January’s Notes from the Board include on article written by Dr. Howard Baumann titled The Prefrontal Lobotomy in Oregon, which was originally published in ChartsNotes, a publication of the Marion-Polk Medical Society, June 2014.
The most famous prefrontal lobotomy that ever occurred, occurred in Oregon, but never really occurred. This particular lobotomy, of course, was the fictional lobotomy created by Oregon author Ken Kesey in his classic novel: One Flew Over the Cuckoo’s Nest. You will recall that the story ends with Randle McMurphy finally losing his power struggle with Nurse Ratched, and landing up as a lobotomized zombie. It should be noted that the most popular display at the recently opened Oregon State Hospital Museum of Mental Health involves the memorabilia and prop artifacts from this movie.
In actuality the first Oregon State Hospital patient to receive a lobotomy was Francis Kochan. In 1947, she was transferred from the Eastern State Hospital to the Oregon State Hospital, where she was paroled to her father so he could take her to Portland, where Dr. John Raaf performed the surgery at Good Samaritan Hospital. She had been described as combative, unpredictably assaultive, and had failed all the current therapies, including ECT. Three months later she was described by a social worker as being much more docile, and now able be managed at home by her family.
Oregon’s most notorious patient to be lobotomized was Roy DeAutremont, one of three brothers involved in the Great Oregon Train Robbery of 1923. This botched holdup resulted in four people dead, a highly publicized manhunt, and eventually life sentences for all three fugitives. Roy’s lobotomy was performed in 1949 due to worsening schizophrenia. He reportedly became easier to manage, and would die in 1983 at age 83 at the State Hospital.
Between 1947 and 1954 there were approximately 130 lobotomies done on Oregon State Hospital patients. Surgeons in Portland did the earlier operations, but later all were done at the State Hospital on the second floor, east wing of the Dome Building. The surgical suite is still there, now filled with partitioned office cubicles, but the beautiful marble-lined walls can still be seen.
Large windows offered extra light for the former lobotomy suite on the east side of the Dome Building. (Photo from the author’s private collection.)
In 1949, Portuguese surgeon Egas Moniz won the Nobel Prize for his 1930’s work in developing this operation. Dr. Walter Freeman later led the charge in the United States and perfected the “trans-orbital” modification of the operation. An estimated 18,000 operations were done in the United States by 1951, and as many as 40-50,000 cases by 1956. This so called “operation of last resort” remained somewhat questionable from the very start, and still remains controversial. The controversy stems mostly from the research methodology that left many wondering about its true effectiveness. Mercifully, with the discovery of effective antipsychotic medications in the 1950s, lobotomies were pretty much put out of business. The Oregon Psychosurgery Review Board was created in 1973 to approve or decline lobotomies. Between 1973 and 1981, only six operations were requested, with only one being approved, and that one proved to be a failure. In 1981 the Oregon State Legislature banned lobotomies as a form of psychiatric therapy.
Although no longer a therapeutic option, our fascination with the prefrontal lobotomy continues. For instance, with the recent 50th anniversary of President Kennedy’s assassination, along with all the usual conspiracy theories, the press somehow decided to recount the failed lobotomy done on the President’s sister Rosemary Kennedy back in 1941. In addition, the Veterans Administration has recently been commanded by Congress to report to them the outcomes of the nearly 2,000 Veterans who had lobotomies done at VA Hospitals at the end of WWII for treatment of post-traumatic stress disorder (then called “battle-fatigue”) and other mental disorders. All of this attention to lobotomies, much like the mental images we retain from the events of Ken Kesey’s masterpiece, helps give us insight into the past difficulties of our therapies. Hopefully this will help us in making the critical decisions our country now faces in the management of the mental health.
[1] The Oregon State Hospital Museum of Mental Health opened its doors on October 6, 2012. Louise Fletcher, who won an Oscar for her portrayal of Nurse Ratched, was present for the opening ceremonies of the Museum.
[2] Oregonian, 10 July 1947.
[3] Diane Goeres-Gardner, Inside Oregon State Hospital: A History of Tragedy and Triumph (Charleston, S.C.: The History Press, 2013), 200.
[4] Goeres-Gardner, 201-202.
[5] Jack El-Hai, The Lobotomist (Hoboken, N.J.: John Wiley and Sons, 2005), 199.
[6] Statesman-Journal, 3 March 1981.
[7] El-Hai, 173-174. An excellent review of this particular episode.
[8] The Wall Street Journal, 12-14 December 2013.