Humans really don't have a great track record as a species when it comes to the way we treat people In fact, we don't even have a great track record of deciding what is and is not a mental illness in the first place. At various times in the last 200 years, we've pathologized a slave's desire to run away from slavery (drapetomania), women who are emotional and like sex (hysteria), and man-on-man or girl-on-girl action (homosexuality). Clearly, it's taken us a really long time to get around to understanding the full complexities of the human condition, and the medicalization of the normal range of human emotions continues today. There are some who are even questioning the psychiatrist's most important book, the Diagnostic and Statistical Manual, which lists mental disorders, their symptoms, and possible treatments.with mental illness.
One of the more recent (and shameful) periods in the history of mental health treatment came in the middle of the 20th century, the era of the lobotomy. A lobotomy is a surgical procedure that creates an incision in the brain, resulting in changes in personality, cognition, and behavior. The theory was that people with certain types of mental illness, especially those that resulted in abnormal, uncontrollable, or violent behavior, could be "cured" by disconnecting the pathways in the brain that are pathologically damaged. The procedure was pioneered by Portuguese neurologist Antonio Egas Moniz, who was awarded the Nobel Prize in Medicine for advancement in psychosurgery. Perhaps the best-known lobotomy patient in the United States was Rosemary Kennedy, oldest sister to President John F. Kennedy. Born with cognitive disabilities, Rosemary's father Joseph ordered the procedure done on her when she was 23. However, serious complications during surgery resulted in her being severely disabled for the rest of her life, which she spent in an institution in Wisconsin. The lobotomy was also a prominent plot point in the novel One Flew Over the Cuckoo's Nest.
In the US, Dr. Walter Freeman was the most vocal and enthusiastic proponent of the procedure, and he developed his own version of the surgery, involving a literal icepick to the brain, inserted through the eye-socket. Freeman performed thousands of these procedures, despite having no surgical training. Up to 40% of his patients were being treated for homosexuality, which resulted in almost 2000 otherwise healthy people being brain damaged for life. He was finally banned from performing the procedure, but not before he had affected thousands of lives, including the lives of at least 19 minors.
One of those children was 12 -year-old Howard Dully. In 1960, Dully's father and step-mother, after a year or more of taking Howard from psychiatrist to psychiatrist, stumbled upon Dr. Freeman. Dully's step-mother, Lou, was physically and emotionally abusive to Howard, constantly berating him and using him as the scapegoat for her biological son's behavior. She had taken Howard to many psychiatrists, none of whom found anything wrong with the boy that couldn't be explained by a stressful and toxic home environment. Dully's father, Rodney, was unwilling or unable to stand up to his wife, and, in fact, was also physically violent with Howard. Lou finding Dr. Freeman was the worst kind of luck for Howard. Lou was determined to have Howard removed from her home, and Dr. Freeman was overly-enthusiastic about performing lobotomies. Despite his own admission that he believed Lou to be the problem in the household, he agreed to perform the procedure on Howard. Instead of fixing the "problem", the surgery resulted in permanent changes to Howard's memory, cognition, and personality, and exacerbated his difficult home life. Forty years later, happy for the first time in his life, Dully decides to try to determine exactly what happened to him in the months and years leading up to and just after the procedure.
The telling is straight-forward and no-nonsense. Dully shares stories of his abuse and neglect, as well as honest accounts of the poor choices he made as he moved into adulthood. He did not have an easy life-he experienced abuse, drug addiction, homelessness, and incarceration. While no direct cause and effect can be drawn between the lobotomy itself and his future outcomes, it certainly couldn't have helped. It was part of a pattern of trauma, physical and emotional, that has certainly been shown over time to correlate to exactly the kind of actions that lead to drug addiction, homelessness, and incarceration later in life. What is clear, however, is that Dr. Freeman was guilty of more than just malpractice. His ethical and moral violations are mind-boggling by today's standards, and even during his most active period, there were those in his field who refused to associate themselves with him. But somehow he convinced enough people that his procedure was "curing" things like schizophrenia and homosexuality that he was allowed to continue practicing for YEARS. Historically, "cures" for mental illness have caused more problems than they've solved, and have led to real torture for some patients.
While we've certainly made advancements from the earliest days of locked asylums, ice baths, and electroshock treatments, we've still got a mental health crisis in the United States. The majority of people incarcerated are diagnosed with or show signs of mental illness. Ditto many people experiencing homelessness. In Cook County, Illinois, the largest provider of mental health services is the Cook County Jail. Lack of funding, lack of community support, lack of adequate mental health first aid training, overpoliced communities, and the effects of trauma on the brain all contribute to a system that abandons the most vulnerable patients to a patchwork of unreliable services, the jail, or the streets. Because I don't see any alternative to hope, I have to believe that eventually, we as a society will recognize the value of prioritizing the elimination of poverty and violence, as well as compassionate care for those who are suffering from mental illness or trauma.
