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Originally published Sunday, February 27, 2005 at 12:00 AM

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Book review

"The Lobotomist" examines an infamous doctor

Mental illness is rampant in every society, in all sorts of forms. Curing mental illness, or even alleviating it, usually ranges from difficult to impossible...

Special to The Seattle Times

"The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness"
by Jack El-Hai
Wiley, 362 pages, $27.95

Mental illness is rampant in every society, in all sorts of forms. Curing mental illness, or even alleviating it, usually ranges from difficult to impossible.

So imagine the fascination of Minneapolis freelance magazine writer Jack El-Hai when he stumbled across the saga of Walter J. Freeman (1895-1972), who devoted his medical career to slicing the brains of mentally ill patients hoping to improve their lives.

Early in his research, El-Hai discovered that "aside from Nazi doctor Josef Mengele, Walter Freeman ranks as the most scorned physician of the twentieth century." Why, when his motives seemed so admirable? The answer is hard to decipher, El-Hai says, but he knows that "the operation Freeman refined and promoted, lobotomy, still maintains a uniquely infamous position in the public mind nearly 70 years after its introduction and a quarter-century past its disappearance."

El-Hai felt compelled to learn about Freeman, despite his initial revulsion. As he started reading Freeman's voluminous personal papers, he realized that during the 1930s and '40s, when Freeman performed the bulk of his 3,500 or so lobotomies, many within the medical establishment supported the surgery as a possible beacon in what seemingly had become a hopeless battle against a mental-illness epidemic.

Freeman found support, for example, at Fort Steilacoom, Pierce County, where he taught his techniques and performed surgeries on psychiatric patients.

Freeman's enemies issued plenty of criticism. After all, some of the surgeries hastened death, and maybe served as a direct cause of death. Yet, in the Freeman papers, El-Hai saw that "patients, some of them writing and speaking with astonishing clarity, observed how their lobotomies had changed them. Their spouses, children, siblings and parents often expressed gratitude for the lobotomies and considered Freeman a member of their extended family."

Certain at first that any biography of Freeman would result in condemnation of him "as a cruel, devious and unprincipled man," El-Hai eventually recognized "the persuasive evidence that at times he acted in the best interests of his lobotomy patients, given the limitations of the medical environment in which he worked and the perilous nature of scientific innovation."

El-Hai's research began in Philadelphia, Freeman's birthplace. Freeman's beloved grandfather William W. Keen, also an iconoclastic physician, guided Walter's career path, as did his medical-doctor father and attentive mother. The biographer follows Freeman through childhood and college to medical practice in Washington, D.C.

Specializing in neurology, Freeman was searching for the best application of his talents when his grandfather found him a position at St. Elizabeth's Hospital, which warehoused mentally ill patients in much the same way government hospitals across the nation did. After marrying and starting what would become a large family, Freeman immersed himself in the medical research regarding cures for insanity.

Despite mixed results — including the now infamously unsuccessful 1941 lobotomy of Rosemary Kennedy, John F. Kennedy's mentally ill sister (who died in January) — Freeman kept laboring to refine his surgical techniques. To help readers understand why, El-Hai provides despairing detail about the state of mental health across the nation, before Prozac and other pharmaceuticals of that ilk had become commonly available.

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"As World War II ended, government-run mental hospitals experienced an overwhelming influx of patients," El-Hai reports. "Psychiatric cases filled more than half of the beds in public hospitals by the end of 1945, and by 1948 the American Psychiatric Association would estimate that state institutions were packed with 50 percent more patients than they could adequately accommodate. To further worsen the problem, psychiatric patients required periods of hospitalization four times longer on average than other patients."

Working tirelessly until his death at age 76, Freeman never perfected a surgical cure. But, El-Hai says, Freeman's surgical techniques still have something to teach in an era of psychiatric drugs that in some mental patients are as likely to contribute to suicide as to recovery.

"Although fewer than 300 brain operations are now conducted annually worldwide to treat psychiatric disorders, the number is certain to rise, perhaps dramatically," El-Hai reports. "These new procedures are not lobotomies; they most often use lasers or radiation to produce tiny lesions in narrowly targeted regions of the brain, especially the regions most closely implicated in the development of obsessive-compulsive disorder. ... Freeman, were he alive, would nod knowingly."

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