The Sunday Gentleman (28 page)

This is Larry Cassidy today. How typical is his post-lobotomy personality? While results vary from individual to individual, it is evident that everyone who has undergone a lobotomy has much in common with Larry. For evidence on other lobotomies, Drs. Goldsmith and Rogers cite the findings of fellow psychosurgeons, especially pioneers like Drs. Freeman and Watts of Washington, D.C.

After performing prefrontal lobotomies on over 400 persons, with whom they kept in contact, Drs. Freeman and Watts came to certain conclusions. “Patients who have been operated on are usually cheerful, responsive, affectionate and unreserved. They are outspoken, often critical of others and lacking in embarrassment…They tend to procrastinate, to make up their minds too quickly and to enunciate opinions without considering the various implications. The most striking and constant change from the preoperative personality lies in a certain unselfconsciousness, and this applies both to the patient’s own body and to his total self as a social unit. The patient emerges from the operation with an immature personality that is at first poorly equipped for maintaining him in a competitive society; but with the passage of time there is progressive improvement, so that in about one-half the cases earning a living again becomes possible.”

The fact that psychosurgery is supported by a large proportion of the medical profession is evident from its widespread acceptance and usage. In August, 1948, when the First International Conference on Psychosurgery was held in Lisbon, 8,000 lobotomy cases were reported on by doctors from twenty different nations. Lobotomies are being performed today in countries as disparate as India, Sweden, Czechoslovakia, New Zealand, and Japan.

Those who support lobotomy stand on its record. The English Board of Control, checking the results of 1,000 lobotomy cases in forty-three hospitals in England and Wales, found 35 percent could be discharged into regular life (of these, 242 were able to earn a living or keep house) and 32 percent were improved in their hospital adjustment. Drs. Freeman and Watts have reported, at different times, that after lobotomy about one-third of the patients recover, one-third improve and one-third fail to improve. “There are variations from one investigator to another and from one disease to another,” Drs. Freeman and Watts conclude, “but the results are sufficiently good to warrant the use of prefrontal lobotomy on a large scale for the relief of the very serious and chronic forms of mental disease that keep the back wards of the psychiatric hospitals filled to capacity and beyond.”

However, the critics of lobotomy are equally numerous. Dr. Stanley D. Porteus, who studied fifty-five cases in Kaneoke Hospital, Hawaii, decided, “Undoubtedly, if everyone in the world was to be simultaneously lobotomized, it would spell the end of all progress. Industry, except at the simplest levels, would cease. A population of cheerful drones could hardly carry on the complex business of modem living.” Dr. Nolan D. C. Lewis feels lobotomy patients should be carefully selected and operated upon only as a last resort. “Meanwhile, the
furor therapeuticus
continues with an enthusiasm that may prove dangerous,” he says, “unless an accurate stock of the situation is soon taken and made known.” A prominent Philadelphia psychiatrist regards lobotomy as “disuseful” in beginning cases, but of value if no other therapy has improved the condition of a serious mental case.

Dr. G. Rylander has quoted the families of lobotomy patients, who are stunned by the personality changes produced by the psychosurgery. One wife, whose husband had a lobotomy, protested, “Doctor, you have given me a new husband. He isn’t the same man.” The mother of a girl who had a lobotomy complained, “She is my daughter, but yet a different person. She is with me in body, but her soul is in some way lost. Those deep feelings, the tenderness, are gone.” There are other objections, too. Some Catholics, like Dr. R. O’Rahilly, feel lobotomy is morally wrong. And, since the announcement that lobotomy has been tried on criminals. Dr. D. H. Winnicott has argued, “What guarantees have we that a Bunyan in prison will be allowed to keep his brain intact and his imagination free?”

Because he has always felt that he played a major role in deciding upon Larry’s lobotomy. Jack Cassidy keeps abreast of this medical controversy. He still does not know whether he did the right thing by Larry or not. On Saturday nights, when Larry is staying over for the weekend, and is asleep in the spare room, and Susan has gone to bed, Jack will often settle into the big living-room chair, and try to read the Sunday papers. But invariably, he admits, his mind returns to Larry. Listening to Larry’s heavy breathing, Jack finds himself automatically reviewing the events of the past years.

If they had waited a little longer, he will reflect, maybe a miracle would have happened after all. Or maybe one of the newer operations would have been better. They are still using prefrontal lobotomy, he knows, but they are also experimenting with all kinds of offshoots and variations like topectomy, gyrectomy, and transorbital leucotomy. Then, thinking about it, he remembers something else. He remembers Larry’s face before the operation. He remembers the agony on that face, and how Larry wanted to die. He is sure Larry would have wound up in an asylum, suffering for the remainder of his life, or possibly insane, or even a suicide. Besides, there was the time element. If they had waited, it might have been too late even for lobotomy.

Thinking about it. Jack tries to rationalize. Sure, it hurts to see what has become of Larry. Why, Larry had been practically a genius, even though his genius was of little value. Now he is dulled, no longer the person that they once knew. On the other hand, some of him is still that same person. And the rest of him is happier, and enjoys certain pleasures, and does not mind what he has become. Perhaps that is better than nothing.

About this time, on Saturday nights. Jack is always tired, and he reaches up to turn off the lamp. He walks through the darkened house to his room, with Larry’s heavy breathing following him. Were they right or wrong? Jack will never know. Anyway, it is a hell of a thing to try to answer at two in the morning.

After all, Jack asks—“What would you have done?”

WHAT HAS HAPPENED SINCE…

When I submitted the foregoing story to
The Saturday Evening Post
in May, 1951, the editors were fascinated by it, but concerned about its strangeness and the moral and religious considerations involved. An associate editor was assigned to learn if lobotomy was really an acceptable surgical procedure, and if I had presented the clinical aspects of Larry Cassidy’s case with accuracy. Among the several psychiatric experts consulted on lobotomy, the most important was a doctor on the faculty of the University of Pennsylvania.

He assured the associate editor on the telephone, “Lobotomy is of help to many who are in a hopeless condition, living at a purely instinctive level, trying to kill themselves or someone else, and existing like caged lions.”

The associate editor reported this conversation to Ben Hibbs, then the editor of
The Saturday Evening Post
, and recommended that my story be evaluated by “an unbiased psychiatrist,” such as the one on the University of Pennsylvania faculty. Mr. Hibbs agreed, and a copy of my Larry Cassidy story was sent to the unbiased psychiatrist. One week later, this psychiatrist replied, in writing, to Mr. Hibbs:

“Psychosurgery in the form of lobotomy, lobectomy, under cutting (topectomy) or transorbital lobotomy, etc., is a recognized treatment procedure and has a definite place in psychiatric therapy. This place in relationship to the general problem of psychiatric treatment can be likened to the role that heart surgery plays in the problem of the treatment of cardiac disease or that the role of total removal of a lung plays in a case of tuberculosis. There are neither psychiatric objections nor moral nor religious arguments against the procedure. Lobotomy as a procedure is definitely accepted. The author describes incidents of behavior on a patient’s part that are fairly typical…”

Immediately,
The Saturday Evening Post
accepted “They Cut Away His Conscience” for publication.

First, however, I was asked to make some minor revisions and major cuts. The average
Post
article, at that time, was eighteen manuscript pages. The story I had submitted was fifty-four manuscript pages. I had not given a damn about formula or length when I wrote the story, for I was determined to present Larry’s saga on my own terms. Now a compromise was effected. The editors of the
Post
agreed to run the story as “a double-length feature,” that is, thirty-six pages in length. I agreed to make the painful excisions. (When re-editing the story for inclusion in this volume, I decided to restore at least a thousand words that I had been forced to put aside in 1951.) On July 8, 1951, I delivered to
The Saturday Evening Post
the cut-down version, and it was accepted with enthusiasm.

So emotionally devoted was I to the story, that I could hardly await its appearance in print. At last, in
The Saturday Evening Post
dated October 20, 1951, it saw the light of day. There was one change. Because my title, “They Cut Away His Conscience,” was considered too controversial, a new title was used. It had become, safely, “The Operation of Last Resort.”

The immediate public response to the story was unexpected. Despite what the reader may have heard to the contrary, authors who write fiction or nonfiction for popular periodicals generally receive little acknowledgment from the vast faceless population of magazine buyers and subscribers. A writer’s short story or article is only one of a dozen or more appearing in a single issue of a magazine. So even if his tale makes some impact, its identity is usually suffocated by the surrounding stories and advertisements. Also, his contribution in a single issue of a weekly has a brief life span, because the next issue is too quickly at hand, offering newer marvels. A writer fades quickly into oblivion in the pages of a magazine.

But there are exceptions. And for me, the appearance of my story on Larry Cassidy was such an exception. Whereas an average article or essay might bring me a half-dozen letters from appreciative or critical readers, the travail of Larry Cassidy inspired a small mountain of mail. Much of the mail was congratulatory; readers were deeply moved. Some of the letters, from physicians and clergymen, questioned or discussed the wisdom of Larry’s psychosurgery. Other letters came from parents or relatives of mentally ailing persons, tragic, heartrending letters, asking for more factual information, inquiring for the real names and addresses of Dr. Leon Goldsmith and Dr. Raymond Rogers. The editors of
The Saturday Evening Post
advised me that the double-length feature had drawn a record amount of mail, and was, in this respect, among the two or three most provocative stories they had published in a decade.

The day after publication, from Los Angeles, I was prompted to write my New York literary agent, Paul R. Reynolds: “The response, out here, to ‘The Operation of Last Resort’ has been overwhelming and gratifying.”

The responses of some of the leading players in the story interested me most of all. Larry’s best friend and former roommate at Princeton, Burt, worried at his publishing desk in New York that the story did not tell enough and might give the impression that Larry’s case was satisfactorily solved.

Larry’s younger brother, Jack, was pleased that Larry’s terrible odyssey and his own dilemma were out in the open, and pleased also to have a portion of my earnings from the sale of the article to help support his charge.

And Larry Cassidy, the lobotomized hero still in the Sawtelle Veterans Hospital, how did he react to the publication of his story? Knowledge of its appearance was not kept from him. He was exhilarated by the biography of himself, even though he had been given a fictional name in the narrative. It gave him real identity in the hospital, and supported his own contention of his superiority over the other patients. During 1951, he marched through the halls of the ward, brandishing a copy—the copy—of
The Saturday Evening Post
, waving it under the noses of fellow inmates and psychiatrists alike, bellowing, “Sec, here it is in print, here is the whole truth—I went to Princeton, I’m smarter than all of you! Look at it!
The Saturday Evening Post
doesn’t publish articles about idiots!” And in the years immediately after, speaking or writing to his friend, Burt, he would constantly announce that the author of that article was as great a man as Burt, or Dwight David Eisenhower, because the article had made Larry “world-famous!”

Of course, Larry’s former physicians around the nation read the popular biography and recognized in it their onetime patient. One doctor in particular, who had been fairly cooperative about supplying information during the early stages of my writing the article, later resented the final form of the case history. When I showed him a copy of the manuscript, he was appalled and angry. He felt that I had relied too much on the Cassidy family for material and consequently had given “a one-sided presentation.” He demanded that his real name be removed from the story, and ended a letter to me with the quotation, “If you can see your words twisted by knaves to make a trap for fools…” After that pronouncement on my knavery, and the startling statement that Larry had been an unsatisfactory lobotomy result (“in the lowest 5 percent of rating of results of lobotomy”), this doctor withdrew further cooperation from me.

But after the story appeared in print, and its reception was favorable, this same doctor did a complete about-face. Unashamedly, he wrote his knave asking for assistance in placing for publication a popular medical article that he had written. I felt little charity then—I might feel more today—so I dropped his literary request into the wastebasket and did not reply to him.

I have since tried to analyze my irritation with this one doctor, and I believe that it comes to this: The doctor had been disappointed in the result of Larry’s lobotomy, which he had advocated, and wanted to bury forever his own contribution (one among many) to that result, and so, figuratively, he had disowned his patient. But when my story, in a conservative periodical, had briefly made Larry a national personality, accepted by a vast public of judges as an object of interest and sympathy, the doctor seemed suddenly to regain a measure of pride in his neglected stepchild. I do not say that this is what happened, but it is my only guess. It was as if, until then, by not responding at top level to recommended psychosurgery, by losing too many of his powers, Larry had failed this doctor and all physicians associated with the case. It was as if Larry had remained a walking rebuke to the doctor’s presumably invincible magic. Larry had failed this doctor, and the doctor had washed his hands of him. When, by an accident of circumstances, Larry had become a public figure, much discussed and debated, the doctor had reconsidered, perhaps decided that in some way his operation had succeeded, and that Larry had been a success, also. In a sense, the doctor permitted Larry to join the club again, mounted his addled but celebrated brain on the medical mantelpiece, and said all was forgiven.