In 1868, a physician named Harlow from Boston writes about him: "His equilibrium, or balance, so to speak, between his intellectual faculties and animal propensities seems to have been destroyed. He is fitful, irreverent, indulging in the grossest profanity, which was not previously his custom, manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires. " The now extremely rude Phineas Gage is an object of immense medical interest, for it seems clear, from his somewhat crude experience of psychosurgery, that one can alter the social behavior of the human animal by physically interfering with the frontal lobes of the brain.

In 1890, Dr. Gottlieb Burckhardt, the superintendent of a psychiatric hospital in Switzerland, drills holes in the heads of six severely agitated patients and extracts sections of the frontal lobes, altering their behavior with varying degrees of success. Two of the patients die. His surgery is considered morally reprehensible at the time, but his work is not forgotten. Phineas and his iron bar have started a train of thought that win come to a strange and tragic fruition in the next century.

It took a few years, and the work of a dedicated band of pioneers, to establish the various forms of lobotomy as everyday treatment for psychiatric patients.

But by 1955 over 40,000 men, women and children in the United States alone had undergone psychosurgery which left large parts of their brains irreparably vandalized by doctors who didn't even need a formal qualification to practice the operation.

The greatest advocate of psychosurgery was Walter Freeman.

Born in Philadelphia in 1895, the son of a doctor with strong Calvinist beliefs, Freeman had been appointed Professor of Neurology at George Washington University in the aftermath of the First World War. America was suffering from a huge increase in psychiatric disorders. An influx of shell-shocked soldiers and bereaved, disturbed relatives was swelling the asylum population. In addition, there was still no cure for tertiary syphilis, which had been discovered to cause up to half the known cases of dementia praecox, or schizophrenia. The need for practical measures to counter madness had never been more urgent.

In July 1935, Freeman, then aged 40, attended a neurological conference in London. It was quite a gathering. Also in attendance were the celebrated Russian, Ivan Pavlov, whose trained salivating dogs were to make him legendary; and Egas Moniz, the celebrated Portuguese neurosurgeon, who had pioneered cerebral angiography, the process of mapping the parts of the brain by injecting "contrast" solutions which can be seen by X-rays.

Pavlov might not have brought his dogs to the conference, but John Fulton from Yale University had brought two chimpanzees. These were the subject of a day long symposium which both Freeman and Moniz attended. Fulton had completely removed the entire frontal lobes from these two animals - a lobectomy - which had radically altered their behavior. He could no longer generate experimental forms of neurosis in the animals. They were seemingly unperturbable. The symposium was fascinated, and the discussion about the significance of the frontal lobes went on and on, as the assembled company hedged gently around the delicate issue that Fulton's chimpanzees raised. Eventually, to much surprise, it was Egas Moniz who stood up and asked the question that Freeman, for one, had been desperate to ask.

"If the frontal lobe removal prevents the development of experimental neurosis in animals and eliminates frustrational behavior," he asked, "why would it not be possible to relieve anxiety states in man by surgical means?"

Many attending were shocked to hear it put so frankly; they believed that Moniz was talking about performing the full lobectomy on humans. Freeman, however, was struck by Moniz's courage.

A year later, he came across Moniz again, this time in the pages of a French medical periodical.

In September 1935, in a Lisbon surgery, Moniz had participated in the first controlled attempt to put into practice the ideas raised at the London conference. With the neurosurgeon Almeida Lima, he had attempted to perform the first leukotomy, on a female asylum patient. The object had been, not to destroy the actual frontal lobes, but rather to destroy (by injecting alcohol into them) the fibers, the white matter or leukos, which connect the frontal lobes - the area they believed to be most immediately concerned with social behavior - to the main body of the human brain.

The results were inconclusive. After surgery, the woman was certainly less agitated and overtly paranoid than she had been before. But she and the other three patients from the asylum who subsequently underwent the same procedure were also, Moniz admitted, somewhat more apathetic and frankly duller than he had hoped. In addition they suffered from nausea, sphincter disorders, sluggishness and disorientation. Still, the results were spectacular enough for Moniz to be encouraged. Unfortunately, he found that the director of the asylum was suffering twinges of professional jealousy and was unwilling to supply any more surgical subjects. Quite apart from this, he was, as Lima put it, experiencing "doctrinal and ethical" doubts about the nature of the operation. In order to maintain his flow of patients, therefore, Moniz not only had to exercise his considerable powers of charm, but began to withhold the results of his work that suggested it was less than perfect, so that it appeared that the operation was already a success, and was so simple that it could be quickly applied on a wide, public basis.

When he did publish his results, it was in six countries simultaneously. And, as one contemporary said, "Seldom in the history of medicine has an experimental procedure been so promptly adapted to the treatment of sick patients everywhere."

As soon as he had read that first, brief article Freeman requested a copy of Moniz's full monograph on the process from its Paris publisher. He had seen his way forward.

Although he was a neurologist, Freeman had no qualifications as a surgeon. He needed a neurosurgeon as a collaborator so he showed the book to his colleague, James Watts. They ordered from France two of Moniz's leukotomies, knives specially designed for the operation, and after practicing for a week on brains from the morgue, Freeman and Watts operated on their first living patient. Watts did the cutting; Freeman navigated.

She was a 63-year-old woman from Kansas, the type of agitated, depressed and fearful personality that Moniz had experimented on. Faced with a choice of a mental institution or surgery, she and her husband opted for the knife. On the operating table, she had second thoughts when she realized that her head was about to be shaved, and she would lose the curls that she was proud of. Freeman assured her that her curls would be saved; this was not the case, but after the operation, as Freeman himself noted, "She no longer cared".

The operation was carried out on 14 September 1936. Freeman and Watts had altered Moniz's prescribed technique since the first leukotomy, and six holes were now cut in the patient's head. When she had been stitched together and had awoken from the anesthetic, the sense of calm she exuded in contrast with her former terror was striking. When asked by Freeman if she could remember why she had previously been so upset, she could only say: "I don't know. I seem to have forgotten. It doesn't seem important now." Freeman and Watts were thrilled.

A week after surgery, the woman began to behave strangely. She talked incoherently, becoming stuck on certain syllables, repeating them endlessly and hopelessly jumbling up her sentences. She could no longer recite the days of the week, and when she was asked to write, the same repetitions and sad, nonsensical constructions occurred on paper. A few days later, her speech had largely returned and she went placidly home, showing neither eagerness nor apprehension.

The two surgeons proceeded to operate on another five patients over the next six weeks, and in November 1936 published a report in which they wrote: "In all our patients there was a...common denominator of worry, apprehension, anxiety, insomnia and nervous tension, and in all of them these particular symptoms have been relieved to a greater or lesser extent." They further....

At least we can also hope some of our rehab friends join us in beautiful alcohol-free Connecticut..only walking distance away...