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Interview with Jack El-Hai, Author

November 7, 2010
Beck: Good Morning Jack. It's a pleasure to speak with you.El-Hai:Thanks Doug. Nice to be with you, too.Beck:Jack, the whole idea of "lobotomy" is very interesting to me as an audiologist and I think it's fascinating for everyone involved with speech, language, audition, cognition and mental health
Beck: Good Morning Jack. It's a pleasure to speak with you.

El-Hai:Thanks Doug. Nice to be with you, too.

Beck:Jack, the whole idea of "lobotomy" is very interesting to me as an audiologist and I think it's fascinating for everyone involved with speech, language, audition, cognition and mental health issues, too. However, before we get involved with your new book, would you please tell me a little about your background?

El-Hai: Sure, Doug. I earned my undergraduate degree in 1979 from Carleton College in Minnesota. For about ten years after that I wrote magazine articles and short stories. I've actually written some 400 magazine articles for publications like American Heritage, The History Channel Magazine, and The Atlantic Monthly. I have also written some interesting corporate histories, and I'm currently working on an article for Harper's. I write history, science and sometimes I write about medical topics, so it's been highly diverse and absolutely enjoyable.

Beck:For those of us who write primarily within one discipline, it's amazing to me that you can write across professional and consumer boundaries. I guess that's the difference between a professional writer, and professionals who write! Nonetheless, please tell me when you first got the idea to explore and write about lobotomies?

El-Hai:I first got interested in the topic after reading Ken Kessey's "One Flew Over the Cuckoo's Nest." Later, I saw the movie "Frances" about the actress Frances Farmer. The film implied she had a lobotomy while she was institutionalized, but my research indicated she probably didn't. I also met a woman in Minnesota, back in 1996, whose uncle had a lobotomy through their state hospital system. That's when I learned that lobotomies were actually more common than I ever suspected.

Beck:When were lobotomies performed in the USA?

El-Hai:In the USA, lobotomies were performed from about 1936 to about 1978. During that time, no one really counted the quantity of lobotomies. Nonetheless, it appears some 40 to 50 thousand procedures were performed.

Beck:What were the primary medical problems treated through lobotomy?

El-Hai:The primary diagnosis categories were schizophrenia and chronic depression, but there were others, such as "hysterical" illnesses, obsessive-compulsive disorders, and also chronic pain.

Beck:And I guess the most prominent lobotomist was Walter J. Freeman MD.?

El-Hai:Yes, he performed about 3400 procedures. That's a lot of lobotomies, but with respect to the total number, he performed less than ten percent. Nonetheless, he was prominent among lobotomists, as he was one of the primary and early advocates of the procedure.

Beck:One thing that fascinates and confuses me about Dr Freeman, was that he was a neurologist, not a neurosurgeon...is that correct?

El-Hai:Yes. That's a good point, Doug. Dr. Freeman had no real surgical training or certification in surgery, but as a physician, he pursued his own interests based on his in-depth knowledge of brain anatomy, and when he became interested in lobotomy he served as a surgical assistant to a neurosurgeon, originally with Dr. James Watts, during 1936.

Beck:That's amazing. I cannot imagine a non-surgically trained physician just "elbowing" his way into the operating room and performing thousands of procedures.

El-Hai:Yes, I agree. It was controversial, and it probably could not happen at all at this time. By the peak lobotomy years, the late 1940s and the early 1950s, the surgeries were done by neurologists, neurosurgeons, psychiatrists, and others, too.

Beck:Wow. That is just incredible. Without getting into too much detail, can you tell me a little about the history of the approach itself?

El-Hai:The first "psychosurgeries" were actually done in 1935, the year before Freeman began. Those were done by a Portuguese neurologist named Egas Moniz. He too, worked with a neurosurgeon. Moniz thought habitual use of particular neural pathways were the root of psychiatric problems such as schizophrenia, chronic depression and other issues, and he thought that if the neural pathways were obliterated, new pathways could occur, which would essentially lead to a healthier state of mind and better and less problematic behaviors. He referred to the procedure as a "leucotomy."

Beck:There is a recognized phenomena we refer to as "neural plasticity" which although less dramatic than lobotomy, is pretty much the same idea and is readily accepted as a real and living event which can be used to help understand and rehabilitate parts of the brain and the central nervous system.

El-Hai:Yes, and that's really a good thing to remember, because it helps explain that men like Moniz and Freeman were not kooks, and in fact, they were working on a hypothesis that was credible at the time. Anyway, Moniz operated on some 20 patients in 1935 and 1936 in Lisbon, and reported his results in the medical literature. Freeman met him in 1935 and Feeeman was really quite taken by all of this. Freeman thought it made sense, and Freeman wanted to be the American to bring lobotomy into the mainstream. Historically, Freeman's dad was an ear, nose and throat specialist and his grandfather had worked in neurosurgery at the end of the nineteenth century, and was reportedly the first American to successfully remove a brain tumor...and so dramatic and daring may have been learned familial traits.

Beck:Very interesting. What about patients with auditory hallucinations?

El-Hai:There were many patients with auditory and visual hallucinations, often diagnosed with schizophrenia. Dr. Freeman operated on them and he believed lobotomy would lessen the hallucinations, by diminishing the intensity with which the patient noticed them. He never claimed he could cure these things, but he thought he could lessen their symptoms. There were also patients whose psychiatric disorders left them mute, and some of them, benefitted from lobotomy. And as briefly noted earlier, some cancer patients in chronic pain with just a few months to live, were offered the procedure to lessen their pain sensation, and of course, this was really a treatment of last resort.

Beck:Does any of this relate to electroconvulsive shock therapy (ECT)?

El-Hai:Yes, well ECT emerged at about the same time, as did a few other shock therapies, and all of these shock treatments were for very seriously ill psychiatric inpatients, usually with no other options.

Beck:And ECT is still performed to this day?

El-Hai:Yes, it's probably done as much today as it was 40 years ago. But importantly, ECT has been refined significantly since it was introduced..

Beck:Jack, thanks for your time. This is absolutely an amazing topic, and a fascinating book - I really enjoyed your treatment of the subject, and importantly of Dr. Freeman, his stubbornness, his humanity and
Purposequite a dynamic man to write about.

El-Hai:Thanks Doug. I appreciate your time and enjoyed the discussion.

The Lobotomist: A Maverick Medical Genius and His Tragic Quest
to Rid the World of Mental llness.

ISBN# 0-471-23292-0
John Wiley and Sons, Inc.
Hoboken, New Jersey