The Stockton lobotomies

Stockton State Hospital, originally called the California Asylum for the Insane, was built in the 1850s at Stockton, eighty miles east of San Francisco, and by 1950 housed over four thousand patients. It was the first state hospital in California to perform a lobotomy and between March 1947 and June 1954 a total of 232 patients were operated on.

Psychiatrist and historian Joel T Braslow studied the Stockton archives for the two chapters on lobotomy in his book (originally a PhD thesis) Mental Ills and Bodily Cures: psychiatric treatment in the first half of the twentieth century (Berkeley: University of California Press, 1997).

The patients operated on at Stockton ranged in age from 19 to 88. Nearly eighty per cent of them had the diagnosis of dementia praecox (schizophrenia). Eighty-five per cent were women, even though men with the diagnosis of dementia praecox outnumbered women at Stockton. And twelve of the thirteen people who underwent a second lobotomy were women. Typically the operation was performed on violent, disruptive and unco-operative women who were subjected to frequent restraint (although Braslow found no evidence that psychosurgery was used as punishment for a single violent act).

Braslow describes how the decision to operate was made at a special clinical case conference, the "lobotomy board", which would attended by the director of clinical services, the surgeon, the hospital superintendent and the patient’s ward physician. The patient would be interviewed and then dismissed so the doctors could discuss their case and decide their fate. The proceedings were recorded by a stenographer.

In order to comply with the law, doctors then had to seek permission to operate from the patient’s relative. Braslow quotes from the letter sent to relatives:

"All forms of medical and psychiatric treatment have not been of more than temporary benefit…. Unless a more drastic therapy is carried out, there will be little hope of any further improvement….the most advanced form of treatment that is now available….The treatment suggested is a delicate brain operation performed by a qualified neuro-surgeon, which involves cutting certain nerve pathways controlling the basic emotions. This is known technically as psychosurgery or prefrontal leucotomy…In selective cases, in which there is much emotional suffering, patients who have this operation may be relieved of prolonged mental anguish, with much improvement in their basic behaviour."

Braslow estimates the mortality rate due to psychosurgery at Stockton as about 12 per cent. And most of the survivors remained in hospital. “In fact” he writes, “ during the 1950s almost an equal percentage of lobotomy patients left the hospital dead as alive (21 % vs 23%).”

But the operation was considered a success if the patient became more manageable on the ward. Braslow notes:

"Stockton physicians transformed what now would be considered neurologic sequelae into measures of effectiveness, as the following discussion among three physicians suggests.
Dr Adams:…[before lobotomy] she was regressed an awful lot – she was in restraint most of the time, would spit at people and break things up.
Dr Toller: It leaves them all pretty flat and indifferent about things. It seems to be characteristic –
Dr Adams: There is not much animation any more.
Dr Batko: Maybe that is what cures them (from a Stockton clinical case conference in 1949)".

Four of the lobotomized women also had their clitoris removed. Braslow quotes from the case history of "Rose", a young woman who was admitted to Stockton in 1944, underwent a lobotomy five years later, then had her clitoris cauterized twice and finally had all her teeth removed as she bit people.

Braslow’s father, a surgeon, worked for a while at Camarillo State Hospital, California, in the 1950s and performed lobotomies. Braslow writes at the beginning of his book:

One of his favourite stories, perhaps because of his brush with fame, recounted Walter Freeman teaching him how to perform a transorbital lobotomy. With a certain amount of flair and drama he described the procedure: “One takes a thing that looks just like an ice-pick and positions it right above the eye. Using a hammer, the pick is pounded into the skull. Then ping!!! the bone breaks enough to let the ice pick slide easily into the patient’s brain. You then swing the pick back and forth, cutting the nerves that connect to the front of the brain. That’s it.”
For my father, this memory and its recitation reaffirmed his skills as a surgeon and his belief in himself as a healer; even in spite of lobotomy's infamous history, he tells the story with pride. For myself, the story was more ambiguous. On the one hand, I found myself wanting to identify with him as a physician, and, later on, my decision to become a doctor was motivated by a positive identification with him. On the other hand, the tale increasingly perplexed me; I wondered how my father's desire to heal coexisted with his performance of this seemingly mutilating operation. My book aimed at understanding this contradiction. In the very human and often tragic dramas in that story, I tried to give voice to both doctors and patients in order to comprehend the meaning of often seemingly incomprehensible acts.