April 28, 2023 • 26 mins
A doctor might dismiss your concerns by saying that something is all in your head…as if the brain doesn’t play host to many kinds of illness. Some of our oldest corpses bear physical evidence that directly cutting into the brain is one way to attempt healing the mind. But what happens when our modern attempts at this become a bit more…misguided?
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Speaker 1 (00:05):
P. T. Barnum knew how to spot someone special. Barnum's
career as a showman taught him that the public wanted
to be surprised. He knew the general public delighted in
novelty and horror and tales almost too fantastical to believe.
In Phineas Gauge, Barnum found all of those things. Barnum
drew up a contract for Phineas and hired him to
(00:26):
stand on stage at his Great American Museum alongside bearded
ladies and giant men. But while Phineas had become a
traveling celebrity, his origins were unremarkable. He had been a
foreman on a railroad construction team, responsible for laying tracks
across Vermont. He was humble and respected. He worked hard
and had a career ahead of him blasting away pathways
(00:48):
through the rugged landscape. But all of that changed in
an instant, or in a flash, if you will. Here's
what we know. While preparing to clear some rock for
the rail line, Phineas jammed his iron tab amping rod
down into a hole filled with gunpowder, just like he
had done a thousand times before, but this time inexplicably,
it exploded. The three foot long piece of metal shot
(01:11):
straight back through his cheek, tore through the top of
his head, and sailed through the air like a javelin.
It landed about one hundred feet away, reportedly slickened with
blood and bits of greasy brain matter. Phineas, if you
can believe it, never lost consciousness. Even more unbelievably still,
he was up walking and talking just a few minutes later.
(01:33):
Even though almost all of the front left side of
his brain had been obliterated, Phineas seemed to be doing
just fine, save for the massive hole in his head.
He told the attending doctors that he'd be back to
blasting rock in two days. But this didn't quite work
out the way that Phineas had hoped. You see, he
bled massively and contracted a fungal infection in his brain.
(01:54):
He slipped in and out of comas, but after emergency
surgery and subsequent recovery, Phineas was back home in a
few weeks. The iron rod now by his side and
a source of a great story. But Phineas wouldn't return
to work in the capacity he had hoped. It wasn't
because he lacked the fine motor skills or cognizance to
handle dangerous materials. It was because his personality had changed.
(02:18):
History tells us that he had turned from an affable
colleague into a rage filled liability. It was after leaving
his post that he found his way to P. T. Barnum,
who was more than happy to welcome him in with
his iron rod and almost unbelievable tale of survival. Doctors,
of course, were highly interested in his case in the
nineteenth century. The brain was a mystery. In some ways.
(02:41):
It felt like trying to explore the farthest reaches of
space or the depths of the sea. So beyond the
sheer fact of his survival, experts were interested in something else.
How the destruction of this particular part of his brain
caused his personality to change. It's been pointed out that
Phineas's story was the first case to suggest that damage
(03:01):
to specific parts of the brain may include other, correspondingly
significant changes to the person. He became something of a
legend in his own right, but what historians have also
come to discover is that his reputation, as it's been
understood to be influential in the development of psychosurgery, is
pretty ahistorical. While He has been credited with inspiring brain
(03:22):
surgeons around the world and encouraging scientists to find the
key to altering personalities. It simply can't be proven, but
it makes for a tidy history and a damn good story.
Phineas has become a kind of mythical figure cemented in
popular culture because of what he seems to represent to us,
a building block in a neat narrative about how we
(03:42):
have tried to understand and control our brains. We love
that he went on to live a seemingly normal life,
continued to work, and died at an older age. We
love what his story seems to show us is possible
in actuality, though Phineas's experience was far more complicated than that,
and the same is true for humans in general. Our
quest to understand the brain will take us to some
(04:05):
very complicated places, and sadly, we won't have to go
back very far in history to find stories that visit
the darker corners of the mind. I'm Aaron Manke, and
welcome to Bedside Manners. The audience was speechless. Gottlieb Bookhart
(04:30):
thought his peers would be excited about his report. Instead,
they were just stunned. An icy chill settled over the
room as the attendees of the eighteen ninety Berlin Medical
Congress considered what Gottlieb had done and what they in
turn needed to do about it. Gottlieb Bookheart ran a
small asylum in Switzerland in the moment when the fields
of psychology and psychoanalysis were in their infancy. Folks in
(04:54):
his position were poised to help patients overcome what was
known as mental alien nation, but as an alienists, as
folks in his profession were called. He wasn't a trained doctor,
let alone a trained surgeon. That didn't stop him, though,
from operating on the brains of six of his patients.
As he told it, he hoped that he could figure
out a way to turn violent, unmanageable asylum residents into
(05:17):
manageable ones. He believed that a simple cut between the
hemispheres of the brain could relieve his patients of their outbursts.
He targeted the location that he believed to control sensory
and motor function. These patients were his living experiments, their
brains the fodder for his trials. Now, humans have been
cutting into heads since the Late Stone or the early
(05:38):
Bronze Age. As we learned in our episode about surgery,
evidence of successful trepanations dates back almost thirty thousand years.
Scientists believe that even prehistoric humans had been attempting to
alleviate each other of demons of the mind. This practice
carried all the way through ancient Greece and Rome, through
the Medieval and Renaissance periods. Surviving cultural evolutions, as we
(05:59):
moved away away from blaming gods and spirits for our
ailments and into blaming other more worldly scapegoats, we have
long been trying to treat the things that we can't see. Historically,
people struggling with what we now understand as mental illness
have suffered mightily in communities and systems that weren't able
or weren't willing to support them. The earliest asylums can
(06:20):
be traced back to twelve forty seven in London, a
place that provided refuge to the sick. While the rich
could afford to take care of their relatives, the poor
often were sent to places that operated on a charitable basis.
These places had no means of diagnosis or treatment for
the folks in their care and conditions. There were often
deplorable and the blame for their condition often fell upon
(06:41):
the patients or their families. As the years went on,
we began to understand more about the brain. It was
discovered that our brain is electric, with different parts in
control of everything that makes us well us. The eighteenth
century brought with it a more complex understanding of this
organ and our central nervousness. Them reformers of the Victorian
(07:02):
era believed that the cure to mental illness could be
found in a person's physical surroundings. So they erected magnificent buildings,
built beautiful gardens, hired nurses, and opened asylums that endeavored
to welcome patients in with care. It was a bright
moment for some, filled with optimism that a cure was
at hand. Unfortunately, many of these places were victims of
(07:23):
their own success. They simply couldn't keep up with the
demand for services. More patients came, more facilities opened, and
many collective standards of care were nearly impossible to enforce.
Resources quickly dried up. Those who were chronically ill stayed,
and the buildings were soon filled with folks who needed
help but just couldn't or wouldn't receive it. Conditions grew
(07:44):
more dire abuse ran, rampant, bodies piled up, people were forgotten.
Despite their best efforts, the reformers soured on their movements.
It appeared to them that mental illness was incurable. If
mental illness couldn't be cured by the envire, then those
working on the business of the mind decided that they
were going to look inward in a very literal sense.
(08:06):
In his countryside asylum, Gottlieb Bookhart got to work. He
decided that he was going to be the man to
investigate and get to the bottom of the brain. He
knew that operations to remove brain tumors, a revolutionary procedure
at the time, had proven successful in alleviating the side
effects that the tumors had caused. Of the six patients
that he operated on, he deemed three or four, according
(08:28):
to some sources, as a success. But one of those
patients died, another drowned a month later, and another began
having seizures. He hoped to start a psychosurgery revolution to
provide overcrowded asylums a way to treat their chronically ill patients,
to cure them once and for all. Instead, our Swiss
innovator found himself standing in front of his silent, stunned
(08:51):
audience colleagues whose enthusiasm for his work had cooled in
a matter of minutes. Gottlieb's professional reputation wasn't one that
he had hoped for. It didn't even provoke debate. The
consensus was that it would be best to bury the work,
and Gottlieb stopped researching. But as it so often happens,
there were other people waiting in the wings to pick
(09:13):
up where he left off. Saint Elizabeth's Hospital in Washington,
d C. Was suffering a similar fate to that of
other hospitals of the early twentieth century. It had opened
in eighteen fifty five under the name Government Hospital for
the Insane. It was the first federally operated psychiatric hospital
(09:35):
in the United States and initially promised to intercept those
coming back from the Civil War, which it did and
quite well. But by the nineteen twenties the facility's population
was booming. It's here that a young doctor, Walter Freeman,
whose grandfather's claim to fame was being the first American
surgeon to remove a brain tumor, got his start. He
was twenty nine years old when he was charged with
(09:57):
heading up the Blackburn Laboratory, stopping place for many of
Saint Elizabeth's patients. It was at Blackburn that Walter used
the hospital's cadavers as research fodder. In one study, he
strung the bodies of schizophrenic patients up by their ears
in order to take their measurements against the wall. As
to what he was looking for exactly, we aren't quite sure.
(10:18):
He deemed that the study produced nothing conclusive. Like his father,
Walter was interested in brains and had more access to
them than most. He began teaching at the nearby George
Washington University and delighted in excavating brains from skulls for
an audience. He thought that they could potentially tell him
something about the lived experience of the hospital's residence. But
(10:39):
he also had designs on practicing on the living where
he could see the results of his studies manifest in
real time. And it's important to remember that this impulse
didn't come out of nowhere. With the rise of asylum care,
the number of folks institutionalized with serious mental illness was
reaching record proportions. As a result, the widespread use of
strait jackets and paddy cells began to come into play,
(11:02):
a move born out of the exhaustion and desperation of
workers at those facilities. An effective therapy model hadn't yet
been found. The suffering was immense. Walter, though, had come
across an idea which his mind compelled him to further pursue.
He was inspired by a report out of Portugal in
which two surgeons developed something called the frontal leucotomy, which
(11:23):
severed the connection between the brain's prefrontal cortex and the thalamus.
After recruiting a surgical student by the name of James
Watts and a patient by the name of Alice hood Hammett,
Walter would improve and I'm using massive air quotes there
upon the leucotomy, taking the surgery a step further. Alice
had long struggled with postpartum depression and suicidal thoughts. To Walter,
(11:46):
she seemed like the perfect candidate, which he noted in
his cruelly unchartable notes about her case. She was, he wrote,
a master of bitching and really led her husband a
dog's life. She was a typical insecure, rigid, emotional, claustrophobic
individual throughout her mature existence. The men decided that they
would completely sever the white frontal lobe of the thalamus
(12:10):
where Walter thought human emotion resided. It was the same
spot where he thought he could locate the cause of
mental illness. It would be dubbed the Freeman Watts procedure,
but would infamously become known as the prefrontal lobotomy. Basically,
he thought that he could carve the sickness right out,
So Walter drilled two holes into Alice's skull that coincided
(12:31):
with her left and right frontal lobes. Then he inserted
a narrow blade through the hole and into the exposed brain.
Alice awoke four hours after the procedure and went on
to live another five years. According to her husband, she
felt like her old self again. What isn't surprising given
this moment in history is that her voice is largely
missing from the historical record. But it does make you wonder.
(12:54):
Walter deaned the operation a success and pushed to make
said success well known. He was met with mixed reviews,
some outrage but some outright embrace. In the following months,
the team found twenty more lobotomy candidates and operated. They
became so confident in their work. In fact, that they
would sometimes conduct these operations in tandem the patients side
(13:15):
by side. Doctors across the world wondered if Walter had
unlocked the secret for solving mental illness. Some tried their
own hand of the operation. It's important to note here
that the majority of lobotomy patients for many years were women.
It's clear who had the power to deem a person
fodder for this experiment. As time went on, though, lobotomies
moved beyond experiments fraught with injustice and eventually came to
(13:38):
be considered a cutting edge science, one that was fit
for royalty, or at the very least America's own equivalent.
Rose Marie had gotten off to an unfortunate start. The
doctor that was supposed to attend her birth was running late.
(13:59):
The nurses encouraged the girl's mother to do everything she
could to delay delivery, and by the time the doctor
finally arrived, the baby had been forced to wait for
two hours in the birth canal. This was a mistake that,
although not uncommon at the time, would cause ripples through
the family for generations to come. In the meantime, baby
Rose had become critically deprived of oxygen. Her brain was
(14:21):
irrevocably shaped by her first breath or lack thereof. However,
her early days passed without alarm. It was only when
her younger siblings began to pass her developmentally that her
parents realized that something was amiss. They took her to
all of the best doctors and talked with her teachers,
and they all agreed that she just wasn't like her
other siblings. The feeling was that there was something amiss
(14:43):
with their daughter, and it cast a dark pall over
the family. It was something only to be whispered about
and spoken of only in private. In the early twentieth century,
many intellectuals were taken with the eugenics movement, an ideology
that suggests that certain kinds of people had di effective
genes and shouldn't be allowed to procreate. This was an
idea that ultimately caused millions of people to lose their lives.
(15:07):
By nineteen thirty eight, Rose was coming into her own.
By then, her father had accepted a job in Great Britain,
and Rose found the space to thrive. She was beautiful
and sweet, dazzling everyone she met. She busied herself training
to be a teacher's aide and took great pride in
her work. Her teachers loved her. They unequivocally sang her
praises and spoke of how much she was blossoming. Rose
(15:30):
was finally happy, but this warm moment wasn't meant to last.
With the outbreak of World War II, the family retreated
home to the United States. They took up residence in
New York, a move that would prove disastrous for Rose.
It was a complete disruption to the life that she
knew and loved. Her seizures returned, as did her patterns
of erratic behavior. She became more and more disregulated with
(15:53):
each passing week, and those around her were known to
bear the physical toll of her violent outbursts. Although she
was out of sight at boarding school in Washington, d c.
She wasn't out of mind. Her family worried about her
near constantly, about her escape attempts and her safety, and
how they believed that she compromised their reputation. Her family
was a high profile one and the stakes were high.
(16:16):
She refused to play by their rules, and her father
had just about t had enough. In nineteen forty one,
the doctors shared a potential solution with him. They pitched
a lobotomy as a way to quell her erratic behavior. So,
without the consent of his wife or twenty three year
old Rose herself, he took his daughter to none other
than Walter Freeman and James Watts for the procedure, one
(16:38):
that the men had been performing regularly now for several years.
They brought Rose into the operating room and gave her
a mild tranquilizer. They made two small incisions in her skull,
and James inserted his instrument, a slender domestic ice pick,
and then he began sign Meanwhile, Walter started talking with
their patient and asking her a series of questions. It
(17:00):
was a seemingly mild mannered and polite conversation, and they
made estimates on how much to cut depending on how
she responded, and cut they did until she became incoherent.
As to whether or not the doctors knew in that
moment that they had made a grave error, we don't know.
But what was immediately evident is that her coherence regressed
(17:21):
to that of a toddler. She lost her ability to
walk and to speak. The doctors told her father that
she suffered from depression, but not anything else. He would
go on to speak of his daughter as mentally retarded
and not mentally ill, for fear that the latter would
implicate him and the rest of his family in her condition.
To make sure that she couldn't, Joe sent his daughter away.
(17:44):
He first sent her to a psychiatric facility in New
York and then to an institution in Wisconsin. Joe didn't
tell the rest of his children where she went, and
he refused to visit her. He suggested to his wife
that she should do the same in order for Rose
to get properly accustomed to her new life. There, she
effectively disappeared from her family's story in an act so
(18:06):
cold and cruel that it still sends shivers through the
Kennedy family and the American public to this day. The
illustrious Kennedys had a reputation as a prominent family to
maintain and huge aspirations to protect. Their political star was
on the rise, and that hunger motivated every move they made.
If their larger social circles knew the truth about Rose
(18:28):
Marie's condition, their fitness for public office might have been
called into question. It's a tragic story that was sadly
not unique. Many folks of the time period were hidden before, during,
and after mental illness struggles, but few individuals were robbed
of so much potential for good or of such a
position of influence as Rose Kennedy. It would be years
(18:57):
before Rose Marie's grown siblings, include voting America's thirty fifth President,
John F. Kennedy, along with her nieces and nephews, would
finally learn about what happened to her. But when they
did find out the truth, they embraced her with open
arms and worked toward rectifying that grievous wrong in both
the private and public spaces. From this dark mark on
(19:18):
the Kennedy family came the inception of the Special Olympics,
Best Buddies International and the sponsoring of the Americans with
Disabilities Act. The case of Rose Marie Kennedy came at
a time when psychosurgery was thought to be the solution
to mental illness. It would be a few more years
before pharmaceutical therapies would be used on the brain. For
the folks who were taking care of the chronically institutionalized,
(19:41):
it seemed like a reasonable last resort. Walter Freeman would
go on to perform over seven thousand lobotomies over the
course of his career, charging roughly twenty five dollars for
each one. It's thought that during its peak of popularity,
the lobotomy was performed on more than forty thousand people
across the United States, far higher than any other nation
(20:02):
in the world. By the nineteen fifties, the procedure had
dramatically fallen out of favor. The terrible side effects that
came with the surgery, including sometimes death, were becoming increasingly
obvious as more people were so dramatically affected. To most,
the outcome of a lobotomy was far worse than the
diseases that the surgery purported to cure. Germany, Japan, and
(20:24):
even the Soviet Union banned the practice on the basis
of its inhumanity, but it might surprise you to hear
that they were still performing it in many European countries
and the United States well into the nineteen eighties. As
for Rose Marie, she lived out the rest of her
days in a private cottage built just for her at
her Wisconsin institution. She loved to swim and joyride, play
(20:46):
with her pets, and passed the time with her caregivers.
When she passed away at the age of eighty six,
She was surrounded by her sisters and her brother, one
last act of love directed towards a woman who had
been made to feel so deeply unlovable and invisible for
far too many years. The inner workings of the mind
(21:11):
have long been a mystery to us, and that great
unknown has led to far too many tragic misunderstandings. Our
journey through the history of lobotomy today is just one
of the many failures along the road to progress. But
even without the sharp instruments and invasive surgical procedures, there
is still a lot of room for error. And if
you stick around through this brief sponsor break, my teammate
(21:33):
Robin Miniter will share one more example with you.
Speaker 2 (21:42):
Albert Hofmann was something of an architect. In truth, he
was a chemist, responsible for breaking things apart and finding
new ways to put them back together. This is exactly
what he was doing when he was assigned to a
program that worked with medicinal plans in nineteen thirty eight.
We've talked in the series about the importance of dose
and frequency when deploying therapeutics. A little bit of something
(22:03):
might be really good for you, and it might make
you better. A lot of this seemed something though, might
kill you. This was certainly true for ergot, a fungus
found and tainted rye. It had been used in folk
medicine for a really long time. In small doses, it
could quicken childbirth, and it could stop bleeding. It was
otherwise responsible, scholars believe for the deaths of hundreds of
(22:24):
thousands of people across the ages. Albert essentially wanted to
isolate the good properties of the substance and strip away
the bad, something like alchemy, if you remember from earlier
in our season. He was able to determine the biologically
active compounds of the ergot and figured out his chemical
starting point, something called lycurgic acid. Over forty percent of
(22:46):
our Western pharmaceutical drugs are derived from plant medicines and
indigenous traditions. For thousands of years, cultures across the world
had been working with their land to heal their bodies
and their spirits. It's true that with the invention of
globalization and pharmacology, this has all become a little more complicated.
In the fifteen hundreds, European bioprospectors knew that indigenous communities
(23:08):
were treasure troves of knowledge. They pillaged these peoples and
took from them their ethnomedical traditions. It might surprise you
to know that exports of tropical medicinal plants in the
sixteenth century were only slightly less valuable than another colonial favorite, sugar.
With the invention of pharmacology in the nineteenth and twentieth centuries,
scientists began applying chemical analysis to all these different plants.
(23:32):
Think the poppy seed from which we derive morphine, or
the sanchona tree from which we get quinine. So while
the academic mines in the West were trying to wrest
control of these plants and extract from them their healing essence,
the propaganda machine got to work. Marginalized communities bore the
brunt of the ensuing criminalization of these plants, which turned
into a longtime war. This peaked with the official declaration
(23:55):
of America's War on drugs in the nineteen seventies. A
federally funded moral panic ensued. Over a short arc of time,
we had managed to take something so revered plant medicine,
and on a federal level, turn it into something so reviled.
To this day, perhaps some two billion people are largely
reliant on medicinal plants, and in the past ten years
(24:16):
or so we have seen them creeping back into our
embrace at a policy level. In twenty thirteen, Uruguay became
the first country in the world to legally regulate cannabis,
while Canada legalized it in twenty eighteen. In twenty twenty,
organ voters passed the nation's first all drug decriminalization measure,
and today some say that we are even at the
beginnings of a psychedelic renaissance, as Western therapeutic practices begin
(24:40):
to welcome hallucinogenic plant medicines back into mainstream use. These
consciousness altering plants have been known to treat a variety
of physical and psychological illnesses and had previously been used
peacefully for centuries. Without knowing it at the time, Albert
Hofmann's ingestion of two hundred and fifty millions of a
gramophysurgic acid compound derived from ergot would change the world.
(25:03):
It sent him on the world first LSD trip and
blew open the possibilities for treating the mind. It soon
became popular to use in conjunction with psychoanalysis, until it's
alignment with a counterculture scented underground. Today, the mainstream is
beginning to look more kindly upon the use of these
therapeutic ethogens, and the clinical research tells us that these
substances seem to be massively effective for treating debilitating issues
(25:26):
of the mind. It looks like a promising lead, but
of course, only time will tell exactly what kind of
trip this will take us on.
Speaker 1 (25:37):
Grimm and Mild Presents Bedside Manners was executive produced by
Aaron Manke and narrated by Aaron Mankey and Robin Miniter.
Writing for this season was provided by Robin Miniter, with
research by Sam Alberty, Taylor, Haggridorn and Robin Miniter. Production
assistance was provided by Josh Thain, Jesse Funk, Alex Williams,
(25:58):
and Matt Frederick. Learn more about this show, the Grim
and Mild team, and all the other podcasts that we
make over at Grimandmild dot com, and, as always, thanks
for listening.
P. T. Barnum knew how to spot someone special. Barnum's
career as a showman taught him that the public wanted
to be surprised. He knew the general public delighted in
novelty and horror and tales almost too fantastical to believe.
In Phineas Gauge, Barnum found all of those things. Barnum
drew up a contract for Phineas and hired him to
(00:26):
stand on stage at his Great American Museum alongside bearded
ladies and giant men. But while Phineas had become a
traveling celebrity, his origins were unremarkable. He had been a
foreman on a railroad construction team, responsible for laying tracks
across Vermont. He was humble and respected. He worked hard
and had a career ahead of him blasting away pathways
(00:48):
through the rugged landscape. But all of that changed in
an instant, or in a flash, if you will. Here's
what we know. While preparing to clear some rock for
the rail line, Phineas jammed his iron tab amping rod
down into a hole filled with gunpowder, just like he
had done a thousand times before, but this time inexplicably,
it exploded. The three foot long piece of metal shot
(01:11):
straight back through his cheek, tore through the top of
his head, and sailed through the air like a javelin.
It landed about one hundred feet away, reportedly slickened with
blood and bits of greasy brain matter. Phineas, if you
can believe it, never lost consciousness. Even more unbelievably still,
he was up walking and talking just a few minutes later.
(01:33):
Even though almost all of the front left side of
his brain had been obliterated, Phineas seemed to be doing
just fine, save for the massive hole in his head.
He told the attending doctors that he'd be back to
blasting rock in two days. But this didn't quite work
out the way that Phineas had hoped. You see, he
bled massively and contracted a fungal infection in his brain.
(01:54):
He slipped in and out of comas, but after emergency
surgery and subsequent recovery, Phineas was back home in a
few weeks. The iron rod now by his side and
a source of a great story. But Phineas wouldn't return
to work in the capacity he had hoped. It wasn't
because he lacked the fine motor skills or cognizance to
handle dangerous materials. It was because his personality had changed.
(02:18):
History tells us that he had turned from an affable
colleague into a rage filled liability. It was after leaving
his post that he found his way to P. T. Barnum,
who was more than happy to welcome him in with
his iron rod and almost unbelievable tale of survival. Doctors,
of course, were highly interested in his case in the
nineteenth century. The brain was a mystery. In some ways.
(02:41):
It felt like trying to explore the farthest reaches of
space or the depths of the sea. So beyond the
sheer fact of his survival, experts were interested in something else.
How the destruction of this particular part of his brain
caused his personality to change. It's been pointed out that
Phineas's story was the first case to suggest that damage
(03:01):
to specific parts of the brain may include other, correspondingly
significant changes to the person. He became something of a
legend in his own right, but what historians have also
come to discover is that his reputation, as it's been
understood to be influential in the development of psychosurgery, is
pretty ahistorical. While He has been credited with inspiring brain
(03:22):
surgeons around the world and encouraging scientists to find the
key to altering personalities. It simply can't be proven, but
it makes for a tidy history and a damn good story.
Phineas has become a kind of mythical figure cemented in
popular culture because of what he seems to represent to us,
a building block in a neat narrative about how we
(03:42):
have tried to understand and control our brains. We love
that he went on to live a seemingly normal life,
continued to work, and died at an older age. We
love what his story seems to show us is possible
in actuality, though Phineas's experience was far more complicated than that,
and the same is true for humans in general. Our
quest to understand the brain will take us to some
(04:05):
very complicated places, and sadly, we won't have to go
back very far in history to find stories that visit
the darker corners of the mind. I'm Aaron Manke, and
welcome to Bedside Manners. The audience was speechless. Gottlieb Bookhart
(04:30):
thought his peers would be excited about his report. Instead,
they were just stunned. An icy chill settled over the
room as the attendees of the eighteen ninety Berlin Medical
Congress considered what Gottlieb had done and what they in
turn needed to do about it. Gottlieb Bookheart ran a
small asylum in Switzerland in the moment when the fields
of psychology and psychoanalysis were in their infancy. Folks in
(04:54):
his position were poised to help patients overcome what was
known as mental alien nation, but as an alienists, as
folks in his profession were called. He wasn't a trained doctor,
let alone a trained surgeon. That didn't stop him, though,
from operating on the brains of six of his patients.
As he told it, he hoped that he could figure
out a way to turn violent, unmanageable asylum residents into
(05:17):
manageable ones. He believed that a simple cut between the
hemispheres of the brain could relieve his patients of their outbursts.
He targeted the location that he believed to control sensory
and motor function. These patients were his living experiments, their
brains the fodder for his trials. Now, humans have been
cutting into heads since the Late Stone or the early
(05:38):
Bronze Age. As we learned in our episode about surgery,
evidence of successful trepanations dates back almost thirty thousand years.
Scientists believe that even prehistoric humans had been attempting to
alleviate each other of demons of the mind. This practice
carried all the way through ancient Greece and Rome, through
the Medieval and Renaissance periods. Surviving cultural evolutions, as we
(05:59):
moved away away from blaming gods and spirits for our
ailments and into blaming other more worldly scapegoats, we have
long been trying to treat the things that we can't see. Historically,
people struggling with what we now understand as mental illness
have suffered mightily in communities and systems that weren't able
or weren't willing to support them. The earliest asylums can
(06:20):
be traced back to twelve forty seven in London, a
place that provided refuge to the sick. While the rich
could afford to take care of their relatives, the poor
often were sent to places that operated on a charitable basis.
These places had no means of diagnosis or treatment for
the folks in their care and conditions. There were often
deplorable and the blame for their condition often fell upon
(06:41):
the patients or their families. As the years went on,
we began to understand more about the brain. It was
discovered that our brain is electric, with different parts in
control of everything that makes us well us. The eighteenth
century brought with it a more complex understanding of this
organ and our central nervousness. Them reformers of the Victorian
(07:02):
era believed that the cure to mental illness could be
found in a person's physical surroundings. So they erected magnificent buildings,
built beautiful gardens, hired nurses, and opened asylums that endeavored
to welcome patients in with care. It was a bright
moment for some, filled with optimism that a cure was
at hand. Unfortunately, many of these places were victims of
(07:23):
their own success. They simply couldn't keep up with the
demand for services. More patients came, more facilities opened, and
many collective standards of care were nearly impossible to enforce.
Resources quickly dried up. Those who were chronically ill stayed,
and the buildings were soon filled with folks who needed
help but just couldn't or wouldn't receive it. Conditions grew
(07:44):
more dire abuse ran, rampant, bodies piled up, people were forgotten.
Despite their best efforts, the reformers soured on their movements.
It appeared to them that mental illness was incurable. If
mental illness couldn't be cured by the envire, then those
working on the business of the mind decided that they
were going to look inward in a very literal sense.
(08:06):
In his countryside asylum, Gottlieb Bookhart got to work. He
decided that he was going to be the man to
investigate and get to the bottom of the brain. He
knew that operations to remove brain tumors, a revolutionary procedure
at the time, had proven successful in alleviating the side
effects that the tumors had caused. Of the six patients
that he operated on, he deemed three or four, according
(08:28):
to some sources, as a success. But one of those
patients died, another drowned a month later, and another began
having seizures. He hoped to start a psychosurgery revolution to
provide overcrowded asylums a way to treat their chronically ill patients,
to cure them once and for all. Instead, our Swiss
innovator found himself standing in front of his silent, stunned
(08:51):
audience colleagues whose enthusiasm for his work had cooled in
a matter of minutes. Gottlieb's professional reputation wasn't one that
he had hoped for. It didn't even provoke debate. The
consensus was that it would be best to bury the work,
and Gottlieb stopped researching. But as it so often happens,
there were other people waiting in the wings to pick
(09:13):
up where he left off. Saint Elizabeth's Hospital in Washington,
d C. Was suffering a similar fate to that of
other hospitals of the early twentieth century. It had opened
in eighteen fifty five under the name Government Hospital for
the Insane. It was the first federally operated psychiatric hospital
(09:35):
in the United States and initially promised to intercept those
coming back from the Civil War, which it did and
quite well. But by the nineteen twenties the facility's population
was booming. It's here that a young doctor, Walter Freeman,
whose grandfather's claim to fame was being the first American
surgeon to remove a brain tumor, got his start. He
was twenty nine years old when he was charged with
(09:57):
heading up the Blackburn Laboratory, stopping place for many of
Saint Elizabeth's patients. It was at Blackburn that Walter used
the hospital's cadavers as research fodder. In one study, he
strung the bodies of schizophrenic patients up by their ears
in order to take their measurements against the wall. As
to what he was looking for exactly, we aren't quite sure.
(10:18):
He deemed that the study produced nothing conclusive. Like his father,
Walter was interested in brains and had more access to
them than most. He began teaching at the nearby George
Washington University and delighted in excavating brains from skulls for
an audience. He thought that they could potentially tell him
something about the lived experience of the hospital's residence. But
(10:39):
he also had designs on practicing on the living where
he could see the results of his studies manifest in
real time. And it's important to remember that this impulse
didn't come out of nowhere. With the rise of asylum care,
the number of folks institutionalized with serious mental illness was
reaching record proportions. As a result, the widespread use of
strait jackets and paddy cells began to come into play,
(11:02):
a move born out of the exhaustion and desperation of
workers at those facilities. An effective therapy model hadn't yet
been found. The suffering was immense. Walter, though, had come
across an idea which his mind compelled him to further pursue.
He was inspired by a report out of Portugal in
which two surgeons developed something called the frontal leucotomy, which
(11:23):
severed the connection between the brain's prefrontal cortex and the thalamus.
After recruiting a surgical student by the name of James
Watts and a patient by the name of Alice hood Hammett,
Walter would improve and I'm using massive air quotes there
upon the leucotomy, taking the surgery a step further. Alice
had long struggled with postpartum depression and suicidal thoughts. To Walter,
(11:46):
she seemed like the perfect candidate, which he noted in
his cruelly unchartable notes about her case. She was, he wrote,
a master of bitching and really led her husband a
dog's life. She was a typical insecure, rigid, emotional, claustrophobic
individual throughout her mature existence. The men decided that they
would completely sever the white frontal lobe of the thalamus
(12:10):
where Walter thought human emotion resided. It was the same
spot where he thought he could locate the cause of
mental illness. It would be dubbed the Freeman Watts procedure,
but would infamously become known as the prefrontal lobotomy. Basically,
he thought that he could carve the sickness right out,
So Walter drilled two holes into Alice's skull that coincided
(12:31):
with her left and right frontal lobes. Then he inserted
a narrow blade through the hole and into the exposed brain.
Alice awoke four hours after the procedure and went on
to live another five years. According to her husband, she
felt like her old self again. What isn't surprising given
this moment in history is that her voice is largely
missing from the historical record. But it does make you wonder.
(12:54):
Walter deaned the operation a success and pushed to make
said success well known. He was met with mixed reviews,
some outrage but some outright embrace. In the following months,
the team found twenty more lobotomy candidates and operated. They
became so confident in their work. In fact, that they
would sometimes conduct these operations in tandem the patients side
(13:15):
by side. Doctors across the world wondered if Walter had
unlocked the secret for solving mental illness. Some tried their
own hand of the operation. It's important to note here
that the majority of lobotomy patients for many years were women.
It's clear who had the power to deem a person
fodder for this experiment. As time went on, though, lobotomies
moved beyond experiments fraught with injustice and eventually came to
(13:38):
be considered a cutting edge science, one that was fit
for royalty, or at the very least America's own equivalent.
Rose Marie had gotten off to an unfortunate start. The
doctor that was supposed to attend her birth was running late.
(13:59):
The nurses encouraged the girl's mother to do everything she
could to delay delivery, and by the time the doctor
finally arrived, the baby had been forced to wait for
two hours in the birth canal. This was a mistake that,
although not uncommon at the time, would cause ripples through
the family for generations to come. In the meantime, baby
Rose had become critically deprived of oxygen. Her brain was
(14:21):
irrevocably shaped by her first breath or lack thereof. However,
her early days passed without alarm. It was only when
her younger siblings began to pass her developmentally that her
parents realized that something was amiss. They took her to
all of the best doctors and talked with her teachers,
and they all agreed that she just wasn't like her
other siblings. The feeling was that there was something amiss
(14:43):
with their daughter, and it cast a dark pall over
the family. It was something only to be whispered about
and spoken of only in private. In the early twentieth century,
many intellectuals were taken with the eugenics movement, an ideology
that suggests that certain kinds of people had di effective
genes and shouldn't be allowed to procreate. This was an
idea that ultimately caused millions of people to lose their lives.
(15:07):
By nineteen thirty eight, Rose was coming into her own.
By then, her father had accepted a job in Great Britain,
and Rose found the space to thrive. She was beautiful
and sweet, dazzling everyone she met. She busied herself training
to be a teacher's aide and took great pride in
her work. Her teachers loved her. They unequivocally sang her
praises and spoke of how much she was blossoming. Rose
(15:30):
was finally happy, but this warm moment wasn't meant to last.
With the outbreak of World War II, the family retreated
home to the United States. They took up residence in
New York, a move that would prove disastrous for Rose.
It was a complete disruption to the life that she
knew and loved. Her seizures returned, as did her patterns
of erratic behavior. She became more and more disregulated with
(15:53):
each passing week, and those around her were known to
bear the physical toll of her violent outbursts. Although she
was out of sight at boarding school in Washington, d c.
She wasn't out of mind. Her family worried about her
near constantly, about her escape attempts and her safety, and
how they believed that she compromised their reputation. Her family
was a high profile one and the stakes were high.
(16:16):
She refused to play by their rules, and her father
had just about t had enough. In nineteen forty one,
the doctors shared a potential solution with him. They pitched
a lobotomy as a way to quell her erratic behavior. So,
without the consent of his wife or twenty three year
old Rose herself, he took his daughter to none other
than Walter Freeman and James Watts for the procedure, one
(16:38):
that the men had been performing regularly now for several years.
They brought Rose into the operating room and gave her
a mild tranquilizer. They made two small incisions in her skull,
and James inserted his instrument, a slender domestic ice pick,
and then he began sign Meanwhile, Walter started talking with
their patient and asking her a series of questions. It
(17:00):
was a seemingly mild mannered and polite conversation, and they
made estimates on how much to cut depending on how
she responded, and cut they did until she became incoherent.
As to whether or not the doctors knew in that
moment that they had made a grave error, we don't know.
But what was immediately evident is that her coherence regressed
(17:21):
to that of a toddler. She lost her ability to
walk and to speak. The doctors told her father that
she suffered from depression, but not anything else. He would
go on to speak of his daughter as mentally retarded
and not mentally ill, for fear that the latter would
implicate him and the rest of his family in her condition.
To make sure that she couldn't, Joe sent his daughter away.
(17:44):
He first sent her to a psychiatric facility in New
York and then to an institution in Wisconsin. Joe didn't
tell the rest of his children where she went, and
he refused to visit her. He suggested to his wife
that she should do the same in order for Rose
to get properly accustomed to her new life. There, she
effectively disappeared from her family's story in an act so
(18:06):
cold and cruel that it still sends shivers through the
Kennedy family and the American public to this day. The
illustrious Kennedys had a reputation as a prominent family to
maintain and huge aspirations to protect. Their political star was
on the rise, and that hunger motivated every move they made.
If their larger social circles knew the truth about Rose
(18:28):
Marie's condition, their fitness for public office might have been
called into question. It's a tragic story that was sadly
not unique. Many folks of the time period were hidden before, during,
and after mental illness struggles, but few individuals were robbed
of so much potential for good or of such a
position of influence as Rose Kennedy. It would be years
(18:57):
before Rose Marie's grown siblings, include voting America's thirty fifth President,
John F. Kennedy, along with her nieces and nephews, would
finally learn about what happened to her. But when they
did find out the truth, they embraced her with open
arms and worked toward rectifying that grievous wrong in both
the private and public spaces. From this dark mark on
(19:18):
the Kennedy family came the inception of the Special Olympics,
Best Buddies International and the sponsoring of the Americans with
Disabilities Act. The case of Rose Marie Kennedy came at
a time when psychosurgery was thought to be the solution
to mental illness. It would be a few more years
before pharmaceutical therapies would be used on the brain. For
the folks who were taking care of the chronically institutionalized,
(19:41):
it seemed like a reasonable last resort. Walter Freeman would
go on to perform over seven thousand lobotomies over the
course of his career, charging roughly twenty five dollars for
each one. It's thought that during its peak of popularity,
the lobotomy was performed on more than forty thousand people
across the United States, far higher than any other nation
(20:02):
in the world. By the nineteen fifties, the procedure had
dramatically fallen out of favor. The terrible side effects that
came with the surgery, including sometimes death, were becoming increasingly
obvious as more people were so dramatically affected. To most,
the outcome of a lobotomy was far worse than the
diseases that the surgery purported to cure. Germany, Japan, and
(20:24):
even the Soviet Union banned the practice on the basis
of its inhumanity, but it might surprise you to hear
that they were still performing it in many European countries
and the United States well into the nineteen eighties. As
for Rose Marie, she lived out the rest of her
days in a private cottage built just for her at
her Wisconsin institution. She loved to swim and joyride, play
(20:46):
with her pets, and passed the time with her caregivers.
When she passed away at the age of eighty six,
She was surrounded by her sisters and her brother, one
last act of love directed towards a woman who had
been made to feel so deeply unlovable and invisible for
far too many years. The inner workings of the mind
(21:11):
have long been a mystery to us, and that great
unknown has led to far too many tragic misunderstandings. Our
journey through the history of lobotomy today is just one
of the many failures along the road to progress. But
even without the sharp instruments and invasive surgical procedures, there
is still a lot of room for error. And if
you stick around through this brief sponsor break, my teammate
(21:33):
Robin Miniter will share one more example with you.
Speaker 2 (21:42):
Albert Hofmann was something of an architect. In truth, he
was a chemist, responsible for breaking things apart and finding
new ways to put them back together. This is exactly
what he was doing when he was assigned to a
program that worked with medicinal plans in nineteen thirty eight.
We've talked in the series about the importance of dose
and frequency when deploying therapeutics. A little bit of something
(22:03):
might be really good for you, and it might make
you better. A lot of this seemed something though, might
kill you. This was certainly true for ergot, a fungus
found and tainted rye. It had been used in folk
medicine for a really long time. In small doses, it
could quicken childbirth, and it could stop bleeding. It was
otherwise responsible, scholars believe for the deaths of hundreds of
(22:24):
thousands of people across the ages. Albert essentially wanted to
isolate the good properties of the substance and strip away
the bad, something like alchemy, if you remember from earlier
in our season. He was able to determine the biologically
active compounds of the ergot and figured out his chemical
starting point, something called lycurgic acid. Over forty percent of
(22:46):
our Western pharmaceutical drugs are derived from plant medicines and
indigenous traditions. For thousands of years, cultures across the world
had been working with their land to heal their bodies
and their spirits. It's true that with the invention of
globalization and pharmacology, this has all become a little more complicated.
In the fifteen hundreds, European bioprospectors knew that indigenous communities
(23:08):
were treasure troves of knowledge. They pillaged these peoples and
took from them their ethnomedical traditions. It might surprise you
to know that exports of tropical medicinal plants in the
sixteenth century were only slightly less valuable than another colonial favorite, sugar.
With the invention of pharmacology in the nineteenth and twentieth centuries,
scientists began applying chemical analysis to all these different plants.
(23:32):
Think the poppy seed from which we derive morphine, or
the sanchona tree from which we get quinine. So while
the academic mines in the West were trying to wrest
control of these plants and extract from them their healing essence,
the propaganda machine got to work. Marginalized communities bore the
brunt of the ensuing criminalization of these plants, which turned
into a longtime war. This peaked with the official declaration
(23:55):
of America's War on drugs in the nineteen seventies. A
federally funded moral panic ensued. Over a short arc of time,
we had managed to take something so revered plant medicine,
and on a federal level, turn it into something so reviled.
To this day, perhaps some two billion people are largely
reliant on medicinal plants, and in the past ten years
(24:16):
or so we have seen them creeping back into our
embrace at a policy level. In twenty thirteen, Uruguay became
the first country in the world to legally regulate cannabis,
while Canada legalized it in twenty eighteen. In twenty twenty,
organ voters passed the nation's first all drug decriminalization measure,
and today some say that we are even at the
beginnings of a psychedelic renaissance, as Western therapeutic practices begin
(24:40):
to welcome hallucinogenic plant medicines back into mainstream use. These
consciousness altering plants have been known to treat a variety
of physical and psychological illnesses and had previously been used
peacefully for centuries. Without knowing it at the time, Albert
Hofmann's ingestion of two hundred and fifty millions of a
gramophysurgic acid compound derived from ergot would change the world.
(25:03):
It sent him on the world first LSD trip and
blew open the possibilities for treating the mind. It soon
became popular to use in conjunction with psychoanalysis, until it's
alignment with a counterculture scented underground. Today, the mainstream is
beginning to look more kindly upon the use of these
therapeutic ethogens, and the clinical research tells us that these
substances seem to be massively effective for treating debilitating issues
(25:26):
of the mind. It looks like a promising lead, but
of course, only time will tell exactly what kind of
trip this will take us on.
Speaker 1 (25:37):
Grimm and Mild Presents Bedside Manners was executive produced by
Aaron Manke and narrated by Aaron Mankey and Robin Miniter.
Writing for this season was provided by Robin Miniter, with
research by Sam Alberty, Taylor, Haggridorn and Robin Miniter. Production
assistance was provided by Josh Thain, Jesse Funk, Alex Williams,
(25:58):
and Matt Frederick. Learn more about this show, the Grim
and Mild team, and all the other podcasts that we
make over at Grimandmild dot com, and, as always, thanks
for listening.
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