Blood and Guts

by Richard Hollingham

  THE CASE OF HOWARD DULLY

  California, 1960

  * * *

  It was a child's worst nightmare. Howard Dully's mother died when he was five, and she was replaced by a stepmother, Lou, who never loved him; she didn't seem even to like him. She was intolerant and criticized Howard, punishing him for things he didn't do, treating him differently from his brother.

  Howard was no angel. He resented his new mother's presence. He could be moody, disrespectful and argumentative, but then so can most young boys. There was nothing particularly unusual about Howard. He was a perfectly healthy boy.

  Howard's father was away for long periods of time, and even when he was around, he appeared oblivious to what was going on. As the years progressed, the relationship between Lou and Howard deteriorated further. The boy was getting into trouble at school; his stepmother would yell or hit him for the most petty of reasons, and the boy would yell back. They were constantly arguing, slowly driving each other up the wall. Howard loathed his impostor of a mother, and Lou was fed up with her stepson. Sooner or later something had to give.

  Over the years, Lou had consulted doctors, psychologists and psychiatrists (six psychiatrists in 1960 alone) about Howard. All of them assured her there was nothing wrong with him. His behaviour might sometimes be challenging, but he was perfectly normal. Even Howard's father couldn't see anything wrong. Angry, and increasingly frustrated, Lou was eventually referred to Walter Freeman, who had set up his offices in Los Altos, California. Perhaps he would find something wrong with the boy?

  Howard's stepmother had her first meeting with Freeman in October 1960. She went alone. Lou told Freeman about Howard's behaviour. Some of it was true, some of it made up. She explained how when she had first seen Howard she thought he was a 'spastic' because of 'a peculiar gait' (the boy was then five and later turned out to be good at sports). She recounted how Howard didn't play with toys, but was destructive with them (much of the time Howard played on his own, so how would she know?). She told Freeman that Howard hated to wash (he was a boy!), she said he daydreamed and scowled if the TV was tuned to some programme other than one he liked, as if this were some sort of damning indictment. Tellingly, Freeman referred to the notes he made of this first meeting as 'the articles of indictment'.

  The doctor's notes ran to several pages. He seemed to accept everything he was being told, including Lou's claim that Howard urinated on his bedroom wall or defecated in his trousers. She would make up anything to convince the doctor that Howard was mentally ill, and it seemed to be working. Freeman noted that the indictment was 'sufficiently impressive' and that Howard was suffering from childhood schizophrenia.

  Over the coming days, in the manner of some sort of selfappointed judge, Freeman took 'evidence' from Howard's aunt, the school janitor and finally the boy's father. Much of it contradicted what Lou had said. Howard met Freeman for the first time on 26 October and, like many patients before him, felt relaxed in Freeman's presence. The doctor seemed kind and gentle, willing to listen to what the boy had to say.

  Taken together, Freeman's notes paint a picture of an eleven-year-old boy living in a dysfunctional family. Today they would probably be offered counselling, but Freeman had other ideas. He told Howard's father that the boy was schizophrenic and that something needed to be done 'pretty promptly'. He offered to change Howard's personality (for a reasonable fee). The decision to operate was made on 30 November 1960 – the date of Howard's twelfth birthday.

  Howard Dully was admitted to a small private hospital in San Jose on Thursday 15 December. The next day he was taken into the operating room, where he was given four jolts of electricity from the ECT machine. Freeman noted that he thought it was 'one more than necessary'. Then the doctor stuck in his 'orbitoclasts' (he had moved on from ice picks to these specially designed instruments) and jiggled them around in Howard's brain. He took a picture of the two orbitoclasts protruding from the boy's head before pulling them out again. A small amount of bloodstained fluid oozed from each bruised eye socket.

  When Howard's brother saw him shortly after the operation he thought Howard looked like a zombie. The boy was listless and staring. It was as if a fog had settled across his mind. But gradually Howard started to recover. However, the operation that his stepmother had hoped would make him docile and obedient seemed to have the opposite effect. He became increasingly disruptive until his parents could take it no more. Howard was sent away, first to other people's homes, then, even though he had committed no crime, to a juvenile detention centre. Finally, he ended up in a psychiatric institution, the only child in a hospital full of mentally ill adults.

  Howard has spent most of his life coming to terms with what happened to him. He suffered problems with work, relationships and money. He drifted in and out of jobs and in and out of jail. Gradually, he was able to piece his life back together. Today he holds down a job as a bus driver. There is absolutely nothing about him to suggest that he has two black holes in his brain. What saved him from going completely off the rails was probably his youth. Howard's young brain was able to rebuild neural pathways and compensate for the damage Freeman had inflicted.

  Dr Freeman operated on a total of nineteen children, including a four-year-old. By the time of Howard Dully's operation in 1960, even as surgery of 'last resort' lobotomy should have been confined to the history books. Drugs were available that did much the same thing only without the danger or permanence of surgery. Some drugs were even marketed as 'chemical lobotomies'. These new treatments should have put Freeman out of a job and saved Howard Dully. They almost did. By the mid-1950s the weight of criticism was piling up and Freeman had fallen out of favour in Washington. This prompted his move to California, where he offered his transorbital lobotomies to all-comers, as a quick fix for neurotic housewives or disruptive children. Somewhere between devising the procedure in the 1930s and practising it on children, Freeman had lost sight of the reasons for developing the lobotomy operation in the first place.

  Some have described Freeman as a monster, sometimes in those same newspapers that sang the praises of his 'miracle' surgery in the 1930s. Even his own son, who witnessed the terrifying spectacle of one of Freeman's transorbital lobotomies, described the operation as 'diabolical'. But it is difficult to reconcile the image of a monster with the kind and gentle doctor his patients encountered. When the lobotomy was conceived it seemed to provide the only treatment for chronic mental illness. It certainly transformed some people's lives for the better.

  But Freeman's greatest failure of judgement was not knowing when to stop. Nor, to be fair, did anyone step in to stop him. Where, for instance, were the authorities who should have prevented the operation on Howard Dully? The fact that Freeman kept performing transorbital lobotomies when the procedure was discredited and opposed by almost the entire medical establishment makes it difficult to forgive him for what he did to so many people. Rosemary Kennedy, Howard Dully and hundreds of others would have had very different lives were it not for Walter Freeman.

  Freeman performed his last transorbital lobotomy in 1967. He was seventy-two. His patient suffered a haemorrhage and died three days later. The hospital where he was operating finally decided that enough was enough and stopped him from performing any further lobotomies. It was the end of his career. The lobotomist had lost his purpose in life. But rather than stay at home, he got back in his camper van and headed off for one final road trip.

  Over the next few years he covered some fifty thousand miles, tracking down his former patients. It was as if he were seeking redemption. Perhaps he was beginning to have doubts about his treatments and wanted to prove that he had helped people, had improved his patients' lives. He visited homes and hospitals; he saw people who were very sick and those whose lives had undoubtedly been changed for the better.

  Walter Freeman died in 1972. The transorbital lobotomy died with him, but to the end of his life he believed in what he had done, and he believed it was right.

 
; Freeman was not completely misguided. Lobotomies are no longer performed, but psychosurgery – using surgery as a treatment for mental illness – is still practised in hospitals around the world. Once again, it has become a treatment of last resort. Although the lobotomy is undoubtedly one of the most disturbing operations in the entire history of surgery, when it comes to matters of the mind it is by no means the only controversial therapy.

  CONTROLLING THE MIND

  Córdoba, Spain, 1964

  * * *

  Dr José Delgado was brave. There is no doubt about that. Few scientists would attempt to do what he was about to do. Delgado claimed he knew a little bit about bullfighting, and was also reasonably confident that he knew about the workings of the brain. But combining the two? That was a different thing altogether.

  The bull is charging across the ring towards Delgado, its nostrils steaming as it kicks up the dirt in the arena. Bred to be aggressive, it is an awfully big, angry bull, its head bowed down as it charges, its horns hard and sharp. If Delgado gets this wrong, there is a good chance he'll be killed.

  Delgado concentrates as he grasps the matador's red cape in his right hand. He stands by a wooden barrier that he can duck behind if the experiment goes wrong, but there is no guarantee he will make it in time. In his left hand he holds what looks like a transistor radio – a small box with a long aerial extending from the top. If anything, Delgado is holding this tighter than the cape.

  The bull's hoofs pound. Delgado stands his ground. The bull is getting closer. Delgado remains still. Ten feet, five feet. The bull is almost on top of him. Then Delgado presses a button on the box. The bull stops in its tracks, turns round and wanders away. It is an audacious stunt: a demonstration of the power of technology.

  The previous day Delgado had anaesthetized the bull and implanted electrodes in its brain. When he pressed the button on the remote control he had been holding, it sent a signal to a receiver on the bull's head. This stimulated the electrodes deep inside the brain, changing the bull's normally violent behaviour. At the flick of a switch, Delgado had control of a ferocious animal.

  By the 1960s, developments in electronics and a better scientific understanding of the workings of the brain were making such impressive demonstrations possible. Delgado used an implant device consisting of a sealed capsule about the size of a small watch. This contained the receiver and all the electronics. Wires emerged from the side of the capsule and these were sunk into particular regions of the brain. Thanks to advances in the understanding of brain anatomy and localization, Delgado could surgically implant the electrodes in specific places to get particular responses.

  The doctor's other experiments were equally impressive, although somewhat less dangerous. Implants in the brain of a monkey could be stimulated to control the diameter of the pupil in the animal's eye. When the doctor pushed the button on the remote, the pupil would contract and dilate – it was almost like controlling the aperture of a camera. He could get other monkeys to yawn on demand or even perform a complex sequence of movements. He also experimented on cats. He could induce expressions of rage – an electrical stimulation caused them to hiss and bare their teeth. The cats even learnt to turn off the stimulation by rotating a wheel Delgado had installed in their cages.

  It was the experiments on groups of animals that revealed the potential of the technology. Delgado discovered that he could use implants to control aggression in monkeys. He could also get other monkeys to do the controlling. In one demonstration he installed electrodes in the brain of Ali, the boss of a small monkey colony. When Ali's brain was stimulated it inhibited his normally aggressive behaviour. Delgado installed a lever in the experimental cage the monkeys lived in. When the lever was pressed, it activated the electrodes. Soon a passive monkey named Elsa learnt that pressing the lever could stop Ali's aggression. She now had control over Ali. Whenever he threatened her, she pushed the lever and Ali stopped. Elsa had become the boss.

  It was one thing to operate on bulls, monkeys or cats, but what would happen if electrodes were implanted in human brains? Could human behaviour be controlled in the same way? Delgado hoped to use the technology to help patients suffering from severe mental illness, epilepsy or chronic pain. Rather than change behaviour by removing bits of the brain as the lobotomists had done (Delgado found the idea of lobotomy abhorrent), he planned to insert his devices in the brain instead.

  When he tried the technology on humans the results were astonishing. With receivers attached to people's heads, he found he could stimulate a whole range of human emotions from fear through lust, hilarity and rage. One of his researchers is said to have narrowly avoided serious injury during an experiment conducted on a young woman with epilepsy. She was playing the guitar when the device was activated and promptly flew into a rage, throwing her guitar against the wall.

  Soon other doctors were taking up Delgado's work. In 1965 psychiatrist Frank Ervin and neurosurgeon Vernon Mark tried out the technology on a sixty-three-year-old man dying of cancer. The patient was in the most terrible pain, and surgeons had run out of treatment options. Injections of morphine were no longer doing the trick, and what remained of his life was a living hell.

  After drilling a series of holes in the man's head, Ervin and Mark inserted electrodes into carefully selected sites in his brain. The electrodes were connected to a plug in the patient's scalp, which led to a 'pain box' – a controller that the man carried in his pocket. When the pain got too much, all he had to do was push a button and the agony would go away. If he kept the switch pressed for more than forty-five minutes, the pain subsided for up to eight hours, allowing him to get a good night's sleep for the first time in months. The only side effect was that the device made him feel a little drunk. But then, the patient figured, if you're dying of cancer, that's not such a bad thing.

  Few would argue against helping a dying patient, but the development of devices that could change people's behaviour at the flick of a switch had far more sinister implications. Delgado was well aware of the potential of his technology, but downplayed any suggestions that it might be used by sinister forces to control people's minds. In his 1969 book Physical Control of the Mind he dismissed the idea of an evil dictator standing at a master control centre stimulating the minds of an enslaved people. But then he didn't reckon on the CIA.

  In the mid-1950s the US intelligence agency had started toying around with the idea of brainwashing individuals, invariably communists. They had looked at using hypnotism or drugs, and investigated the notion of using lobotomy to control antisocial behaviour. A psychiatrist, Henry Laughlin, had even been dispatched to witness some of Walter Freeman's operations. In his report, Laughlin suggested that lobotomy might be used as a 'neutralizing weapon' to 'quench crusading spirits' or 'zealous and fanatic communists'. If lobotomy could do that, just think what brain implants could do.

  Following the Detroit riots in 1967 and subsequent civil unrest in deprived inner-city areas across the United States, Ervin and Mark suggested that brain implants might be used to subdue black rioters. In an article in the prestigious Journal of the American Medical Association they proposed that urban riots and other 'acts of senseless violence' could be prevented by surgery.

  In 1972 psychiatrist Robert Heath came up with another idea. Why not use brain implants to 'cure' homosexuality? With a long list of ethically dubious research behind him, Heath conducted an experiment on a gay man. The psychiatrist placed electrodes inside the subject's brain and stimulated them while the man had sex with a female prostitute. The aim of the experiment was to condition the subject to want to have sex with women rather than men.

  The backlash against using brain stimulation was swift. Delgado was lumped in with Ervin, Mark and Heath, even though their experiments were nothing to do with him. The rise of the implant in science fiction did nothing to help his cause. More and more conspiracy theorists claimed that the government had secretly implanted chips in their brains, and books such as The Terminal Man
(see Further Reading) painted a terrifying portrait of a medical experiment gone wrong. That its author, Michael Crichton, was once one of Ervin's students probably did little to help.*

  * The reality was that if the government really wanted to control the population through mind control, they would stick drugs in the drinking water, rather than go through the impractical and messy business of implanting chips.

  It looked as though it was the end of the line for the brain implant. The research was discredited, ethical approval for brain stimulation experiments became impossible to obtain, and funding for studies simply fizzled out. However, unlike Freeman's transorbital lobotomies, brain implants still held enormous potential.

  STUART'S STORY

  London, 2006

  * * *

  Sixty-eight-year-old Stuart Carter felt trapped within his own mind. He could think about moving but his body would not move. He could not smile or laugh or frown or cry. He had lost his sense of balance and could barely stand. When he placed his hand down on a table he could no longer lift it up. His face was an expressionless blank. He was a living statue watching life through a mask.

  Carter had Parkinson's disease. This degenerative illness affects nerve cells in the brain that coordinate movement. Whereas many people with Parkinson's have uncontrollable tremors, Carter's body froze. He found that his facial muscles would no longer react to emotion and that his body would lock in a particular position. Sometimes it took him an enormous mental effort to get moving again. He knew that without treatment his condition would only get worse, but the drugs he was taking were no longer working. His mind remained sharp, but his body was gradually shutting down.