Howard Dully’s Lobotomy

by Jason Tougaw

When he was 12, Howard Dully had his brain sliced into by a notorious surgeon with a reputation in decline. According to Dully’s convincing account, his stepmother Lou fabricated a diagnostic history so that the stepson she always hated would appear to be a candidate for the transorbital lobotomy favored by California physician Walter Freeman.

It used to be that when I thought lobotomy, I’d see images of a zombiefied Frances Farmer on a grainy black-and-white TV screen, zoning her way through an interview with Ed Sullivan. The lobotomy seems to have become a retro sci-fi setpiece in twentieth-century history. Dully’s memoir, co-written with Charles Fleming, helps dispel the sensational while preserving the horror of the medical abuse he endured. Surgical interventions in the brain are by no means a thing of the past. Corpus callostomies—or split brain surgeries—are used to treat cases of severe epilsepsy, often effectively.

Dr. Freeman learned his “ice pick” lobotomy technique from James Watt, the doctor who conducted Farmer’s lobotomy. Watt’s theory was that severing connections between the frontal lobe and the rest of the brain interrupted “the flow of energy in the brain” and that this “seemed to interrupt the progression of anxiety and depression” (as well as psychosis and violent behavior). The practice Freeman learned from Watt involved pushing an ice pick or scalpel through the patient’s eye socket and slicing through a prefontal lobe he couldn’t see. Freeman touted his technique as a quick and efficient technique that could be done right in his office. No need for hospitals.

Diagram from Freeman's book, Transorbital Lobotomy, reproduced in Miriam Posner's "The Visual Culture of Lobotomy"

In their book Manipulative Monkeys, primatologists Susan Perry and Joseph Manson report on a practice among white-faced capuchin monkeys that resonates weirdly with Freeman’s violation of Dully’s eye socket–a story retold in Dale Peterson’s The Moral Lives of Animals. Apparently, male capuchins will sit face-to-face and guide each other’s fingers into their eye sockets, slipping all the way behind the eyeball. The primatologists theorize that this is a method of demonstrating trust. For this human, the capuchin eyeball probing seems bizarre and slightly terrifying. I wonder what kinds of satisfaction or pleasure motivate the capuchins, but I can’t argue with the fact that the practice implies–and requires!–a great deal of trust. It’s tempting, though probably irresponsible, to imagine an evolutionary lineage between the capuchins’ eyeball probing and Freeman’s. There is a parallel, though, that requires no evolutionary theory. Freeman worked hard to gain a wavering trust from Dully, partly by differentiating himself from Lou. To a degree, he was successful. The lobotomy was both an assault and an act of malpractice (in ethical terms, if not legal ones)–but the trust involved made it an act of betrayal as well.

Freeman and Watts performing a lobotomy, from Miriam Watts's "The Visual Culture of Lobotomy"

Freeman’s zeal, bolstered by his belief that the biology of the brain was the sole source for human behavior, was his only real justification for such repeated violation of his patients’ trust. If he thought he could intervene therapeutically by cutting up brain matter he couldn’t even see, he must have believed the relationship between brain matter and the feelings and actions of his patients was pretty crude. Freeman’s conduct and confidence stemmed from a common mistake, like so many personal and social abuses in the history of medicine—the nineteenth-century treatment of hysterics or the decades of syphilis experiments conducted on African-American men in Tuskegee Alabama, for example. He believed biology was simple enough that he could manipulate it with rough tools and limited understanding. In “The Visual Culture of Lobotomy,” Miriam Posner has collected a vivid and disturbing archive of images that document the theory and practice that motivated Freeman and Watt.

Dully’s book is all about limited understanding, of his own history, his family, the procedure that changed his life in ways he’ll never be able to reconstruct. He begins with the ironic sentence, “This much I know for sure: I was borin in Peralta Hospital in Oakland, California, on November 30, 1948.” He’s certain of little else. His parents divorced, and he was raised his father and stepmother. A bus driver by trade, Dully defies the stereotype of the lobotomized patient institutionalized for life. You wouldn’t know he’d been lobotomized if you met him. But you also wouldn’t know, just as he doesn’t, what he’d be like if Freeman hadn’t sliced his brain matter.

The memoir is co-written, with Charles Fleming, so readers are never sure which aspects of the writing come from Dully and which from Fleming. This makes for complicated reading. Many people hire professional writers to help them turn their great stories into great (or at least readable) books. But Dully’s great story is about his lobotomy, so it’s just about impossible not to wonder whether diminished cognition would make it impossible for him to write any book at all. To be fair, though, no other detail of Dully’s current life supports that idea. Dully has a job; he made the decision to write this book; he did a lot of research; in the process he has confronted difficult emotional situations with his family. All of this requires healthy cognition.

We do know that to write his book, Dully tracked down Fleming’s files on him. “The great mystery of my life was inside,” he writes. “The question that haunted me for more than forty years was about to be answered.” He learns quite a bit from the file, about exactly what happened and how. Freeman’s notes are detailed and frank, so much that they reveal his stepmother Lou’s manipulation of Dully’s “symptoms” and Freeman’s doubts about his young patient’s candidacy and his outcome. He learns that Lou visited six psychiatrists before finding Freeman; four of these diagnosed her as the problem. He learns that Freeman was concerned about his professional status and that his lobotomies had already fallen out of favor by the time he treated Dully.

Lou reports a variety of Dully’s disruptive behaviors—violence with other kids, defecation in his pants, urinating on the walls of his bedrooms—many of which are disputed by Dully and other family members. Freeman reports a meeting with a family friend named Orville Black that tells a different story:

I gather from Mr. Black that Mrs. Dully is perpetually talking, admonishing, correcting, and getting worked up into a spasm, wehreas her husband is impatient, explosive, rather brutal, infact, in the way he won’t let the boy speak for himself, and calls him a numb-skull, dimwit, and other uncomplimentary names. Under Mr. Black’s rather serene directions Howard has not only looked after himself, such as going and washing his hands, straightening things out, but has been quite helpful at a church picnic where he helped set the table and lay things out and has also shown politeness and consideration of others.

Memoir readers can’t expect literal truth, given the subjective and loopy nature of memory, which seems to work through distortion as much as preservation. Documentary evidence like Freeman’s notes is always sketchy and full of gaps—and of course reflects the biases of its creator. As the memoir progresses, Dully seems increasingly aware that the mystery he hopes to solve leads to as many new questions as answers. One thing is certain: “It had taken less than two months and four visits from Lou, and four visits with me, to convince Dr. Freeman that a transorbital lobotomy was the only answer to our family’s problems.” Freeman’s notes do seem to treat the whole family as the patient, so it becomes particularly troubling that one member’s brain is thought to contain the solution. On December 15, 1960, Dully was admitted to Doctors General Hospital in San Jose, and Freeman performed his lobotomy—despite a great deal of evidence you’d think would give any physician pause.

But Freeman was an ideologue, an anti-Freudian who “believed instead that there were biological explanations for depression and schizophrenia and that there had to be surgical treatments for them.” Of course, our brains are integral to thinking, feeling, and action. Only the most rabid social constructionist would dispute that. But in 2011, we are still far from understanding the fine-grained cellular mechanisms that connect our brains and bodies with the world and the other organisms who inhabit it.

Dully dedicates his book “To all of us, victims  and survivors, who keep going no matter what.” He’s addressing the victims and survivors of a psychiatric history that allowed lobotomies to become a fad, those who were killed, those whose minds were destroyed, and those who, like him, live with the itch of never quite knowing who or what they’d have become without their lobotomies. But he’s also addressing both patients and doctors in an age when some are responding to the advances of neuroscience without sufficient reflection, as Freeman did with regard to advances in brain research during his time.

In that sense, Dully’s memoir is a work of activism and pedagogy. We’ve traded lobotomies for SSRIs (serotonin reuptake inhibitors), painkillers, and psychostimulants like Ritalin and Adderall. When prescribing these medications, many in the medical establishment enjoy the kind of confidence Freeman felt, the confidence that we finally know how the brain works in the body to create the feeling of being alive. When that feeling is erratic or uncomfortable or angry or psychotic, these confident doctors have the tools to modulate it. It’s the over-confidence that’s troubling. While people can be helped by SSRIs (or any of the pharmaceuticals I mention above), only the most thoughtful or circumspect of doctors will admit readily that we don’t really understand how or why inhibiting the reuptake of serotonin results in a pretty wide range of changed feelings or behaviors among individuals, who might be calmed, lightened, enranged, or despondent as a result. The biology is fascinating, but it’s still outsmarting us. Its nuance eludes our tools and our understanding. The age of rampant and irresponsible lobotomies is in the past. But Dully’s memoir should remind us that we get into trouble when we start thinking we know all there is to know about the biology of our bodies and brains. In order to make ethical decisions about medical treatment, we need humility in the face of biology’s magnificent complexity.

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