Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, February 2, 1991 TAG: 9102020023
SECTION: EXTRA PAGE: E-1 EDITION: METRO
SOURCE: JAMIE TALAN NEWSDAY
DATELINE: LENGTH: Long
"Today. I am going home. I am discharged," the 80-year-old woman mutters, her chin tucked in her chest. "I have a 47-year-old son by a policeman. I have a daughter, 28. My baby was born in the room you took me to."
Mary's home is Pilgrim Psychiatric Center in Brentwood, N.Y., where she was sent in 1949 after she stopped cooking dinner for her husband and small child, after she hid in the darkness of her room, sneaking out by the light of the moon for food, after she said that people in the building were killing each other.
Doctors thought she was hearing voices, even though Mary denied any hallucinations. Two months into her Preliminary findings show that lobotomies did not help these patients and in some cases may even have triggered more mental illness. hospital stay, they gave her 40 rounds of electroshock therapy. And on Jan. 13, 1950, doctors drilled two holes in the top of her head, inserted a thin metal pick and sliced away at her frontal lobes.
Mary is not going home.
She is a living legacy of the lobotomy - a medical blunder that left tens of thousands of people in the United States without segments of brain. In the era before antipsychotic drugs, the surgery also represented a desperate attempt to treat everything from depression to schizophrenia to obsessive-compulsive disorder.
Many psychiatrists and neurologists thought that such surgery would cure mental illness.
It didn't.
Now researchers are trying to find out just what lobotomies did do. More than a dozen psychiatrists and psychologists from the Mount Sinai School of Medicine have come to what was once the largest mental hospital in the United States.
A disparate group of more than 200 lobotomy patients - the largest such population in any New York state hospital - are scattered through 11 large buildings that loom like Gothic shadows over the well-tended gardens. All are elderly and have spent most of their adult lives behind locked doors and barred windows. Some spend their days staring vacantly; others are forever agitated.
They range from Frances Kichinski, who no matter what she is doing is always weeping, to Pauline White, who smiles constantly and wonders why the family that exists only in her mind never comes to visit. To Justin Stuback, who takes care of the grounds and doesn't know what he would be like without pills. And to Jean (she goes by the name Mary) Tobag, who is still waiting after 40 years for her husband to take her home.
The patients are tied together by two telltale scars atop their heads.
"If you want to learn why people don't get better, you do it here," said Dr. Peter Powchik, who has moved with his wife to the grounds of the 800-acre state hospital. Powchik and his colleagues administer tests that assess patients' thought processes and motor coordination.
Their preliminary findings show that lobotomies did not help these patients and in some cases may even have triggered more mental illness. The project has turned up evidence that some people who had lobotomies for depression, anxiety or disruptive behavior developed symptoms of schizophrenia following the surgery.
The researchers do not expect to improve the lives of their subjects, but they are searching for clues as to how the lobotomies changed these people, who appear little different from many others with whom they share the Pilgrim wards. And, most important, they say the study may help other mental patients - especially schizophrenics, who make up the majority of the chronically hospitalized.
The project directors, Drs. Michael Davidson and Ken Davis, said that if lobotomies did induce schizophrenic symptoms, perhaps the disease is caused by disruptions in the frontal-lobe area. They said such findings could lead to new treatments for the illness.
Powchik and his colleagues said this is their last chance to study the effects of this surgery.
"It is OK to study brain tissue after someone dies, but it really wouldn't tell us what it did to a patient's mind." said Janice McCrystal-Simon, coordinator of the autopsy program at Pilgrim's Neuro-science Research Center.
Rare cases
Today, brain surgery may be used in rare cases for the treatment of obsessive-compulsive disorder. But lobotomies as they existed 50 years ago are no longer being performed. National estimates are that 5 percent to 10 percent of the subjects died from the surgery.
There were more than 3,000 lobotomized patients at Pilgrim in the 1940s and 1950s. No one knows how many are still alive or how many were released. Al Powchik and his colleagues have scanned records to uncover more than 200 patients at Pilgrim.
The theory behind lobotomies was based on the belief that emotions and behavior were governed by the frontal lobes - the area of the brain responsible for conceptual thinking, planning and regulation of emotions. The area that coordinates movement is also there.
Decades ago, doctors were excited about what seemed to be the potential of this drastic technique. There were no drugs to control psychotic symptoms. Doctors thought that by cutting the nerves connected to the frontal lobes, they would be able to calm aggressive and violent patients.
The late Dr. Walter Freeman, a neuropathologist who roamed the country teaching psychiatrists the art of lobotomizing mental patients, was responsible for the growth of psychosurgery in the United States.
Freeman's basic technique was to get at the brain tissue through a patient's eye sockets, where few blood vessels are located. Others such as Portuguese neurologist Dr. Egas Moniz - who, ironically, won the Nobel Prize in Medicine in 1949 for his work in developing the lobotomy technique - pierced two holes in the skull and swiped away at tissue.
> Two families
Scar tissue covers the holes on Mary Tobag's head. Her life as a wife and mother ended on Valentine's Day, 1949, when she was admitted to Pilgrim. Her husband, Vincent, says that she had become nervous and fearful months before after finding a man lying soaked in his blood in the elevator of her Manhattan apartment building.
The records of her illness weigh 19 pounds. Doctors have regularly found her psychotic, out of touch with reality, never well enough to be with her family, who moved from Manhattan to Levittown soon after Mary was hospitalized.
"I didn't think that she would be there so long," Vincent, now 86, said recently.
Mary was 40 when Vincent signed the consent papers for her lobotomy.
"The doctors said it was the only way they could improve her," Vincent said. "But she never recovered."
He still tries to keep the family together. Mary attended her daughter's wedding and has seen her grandson grow up. But she has another family composed of doctors and nurses and fellow patients.
Doctors say it is impossible to determine how much the incident in her apartment elevator, the subsequent rounds of electroshock, the lobotomy or the endless years of hospitalization contributed to Mary Tobag as she is today - an angry, psychotic white-haired woman who sits staring, day after day.
What doctors do know is that there is little scientific proof that lobotomy ever was an effective treatment for mental illness. Powchik says that animals given frontal lobotomies and sent back into the wild died in a week. "Remove virtually any other area - the parietal lobe, the temporal lobe - and these animals will still survive."
Cognitive tests have found little difference between lobotomized patients and schizophrenics who never underwent the surgery.
Philip Harvey, coordinator of clinical research in the department of psychiatry at Mount Sinai, is convinced that the present-day symptoms of the lobotomized patients were not there before doctors took out large segments of their brains.
"We suspect that in some cases lobotomies caused schizophrenia, not cured it," he said.
Elliot Valenstein, a researcher at the University of Michigan and an expert on psychosurgery, says that although hospital records are hard to interpret, "it is easy to say that such operations that were so crude could cause some kinds of schizophrenic symptoms."
Permanent home
At 57, Justin Stuback has been in and out of Pilgrim for 34 years. He spends segments of his days wandering the acres and acres of state land in Brentwood. He works Monday through Thursday, cleaning the grounds for $1.69 an hour. He has an honor card that offers him bits of freedom four hours a day. Otherwise, he lives on the locked wards.
In high school, Justin played the trombone. He was tall, handsome with blond hair and blue eyes. He spent one summer as a bellhop in Monticello, N.Y. He was also a messenger for Mutual Broadcasting Co.
"Are you happy?" Justin is asked.
"No."
"Were you ever happy?"
"Yes. When I was a boy."
Justin's medical history tells a different story. It shows that he was an unwanted child whose parents began toilet training him not even two months after he was born. At 4, he found his mother in the arms of a stranger.
The charts show that Justin developed a severe case of whooping cough at 10, and his mother beat him while he was sick. During this period, he told his mother he heard voices in his head. At 16, he contracted malaria. That same year he had a psychotic breakdown, becoming violent, delusional and unreachable. He cried out that he was God.
Justin the teen-ager was admitted to the New York State Psychiatric Institute in Manhattan. He was diagnosed as having manic-depression and underwent electroshock treatments and insulin-coma therapy. At 20, he had a lobotomy.
"I was awake during the operation. It was a Friday morning, and the halls of the hospital were very quiet. Somebody asked me to lift my arm. I looked up and these instruments were coming down around me. Ouch. It hurt. I let out a whimper, a small scream. Next thing I knew I was in the recovery room with a bandage around my head. My mother and grandmother were there."
After the lobotomy, Justin says, life seemed better. He left the hospital and attended cooking courses at Hofstra University. But he was sent right back to his parents and he lost control again. He said at the time: "I cannot assemble my hands and my thoughts don't stay together."
His charts show that he lost jobs because he was accused of stealing. He was violent and angry at home.
For the next two decades, he was shuttled back and forth from Pilgrim to his childhood home. Pilgrim has been his permanent home since 1980. Both his parents are dead, and there are no visits from family.
Endless tears
Frances Kichinski also works on the Pilgrim grounds. Even when Frances laughs, tears cling to the corners of her eyes. She is 77 years old and thinks that her mother is going to adopt Ronald Reagan.
She also talks about many husbands and children, yet Frances never married and is childless.
Frances has been trapped in her mind for at least 40 years. "I came here in a little green metal bus from Kings County Hospital," she recalls, crying. "I was married to the Pope last night."
She wears a powder-blue sweater over a white dress. Her white grocery bag contains plastic spoons, socks and a Styrofoam cup.
Frances suffers from paranoid schizophrenia. And all the medication that she has taken, the electroshock and the lobotomy have done little to stop the jumble of thoughts.
No one visits Frances. On this afternoon, she can be found on the porch, curled up and napping. In her slumber, she wears a sly smile. Her eyelids flicker. She is dreaming.
by CNB