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Book Note: My Lobotomy, by Howard Dully and Charles Fleming

The lobotomy continues to fascinate and to haunt.  How could the 1949 Nobel Prize for Medicine or Physiology go to Egas Moniz for the invention of a procedure that, within two decades, was rejected, with horror, as barbaric?  As a matter of inside Nobel politics, there has long been some thought that Moniz really won the prize for inventing angiography, but the Prize is given for an invention or discovery, not for a body of work, and the citation is for the “frontal leucotomy.”  The terms frontal lobotomy or prefrontal lobotomy were popularized by the procedure’s American exponent – Walter Freeman, the neurologist who invented the surgical procedure that allowed out-patient use of the procedure, the “ice pick” (literally in the first cases) through the orbit behind the eye.

This same Walter Freeman ended his career with an office in the wealthy Silicon Valley (then in its silicon infancy) suburb of Los Altos.  And, in 1960, he “gave” (the verb seems wrong) a prefrontal lobotomy to a 12 year-old boy named Howard Dully. My Lobotomy is Dully’s story, told by the now 60 year-old Dully himself, with the aid of writer Charles Fleming.

The book began as a result of a National Public Radio program on lobotomies, which, in effect, became a program on Dully.  Dully had been a difficult boy, but not, at least as he tells the story, a particularly abnormal one.  He speculates, plausibly, that today he might have been diagnosed with ADD or ADHD.  He believes his stepmother hated him, irrationally, and was willing to do anything to make him disappear, before and after his “successful” lobotomy.  Freeman, he thinks, was gripped by an overriding urge to keep experimenting with his procedure, extending it still further to children, including Howard, whom he diagnosed as having had juvenile schizophrenia since age 4.

After the procedure Dully did not become a zombie or an idiot. It sounds, from his description (the main one we have) that he became more detached and vague, at least for a while. (Freeman, however, thought his improvement was remarkable.)   His stepmother still would not take him back into the home so he drifted back and forth from the juvenile hall to Agnews, a state hospital for the insane, to a special school for the disabled.  As an adult he lived mainly on social security disability payments and a few women in his life, engaging in too many drugs, too much alcohol, and occasional petty crime, until, at about age 45, he decided to straighten out his life.  He seems to have done well; he has supported himself and his wife through driving a school bus and training other bus drivers for most of the last fifteen years.

The book is mainly Howard’s story, of his family and his early life.  His misbehavior in school, his childhood trips to the mountains, or his complex and painful relationship with his stepmother may or may not interest you, depending on your tastes.  The discussion of Freeman, and the contents of the notes Freeman took on Howard, are more interesting from the perspective of neuroethics. I would have liked more scientific discussion of the lobotomy generally and of Howard’s case in particular.  But this is Howard’s memoir, not a scientific report on him.

The latter may be coming.  According to the afterward of the paperback edition of the book, Dully has now been scanned in an MRI.  The researchers found major brain damage that they would expect to render a person completely incompetent.  They can only attribute his normal or close to normal life to the remarkable brain plasticity of the young.  I understand that they hope to have a manuscript submitted around the end of 2009.  That paper should be well worth reading and will make this already interesting memoir even more useful in neuroethics.

- Hank Greely

2 Responses to “Book Note: My Lobotomy, by Howard Dully and Charles Fleming”

  1. cemurdoch says:

    Hank, do you think there’s anything to the lobotomy/dbs comparison?

    When used to treat mood and behavioral disorders, both treatments are very invasive and act fairly bluntly on the brain. Both have charismatic young doctors championing their widespread application beyond their initial treatment utility. Both are intended to treat conditions that are not very well understood etiologically and are in some way recalcitrant to conventional treatment.

    On the other hand, of course, there is no evidence as yet that anything as horrific as the fallout of lobotomy results from dbs treatment. But it is worth noting that the initial anecdoctal evidence for lobotomy was actually overwhelmingly positive, and it took several years and significant popularization of the treatment before the tides started to turn.

    I must also note that one of the first sets of ethical guidelines for the use of dbs in mood disorder treatment was released recently, which is promising. Lobotomy could have used some of these:

    http://archpsyc.ama-assn.org/cgi/content/short/66/9/931?rss=1

  2. hgreely says:

    Enough to worry about. And I think many of those pursuing DBS are worrying about it, or, more broadly, about the uncertainties in what they are doing. There are some very careful investigators out there – among those I have met, I’d single out Helen Mayberg and Niko Schiff, though I’m sure there are more. But my sense is that there are also some less careful folks. Nonetheless, I think the field has not forgotten the lessons of the “great and desperate cures,” using the title of Eliot Valenstine’s invaluable book on lobotomy and other drastic mid-20th century interventions.

    At the same time, DBS does appear to be safer than lobotomy. We know, with some precision, where we are intervening and we can stop the intervention.

    I do worry, though, that the desire for “great and desperate cures” is still with us, in medicine (using neuroscience tools, stem cells, or other interventions) and, specifically in neuroscience, with interventions against anti-social behavior. (See my article in the Kansas Law Review on neuroscience “treatments”.) I see “chemical castration” as an example of an intervention that has been adopted far more than justified by our knowledge of its efficacy and safety. (John Stinneford has a very nice law review article on that subject.)

    In all aspect of life, enthusiasm and caution need to be balanced carefully; I think that’s particularly true when messing with people’s brains.

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