A Portrait of the Brain by Adam Zeman

My Lobotomy: A Memoir by Howard Dully and Charles Fleming

BOOKS ABOUT the brain are often a disappointment. There have been huge advances in understanding, but neuroscience needs a paradigm shift to make it accessible. It is like genetics before DNA, or geology without plate tectonics: a lot of interesting information but without an overarching theory to make sense of it. Even the brightest diamonds need a setting.

Adam Zeman's book combines science with the case-history approach that has proved so successful for Oliver Sacks. Each chapter features a case - a woman inexplicably exhausted, a man who sees a vision while driving a bus, a Dutch farmer who suddenly discovers he can paint - and then explores the diagnosis and its causes.

Zeman writes well, and this is a good way of drawing the reader in. He covers a lot of ground in an easy-paced way, but it doesn't grip. I found myself impatiently waiting for the next case and reluctant to read the intervening neuroscience. But for those with a longer attention span, this is an excellent introduction to the subject and Professor Zeman comes across as the kind of man one would be glad to consult if anything went wrong inside one's skull.

Not so the late Dr Walter Freeman, the villain of Howard Dully's distressing story. Freeman was the evangelist of lobotomy, criss-crossing the United States armed with an ice pick, which he drove into the brains of the mentally ill through their eye sockets, bypassing the eye. Even writing this makes me shiver.

The aim was to sever the connections between the frontal lobes of the brain and the thalamus. Invented by Ega Moniz, the Portuguese neurologist, who won a Nobel prize for it, the results of the operation were utterly haphazard. Some patients died; many were left as cabbages.

Freeman took it up with the energy of a huckster. He could perform the operation in ten minutes, he boasted; sometimes he did both eyes at once, twirling his ice picks like a magician. Between 1948 and 1960, he carried out nearly 3,500 lobotomies across the US, travelling between asylums for the insane in a van he christened the Lobotmobile.

Among his victims were Rosemary Kennedy, the sister of President John Kennedy, who was permanently incapacitated, and Howard Dully, a 12-year-old boy from California with no real evidence of mental-health problems.

He was taken to Freeman by his stepmother, who believed he was mentally ill. As Dully himself tells the story, he was no more than a disruptive adolescent denied love. Freeman diagnosed schizophrenia and suggested a lobotomy; Dully's parents agreed, and a couple of months later it was done.

Freeman seems genuinely to have believed in his crude technique. A few weeks later, he took Dully and two teenagers he had operated on to a psychiatric clinic in San Francisco for a presentation. The audience was unimpressed by the three lethargic patients and shocked when Freeman admitted that Dully had only just turned 12. Instead of making a good impression, Freeman was booed off the stage.

By then, this shameful episode in neurology had almost run its course. Aided by an uncritical press and a supine medical establishment, Freeman had been able to perform his operations - sometimes in front of an admiring audience - without providing any real evidence of their benefit. He claimed that in half the cases, results were “good” but offered no clinical yardstick.

For Dully, the results were certainly not good. He spent his teens in an institution, his twenties in and out of jail, and was an alcoholic in his thirties. Astonishingly, he then began to recover. He became a bus driver, married and discovered a kind of contentment.

He also found out exactly what had happened to him. Freeman's voluminous notes included a photograph of the operation and the chilling entry: “December 3 1960. Mr and Mrs Dully have apparently decided to have Howard operated on. I suggested they not tell Howard anything about it.”

My Lobotomy is Dully's account of his life, and it makes uncomfortable reading. It would be easy to dismiss Freeman as a freak, but thousands of lobotomies were carried out in the UK, some as recently as the 1970s. Today neurosurgery for mental disorder (NMD) is a treatment used in the UK only for a handful of the most difficult cases.

If Freeman were still alive, he would doubtless claim that Dully's memoir was evidence of the effectiveness of lobotomy. It is, given the circumstances, astonishingly free of rancour. Dully is even willing to forgive his father, who has never apologised for giving Freeman permission to drive a sharp implement into his son's head.

A Portrait of the Brain by Adam Zeman
Yale, £18.99; 256pp

My Lobotomy: A Memoir by Howard Dully and Charles Fleming
Vermillion, £12.99; 299pp

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