Bedside Manners 9: Mind Games

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 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 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. 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. 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.

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. 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 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 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 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 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 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 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 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 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 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 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 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 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 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 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. 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 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 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 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 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 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.

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 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, 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 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, 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 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

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. 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 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 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. 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 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 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.

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 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 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. 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 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 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 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. 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 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 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 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 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, 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 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 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 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 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 Robin Miniter will share one more example with you.

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

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 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 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. 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 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 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 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. 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 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.

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.