Hope and horror

H. Bosch, The Extraction of the Stone of Madness and Folly

The word lobotomy strikes terror in the heart of most of us today, despite the fact that the procedure was once the darling of mental health professionals--and the fact that Antonio Egas Minoz, inventor thereof, for his efforts won the Nobel Prize for medicine in 1949. In this country 40,000 lobotomies were performed in the two decades when the procedure was considered a godsend. Today, however, even the word sounds medieval.

It looks worse. What Minoz designed, and dozens, even hundreds of practitioners copied, was gaining entrance to the brain and then simply messing things up, disconnecting connections between the prefrontal cortex and the rest of the brain. Someone determined to call the procedure "ice-pick surgery" because those who performed it gained access to the brain via--gulp!--extra long nails. A couple of days ago, I saw such nails, behind glass, at St. Joseph's (MO) Glore Psychiatric Museum, in a display that included pictures and drawings I've unfortunately not forgotten. 

The whole operation, I'm told, took ten minutes, no more; and for twenty years it seemed a perfect blessing to mental health professionals. Right from the get-go, the procedure had its detractors, some registering criticism simply on the basis of the repulsive nature of procedure--poke something sharp through the eye and into the cranial cavity, then stir things up.

The truth is, success was, from the start, a mixed bag. Some patients' conditions didn't change a bit. Another third came out of the lobotomy changed--for the worse, often badly for the worse. The behavior of yet another third clearly improved. 

Lobotomy never became the miracle cure its proponents claimed it would. Worse, in a high profile cases like that of Rosemary Kennedy, sister of JFK, the failure was awful. Her father, Joseph, determined a lobotomy would cure his often petulant daughter of violent mood swings. It was November of 1941, and approximately 80 lobotomies had been performed in this country. Tragically, Rosemary Kennedy's operation was an appalling failure, leaving her in a state for which we have no words easy to use. 

Seen in context, the immense and immediate popularity of the lobodomy is somehow humanly understandable, despite the disasters. During the Depression, when money was tight, funding for mental hospitals was frequently the first government expenditure cut. Huge institutions found themselves with thousands of patients on budgets that became, with each passing year, more draconian. In the era of "insane asylums," as they were called, many Americans--and mental health professionals--advised patients' families to pack clothes proper for burial since it was simply assumed that signing family members into mental health facilities--many of those institutions cities in and of themselves--meant the patient would likely leave only in a casket. 

The lobotomy, an incredibly cheap and quick procedure, offered a miracle fix we all still search for in the face of our own intractable problems. We've come a long way in our treatment of mental health--or so museums like the Glore amply display; but as many of us sadly know, coping with significant mental and emotional distress is too often no easier today than it was before the lobotomy. Hope, the "thing with feathers," flits alluringly through all of our dreams, but it's ever fragile, easily broken.

Almost as if by chance, I've been in two mental health museums in the last few weeks, seen all kinds of hope demonstrated in a hundred historic procedures and therapies that, throughout the years, offered miracles. But even with pharmaceuticals, mental health remains a mystery. Those sprawling facilities we built long ago in places like Cherokee, Iowa, and St. Joseph, Missouri, those massive ornate structures (the distance around Cherokee's is more than a mile!) were once an alternative world where the rest of us could file away those we judged insane or lunatic, words today considered obscene.

The history of mental health treatment is full of false starts, misplaced enthusiasm, and remarkable failures. Still, walk through those old institutions sometime and it's hard not to be taken by an undercurrent of unyielding hope in people, professionals, who weren't themselves as evil as they might well seem, men and women who did their best with what they had, which wasn't much. 

The stories may well be garish, scary as ice-picks; but the hopes are as much ours as the nightmares. The stories are our stories too.