As a psychiatrist, my reason for offering to review this book was obviously because Rosemary Kennedy, the sister of President John F. Kennedy, and SenatorsRobert F. Kennedy and Ted Kennedy, was one of the most notorious cases operated on by the lobotomists, Walter Freeman and James Watts. She was of low intelligence and years of training and close supervision within the powerful Kennedy family helped mask her disability so that outsiders did not suspect how different she was. She remained emotionally and intellectually immature as a young woman and began to have tantrums and rages in which she would break things, hit people and have convulsions. Because of this deterioration, consideration was given to sending her to a psychiatric hospital.

The parents, Joe Sr and Rose Kennedy, according to the mother’s memoirs, were coming to the conclusion that Rosemary was suffering from a “neurological disturbance”. The father, in particular, was concerned about any potential disgrace to his political career, especially when Rosemary began to sneak out at night from her convent school where she had been accommodated. Joe approached Rose about the option of psychosurgery.

An article in the Saturday Evening Post in May 1941 may have made this option seem very attractive. It explained that:

There must be at least two hundred men and women in the United States who have had worries, persecution, complexes, suicidal intentions, obsessions, indecisiveness, nervous tensions, literally cut out of their minds with a knife by a new operation on the brain.

The term psychosurgery was not yet in the dictionary, but the article went on:

From problems to their families and nuisances to themselves, from ineffectives and unemployables, many of the two hundred have been transformed into useful members of society. A world that once seemed the abode of misery, cruelty and hate is now radiant with sunshine and kindness to them.

As far as Freeman and Watts were concerned, separating the prefrontal cortex from the thalamus took the ‘sting’ out of mental disorder by reducing disabling fear. As the article more colloquially put it,  “Worry has been cut out of their minds.”

An editorial in the more scientific Journal of the American Medical Association in August 1941, commented on a panel discussion, which Freeman attended, on frontal lobotomy at the annual session of the American Medical Association in June 1941. It complained that the defects of the operation were only superficially understood. It accepted, nonetheless, that further experimentation was justified to produce scientific evidence. By the end of the decade in 1949, Egas Moniz, whose procedure Freeman & Watts had modified, was awarded the Nobel Prize for his discovery of the therapeutic value of leucotomy in certain psychoses.

Joe Sr. met with Freeman and would have been affected by Freeman’s enthusiasm, making the decision on his own to proceed with Rosemary’s lobotomy.She had her operation in November 1941. As the brain is insensitive, the operation was performed under local anaesthetic and Rosemary complied with requests to recite simple songs and stories to check the effect of cuts into her frontal lobe until she unfortunately became incoherent and stopped talking. She never fully recovered her motor function, walking thereafter with one leg and foot turned in and having only partial use of one of her arms. She could only speak a few words. She was incapable of looking after herself. She was institutionalized in a debilitated state.

The trouble was, as the Saturday Evening Post article said:

The brain has now ceased to be sacred. Surgeons now think no more of operating upon it than they do of cutting out an appendix.

Disastrous results, however, did not sway the efforts of Freeman and Watts and they published biased assessments of their outcomes. The year after Rosemary’s lobotomy, they were saying that only 14% of the survivors could be considered bad results. This figure excluded the 9% that died because of the surgery. Rosemary’s case number remains unknown in this published research. Her medical records are inaccessible because of the Health Insurance Portability and Accountability Act passed by Congress in 1996.

Kate Clifford Larson’s attempt to put Rosemary’s story at the center of the Kennedy family narrative is admirable. Hiding Rosemary away from the public was often covered by the false claim that she was teaching at a school for handicapped children in the Midwest and preferred her privacy. The family promoted the interests of the mentally retarded in various ways and did eventually acknowledge she was mentally retarded. However, the family was complicit in keeping the lobotomy secret and it was not revealed until Doris Kearns Goodwin’s biography The Fitzgeralds and the Kennedys in 1987. Rosemary died in 2005 aged 86, the first of the Kennedy children to die from natural causes.

Larson’s rather uncomplicated biography utilised access for the first time to all of Rosemary’s known letters and describes some interesting anecdotes. However, there are no cataclysmic discoveries or even much attempt at analysis about the motivation for Joseph Kennedy’s decision to have his daughter lobotomised. Perhaps that will remain hidden forever. Rosemary Kennedy’s history highlights, nonetheless, the need to defend and promote the rights of the mentally ill and disabled.

 

© 2016 Duncan Double

 

 

Duncan Double is a Consultant Psychiatrist and Honorary Senior Lecturer, Norfolk & Suffolk NHS Foundation Trust and University of East Anglia, UK; blogs at critical psychiatry.