Abstract
In The Lobotomy Letters, Raz closely examines how and why the lobotomy gained acceptance in the USA. Other books on this topic have usually kept Walter Freeman, America’s biggest proponent of the procedure, close at hand. In this regard, Raz is no different. Very adeptly the author shows how Freeman, a French-trained neurologist, brought the lobotomy into the American medical discourse. His acceptance and publicizing of the procedure was due to an amalgam of his personal understanding of mental illness and his specialized training in France. The focus on the training and the personality allows the reader to grasp better how Freeman came to see the lobotomy as a viable therapeutic tool. To underscore this appreciation, Raz focuses on the rise of the lobotomy and ends the study before the procedure fell out of favour and Freeman was struggling to keep it (and himself) relevant.
The book is separated into two parts. The first explains how the procedure ‘was interpreted within the framework of prevailing neurological and psychiatric theories’, while the second focuses on ‘the clinical encounter’ to show how the results were ‘positively interpreted by Freeman, his patients, and their families.’ (p. 2). In the first chapter, Raz explains that Freeman believed the fields of neurology and psychology were not mutually exclusive. In fact, the more he looked into it, the more he saw that they tended to overlap, and the lobotomy emerged at the intersection. Subsequently, Raz tackles each of these medical fields separately and describes how they both accepted it and how the procedure became part of the medical discourse. To publicize the lobotomy, Freeman often described it in mixed social and neurological terms to explain it as a viable procedure that cured a neurological disorder and allowed patients to regain their place in society. Psychoanalysts and psychotherapists, with the help of Freeman, defined the procedure as something that aimed to separate the ego from the self. Like the neurologists, they saw the lobotomy as a feasible option, yet they never completely embraced the notion of a somatic therapy having a place within their discipline. They accepted it, but only in combination with psychoanalysis. If psychoanalysis failed to produce positive results, then the lobotomy became a viable option. After the procedure, however, psychoanalysis resumed, when presumably the patient was in a different position and better able to appreciate the treatment.
While the first section – the acceptance and adoption of the procedure by the medical community – is compelling, Part Two contains the more innovative portions of the book in which Raz explains how patients and their family members came to accept this radical medical procedure. The three chapters in this section describe how Freeman corresponded with his patients and their families to help them understand the results of the lobotomy. He would use childhood as a metaphor for post-operative patients’ initial behaviour, and argued that the ultimate marker of success was when the patient entered or re-entered the work-force.
By maintaining the focus on Freeman and his correspondence with patients and families, Raz is able to show that the medical community accepted the lobotomy, not necessarily because of its outcome, but because Freeman tended positively to define and redefine the results within the patient-physician and the patient family-physician relationship. After describing the initial, if somewhat hesitant, acceptance from neurologists and psychologists, this is the book’s main focus. In these chapters, Raz shows that it was within this discourse, this area of negotiation, that the lobotomy was accepted. Medical figures argued over the usefulness, practicality and humanity of this procedure, but its real acceptance, Raz argues, came from patient-physician negotiation.
In his correspondence, which often lasted for years, Freeman would optimistically attempt to interpret the results of the surgery, offer solutions to major problems and provide encouragement to his former patients. He would argue, and the family and the patients tended to believe, that whatever the results – barring death – life was better than before the lobotomy. The doctor became such a presence in his patients’ post-operative lives that they would send him Christmas cards and maintain correspondence long after the lobotomy was performed.
This narrow focus on Freeman has its merits. Through it, Raz shows his readers how the tenaciousness of one individual was a major factor in the positive reception of this radical procedure. Still, as the author points out, many physicians practised psychosurgery at its zenith during the 1950s, and they did so in ‘state hospitals … private asylums, general hospitals, university medical centers, and psychiatric research institutes’ (p. 47). Yet Raz, like many scholars before him, ignores those physicians in favour of Freeman, because they did not necessarily play a part in the rise of psychosurgery, but merely adopted it, largely due to the persistence of one man.
As a whole, the book is accessible. At times, namely in the first few chapters, Raz, a physician by training, tends to get caught up in the medical jargon, but never so much that the reader is lost in the descriptions. The presentation is clear enough for researchers and students in a variety of fields to find it a useful history of the lobotomy.