Many would consider distasteful the way Dr. Freeman described his mishaps: “I'm afraid she is a gone goose as far as useful life hereafter is concerned,” he said about one patient. Another had a hemiparesis after the procedure; Dr. Freeman went to the adjacent waiting room and requested $1,000 from the husband to treat the complication.
By the mid-1950s, however, the lobotomy was about to become obsolete. The advent of chlorpromazine and other treatments, a more enlightened view of mental disorders, a better diagnostic system, the progressive reduction of the census in state hospitals, and other factors doomed lobotomy to obsolescence in the midst of progressive rejection, if not total repudiation.
Dr. Freeman emerged at a time when somatic treatments, careful clinical evaluation, and general theories of psychotherapy were competing. If Mr. El-Hai believes that Dr. Freeman has been replaced by the “medication management” crowd, the only consolation is that the present epidemic may not be as bad and may end with the demise of managed care.
So, are we safe from a repeat? It must be remembered that Dr. Freeman was not a charlatan who came from nowhere. His grandfather, William Keen, M.D., had been an acclaimed president of the American Medical Association, and his father and brother also were physicians.
Dr. Freeman went to Yale University and the University of Pennsylvania. He organized a well-run laboratory at St. Elizabeths Hospital in Washington and was the first secretary of the American Board of Psychiatry and Neurology. His credentials clearly distinguished him from the average snake-oil salesman, even if his practice did not.
The moral of the story is that we must not rely on credentials alone. Solid clinical research, persistent demands for compelling evidence when a new procedure is proposed, and ongoing supervision of its application are the best defenses against any future travesty.