/ Michigan quarterly review: Vol. 27, No. 3
428 MICHIGAN QUARTERLY REVIEW resulted- they became inert, practically mute, justifying the label "zombies." But to assert, as some critics do, that all lobotomized patients became intellectual and emotional "vegetables" implies that the physicians involved were all stupid, callous, or malevolent. This was clearly not the case. Such a charge is a disservice and trivializes the problem. If anything is to be learned from this history, it is that well-meaning and highly-trained physicians can convince themselves too easily that their patients are better off than they would have been if left alone. By 1946, after having promoted prefrontal lobotomy for a decade, Walter Freeman decided that lobotomies as normally performed could not solve the problem in state mental hospitals where the majority of mental patients was housed. There were few state hospitals that could afford neurosurgeons or the extensive postoperative nursing care required after a major lobotomy. What was needed, Freeman reasoned, was a "simple" operation that did not require neurosurgeons or protracted postoperative care and could be justified at an earlier stage of mental illness. Freeman had become convinced that there was a danger in waiting too long because lobotomies rarely helped chronic, deteriorated patients. This was Freeman's motivation for developing the transorbital lobotomy, the infamous "ice pick" operation, which he had modified from a procedure originally developed by an Italian psychiatrist. As he performed it, after patients were made comatose with two or three electroconvulsive shocks - thereby eliminating the need for an anesthetist as well as a neurosurgeon- a pointed instrument resembling an ice pick was inserted over the eye ball and then driven with a mallet through the bony eye socket into the frontal lobes. By moving the instrument's handle, sideways and up and down, a part of the frontal lobes could be destroyed. Freeman initially did ten transorbital lobotomies in his office in downtown Washington, operating on private patients on an outpatient basis. Incredible as it may seem, in most instances patients could go home within an hour, usually wearing sun glasses to conceal their "black eyes." There were several tragic accidents, however, usually when a cerebral blood vessel was torn, but Freeman insisted that transorbital lobotomies were generally safer and more effective than the major prefrontal lobotomies, which had a 5 percent mortality rate and produced a high incidence of seizures.
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