Intro. [Recording date: February 19, 2023.]

Russ Roberts:

As we speak is February nineteenth, 2023, and my visitor is journalist and writer Megan McArdle of the Washington Publish. That is Megan’s seventh look on EconTalk. She was final right here in December of 2021 speaking about belonging and nationwide identification.

We’ll begin our dialog at present speaking about lobotomies and psychological sickness, however the overarching subject is about confronting our errors, skilled and private, the problem of affirmation bias.

I wish to warn dad and mom with younger youngsters that this episode will possible take care of quite a few grownup themes, together with these associated to Oedipus.

That is a reasonably good teaser, I believed. Megan, welcome again to EconTalk.

Megan McArdle: Thanks for having me, Russ.


Russ Roberts: We’ll discuss, to begin with, a few latest column you wrote within the Washington Publish, which centered on Walter Freeman, a health care provider who was, till your column, obscure to me, and a biography written in 2007 of Walter Freeman that you just wrote about. So, inform us who Walter Freeman was. Inform us how you bought desirous about Dr. Freeman.

Megan McArdle: Nicely, let’s begin with the second query as a result of I got here throughout a reference–it was a glancing reference in an article about one thing else. And, in truth, I do not even keep in mind what the article was. However this actually caught with me. It was a reference to the truth that Walter Freeman died within the early Nineteen Seventies nonetheless believing in lobotomy. And, that was surprising to me as a result of I believe–and I believe we will discuss this later within the podcast–you can sort of perceive how lobotomy occurred within the context of a world the place there have been simply no good therapies in any respect for psychological sickness, for many sorts of psychological sickness, the place, particularly, extreme issues, like schizophrenia, the options had been Freudian pseudoscience that did not work. And, medical doctors had been determined, they usually did a bunch of determined issues of which lobotomy was essentially the most horrifying, however the others had been fairly villainous themselves.

Russ Roberts: And, inform our listeners what a lobotomy is.

Megan McArdle: A lobotomy is, you basically–so, the prefrontal lobes of the mind, they management a whole lot of issues, like impulse management. They’re character and need. You principally stick an instrument into the prefrontal lobes and also you sort of take bits of the mind out and depart a scar. That was the unique operation.

After which, Walter Freeman’s advance, should you can name it that, was that he would take a pick-like instrument–originally, really, an ice choose was how he began, how he obtained the concept originally–and he would insert it subsequent to your eye by means of the attention socket, and the bone could be very skinny behind the attention socket. And, he would simply faucet power it by means of the bone into the prefrontal lobe. After which he would simply wiggle it round, for need of a greater time period.

And that, in fact, would go away some fairly critical scars in your mind. And it produces an effect–it makes folks apathetic. Truly, I should not say it does something, as a result of this was so unscientific. They’d no concept what they had been doing. After they began, they did not have any concept what the lobes did. And so, it really actually relied on the place they occurred to hit and the way a lot harm they did. However, it continuously left folks fairly apathetic, which should you’re treating an anxiousness dysfunction, it seems form of confusingly like a treatment.

And, I imply, Walter Freeman, himself, did hundreds of those. He began within the Thirties. He didn’t really invent the process. That honor goes to a Portuguese physician named Egas Moniz, who obtained the Nobel Prize for it in 1949, by the way in which. By no means rescinded–which is form of tragic as a result of, in truth, he deserved the Nobel Prize for his work on angiograms. However, what he obtained it for was this horrific operation, partly–due largely, perhaps–to the lobbying of Walter Freeman.

However, Walter Freeman was the American entrepreneur who picked up the operation. And, it went out of favor, principally, as quickly as the primary antipsychotics had been developed in 1954. And, as you began to get Lithium and Thorazine and all of those different medicine that were–even should you had been a part of the motion that claims that psychiatric medicine are dangerous, all you are doing is sedating sufferers, and so forth–they’re undoubtedly higher than simply hacking round on somebody’s mind.

And so, the operation begins to fall out of favor in a short time with the medical institution, which had all the time, by the way in which, been considerably queasy about it. However, Freeman never–he by no means gave up on it. In 1968, only a few years earlier than he died, he’s telling folks, ‘I believe this can be a nice operation, and it is due for revival when surgeons make their thoughts to it.’

And so, that captivated me. I believed, ‘How may you be so flawed about one thing so apparent and never understand it?’ And so, I began studying about his life and the process.

Russ Roberts: And, in 1967, he carried out the final lobotomy in the US. The affected person died. And, the biography that you just draw on, largely, is by Jack El-Hai. Is that his title?

Megan McArdle: That is right.

Russ Roberts: Okay.

Megan McArdle: I additionally learn a few different books, together with one thing known as The Lobotomy Letters, which is fascinating–it’s very tutorial, so I would not essentially suggest it as gentle studying. And, certainly, I’ll say that this challenge has taken me a 12 months and a half to supply one column, and the explanation it took so lengthy was that each time I obtained by means of an outline of the process, I must take a two-week break.

Russ Roberts: Yeah.

Megan McArdle: It is actually, actually troublesome, unsettling studying.

Russ Roberts: Yeah.

Megan McArdle: However, it is fascinating to see how the letters between him and sufferers, between him and different folks, to see how he thought concerning the process, but in addition about how they thought concerning the process, which was in no way how we’d assume that they did.


Russ Roberts: So, discuss that, and discuss how he, on the finish of his life, was speaking to sufferers he had operated on.

Megan McArdle: So, he maintained all through his life a voluminous correspondence together with his sufferers. They exchanged Christmas playing cards. And, I believe a few of this–he was not a very hot man. He was probably not, I will be sincere, a very likable man. I wish to make this right into a tragedy of this glorious man who simply made one mistake, however that is not the case. He was useless and over-ambitious and had determined that lobotomy was his path to being a bonafide medical–pioneering medical hero. Which is a part of how he did go so flawed.

I do not assume that is all that occurred there. He genuinely did care about his sufferers and did consider he was serving to them. However, when he first proposes doing this process, there’s fairly a blended response. And, a form of elder statesman of the sphere, who is–by the way in which, I believe one of many causes that this caught on is that he had assist from folks, older folks, within the discipline. He was additionally improbable at getting press, in a sort of gross manner, and to see how large a task the media performed in creating the social assist for a lobotomy was fairly disturbing.

However, this man who stands up and says, ‘No, I believe that is’–when folks say, ‘Are you kidding? You are simply going to begin rooting round in folks’s brains? Are you mad?’–this man stands up and says, ‘No, I believe that is actually fascinating, however it’s best to take detailed case histories.’ And so, his entire life, he is taking extraordinarily detailed case histories; he is following up with the sufferers.

And, I went into this with the stereotype that principally everybody has, which is the Ken Kesey-‘this can be a technique of social management’–and, I do not wish to say that it wasn’t ever a method of social management. It completely was. There have been completely tragic instances of people that had been lobotomized as a result of it was in a roundabout way extra handy for the caregivers. And, I believe that we do have to–

Russ Roberts: The Ken Kesey reference is a reference to the guide, One Flew Over the Cuckoo’s Nest.

Megan McArdle: [SPOILER ALERT!] Sure, I am sorry. One Flew Over the Cuckoo’s Nest, the place, famously, the troublemaking affected person, who is just not mentally in any respect, who has gotten himself into an asylum as a solution to keep away from jail, he will get lobotomized on the finish of the guide. [END SPOILER ALERT!]

And, that occurred.

But in addition, I imply, we do have to grasp the context. You’ve gotten individuals who can not dwell in the neighborhood as a result of they’re violently psychotic, as a result of they’re delusional, as a result of they’re so anxious that they are hurting themselves by washing their fingers 97 occasions a day. These individuals are ending up in establishments. The establishments are horrible.

There is a actually unhappy story of a surgeon whose son had all the time been liable to violent suits. And, this is–I imply, that is nonetheless a typical drawback that folks take care of of severely disabled youngsters: is that you’ve slightly child who, yeah, is likely to be liable to violent suits, however it’s fairly simple for the lecturers to take care of them.

Then, if it is a boy and it goes by means of puberty, that little one will get very giant, and you may’t simply seize him and maintain his arms. And, what this surgeon is is, like, ‘I am afraid that the choice is my son spends his life in a straitjacket.’

And so, we assume that there was no knowledgeable consent. No: these sufferers had been typically pondering deeply and thoughtfully about it, and never nearly: ‘Is it going to be extra handy to have my disabled little one sitting quietly on the sofa than going out and making hassle?’ Though, there’s additionally a few of that, proper? One of many issues that comes out of a lobotomy is a distinct concept about knowledgeable consent.

So, he is following up with these sufferers. After which, as he will get older, this operation goes out of favor. He strikes to California. He nonetheless continues working, however at a lowered degree. After which, in 1967, as you say, he killed a affected person who was really somebody he had operated on earlier than. She died on the desk, and that is the top of his profession. However, even earlier than that, he was all the time somebody who liked highway journeys. Even within the Forties, he would go. And, in truth, tragically, certainly one of his sons died on a highway journey falling right into a waterfall.

However, from about 1956 to 1969, he simply goes on these frantic highway journeys. He is doing 25,000 miles in his automobile. In 1967, he buys a camper bus. Actually, I imply, at this level, he is obtained most cancers. He’s badly wasted. He’s lacking an enormous chunk of his colon, and he simply goes on the highway and he’s simply accumulating as many affected person histories as he can. He known as these his head-hunting journeys. Which, I imply, as I mentioned, he could possibly be fairly grizzly. He used to name these, when he would go on the highway and do a bunch of lobotomies–he would display it to different medical doctors. He was not simply chargeable for the three,000 that he did. He was accountable for lots of different medical doctors doing a whole lot of different lobotomies. He was a tireless entrepreneur selling this horrific process.

However, now his head-hunting journeys switched to simply discovering folks, taking case histories, determining the place they’re. And, the factor is that, in a whole lot of instances, they’re very joyful to see him. There have been individuals who had been glad with their operations.

And so, to begin with, there have been individuals who went on to have–not a lot–there had been individuals who went on to have actually fairly high-powered careers. There’s somebody who completed her math Ph.D. after her lobotomy, and went on and obtained a job as a professor. There have been attorneys and medical doctors and vital folks with vital jobs who had lobotomies. That is, by far, not the bulk. However then, Walter Freeman’s protection can be, ‘Nicely, that wasn’t nearly all of folks,’ which is considerably truthful, I suppose. And so, he goes on these journeys, and there have been individuals who would suggest lobotomies to people who they knew. It would be like, ‘This was nice for me. I will suggest this to my family and friends.’

So, our understanding of lobotomy is that this factor the place you simply find yourself with this zombie vegetable who does what they’re advised is just not right. That mentioned, it was a horrific process. The unwanted side effects had been horrible. It did, it produced apathy. It may produce incontinence. It may produce seizures. I imply, a shocking variety of his sufferers died on the desk or shortly thereafter. I am not defending lobotomy. However, it wasn’t what I believed it had been. And so, that was a extremely, actually fascinating factor to be taught.


Russ Roberts: So, when he went on the road–I imply, clearly, you could not get on a Zoom name with him in 1968. However, he wished to do greater than write them a letter, evidently. He may have written them a letter. I suppose he knew the place they had been. So, he went on the road–

Megan McArdle: Nicely, a few of them–he actually tracked them down. Like, he would simply monitor them down by means of, like, adjustments of title and a job and handle. As a result of, you keep in mind, any girl who obtained married would change her title again then. So, it was actually fairly a formidable little bit of detective work to have tracked down as many as he did.

Russ Roberts: And, do we have now any sense–and I am shocked that anyone thought it was a good suggestion, any affected person, or that any affected person went on to a profitable profession of some kind–do we have now any really feel for the general influence of a minimum of the hundreds that he did? I imply, it is one factor to say, ‘Yeah, there have been some individuals who survived it and did properly.’ Or: Most people, a whole lot of them died. Do we have now any really feel for what the panorama regarded like?

Megan McArdle: I do not assume there’s been a scientific examine performed. I imply, that I am conscious of–which a reader might write in to right me. And, I’d be very joyful to be taught that there’s a extra systematic–I believe a part of it’s that what they had been doing was so variable.

Russ Roberts: Proper.

Megan McArdle: Entering into by means of the attention socket, you possibly can’t see the place you are going. As we speak, in the event that they do mind surgical procedure, they’re imaging the mind. They’re doing these extraordinarily exact [?]–because they will nonetheless, generally, do issues to the prefrontal lobes as a result of, for instance, you might have a mind tumor there. However, they’re taking excessive care to be extraordinarily exact about the place they’re hitting and to reduce the harm to surrounding mind tissue. And, that is not what they had been doing. They typically did two or extra lobotomies. They might observe up, and, ‘Nicely, it wasn’t passable, so let’s do one other one,’ which is insane.

So, I do not know what the systematic impact was. I believe that the final notion is that it was not good.

Russ Roberts: Yeah.

Megan McArdle: It left folks apathetic. It damages your impulse management. So, some folks would go on alcoholic benders, or they might in any other case disappear. Individuals wrote in to me, really, apparently, after I wrote this column and mentioned, ‘Yeah, no, I had an aunt who this occurred to, or I had an uncle who this occurred to, and I keep in mind them as a quiet one that did a menial job and did not say a lot.’ Or folks can be house and they might be cared for till they died. The median final result, I don’t assume, was you bought a math Ph.D.

Russ Roberts: Yeah.

Megan McArdle: I do not assume that is near the median final result.

Russ Roberts: I perceive.

Megan McArdle: It was largely a particularly damaging operation.

I believe what the medical doctors would say is that the people who they had been coping with had been typically in establishments, and that Freeman, a minimum of, maintained that the majority–early on, at least–the majority of the folks he labored on had been out of establishments after he labored on them. And, that that was higher than the place they’d been earlier than. He was not below any phantasm that this was side-effect free. However, I do assume that he was in search of it to work, proper? And, he was wanting so arduous that he noticed what he wished to see. You noticed the proof that it was good, and also you did not take note of the proof that it was dangerous.

Russ Roberts: That jogs my memory of shock therapies, the same shot in the dead of night to attempt to assist individuals who had been in any other case, I wish to say, unable to combine themselves into the traditional tempo of life.

Russ Roberts: I discussed–

Megan McArdle: And, which, by the way in which, continues to be performed for extreme melancholy.

Russ Roberts: Actually?

Megan McArdle: Yeah. So, I mentioned earlier on that lobotomy was simply certainly one of this array of horrible therapies. So, there was one–oh gosh. I’ve by no means pronounced this word–it was metrazol, I believe. It was a convulsive. They’ve discontinued it as a result of it stored killing sufferers.

However, they’d quite a few convulsive therapies. Electrical shock was one. They might put folks into diabetic comas. They might use this convulsant drug.

Now, most of these we do not do. However, the electrical shock continues to be performed for extraordinarily refractory melancholy. In case you are severely depressed, and you can’t recover from it, and also you principally don’t have any high quality of life, and medicines do not work, they’ll attempt electrical shock. And, it really does appear to work. We do it way more humanely. I imply, again then folks used to interrupt their legs from the shocks. And, one factor, really, early on that Freeman would use ECT–electroconvulsive therapy–he would use the electrical shocks to anesthetize the sufferers. Which is insane. And, they might break their legs. I imply, it was horrible.

Actually simply barbaric, this entire factor. However, they had been additionally coping with these extremely barbaric asylums, they usually did not know what else to do with folks. And, we have now higher options, and we should always do not forget that it’s simple to go judgment after we have options.


Russ Roberts: I believe there are various disturbing facets to the story. One among them is the concern that should you persuade your self that it helps folks, you can begin altering the inhabitants you assume it is applicable for. I believe I discussed on this system earlier than that John Nash, the Nobel Laureate in Economics, when he was within the worst of his delusions and challenges mentally, he was a really disagreeable particular person for his household to be round. And, they typically did issues to him that had been in opposition to his will. However they by no means gave him shock therapies, as a result of they didn’t wish to harm his mind. They knew and acknowledged that he had a rare cognitive instrument, that–whether it could possibly be used for good or not was not the query. There was one thing valuable and uncommon about it. And so, they restricted their harm to him to incarceration–physical constraints, and different issues. However, not shock remedy. I do not assume they lobotomized him both. I would be fairly assured. I do not keep in mind, however I am fairly positive they did not.

Megan McArdle: No, I really feel like I’d do not forget that half.

Russ Roberts: Yeah.

Megan McArdle: It has been some time since I learn the guide.

Russ Roberts: Me, too.

Megan McArdle: However, I really feel prefer it really would’ve been talked about as a result of essentially the most well-known particular person to have been lobotomized was John F. Kennedy’s sister–

Russ Roberts: Oh–

Megan McArdle: that I am conscious of. I imply, there are some instances which might be well-known for their lobotomies. However, so far as I do know, essentially the most well-known particular person to have been lobotomized was John F. Kennedy’s sister, who was considerably mildly brain-damaged throughout delivery, is my understanding. I do not really know the small print, however I believe she had some delicate cognitive incapacity. And, I do not know if that is true. So, one telling of the story–one factor that you’ll hear a lot–is that Joseph Kennedy was afraid she would turn into sexually lively, and subsequently had her lobotomized. I do not know that that is the reality of it. I do know that the lobotomy didn’t go properly, his spouse by no means forgave him, and that Rosemary spent the remainder of her life in an establishment. Which–

Russ Roberts: Joseph–

Megan McArdle: I imply goes to this was a horrific operation that ought to not have been performed.

Russ Roberts: Joseph being John F. Kennedy’s father-.

Megan McArdle: Sure. Sorry.

Russ Roberts: who had some unattractive facets. I am going to simply say that, and we’ll transfer on.


Russ Roberts: However, the purpose is that there are individuals who have insufferable burdens in both attempting to outlive these in an establishment, which is a horrible problem within the first half of the twentieth century and earlier than. After which, there are people who find themselves simply disagreeable or troublesome to take care of. And, I believe in any of those treatments–and these embody prescribed drugs, as well–the temptation to alter the place you determine this particular person is past the pale of consideration that we’d give a, quote, “regular” human being–I believe that is the problem. And, I haven’t got something to say on that aside from to that might be the problem I’d fear about on this case. And, I do not know if Walter Freeman drifted over the course of his life by way of recommending the process for those that, possibly 20 years earlier than, 10 years earlier than, he would not have. That is what I would be desirous about. [More to come, 23:26]

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