> The Washington Post
> April 6, 1980, Sunday, Final Edition
> SECTION: First Section; A1
> HEADLINE: Psychosurgery's Effects Still Linger;Benefits of
> Psychosurgery Still Debated by Doctors;
> After 20 Years, Effects of the Lobotomy Era Still Linger

> SERIES: The Lobotomy Era; First of a series

> BYLINE: By Glenn Frankel, Washington Post Staff Writer; Staff writer Stephen J. Lynton and researcher Regina Fraind contributed to this story.

> His head jerks from side to side in constant motion. So do his restless eyes, which roam the drab concrete walls of Building 94 at Eastern State Hospital in Petersburg, Va., where he is confined. His mind wanders too, jumping from thought to unconnected thought, never settling on one for more than a few seconds, often doubling back to something he has said just moments before.

> His name is Edgar and he is the product of one of the most bizarre and disturbing episodes in United States medical history: the years from 1936 to 1960 when between 40,000 and 50,000 Americans were subjected to brain operations -- often without their knowledge or permission -- in a popular crusade to cure, or at least render manageable, the nation's mental patients.

> Today, an estimated 200 to 500 lobotomies are performed annually by perhaps a dozen doctors in the United States. But the medical standards and legal restrictions of 1980 bear only small resemblance to those of the heyday of the lobotomists.

> Children as young as four and adults as old as 70 had their brains cut by the surgeon's knife. Besides vast numbers of the mentally ill, those lobotomized or subjected to other experimental psychosurgery, included drug addicts, alcoholics, hyperactive children, juvenile delinquents, homosexuals and the mentally retarded, according to studies published at the time.

> Some patients were lobotomized while under local anesthesia and could hear the buzz of the surgical drill and the scraping of the surgeon's knife. Others were electroshocked into unconsciousness, after which doctors severed their brain tissues with icepick-like instruments inserted through their eye sockets.

> In almost every case, doctors permanently removed or destroyed tissue from brains that were physically normal in order to alter what they believed was abherrant behavior. In most instances because they did not remove part of the skull, doctors used "blind cut" procedures and could not be certain of the extent of the damage they were doing.

> In many states, including Virginia and West Virginia, the operations were performed not by surgeons but by ordinary doctors with little or no surgical training.

> "Some patients were greatly helped, and many were improved enough to eventually be discharged. But the price for many was irreversible brain damage -- their emotions flattened, their minds remained docile, dull and vague.

> "It was a tragic and unfortune chapter in psychiatry," says Dr. Alan Stone, Harvard University professor of law and psychiatry and president of the American Psychiatric Association,whose monthly journal avidly promoted lobotomy until the 1960s.

> "I found it shocking when I was a medical student back then and I still do," says Stone. "There was no excusefor what was done."

> Despite lack of scientific proof justifying its widespread use, the lobotomy era continued unabated and rarely challenged until a new therapy craze -- tranquilizers -- rose to take its place.

> Although that era ended more than 20 years ago, its excesses still cast a long shadow in the nation's courts, state legislatures and federal agencies where debate over modern use of psychosurgery continues. It is a debate between psychosurgeons who argue their sophisticated techniques are far more damaging than those of the lobotomists, and their opponents, who contend most or all psychosurgery is still experimental brain mutilation.

> Washington has a special place in thehistory of lobotomies. It was the Veterans Administration, headquarteredhere, that gave the operations their greatest impetus in this country, subjecting nearly 3,000 war-disturbed veterans to the psychosurgeon's knife between 1943 and 1951 in hope of ending, or at least reducing, overcrowding in the agency's mental wards.

> "The government played in some ways acritical and pivotal role in the development of lobotomy," says University of Michigan psychologist Elliot S. Valenstein. "They (the VA) had a lot of patients crying out for help and a lot of pressure from families and there were no alternative treatments."

> It was a distinguished Washington neurologist who refined the technique of the European operation and promoted itsuse in state mental institutions throughout the country.

> The late Dr. Walter J. Freeman, chief of neurology at George Washington University Hospital, one-time president of the District of Columbia Medical Society, once estimated he performed or directed nearly 4,000 lobotomies in his career. Frustrated by the slow pace of early lobotomy procedures, Freeman developed an assembly-line method by which the operation could be done in 10 to 15 minutes in a doctor's office without use of regular anesthesia.

> "A lobotomy program in a state mentalhospital, carried out actively and conscientiously, can transform a lunaticasylum into an old people's home," Freeman told an enthusiastic group of doctors and state officials in Richmond in 1951. That group set up a lobotomy program that involved nearly 400 state mental patients over the next four years, including Edgar.

> Virginia was far from alone. Freeman estimated that by 1951 he had been instrumental in developing similar programs in 30 mental hospitals in 15 states.

> Diagnosed as paranoid schizophrenic, Edgar, now 53, went under Freeman's knife in 1953 at Eastern State Hospital in Williamsburg. Although his parents signed a consent form, he says he was not aware he was to have brain surgery until the operation was over.

> "I think it helped me," he says, adding, "it made me feel better." But beyond that, Edgar cannot be specific.

> A family member says Edgar used to hit himself in the jaw, gradually opening up a small hole in his skin. After the operation, Edgar stopped and his face healed. But despite Freeman's claim that "lobotomy gets them home," Edgar has spent almost all of the 27 years since his operation in state mental hospitals.

> At the height of his fame in 1952, Freeman gave a virtuoso demonstration of his work in West Virginia. In 12 days that August, Freeman performed or supervised 228 lobotomies at five state hospitals. Press reports dubbed his performance "Operation Icepick."

> Despite the exaggerated claims of thelobotomists and the excesses of that era, many psychiatrists still believe the operations were a justifiable "therapy of desperation," as doctors described it then.

> "It wasn't all negative -- many patients were able to go home," says psychiatrist John Donnelly of the Institute of Living in Hartford, Conn., who headed an APA Psychosurgery study group.

> Donnely contends that before the introduction of tranquilizers, "there was no hope for those people without it (lobotomy) . . . In terms of that time, it's very understandable why they did asmany as they did," He and others believe that, faced with a lifetime of institutionalization, lobotomies were a practical "last resort" for patients for whom other cures had been tried and failed.

> But other students of the lobotomy era say the operation was used for people far from truly "hopeless" even bythe standards of those days.

> "The urgent hope for the dramatic andthe magical in patients; the seductiveness of the facile and quick procedure for the psychiatrist; the exploitation of the easy and the profitable by the least competent therapist led . . . to a sickening abuse of this procedure," writes psychiatrist Willard Gaylin in a psychosurgery study by the Hastings Institute in New York, of which he is president.

> Freeman at first had insisted lobotomies should be used only on the hopelessly ill. But gradually he came to believe it should be a "treatment of choice" to be used on those patients who had not improved within six months of confinement to a hospital.

> As he told his Richmond audience, "It is safer to operate than to wait."

> Dozens of doctors apparently heeded Freeman's call, some adopting his six-month standard, others waiting longer. By 1949, according to Dr. Herbert Vaughan, professor of neurology at Albert Einstein College of Medicine, "there was a veritable explosion in the frontal lobal lobotomy, which reached a peak of 5,000 operationsper year in 1949."

> And two Columbia University neurologists, writing in the American Journal of Psychiatry in 1954, concluded that "While the major procedure was originally applied almost entirely to severely deteriorated schizophrenics, a survey of the current literature discloses that almost every imaginable category of mental illness has been subjcted to some frontal lob procedure."

> The concept was a relatively simple one, based on research suggesting the front lobes of the brain are the center of human anxieties and emotions. When experiments on apes showed the lobes could theoretically be severed without killing the brain, the lobotomists went to work on human subjects.

> Freeman and his early colleague, noted Washington neurosurgeon James W. Watts, did a half-dozen lobotomies in the fall of 1936. They were encouraged enough by the results to do more than 600 over the next 12 years. They reported "success" in about two-thirds of their patients.

> But there were problems. Freeman and Watts, in their landmark book "psychosurgery," republished in 1950, conceded that "Prefrontal lobotomy smashes the fantasy life and ruins creative capacity in doing so . . . One is justified in speaking of the (lobotomized) individual as good solid cake but no icing."

> They argued the loss of creativity was a small price to pay for a ticket home for an otherwise hopeless patient. Freeman reported that between 35 and 50 percent of his patients were able to be discharged within a year depending on the seriousness of their illness and the skillfulness of the operation.

> Later studies suggestsed less success. A 1962 report on more than 200 lobotomies done in western Pennsylvaniapointed out "how little relationship there may be between discharge and 'recovery':"

> "Four of the 17 discharged (from one hospital) . . . seem to feel happier, are able to work more conistently and are certainly less destsructive . . . This is to say they are cured, according to clinical standards. The remaining 13 . . . show a variety of symptoms ranging from overt psychosis and vegetable existence to persistence and even exacerbation of functional complaints and obsessional rumination."

> A 1970 Missouri Institute of Psychiatry report concluded that "Although many patients benefited from it (lobotomy), the neurlogical and psychiatric side effects often proved more disablingthan the psychiatric illness itself." The authors then went on to describe what they called "post-lobotomy syndrome" in patients whose brains had been too deeply cut:

> "The frequent effect of such overoperation was irrevesible change in mood, emotion, temperament and all higher mental functions . . . postoperative mortality and morbidity, incidence and duration of confusion, urinary incontinence, unequal pupils, facial assymetry, convulsions . . . were greater when the section had been more extensive."

> There were indications as early as 1949, according to a National Institute of Mental Health report on psychosurgery, that lobotomy was not the cure its promoters claimed. The results of a four-year Columbia University study of lobotomies at Greystone Hospital in New Jersey published that year and followed up with a second report four years later were negative, according to NIMH.

> "Neither the original nor the followup was able to provide any substantial scientific evidence that these psychosurgical procedures were useful."

> All of which, reported NIMH, "had little effect on the psychosurgeons, who continued to ignore or gloss over the side- effects of their procedures."

> Virginia, which adopted its own use of lobotomy in 1951 following Freeman's enthusiastic reception in Richmond, ran a typical state psychosurgery program, according to those who have studied the era.

> "I think Virginia was wrong, but it certainly wasn't alone in terms of the number of states that allowed those things to go on," says Robert Plotkin, attorney for the Mental Health Law Project in Washington.

> The prospect of lobotomy was not muchmore grim than other now- discredited or seldom-used practices such as electro-shock and highly dangerous insulin coma -- in which patients were overdosedwith insulin into a "therapeutic" convulsive state of unconsciousness -- that were widespread in Virginia institutions.

> A 1954 State Hospital Board report listed 25,199 "special therapy procedures" for the year, including electroshock and insulin coma, as well as 171 sexual sterilizations, performed under the mistaken notion that most mental illness was hereditary.

> Virginia policy required that each lobotomy be approved by state Mental Commissioner Joseph E. Barrett, thatwritten consent be obtained from the patient's parents of guardian and that the operations be performed only on patients for whom all other "reasonable"treatments had failed.

> "You have to remember they had no tranquilizers and virtually no effective way to treat people," says Dr. Donald Jones, hospital medical director for the modern-day state Department of Mental Health and Retardation. "It (lobotomy) was used for the most severe cases where nothing else worked."

> But reports at the time indicated that lack of funding and staff played a large role in the drive for lobotomies.

> Dr. Granville L. Jones, then superintendent of Eastern State Hospital in Williamsburg, where 190 patients were lobotomized between 1951 and 1955, wrote in 1954:

> "Obviously in the state hospital witha large case load and the relatively limited staff, we cannot undertake extensive psychotherapeutic efforts in the severely psychotic patient and for that reason it is entirely possible that some of the patients on whom we have performed lobotomies might have been helped by . . . psychotherapy."

> The Department of Mental Hygiene and Hospitals declared the lobotomy program a complete success, noting that one-third of the patients had been discharged and another third helped considerably.

> "Many of these patients are now enjoying life with their famalies after having been hospitalized for many years,and those remaining in the hospital have made a better adjustment and lead happier lives," noted a 1954 department report entitled "Sixteen Years of Progress."

> But some officials had doubts. The State Hospital Board never officially endorsed the procedure, according to board minutes and news reports from the time, because its two physicianmembers "expressed reservations." Despite that, state oficials today estimate 379 mental patients were lobotomized at four state institutions by the program's end in 1955.

> A Norfolk native, Edgar had been atEastern State Hospital for 10 years when he underwent a lobotomy in 1953. He had been sent there after he got in trouble with the law at age 16 for reasons that he either cannot or prefers not to remember.

> In a recent interview at Central State, where he now lives, Edgar struggled to recall the circumstances ofhis surgery. He does not recall meeting Freeman but says he would like to and is mildly disappointed to hear the neurologist has been dead since 1972. As he talks, he struggles to light a cigarette that he later forgets is in his hand.

> Officials thought the lobotomies would help clear their wards; but Edgar lingered on at Eastern State until 1978, when at age 52 he was finally released. He married another ex-patient and moved to Richmond, where he and his wife were forced to live in separate boarding houses for former mental patients because neither was capable of total personal care.

> Edgar lasted for a year on the outside until what he recals as a trivial argument in which he mockingly threatened another ex-patient led to his return to Central State. He is allowed to leave to visit friends and relatives on weekends.

> With his gray hair cropped institutional style and his battered plaid sport coat and baggy green pants, Edgarlooks at home. Having spent most of his life in state hospitals, he says he is comfortable here but would rather be on the outside.

> "It's not a bad place," he says, noting his wife has also committed herself here. When will they get out again? "Maybe never," he says unhappily.

> GRAPHIC: Illustration, no caption; Picture, Dr. Alan Stone. . . "a tragic chapter"; Picture 2, Dr. James Watts. . . early psychosurgeon; Picture 3, Lobotomy technique, "Psychosurgery," Charles C. Thomas, publisher.