WEBVTT - Bedside Manners 9: Mind Games 0:00:05.000 --> 0:00:08.720 P. T. Barnum knew how to spot someone special. Barnum's 0:00:08.760 --> 0:00:11.200 career as a showman taught him that the public wanted 0:00:11.240 --> 0:00:14.400 to be surprised. He knew the general public delighted in 0:00:14.520 --> 0:00:18.680 novelty and horror and tales almost too fantastical to believe. 0:00:19.400 --> 0:00:23.520 In Phineas Gauge, Barnum found all of those things. Barnum 0:00:23.600 --> 0:00:26.000 drew up a contract for Phineas and hired him to 0:00:26.079 --> 0:00:30.000 stand on stage at his Great American Museum alongside bearded 0:00:30.080 --> 0:00:33.360 ladies and giant men. But while Phineas had become a 0:00:33.400 --> 0:00:37.440 traveling celebrity, his origins were unremarkable. He had been a 0:00:37.479 --> 0:00:41.240 foreman on a railroad construction team, responsible for laying tracks 0:00:41.240 --> 0:00:44.760 across Vermont. He was humble and respected. He worked hard 0:00:44.920 --> 0:00:47.920 and had a career ahead of him blasting away pathways 0:00:48.080 --> 0:00:51.120 through the rugged landscape. But all of that changed in 0:00:51.159 --> 0:00:54.840 an instant, or in a flash, if you will. Here's 0:00:54.840 --> 0:00:57.560 what we know. While preparing to clear some rock for 0:00:57.600 --> 0:01:00.680 the rail line, Phineas jammed his iron tab amping rod 0:01:00.720 --> 0:01:03.320 down into a hole filled with gunpowder, just like he 0:01:03.360 --> 0:01:07.240 had done a thousand times before, but this time inexplicably, 0:01:07.600 --> 0:01:11.039 it exploded. The three foot long piece of metal shot 0:01:11.080 --> 0:01:13.840 straight back through his cheek, tore through the top of 0:01:13.880 --> 0:01:16.640 his head, and sailed through the air like a javelin. 0:01:16.920 --> 0:01:20.240 It landed about one hundred feet away, reportedly slickened with 0:01:20.360 --> 0:01:24.200 blood and bits of greasy brain matter. Phineas, if you 0:01:24.200 --> 0:01:28.840 can believe it, never lost consciousness. Even more unbelievably still, 0:01:29.200 --> 0:01:32.679 he was up walking and talking just a few minutes later. 0:01:33.080 --> 0:01:35.640 Even though almost all of the front left side of 0:01:35.680 --> 0:01:38.839 his brain had been obliterated, Phineas seemed to be doing 0:01:38.959 --> 0:01:41.880 just fine, save for the massive hole in his head. 0:01:42.280 --> 0:01:44.280 He told the attending doctors that he'd be back to 0:01:44.319 --> 0:01:48.000 blasting rock in two days. But this didn't quite work 0:01:48.040 --> 0:01:50.400 out the way that Phineas had hoped. You see, he 0:01:50.640 --> 0:01:54.120 bled massively and contracted a fungal infection in his brain. 0:01:54.480 --> 0:01:57.680 He slipped in and out of comas, but after emergency 0:01:57.720 --> 0:02:01.480 surgery and subsequent recovery, Phineas was back home in a 0:02:01.480 --> 0:02:04.640 few weeks. The iron rod now by his side and 0:02:04.800 --> 0:02:08.040 a source of a great story. But Phineas wouldn't return 0:02:08.120 --> 0:02:10.680 to work in the capacity he had hoped. It wasn't 0:02:10.680 --> 0:02:14.080 because he lacked the fine motor skills or cognizance to 0:02:14.120 --> 0:02:18.320 handle dangerous materials. It was because his personality had changed. 0:02:18.760 --> 0:02:21.399 History tells us that he had turned from an affable 0:02:21.440 --> 0:02:25.519 colleague into a rage filled liability. It was after leaving 0:02:25.560 --> 0:02:27.960 his post that he found his way to P. T. Barnum, 0:02:28.240 --> 0:02:30.480 who was more than happy to welcome him in with 0:02:30.600 --> 0:02:35.120 his iron rod and almost unbelievable tale of survival. Doctors, 0:02:35.160 --> 0:02:38.040 of course, were highly interested in his case in the 0:02:38.120 --> 0:02:41.080 nineteenth century. The brain was a mystery. In some ways. 0:02:41.120 --> 0:02:43.720 It felt like trying to explore the farthest reaches of 0:02:43.800 --> 0:02:46.760 space or the depths of the sea. So beyond the 0:02:46.760 --> 0:02:50.240 sheer fact of his survival, experts were interested in something else. 0:02:50.680 --> 0:02:53.560 How the destruction of this particular part of his brain 0:02:54.000 --> 0:02:57.919 caused his personality to change. It's been pointed out that 0:02:57.960 --> 0:03:01.320 Phineas's story was the first case to suggest that damage 0:03:01.360 --> 0:03:05.200 to specific parts of the brain may include other, correspondingly 0:03:05.240 --> 0:03:08.240 significant changes to the person. He became something of a 0:03:08.320 --> 0:03:11.200 legend in his own right, but what historians have also 0:03:11.240 --> 0:03:14.160 come to discover is that his reputation, as it's been 0:03:14.240 --> 0:03:18.120 understood to be influential in the development of psychosurgery, is 0:03:18.200 --> 0:03:22.320 pretty ahistorical. While He has been credited with inspiring brain 0:03:22.360 --> 0:03:25.400 surgeons around the world and encouraging scientists to find the 0:03:25.480 --> 0:03:29.320 key to altering personalities. It simply can't be proven, but 0:03:29.400 --> 0:03:32.160 it makes for a tidy history and a damn good story. 0:03:32.840 --> 0:03:36.000 Phineas has become a kind of mythical figure cemented in 0:03:36.040 --> 0:03:39.040 popular culture because of what he seems to represent to us, 0:03:39.320 --> 0:03:42.360 a building block in a neat narrative about how we 0:03:42.440 --> 0:03:45.800 have tried to understand and control our brains. We love 0:03:45.840 --> 0:03:48.120 that he went on to live a seemingly normal life, 0:03:48.320 --> 0:03:51.440 continued to work, and died at an older age. We 0:03:51.560 --> 0:03:54.280 love what his story seems to show us is possible 0:03:54.680 --> 0:03:58.680 in actuality, though Phineas's experience was far more complicated than that, 0:03:59.120 --> 0:04:02.320 and the same is true for humans in general. Our 0:04:02.400 --> 0:04:04.880 quest to understand the brain will take us to some 0:04:05.120 --> 0:04:08.520 very complicated places, and sadly, we won't have to go 0:04:08.600 --> 0:04:11.880 back very far in history to find stories that visit 0:04:12.200 --> 0:04:16.919 the darker corners of the mind. I'm Aaron Manke, and 0:04:17.040 --> 0:04:30.480 welcome to Bedside Manners. The audience was speechless. Gottlieb Bookhart 0:04:30.520 --> 0:04:33.520 thought his peers would be excited about his report. Instead, 0:04:33.560 --> 0:04:36.760 they were just stunned. An icy chill settled over the 0:04:36.839 --> 0:04:40.120 room as the attendees of the eighteen ninety Berlin Medical 0:04:40.160 --> 0:04:43.360 Congress considered what Gottlieb had done and what they in 0:04:43.400 --> 0:04:47.080 turn needed to do about it. Gottlieb Bookheart ran a 0:04:47.080 --> 0:04:50.280 small asylum in Switzerland in the moment when the fields 0:04:50.279 --> 0:04:54.120 of psychology and psychoanalysis were in their infancy. Folks in 0:04:54.160 --> 0:04:56.800 his position were poised to help patients overcome what was 0:04:56.880 --> 0:05:01.120 known as mental alien nation, but as an alienists, as 0:05:01.120 --> 0:05:04.280 folks in his profession were called. He wasn't a trained doctor, 0:05:04.520 --> 0:05:07.680 let alone a trained surgeon. That didn't stop him, though, 0:05:07.680 --> 0:05:10.480 from operating on the brains of six of his patients. 0:05:11.000 --> 0:05:13.120 As he told it, he hoped that he could figure 0:05:13.120 --> 0:05:17.280 out a way to turn violent, unmanageable asylum residents into 0:05:17.320 --> 0:05:20.440 manageable ones. He believed that a simple cut between the 0:05:20.480 --> 0:05:24.400 hemispheres of the brain could relieve his patients of their outbursts. 0:05:24.560 --> 0:05:27.640 He targeted the location that he believed to control sensory 0:05:27.720 --> 0:05:32.040 and motor function. These patients were his living experiments, their 0:05:32.080 --> 0:05:36.040 brains the fodder for his trials. Now, humans have been 0:05:36.080 --> 0:05:38.799 cutting into heads since the Late Stone or the early 0:05:38.839 --> 0:05:41.800 Bronze Age. As we learned in our episode about surgery, 0:05:41.880 --> 0:05:46.000 evidence of successful trepanations dates back almost thirty thousand years. 0:05:46.279 --> 0:05:49.279 Scientists believe that even prehistoric humans had been attempting to 0:05:49.320 --> 0:05:53.080 alleviate each other of demons of the mind. This practice 0:05:53.080 --> 0:05:55.599 carried all the way through ancient Greece and Rome, through 0:05:55.640 --> 0:05:59.520 the Medieval and Renaissance periods. Surviving cultural evolutions, as we 0:05:59.560 --> 0:06:02.160 moved away away from blaming gods and spirits for our 0:06:02.200 --> 0:06:06.120 ailments and into blaming other more worldly scapegoats, we have 0:06:06.279 --> 0:06:10.360 long been trying to treat the things that we can't see. Historically, 0:06:10.480 --> 0:06:13.400 people struggling with what we now understand as mental illness 0:06:13.440 --> 0:06:16.880 have suffered mightily in communities and systems that weren't able 0:06:17.160 --> 0:06:20.880 or weren't willing to support them. The earliest asylums can 0:06:20.920 --> 0:06:23.520 be traced back to twelve forty seven in London, a 0:06:23.560 --> 0:06:26.479 place that provided refuge to the sick. While the rich 0:06:26.520 --> 0:06:29.000 could afford to take care of their relatives, the poor 0:06:29.200 --> 0:06:32.400 often were sent to places that operated on a charitable basis. 0:06:32.800 --> 0:06:35.479 These places had no means of diagnosis or treatment for 0:06:35.520 --> 0:06:38.239 the folks in their care and conditions. There were often 0:06:38.240 --> 0:06:41.640 deplorable and the blame for their condition often fell upon 0:06:41.680 --> 0:06:44.920 the patients or their families. As the years went on, 0:06:45.080 --> 0:06:47.880 we began to understand more about the brain. It was 0:06:47.920 --> 0:06:51.080 discovered that our brain is electric, with different parts in 0:06:51.160 --> 0:06:55.080 control of everything that makes us well us. The eighteenth 0:06:55.120 --> 0:06:57.960 century brought with it a more complex understanding of this 0:06:58.160 --> 0:07:02.120 organ and our central nervousness. Them reformers of the Victorian 0:07:02.120 --> 0:07:04.520 era believed that the cure to mental illness could be 0:07:04.560 --> 0:07:09.000 found in a person's physical surroundings. So they erected magnificent buildings, 0:07:09.240 --> 0:07:13.640 built beautiful gardens, hired nurses, and opened asylums that endeavored 0:07:13.640 --> 0:07:16.400 to welcome patients in with care. It was a bright 0:07:16.480 --> 0:07:19.640 moment for some, filled with optimism that a cure was 0:07:19.640 --> 0:07:23.480 at hand. Unfortunately, many of these places were victims of 0:07:23.520 --> 0:07:26.200 their own success. They simply couldn't keep up with the 0:07:26.240 --> 0:07:30.600 demand for services. More patients came, more facilities opened, and 0:07:30.680 --> 0:07:34.320 many collective standards of care were nearly impossible to enforce. 0:07:34.760 --> 0:07:38.640 Resources quickly dried up. Those who were chronically ill stayed, 0:07:38.680 --> 0:07:41.120 and the buildings were soon filled with folks who needed 0:07:41.120 --> 0:07:44.600 help but just couldn't or wouldn't receive it. Conditions grew 0:07:44.640 --> 0:07:49.640 more dire abuse ran, rampant, bodies piled up, people were forgotten. 0:07:50.040 --> 0:07:53.600 Despite their best efforts, the reformers soured on their movements. 0:07:53.960 --> 0:07:57.720 It appeared to them that mental illness was incurable. If 0:07:57.760 --> 0:08:01.160 mental illness couldn't be cured by the envire, then those 0:08:01.240 --> 0:08:03.400 working on the business of the mind decided that they 0:08:03.440 --> 0:08:06.040 were going to look inward in a very literal sense. 0:08:06.440 --> 0:08:10.000 In his countryside asylum, Gottlieb Bookhart got to work. He 0:08:10.080 --> 0:08:11.640 decided that he was going to be the man to 0:08:11.720 --> 0:08:14.640 investigate and get to the bottom of the brain. He 0:08:14.720 --> 0:08:18.720 knew that operations to remove brain tumors, a revolutionary procedure 0:08:18.760 --> 0:08:22.040 at the time, had proven successful in alleviating the side 0:08:22.040 --> 0:08:25.040 effects that the tumors had caused. Of the six patients 0:08:25.080 --> 0:08:28.520 that he operated on, he deemed three or four, according 0:08:28.520 --> 0:08:31.360 to some sources, as a success. But one of those 0:08:31.360 --> 0:08:35.040 patients died, another drowned a month later, and another began 0:08:35.120 --> 0:08:39.480 having seizures. He hoped to start a psychosurgery revolution to 0:08:39.559 --> 0:08:43.679 provide overcrowded asylums a way to treat their chronically ill patients, 0:08:43.720 --> 0:08:47.920 to cure them once and for all. Instead, our Swiss 0:08:47.920 --> 0:08:51.080 innovator found himself standing in front of his silent, stunned 0:08:51.120 --> 0:08:55.200 audience colleagues whose enthusiasm for his work had cooled in 0:08:55.240 --> 0:08:59.600 a matter of minutes. Gottlieb's professional reputation wasn't one that 0:08:59.600 --> 0:09:02.440 he had hoped for. It didn't even provoke debate. The 0:09:02.520 --> 0:09:05.280 consensus was that it would be best to bury the work, 0:09:05.679 --> 0:09:09.840 and Gottlieb stopped researching. But as it so often happens, 0:09:10.160 --> 0:09:12.960 there were other people waiting in the wings to pick 0:09:13.040 --> 0:09:22.800 up where he left off. Saint Elizabeth's Hospital in Washington, 0:09:22.880 --> 0:09:25.160 d C. Was suffering a similar fate to that of 0:09:25.200 --> 0:09:28.439 other hospitals of the early twentieth century. It had opened 0:09:28.440 --> 0:09:31.720 in eighteen fifty five under the name Government Hospital for 0:09:31.760 --> 0:09:35.760 the Insane. It was the first federally operated psychiatric hospital 0:09:35.800 --> 0:09:39.000 in the United States and initially promised to intercept those 0:09:39.040 --> 0:09:41.920 coming back from the Civil War, which it did and 0:09:42.240 --> 0:09:45.679 quite well. But by the nineteen twenties the facility's population 0:09:45.960 --> 0:09:49.160 was booming. It's here that a young doctor, Walter Freeman, 0:09:49.400 --> 0:09:52.280 whose grandfather's claim to fame was being the first American 0:09:52.280 --> 0:09:55.680 surgeon to remove a brain tumor, got his start. He 0:09:55.760 --> 0:09:57.640 was twenty nine years old when he was charged with 0:09:57.679 --> 0:10:01.760 heading up the Blackburn Laboratory, stopping place for many of 0:10:01.840 --> 0:10:05.200 Saint Elizabeth's patients. It was at Blackburn that Walter used 0:10:05.200 --> 0:10:09.080 the hospital's cadavers as research fodder. In one study, he 0:10:09.160 --> 0:10:12.160 strung the bodies of schizophrenic patients up by their ears 0:10:12.200 --> 0:10:14.960 in order to take their measurements against the wall. As 0:10:14.960 --> 0:10:17.520 to what he was looking for exactly, we aren't quite sure. 0:10:18.040 --> 0:10:22.240 He deemed that the study produced nothing conclusive. Like his father, 0:10:22.480 --> 0:10:25.600 Walter was interested in brains and had more access to 0:10:25.679 --> 0:10:28.400 them than most. He began teaching at the nearby George 0:10:28.440 --> 0:10:32.640 Washington University and delighted in excavating brains from skulls for 0:10:32.679 --> 0:10:35.360 an audience. He thought that they could potentially tell him 0:10:35.360 --> 0:10:38.920 something about the lived experience of the hospital's residence. But 0:10:39.000 --> 0:10:41.679 he also had designs on practicing on the living where 0:10:41.720 --> 0:10:44.280 he could see the results of his studies manifest in 0:10:44.360 --> 0:10:47.560 real time. And it's important to remember that this impulse 0:10:47.840 --> 0:10:51.080 didn't come out of nowhere. With the rise of asylum care, 0:10:51.280 --> 0:10:54.720 the number of folks institutionalized with serious mental illness was 0:10:54.760 --> 0:10:58.600 reaching record proportions. As a result, the widespread use of 0:10:58.679 --> 0:11:01.880 strait jackets and paddy cells began to come into play, 0:11:02.160 --> 0:11:05.040 a move born out of the exhaustion and desperation of 0:11:05.080 --> 0:11:09.079 workers at those facilities. An effective therapy model hadn't yet 0:11:09.120 --> 0:11:13.240 been found. The suffering was immense. Walter, though, had come 0:11:13.280 --> 0:11:16.400 across an idea which his mind compelled him to further pursue. 0:11:16.760 --> 0:11:19.480 He was inspired by a report out of Portugal in 0:11:19.520 --> 0:11:23.559 which two surgeons developed something called the frontal leucotomy, which 0:11:23.679 --> 0:11:27.880 severed the connection between the brain's prefrontal cortex and the thalamus. 0:11:28.280 --> 0:11:30.680 After recruiting a surgical student by the name of James 0:11:30.720 --> 0:11:33.840 Watts and a patient by the name of Alice hood Hammett, 0:11:34.160 --> 0:11:37.920 Walter would improve and I'm using massive air quotes there 0:11:38.240 --> 0:11:42.320 upon the leucotomy, taking the surgery a step further. Alice 0:11:42.360 --> 0:11:46.760 had long struggled with postpartum depression and suicidal thoughts. To Walter, 0:11:46.880 --> 0:11:49.600 she seemed like the perfect candidate, which he noted in 0:11:49.640 --> 0:11:53.760 his cruelly unchartable notes about her case. She was, he wrote, 0:11:54.080 --> 0:11:57.120 a master of bitching and really led her husband a 0:11:57.200 --> 0:12:02.640 dog's life. She was a typical insecure, rigid, emotional, claustrophobic 0:12:02.679 --> 0:12:06.760 individual throughout her mature existence. The men decided that they 0:12:06.760 --> 0:12:10.080 would completely sever the white frontal lobe of the thalamus 0:12:10.080 --> 0:12:13.600 where Walter thought human emotion resided. It was the same 0:12:13.640 --> 0:12:15.480 spot where he thought he could locate the cause of 0:12:15.520 --> 0:12:19.040 mental illness. It would be dubbed the Freeman Watts procedure, 0:12:19.440 --> 0:12:23.840 but would infamously become known as the prefrontal lobotomy. Basically, 0:12:23.880 --> 0:12:26.680 he thought that he could carve the sickness right out, 0:12:27.520 --> 0:12:31.439 So Walter drilled two holes into Alice's skull that coincided 0:12:31.480 --> 0:12:34.600 with her left and right frontal lobes. Then he inserted 0:12:34.640 --> 0:12:37.800 a narrow blade through the hole and into the exposed brain. 0:12:38.400 --> 0:12:41.320 Alice awoke four hours after the procedure and went on 0:12:41.400 --> 0:12:44.560 to live another five years. According to her husband, she 0:12:44.600 --> 0:12:47.840 felt like her old self again. What isn't surprising given 0:12:47.880 --> 0:12:50.880 this moment in history is that her voice is largely 0:12:50.920 --> 0:12:53.920 missing from the historical record. But it does make you wonder. 0:12:54.679 --> 0:12:58.040 Walter deaned the operation a success and pushed to make 0:12:58.120 --> 0:13:01.480 said success well known. He was met with mixed reviews, 0:13:01.720 --> 0:13:05.839 some outrage but some outright embrace. In the following months, 0:13:05.880 --> 0:13:09.880 the team found twenty more lobotomy candidates and operated. They 0:13:09.880 --> 0:13:12.000 became so confident in their work. In fact, that they 0:13:12.000 --> 0:13:15.839 would sometimes conduct these operations in tandem the patients side 0:13:15.840 --> 0:13:18.959 by side. Doctors across the world wondered if Walter had 0:13:19.040 --> 0:13:22.360 unlocked the secret for solving mental illness. Some tried their 0:13:22.360 --> 0:13:25.040 own hand of the operation. It's important to note here 0:13:25.240 --> 0:13:28.480 that the majority of lobotomy patients for many years were women. 0:13:28.960 --> 0:13:31.200 It's clear who had the power to deem a person 0:13:31.280 --> 0:13:35.000 fodder for this experiment. As time went on, though, lobotomies 0:13:35.080 --> 0:13:38.720 moved beyond experiments fraught with injustice and eventually came to 0:13:38.720 --> 0:13:42.000 be considered a cutting edge science, one that was fit 0:13:42.240 --> 0:13:46.679 for royalty, or at the very least America's own equivalent. 0:13:53.080 --> 0:13:56.320 Rose Marie had gotten off to an unfortunate start. The 0:13:56.400 --> 0:13:59.120 doctor that was supposed to attend her birth was running late. 0:13:59.440 --> 0:14:02.040 The nurses encouraged the girl's mother to do everything she 0:14:02.080 --> 0:14:04.800 could to delay delivery, and by the time the doctor 0:14:04.840 --> 0:14:07.400 finally arrived, the baby had been forced to wait for 0:14:07.440 --> 0:14:10.719 two hours in the birth canal. This was a mistake that, 0:14:10.880 --> 0:14:13.920 although not uncommon at the time, would cause ripples through 0:14:13.960 --> 0:14:17.560 the family for generations to come. In the meantime, baby 0:14:17.640 --> 0:14:21.240 Rose had become critically deprived of oxygen. Her brain was 0:14:21.280 --> 0:14:26.000 irrevocably shaped by her first breath or lack thereof. However, 0:14:26.080 --> 0:14:29.000 her early days passed without alarm. It was only when 0:14:29.000 --> 0:14:32.440 her younger siblings began to pass her developmentally that her 0:14:32.480 --> 0:14:35.640 parents realized that something was amiss. They took her to 0:14:35.880 --> 0:14:38.400 all of the best doctors and talked with her teachers, 0:14:38.560 --> 0:14:40.680 and they all agreed that she just wasn't like her 0:14:40.720 --> 0:14:43.680 other siblings. The feeling was that there was something amiss 0:14:43.720 --> 0:14:46.160 with their daughter, and it cast a dark pall over 0:14:46.200 --> 0:14:49.160 the family. It was something only to be whispered about 0:14:49.440 --> 0:14:53.160 and spoken of only in private. In the early twentieth century, 0:14:53.240 --> 0:14:57.080 many intellectuals were taken with the eugenics movement, an ideology 0:14:57.120 --> 0:15:00.480 that suggests that certain kinds of people had di effective 0:15:00.520 --> 0:15:03.600 genes and shouldn't be allowed to procreate. This was an 0:15:03.640 --> 0:15:06.680 idea that ultimately caused millions of people to lose their lives. 0:15:07.200 --> 0:15:10.120 By nineteen thirty eight, Rose was coming into her own. 0:15:10.320 --> 0:15:12.760 By then, her father had accepted a job in Great Britain, 0:15:13.000 --> 0:15:15.800 and Rose found the space to thrive. She was beautiful 0:15:15.880 --> 0:15:19.800 and sweet, dazzling everyone she met. She busied herself training 0:15:19.800 --> 0:15:22.280 to be a teacher's aide and took great pride in 0:15:22.320 --> 0:15:25.920 her work. Her teachers loved her. They unequivocally sang her 0:15:25.920 --> 0:15:29.560 praises and spoke of how much she was blossoming. Rose 0:15:30.000 --> 0:15:34.080 was finally happy, but this warm moment wasn't meant to last. 0:15:35.040 --> 0:15:37.760 With the outbreak of World War II, the family retreated 0:15:37.800 --> 0:15:40.360 home to the United States. They took up residence in 0:15:40.440 --> 0:15:43.440 New York, a move that would prove disastrous for Rose. 0:15:43.960 --> 0:15:46.200 It was a complete disruption to the life that she 0:15:46.280 --> 0:15:49.800 knew and loved. Her seizures returned, as did her patterns 0:15:49.800 --> 0:15:53.520 of erratic behavior. She became more and more disregulated with 0:15:53.600 --> 0:15:56.000 each passing week, and those around her were known to 0:15:56.040 --> 0:15:59.280 bear the physical toll of her violent outbursts. Although she 0:15:59.400 --> 0:16:01.880 was out of sight at boarding school in Washington, d c. 0:16:02.440 --> 0:16:05.400 She wasn't out of mind. Her family worried about her 0:16:05.600 --> 0:16:09.160 near constantly, about her escape attempts and her safety, and 0:16:09.200 --> 0:16:13.240 how they believed that she compromised their reputation. Her family 0:16:13.520 --> 0:16:16.320 was a high profile one and the stakes were high. 0:16:16.760 --> 0:16:19.400 She refused to play by their rules, and her father 0:16:19.800 --> 0:16:22.920 had just about t had enough. In nineteen forty one, 0:16:23.120 --> 0:16:26.320 the doctors shared a potential solution with him. They pitched 0:16:26.360 --> 0:16:29.680 a lobotomy as a way to quell her erratic behavior. So, 0:16:29.920 --> 0:16:32.600 without the consent of his wife or twenty three year 0:16:32.640 --> 0:16:35.320 old Rose herself, he took his daughter to none other 0:16:35.360 --> 0:16:38.840 than Walter Freeman and James Watts for the procedure, one 0:16:38.880 --> 0:16:42.120 that the men had been performing regularly now for several years. 0:16:42.520 --> 0:16:45.120 They brought Rose into the operating room and gave her 0:16:45.120 --> 0:16:48.600 a mild tranquilizer. They made two small incisions in her skull, 0:16:48.880 --> 0:16:53.080 and James inserted his instrument, a slender domestic ice pick, 0:16:53.560 --> 0:16:57.640 and then he began sign Meanwhile, Walter started talking with 0:16:57.680 --> 0:17:00.800 their patient and asking her a series of questions. It 0:17:00.840 --> 0:17:04.040 was a seemingly mild mannered and polite conversation, and they 0:17:04.080 --> 0:17:06.960 made estimates on how much to cut depending on how 0:17:06.960 --> 0:17:11.160 she responded, and cut they did until she became incoherent. 0:17:12.240 --> 0:17:14.199 As to whether or not the doctors knew in that 0:17:14.320 --> 0:17:17.440 moment that they had made a grave error, we don't know. 0:17:17.960 --> 0:17:21.760 But what was immediately evident is that her coherence regressed 0:17:21.760 --> 0:17:24.240 to that of a toddler. She lost her ability to 0:17:24.359 --> 0:17:27.280 walk and to speak. The doctors told her father that 0:17:27.320 --> 0:17:30.800 she suffered from depression, but not anything else. He would 0:17:30.840 --> 0:17:33.920 go on to speak of his daughter as mentally retarded 0:17:33.960 --> 0:17:37.359 and not mentally ill, for fear that the latter would 0:17:37.359 --> 0:17:40.800 implicate him and the rest of his family in her condition. 0:17:41.600 --> 0:17:44.520 To make sure that she couldn't, Joe sent his daughter away. 0:17:44.880 --> 0:17:47.399 He first sent her to a psychiatric facility in New 0:17:47.520 --> 0:17:51.359 York and then to an institution in Wisconsin. Joe didn't 0:17:51.359 --> 0:17:53.800 tell the rest of his children where she went, and 0:17:53.880 --> 0:17:56.880 he refused to visit her. He suggested to his wife 0:17:56.960 --> 0:17:59.240 that she should do the same in order for Rose 0:17:59.280 --> 0:18:02.320 to get properly accustomed to her new life. There, she 0:18:02.400 --> 0:18:05.960 effectively disappeared from her family's story in an act so 0:18:06.200 --> 0:18:09.159 cold and cruel that it still sends shivers through the 0:18:09.240 --> 0:18:13.159 Kennedy family and the American public to this day. The 0:18:13.200 --> 0:18:16.720 illustrious Kennedys had a reputation as a prominent family to 0:18:16.800 --> 0:18:21.439 maintain and huge aspirations to protect. Their political star was 0:18:21.440 --> 0:18:25.400 on the rise, and that hunger motivated every move they made. 0:18:25.440 --> 0:18:28.240 If their larger social circles knew the truth about Rose 0:18:28.280 --> 0:18:32.000 Marie's condition, their fitness for public office might have been 0:18:32.040 --> 0:18:35.600 called into question. It's a tragic story that was sadly 0:18:35.680 --> 0:18:40.280 not unique. Many folks of the time period were hidden before, during, 0:18:40.480 --> 0:18:44.800 and after mental illness struggles, but few individuals were robbed 0:18:44.840 --> 0:18:47.760 of so much potential for good or of such a 0:18:47.800 --> 0:18:57.680 position of influence as Rose Kennedy. It would be years 0:18:57.720 --> 0:19:01.880 before Rose Marie's grown siblings, include voting America's thirty fifth President, 0:19:02.040 --> 0:19:05.240 John F. Kennedy, along with her nieces and nephews, would 0:19:05.240 --> 0:19:08.040 finally learn about what happened to her. But when they 0:19:08.040 --> 0:19:11.040 did find out the truth, they embraced her with open 0:19:11.200 --> 0:19:14.960 arms and worked toward rectifying that grievous wrong in both 0:19:14.960 --> 0:19:18.639 the private and public spaces. From this dark mark on 0:19:18.680 --> 0:19:22.280 the Kennedy family came the inception of the Special Olympics, 0:19:22.640 --> 0:19:26.119 Best Buddies International and the sponsoring of the Americans with 0:19:26.160 --> 0:19:29.679 Disabilities Act. The case of Rose Marie Kennedy came at 0:19:29.680 --> 0:19:32.280 a time when psychosurgery was thought to be the solution 0:19:32.440 --> 0:19:35.119 to mental illness. It would be a few more years 0:19:35.160 --> 0:19:38.439 before pharmaceutical therapies would be used on the brain. For 0:19:38.480 --> 0:19:41.399 the folks who were taking care of the chronically institutionalized, 0:19:41.640 --> 0:19:45.520 it seemed like a reasonable last resort. Walter Freeman would 0:19:45.520 --> 0:19:48.480 go on to perform over seven thousand lobotomies over the 0:19:48.480 --> 0:19:51.840 course of his career, charging roughly twenty five dollars for 0:19:51.880 --> 0:19:55.040 each one. It's thought that during its peak of popularity, 0:19:55.240 --> 0:19:58.119 the lobotomy was performed on more than forty thousand people 0:19:58.160 --> 0:20:02.240 across the United States, far higher than any other nation 0:20:02.359 --> 0:20:05.320 in the world. By the nineteen fifties, the procedure had 0:20:05.400 --> 0:20:08.720 dramatically fallen out of favor. The terrible side effects that 0:20:08.720 --> 0:20:12.920 came with the surgery, including sometimes death, were becoming increasingly 0:20:13.000 --> 0:20:16.800 obvious as more people were so dramatically affected. To most, 0:20:17.119 --> 0:20:20.000 the outcome of a lobotomy was far worse than the 0:20:20.040 --> 0:20:24.320 diseases that the surgery purported to cure. Germany, Japan, and 0:20:24.400 --> 0:20:27.280 even the Soviet Union banned the practice on the basis 0:20:27.280 --> 0:20:30.200 of its inhumanity, but it might surprise you to hear 0:20:30.240 --> 0:20:33.000 that they were still performing it in many European countries 0:20:33.280 --> 0:20:37.040 and the United States well into the nineteen eighties. As 0:20:37.080 --> 0:20:39.320 for Rose Marie, she lived out the rest of her 0:20:39.400 --> 0:20:42.080 days in a private cottage built just for her at 0:20:42.080 --> 0:20:46.520 her Wisconsin institution. She loved to swim and joyride, play 0:20:46.520 --> 0:20:49.200 with her pets, and passed the time with her caregivers. 0:20:49.640 --> 0:20:51.680 When she passed away at the age of eighty six, 0:20:52.080 --> 0:20:55.680 She was surrounded by her sisters and her brother, one 0:20:55.760 --> 0:20:58.679 last act of love directed towards a woman who had 0:20:58.680 --> 0:21:02.240 been made to feel so deeply unlovable and invisible for 0:21:02.359 --> 0:21:11.040 far too many years. The inner workings of the mind 0:21:11.240 --> 0:21:13.880 have long been a mystery to us, and that great 0:21:13.960 --> 0:21:17.920 unknown has led to far too many tragic misunderstandings. Our 0:21:18.000 --> 0:21:20.920 journey through the history of lobotomy today is just one 0:21:21.000 --> 0:21:24.240 of the many failures along the road to progress. But 0:21:24.320 --> 0:21:28.320 even without the sharp instruments and invasive surgical procedures, there 0:21:28.359 --> 0:21:30.760 is still a lot of room for error. And if 0:21:30.800 --> 0:21:33.680 you stick around through this brief sponsor break, my teammate 0:21:33.800 --> 0:21:36.639 Robin Miniter will share one more example with you. 0:21:42.680 --> 0:21:46.239 Albert Hofmann was something of an architect. In truth, he 0:21:46.280 --> 0:21:49.560 was a chemist, responsible for breaking things apart and finding 0:21:49.560 --> 0:21:52.320 new ways to put them back together. This is exactly 0:21:52.359 --> 0:21:54.080 what he was doing when he was assigned to a 0:21:54.119 --> 0:21:57.320 program that worked with medicinal plans in nineteen thirty eight. 0:21:57.880 --> 0:22:00.320 We've talked in the series about the importance of dose 0:22:00.400 --> 0:22:03.600 and frequency when deploying therapeutics. A little bit of something 0:22:03.680 --> 0:22:05.520 might be really good for you, and it might make 0:22:05.560 --> 0:22:08.360 you better. A lot of this seemed something though, might 0:22:08.440 --> 0:22:11.920 kill you. This was certainly true for ergot, a fungus 0:22:11.920 --> 0:22:14.360 found and tainted rye. It had been used in folk 0:22:14.480 --> 0:22:17.320 medicine for a really long time. In small doses, it 0:22:17.359 --> 0:22:20.359 could quicken childbirth, and it could stop bleeding. It was 0:22:20.440 --> 0:22:24.280 otherwise responsible, scholars believe for the deaths of hundreds of 0:22:24.280 --> 0:22:28.320 thousands of people across the ages. Albert essentially wanted to 0:22:28.359 --> 0:22:31.320 isolate the good properties of the substance and strip away 0:22:31.320 --> 0:22:34.879 the bad, something like alchemy, if you remember from earlier 0:22:34.880 --> 0:22:38.320 in our season. He was able to determine the biologically 0:22:38.359 --> 0:22:41.359 active compounds of the ergot and figured out his chemical 0:22:41.400 --> 0:22:46.520 starting point, something called lycurgic acid. Over forty percent of 0:22:46.520 --> 0:22:49.879 our Western pharmaceutical drugs are derived from plant medicines and 0:22:49.920 --> 0:22:53.760 indigenous traditions. For thousands of years, cultures across the world 0:22:53.800 --> 0:22:56.000 had been working with their land to heal their bodies 0:22:56.040 --> 0:22:59.000 and their spirits. It's true that with the invention of 0:22:59.040 --> 0:23:03.840 globalization and pharmacology, this has all become a little more complicated. 0:23:04.080 --> 0:23:08.480 In the fifteen hundreds, European bioprospectors knew that indigenous communities 0:23:08.480 --> 0:23:12.000 were treasure troves of knowledge. They pillaged these peoples and 0:23:12.040 --> 0:23:15.760 took from them their ethnomedical traditions. It might surprise you 0:23:15.840 --> 0:23:18.440 to know that exports of tropical medicinal plants in the 0:23:18.480 --> 0:23:23.520 sixteenth century were only slightly less valuable than another colonial favorite, sugar. 0:23:24.160 --> 0:23:27.679 With the invention of pharmacology in the nineteenth and twentieth centuries, 0:23:28.119 --> 0:23:31.840