are.  But his flaws had a serious effect on the way that he decided to pursue his interests and treat his patients and he was all of the things that revolving around his character that interested me the most. 

I don't think the previous writers of Walter Freemen’s life and chroniclers of the history of lobotomy were interested in this.

Listen to Session II

BB: You are the Executive Vice President of the American Society of Journalists, and winner of the June Roth Memorial Award for Medical Journalism. What qualities does a good medical journalist require – what does the work involve? 

JE: [laughs] It's humbling - that is the best single word I can use to describe it, because I went into this project knowing very little about neuroscience, brain anatomy or brain operations and the treatment of psychiatric illness.  For the initial times of my research I was really just a sponge asking a lot of stupid questions and absorbing the answers and filling this great void that I had in my knowledge.  So I would say a tolerance for feeling humbled, is a big requirement for writing medical journalism.

People can go about it in all kinds of ways.  There are some medical journalists who like to focus on the biological aspects of the workings of the human body.  I am more of a human-interest writer.  I like to write about character and motivation. I think it's important to know that you can still pursue those interests and still be a medical writer; there are just all types.

BB: Your book captures the state of psychiatry and the treatment of mental illness from the 1930’s forward and I’d like you to describe the sort and number of patients that were institutionalized in the asylums of the day; what sort of expectations could families hope for before the advent of psychosurgery or modern pharmaceuticals?

JE: Well it is important to remember that up until the mid-1950s there were not very many effective treatments for serious psychoses like schizophrenia, chronic debilitating depression, and psycho-obsessive disorders.  What was available to patients before that time was hospitalization, institutionalization with the hope that over time, symptoms would improve. In some cases patients did get better on their own, but in many cases they didn't. 

Then in the 1930s there became available some of the shock treatments that were being devised at the time: electroshock as well as chemical shock therapy using a compound called Metrazol, and also Insulin coma therapy.  These treatments did have their success stories but they were very frightening procedures,

BB: And painful.

JE: ...right, and painful procedures. In the case of Insulin coma the idea was to really to bring the patient to death's doorstep and then hope that by going through this period of coma the brain would sort of re-boot and perhaps be better in the end. 

One of the things that really impressed me as I was researching [this material] was this feeling of despair that hung over a great many psychiatric hospitals up through the 1950's; despair on the part of the patients and the doctors and other caregivers there.  They felt there was very little that they could do, and it was in that feeling of despair that lobotomy really took root. Lobotomy held the promise of a much quicker recovery and a much more effective kind of treatment.  Freeman and his collaborator Watts were real innovators in biological psychiatry in putting out the idea that mental illness is produced by brain disorders, and that surgically you can treat these brain disorders and produce improvement in the patient.  

Listen to Session III

 

BB: Exactly, [you describe] two streams of treatment: use of Freudian psychoanalytic discussions and then there is the organic treatment modality... two branches, [one] that he was at the forefront.

 

JE: Yes, I grew very interested in that conflict between those two branches of psychiatry, and a lot of The Lobotomist is about Freeman's battles against the psychoanalytically oriented psychiatrists who were very much opposed to operating on healthy tissue in the brain to try and make improvements. 

 

Freeman to his credit, or maybe more accurately... something that made him very interesting to me was the way he loved to sally forth into this battle, he was a fighter.

 

BB: And he was a showman by your description, which is sort of a conflicting character trait in someone advancing medical knowledge.

 

JE: Yes a showman is not really a character trait you want in your doctor,  but I think I quoted him in the book as saying, "He would rather be wrong than be boring."  So that's why as a teacher in medical school in George Washington University he cultivated all of these tricks and techniques to keep students interested like writing on the chalkboard using both hands, each hand writing something different, something independently. 

He believed that his first responsibility to himself was to hold other people's interest, and if a person's attention drifted he thought that reflected badly on him.

BB: You also mention that Walter Freeman had two generations of medical practitioners to follow and this shaped his own aspirations.  Can you impose on those family influences his own basic character traits to describe how these factors combined to shape his personal and professional life?

JE: Ok.  I got into it to begin with because I was interested in Freeman's motivation and how he ended up the way he ended up, and for that reason his family history was important to me.  I found out that he did have two physicians ahead of him in his family. One was his father, an Ear Nose and Throat Specialist, who represented, I guess you could call it "a drudge variety" of physician who put in his hours in his office every day, but didn't get much pleasure in his work; never attended medical conferences; never wrote medical papers for journals. 

Then on the other hand there was a much different kind of medical example in his family, his maternal grandfather, Dr. William Williams Keen, who was America's first brain surgeon.  He operated on United States Presidents and was endlessly curious and innovative even after his retirement spent years after that exploring his interests and attending medical conferences. 

I think Freeman came to believe he had a choice; he could become one kind of doctor or the other, and he was drawn to become the kind of doctor his grandfather was. But to be that kind of doctor he had to be innovative, and when psychosurgery first came to his attention in early 1936 from reading about the surgeries of Egas Moniz, a Portuguese neurologist -- I think something clicked in Freeman's brain. He thought that lobotomy could be his ticket, could dictate his career path.

BB: Isn't it interesting to look at what sparks people's interests in a career; there always seems to be a defining moment which shapes our direction.

JE: Right, and I would say here that there were a few of them, and one was when he first heard about Moniz' work and decided to change his own [professional] course and follow that path -- and he really held to it.  He remained a staunch believer in lobotomy until he died in 1972. 

Session IV   Session V  Session VI  Session VII

Jack El-Hai can be reached for questions via jack@thelobotomist.com Visit his website for more information.

**Jack's publicist has offered BookBuffet 2 FREE copies of The Lobotomist to give away. Just sign-up as a member and write us with your request.  First come first serve.

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