On Saturday at exactly 3pm, hundreds of people will converge on Parliament Square in London, inhale nitrous oxide, or “laughing gas”, collectively giggle for 30 seconds, and then disperse. The Psychedelic Society insists “this is not a party” but a serious act of political dissent. “We’ll all inhale together in a sea of coloured rubber to send the message: My mind, my choice.”
The “mass inhalation” is in protest against the proposed psychoactive substances bill, which would make possession or supply of any “psychoactive substance” (with the exceptions of nicotine, alcohol and caffeine) punishable by up to seven years in prison. The aim is to crack down on legal highs, which chemists constantly concoct when old favourites are banned. No more “meow meow”, “spice”, “vanilla sky” or other new chemical substances. The catch-all legislation would also remove well-established legal highs such as nitrous oxide.
The Psychedelic Society believes it should be legal to consume any drug, as a human right. “These are our bodies, our minds, and it should be up to us what we do with them.” This applies to magic mushrooms, MDMA and, yes, even heroin.
The society has singled out nitrous oxide – cheap, easy to acquire, and spectacularly camera-friendly – for the action, which is based on historical precedents. Collective cannabis smoke-a-thons, featuring drumming, juggling and all the chilled-out tropes of stoner culture, did succeed in finessing public perception of marijuana. Speakeasy bars similarly proved the futility of prohibition.
Whether the balloon protest will similarly change public opinion remains to be seen. But there are reasons to think it won’t.
There is no single drug that looks less sophisticated than nitrous oxide. Smoking cigarettes will always look cool. Snorting lines carries an air of affluence. But huffing a bright pink balloon, turning cross-eyed, giggling and hyperventilating invariably looks inane. If the aim is to convince conservative prohibitionists that nitrous oxide is a legitimate leisure activity, this will not succeed.
However, the stance of the Psychedelic Society – that the bill is frivolous, and nitrous oxide nowhere near as dangerous as current news reports attest – is defensible. But for different reasons.
To call N2O laughing gas overlooks the true importance of this molecule – as a painkiller. And not just any painkiller, but one whose birth led to the development of anaesthesia, one of the greatest accomplishments of modern medicine. We have Sir Humphry Davy, founder of the Royal Society, to thank for this. His love affair with the gas in 1800 led to the popularisation of the drug and eventually to its use by others for tooth extraction and the development of pain-free surgery. Nitrous oxide has an illustrious history.
All drugs are double-edged swords, and can harm or heal depending how and when they are used. The main mistake of prohibition was to claim that some drugs were good and some bad. All drugs are both.
Has prohibition ever worked? No. Will the war on drugs ever end? No. Will humans always crave intoxicants? Yes. Is the psychoactive substances bill frivolous? Yes.
But is the best way to draw attention to a silly piece of legislation a silly protest that could be seen as equally silly?
Perhaps those who join in the mass inhalation should instead spend their energies devising ways to enjoy nitrous oxide without leaving horrendous amounts of waste behind (neither the balloons nor the steel canisters are easily recycled).
Campaigners might also do better if they worked on ways to establish legal consumption of nitrous purely for pleasure.
Again, there are historical precedents. Is there a legitimate place for inebriation? Yes. It’s called a bar. Alcohol is, in too many ways to count, far more dangerous than nitrous oxide.
What if nitrous oxide could be enjoyed in a regulated, taxed, and socially acceptable place? Like an up-tempo breed of cannabis cafe? It would mark the first occasion that a chemical borrowed from the world of medicine became a legal, communal, publicly available form of stress relief. A historic first.
It’s the holy grail for scientists working in sexual health: a device that women can use discreetly to protect themselves from contracting HIV.
Worldwide, only five percent of men wear condoms routinely. Convincing men to wear them can be difficult to say the least, especially in regions where rape is at epidemic levels. Dumping millions of condoms onto developing countries every year has not changed the fact that one in five people in some parts of Sub-Saharan Africa have HIV.
The International Partnership on Microbicides (IPM) hopes that the “Dapivirine Ring” could be the solution we have been waiting for. A non-profit, the IPM has managed to secure funding from a broad range of philanthropic and national organisations, because the need for a female-controlled form of HIV protection is so desperately needed.
“We’re hoping that, for the first time, an anti-HIV ring will help women be able to protect themselves against infection,” said Zeda Rosenberg, chief executive officer of IPM.
The Dapivirine ring is a porous silicone hoop designed for women to wear around their cervix. It is soaked in an anti-retroviral drug capable of killing the HIV virus, which is slowly released over time; women will need to change the ring monthly. Because they carry it with them day-in-day-out, even if condoms aren’t to hand, women will be able to know they are protected—especially important as women are twice as likely to be infected with HIV through sex with a man than vice versa.
The Dapivirine ring is currently being tested in Africa in Phase III clinical trials, involving thousands of women. More than 5,000 women worldwide have tested the ring so far. These foot soldiers on the frontlines of the war on HIV are taking the brave step of road-testing an experimental device, knowing there’s a chance they could still contract the virus (they are also given male condoms). Will it work? Preliminary results are expected in 2016, and it could be available in target countries in Africa and the tropics by 2018.
The Dapivirine ring is just one of many microbicide rings being developed worldwide in the race to create a discreet barrier protecting women against HIV infection. Virginia-based CONRAD—which has been in the field refining protection for women for two decades—is developing another front-runner.
This is not the first time that “female-controlled” microbicides have been hailed as poised to change the world. Last time, it was a catastrophic disappointment. In 2004, scientists believed we would have microbial gels on the market by 2010; more than 60different kinds were being tested, in the form of gels, sponges, creams, suppositories, and rings. But clinical trials revealed that not only were many ineffective, some actually worsened HIV infection rates: cellulose sulphate vaginal gels, for example, were slightly caustic to the vaginal tissue and increased the risk of tiny tears that make infection more likely.
“The failure of the gels in the 2000s was very disheartening,” said Rosenberg. But the need for an effective microbicide is so urgent, IPM, CONRAD and other organisations felt abandoning the goal would be unconscionable. Rosenberg has been working in the field since the 90s and remembers the hype, the hope and the disappointment of microbial gels very well.
Considering that it might be impossible to create an HIV vaccine, IPM—which has been working for 11 years on this concept—thinks their antiretroviral (ARV) drug-soaked rings could be the horse to bet on in the battle to halt the pandemic. The rings are intended only for release in the developing world, because that is where they are most needed—essentially flipping the traditional R&D model on its head by creating something explicitly for the developing world first, rather than rich countries.
Crucially, their work has been funded by philanthropists, such as the Bill and Melinda Gates Foundation, which has gifted them with grants of up to $130 million. Much like the development of the combined progesterone-estrogen pill, bankrolled in the 1920s by philanthropists and suffragettes Margaret Sanger and Katharine Dexter McCormick, who felt that the world needed a safe contraceptive women could control, microbicides have been fueled by political conviction.
“Despite the failures of microbicide gels, there’s still a lot of interest in rings because they are—in terms of contraception—relatively low dose, and the Nuvaring [a contraceptive ring already on the market] is pretty popular,” said Terri Walsh, director of research and evaluation with the California Family Health Council (CHFC) in Los Angeles. Eventually, the plan is to produce a ring that prevents both pregnancy and HIV infection. “The possibility of having a ring that contains a microbicide and a contraceptive, in the same device? Now that would very attractive.”
But just because an idea sounds amazing on paper doesn’t mean it will actually work in the sweaty, messy, real-life scenario of the bedroom. Take the female condom, which sexual health specialists have long championed as a “female-controlled” prophylactic that gives women the power to protect themselves even if an inconsiderate lover refuses to don a condom. Whether or not this is actually true remains unclear. Surely a man can refuse to penetrate a female condom just as easily as refuse to wear a male condom—or (in the case of rape) yank it out?
More importantly, the female condom routinely ranks just a 16 percent approval rating in clinical trials. As the husband in one LA couple told me when I was researching for a piece on new designs in condoms, “They are terrible and deserve their reputation.”
Will women find inserting the ring cumbersome or wearing it unpleasant?
“We didn’t have any trouble with our participants putting in the Dapivirine ring,” said Walsh of the CHFC, who conducts trials to test new forms of contraception (such as their large-scale condom “breakage and slippage” studies). Considering that Nuvaring is already on the market with fair success, it’s reasonable to assume that HIV-preventing rings should be equally unobtrusive.
How’s the study going? “Everyone is holding their breath,” said Rosenberg. “And at the end of the day, we have to remember that these viruses mutate and adapt quickly, so we will still need to keep on our toes and simply not assume that everything has been solved when one product comes out.”
In other words: even if the Dapivirine ring proves successful, it won’t be the last weapon we will need in the fight to protect people—and women in particular—from HIV.
“Just as we have a variety of birth control options that women can use at their discretion—pills, rings, IUDs, diaphragms, injectables, implants etc—we need to keep in mind that women also need a variety of options when it comes to HIV prevention, because we all have different needs,” said Annette Larkin of CONRAD, which hopes to have its microbicide rings in women’s hands (or, rather, around their cervixes) in the next three years. “Currently, there are no HIV prevention methods that women can use on-demand and at their discretion. Why would we NOT do this research is the question.”
I will be speaking at Latitude tomorrow as part of a panel on drugs – the science, the policy, the controversy, the unavoidable truths. I’ll be joining neuroscientist Robin Carhart-Harris and addictions specialist Dr Owen Bowden-Jones.
For the first time in four decades, an illegal psychedelic drug is being clinically tested in Canada. A team of psychiatrists and psychologists in Vancouver are giving 3,4-methylenedioxy-methamphetamine (MDMA)—better known as the party drug ecstasy—to 12 people suffering from chronic post-traumatic stress disorder (PTSD). The drug will be administered in therapeutic sessions to help them deal with memories they have found difficult or impossible to confront, as part of a group of clinical trials, including in the U.S. and Israel.
The aim is to see if the club drug will help people with debilitating symptoms—including re-experiencing trauma through flashbacks or nightmares, as well as sky-high stress levels—who have not responded to conventional remedies. More typical treatments for PTSD include daily medications, cognitive behavioural therapy, traditional “talking” treatments and exposure therapies. Despite the range of options, at least a quarter of people coping with PTSD do not respond to any of them.
MDMA has already been studied for treatment-resistant PTSD in Switzerland, Israel and the U.S., and, although the studies are very small, the preliminary results sometimes seem too good to be true. A 2011 paper—the first randomized, controlled study—reported that 83 per cent of patients given MDMA-assisted psychotherapy experienced a significant reduction in their symptoms, compared to just 25 per cent given standard psychotherapy. It’s crucial that the MDMA dosing occurs in conjunction with focused psychotherapy. The current trials consist of a number of sober sessions to establish a trusting relationship with the therapist, followed by three therapy sessions when the patient is also given a set dose of MDMA.
It took six years and $200,000 to get approval from Health Canada, which even required building a bomb-proof room with multiple locks, motion sensors and a locked cabinet bolted to the floor to store a tablespoon of medical-grade MDMA. “Yes, it’s been difficult—but, at the end of the day, they said yes, and I do want to applaud them for saying yes,” says Mark Haden, adjunct professor at the University of British Columbia’s school of population and public health, and chairman of the Canadian branch of the Multidisciplinary Association for Psychedelic Studies (MAPS), which is running the study. Haden has devoted much of his recent professional life to advocating for research into the benefits of illegal drugs, such as cannabis for pain and psilocybin (magic mushrooms) for end-of-life anxiety in terminally ill patients. Now the study will help to determine if MDMA could be a treatment for trauma.
The widespread public perception is that MDMA is dangerous and can cause brain damage, or worse. That weekend party warriors have collapsed on the dance floor after popping ecstasy is without question. However, it’s not clear that MDMA is always to blame. A spate of deaths in recent years in Britain were initially attributed to MDMA, but were later found to be due to another drug, PMA, a cheaper synthetic amphetamine known as “Dr. Death” that had been passed off by dealers as the real thing. “PMA is five to 10 times more dangerous than MDMA,” says Dr. David Nutt, a psychiatrist and neuropharmacologist at Imperial College in London.
But one crucial question remains unanswered: What is the effect of quality-controlled MDMA on the body?
Nutt inflamed British media in 2009 when he publicly stated that taking MDMA is less dangerous than horse riding—showing statistically how the sport is far more likely to cause injury than taking MDMA—and the furor led to his dismissal as the chair of the government’s Advisory Council on the Misuse of Drugs. Six years later, he says evidence continues to demonstrate that the risks of MDMA have been greatly exaggerated—and the benefits under-reported. “I’m not interested in helping people get high; my goal is to get MDMA approved as a treatment for PTSD in the U.K., because there is nothing that works the way this drug can. And it certainly isn’t as dangerous as legal drugs, such as alcohol and tobacco.”
Mark Haden is not unfamiliar with the dangers of drugs: He has worked for three decades as a drug counsellor with addicts in Vancouver. Nor is he unfamiliar with the hazards of MDMA: His brother died in 2008 while cooking a batch of the drug for sale on the black market.
Haden first became interested in the potential for illegal narcotics—and psychedelics, in particular—as possible treatments six years ago when a patient of his, addicted to heroin for a decade, felt transformed by an experience in Mexico with the hallucinogenic substance called ibogaine, which helped him kick heroin. Haden had never seen such a speedy recovery from addiction.
When Haden found it difficult to have a conversation with professional colleagues about the potential benefits of illegal or banned drugs to help addicts, he left his job as a counsellor to work as head of MAPS Canada. “Frankly, I’d like to apologize for the past lies of drugs educators—including myself,” says Haden. “We exaggerated the harms of drugs, we never discussed the potential benefits, and we failed to deal with the dominant model for dealing with addiction, which is prohibition, which just doesn’t work,” he adds.
Furthermore, given the enormous overlap between PTSD and addiction—how many people become addicted to drugs in response to trauma in their lives and how few treatments are available for both afﬂictions—MDMA (long medically championed by MAPS in the U.S., which instigated the Vancouver study before Haden’s involvement) was an obvious drug to investigate.
PTSD (once largely associated with war veterans) is a complex manifestation of trauma stored in the body. Victims of war, rape, childhood sexual abuse and other devastating experiences can find themselves continuing to shake, sweat and crumble with anxiety and flashbacks, decades after the initial trauma. Perhaps more than any other condition, PTSD demonstrates the intimate relationship between mind and body: Psychological scars can have physical repercussions.
Virgil Huston is an American vet who served in Iraq in 2004 and 2005, and was a contractor in Afghanistan in 2011. During his time overseas, Huston saw people killed, flew in planes that were shot at, and his Iraqi base was attacked daily. Back in the U.S., he suffered from depression, nightmares and haunting visions. “I tried every single antidepressant there is; none of them worked,” he says. “They just numbed me, and they were so much more addictive than I ever imagined. The withdrawal was horrible. And I wasn’t even given simple talking therapy. Psychiatry in America has become nothing but about altering chemical balances in the brain with daily medications.”
Although using a drug that is, in many respects, far more potent than any he had been prescribed (including Klonopin and Wellbutrin) to alter chemical balances in the brain might seem like the last thing he would want, Huston signed up for an MDMA PTSD trial after seeing discussions on Facebook. “I was stunned that MAPS was operating in Charleston, S.C. I thought it would be in California or Colorado—not here, where even marijuana will never be legal,” he laughs.
“I was definitely high, but totally in control—which is a good thing,” he says now, adding that he went through more therapy sessions without MDMA than with it. “This isn’t just about the drug; it’s about the psychological process, and building trust with a wonderful therapist,” he says. “I still think about the wars, but they don’t keep me awake at night all the time—which is, frankly, incredible.”
Haden thinks the key to MDMA’s potential to heal traumatic stress may lie in its molecular makeup. “It is a marriage between methamphetamine and mescaline,” he explains. “The stimulant gives people confidence, and the psychedelic allows people to reflect on themselves and their experiences in a different way. The combination helps them confront painful memories.”
Haden, Nutt and other proponents of MDMA-assisted therapy know they face an uphill battle in convincing colleagues of the efficacy of the drug. Most therapists and doctors who work with patients suffering from PTSD will have reservations about MDMA until large trials are successfully concluded.
Psychiatrist David Wright of the Homewood Health Centre in Guelph, Ont.—one of the few facilities providing live-in care for PTSD patients in Canada—is cautious to endorse the use of any inebriant. As of now, Homewood does not approve of marijuana—even for those with a licence. “A third of the patients here are trying to recover from addiction; it’s not fair to expose them to their triggers,” he says. “But if this is truly capable of enhancing people’s capacity to learn, then I would approve of it. I will be driven by the science.”
What Wright finds far more useful than talk of silver-bullet cures—which have been trotted out before, from propranolol to lobotomy—is routine, security, and focused psychotherapy. “People who come here usually just need to be stabilized, more than anything else. It’s not useful to think about cures only in terms of how few sessions are needed,” says Wright.
He does agree with some of what MDMA’s proponents suggest, however. “Basic antidepressants just don’t have a robust response,” he says. And he agrees that the biggest hurdle is “building trust.”
Which is why Norwegian psychologist Pål-Ørjan Johansen thinks MDMA could be so effective. In a 2009 scientific article, he argued that MDMA might work through several mechanisms—mainly by increasing levels of oxytocin, colloquially known as the “cuddle chemical” also released during breastfeeding. This would have the net effect of preventing the amygdala (thought of as the brain’s emotional processing centre, key for regulating fear) from overpowering the prefrontal cortex (considered the centre of higher thought). He thinks the overall effect is a fostering of the capacity for trust, while at the same time quelling hyperactive fear.
Johansen has experienced the effects of MDMA. A decade ago, he was so persuaded by what he read about MDMA therapy that he decided to treat his own depression and excessive drinking following the sudden deaths of his brother and several relatives. MDMA-assisted psychotherapeutic trials were not available where he lived, he says, so Johansen acquired the drug himself and asked a close friend trained in psychology to help him. “MDMA made it easier for me to be open, and talk about difficult and shameful experiences in my life,” he says.
“The reason pharmaceutical companies are not interested in exploring the benefits of these drugs has more to do with money—because the patents have expired—than anything else,” Johansen adds. Which is one reason he and his wife and academic partner, Teri Krebs, founded EmmaSofia, which aims to produce affordable, medical-grade MDMA and other psychedelics. Having partnered with a Norwegian pharmaceutical firm, they hope to “democratize” legitimate access to these drugs. Their unorthodox approach has garnered attention and criticism.
One big hurdle researchers face when it comes to MDMA research is cost: A gram of medical-grade MDMA can cost thousands of dollars. Haden says MAPS Canada is spending $170 per gram, which is the equivalent of $75 for an average dose. (Three doses are given during the trial.) MAPS is working through traditional regulatory channels and, if the trials prove the drug effective, it hopes to get MDMA approved as a treatment for PTSD by the U.S. Food and Drug Administration and by Health Canada by 2021.
For now, Homewood’s Wright says although PTSD can be difficult to treat, recovery with existing methods is possible: He has seen countless people recover with compassionate, focused psychotherapy—so much so, that the terminology used to describe his patients has shifted from “PTSD victims” to “PTSD survivors.”
“It’s not all negative; sometimes people can respond to trauma by deciding to then change the world for the better,” Wright says. “PTSD shows how the body can be fragile—but also how can it can recover.”
I explore the possibilities in the magazine Maclean’s, and report on the first clinical study to test a psychedelic for human health in four decades. This was a labour of love – having seen some of my closest friends suffer terribly from the condition
I’ve given my Rdio playlists some quirky but self-explanatory titles, such as “Feisty Women Rock” (PJ Harvey, Neneh Cherry, and other chicks who don’t take shit), “Melancholic and Profound” (Nick Drake, Low, you get the picture), “Hearty Nostalgia” (Credence Clearwater Revival, The Band, and a few comfortingly familiar guilty pleasures for when I need a sonic security blanket), and other self-indulgent themes that provide some order to the auditory landscape of my life.
I don’t have a collection called “Music To Slit My Wrists To”, but if and when I ever start one, The Soft Moon will definitely feature prominently. Not because it’s awful, but because that’s clearly the vibe they’re going for.
The name “soft moon” might seem like what you’d find on the label attached to a doe-eyed lunar-themed plush toy. But this Oakland trio in fact makes the exact kind of music that scowling parents want to keep their kids far away from, lest it poison their ambition (or at the very least, damage their eardrums). If refusing to clean up your room or tie your shoelaces isn’t enough to piss off your folks, this is the music for you.
Yet the crowd at the Hoxton Square Bar & Kitchen was anything but young – it was hard to mark out anyone younger than 25. Instead of angsty music for the young and frustrated, this instead was clearly heavily inspired by and drawn from the angry music of decades past, appealing to now grown-up 30-somethings in a comfortingly familiar way – in a way, a form of “hearty nostalgia”.
I scribbled “reminiscent of the best angry angst goth” on my notepad, but Wikipedia’s entry on The Soft Moon corrected me with the more appropriate genres the band should be slotted into: “post-punk”, “darkwave”, “noise rock”, and “EBM’ or “electronic body music” (which might sound like the label for boppy techno, but actually combines “post-industrial” with “synthpunk”).
Record shop jargon aside, what does that actually sound like? Heavy and slow 4/4 drums with thick basslines set the bedrock for the entire show, right from the first note of opening track ‘Inward’, off their third album Deeper 2015. Treacle-thick dark synths throughout flooded the room with viscerally tingling low frequencies (including from drum machine set within the drum kit). Assaultive noise, as I always say, can feel strangely soothing. There’s something weirdly comforting about being able to feel the loo seat shake when you’re two rooms over.
Plus, of course, lyrics scripted to slit your wrists to. “Take me far away / To escape myself / Cos I was born to suffer / It kills my mind / It kills me inside / Happens all the time” (“Far”, also off Deeper).
Plus, of course, teenage angst. “I don’t care what you say, you say / Living life my own way, own way” (‘Black’). The crowd may have been all grown up, but repetitions of these two stroppy lines for five straight minutes didn’t fail to chime with them. It’s clear many people who were teens in the ’90s harbour a bit of that bitter adolescent resentment somewhere deep down inside. Plucking those strings now and then probably relieves a bit of pent up psychological pressure, like a tiny but precisely placed acupuncture needle pricked into a stiff and aching muscle. Hearts may have felt temporarily young, but the embryonic mosh pit couldn’t quite muster the critical mass necessary to get going.
Still, the energy in the room undeniably kept building. Continuing with songs with such cheery titles as ‘Dead Love’, ‘Die Life’, and simply, ‘Wrong’, it becomes clear The Soft Moon might be doing everything they can to encapsulate the sound of abject, suffocated misery.
Now, some people – probably anyone over the age of 65 in this country, and most people the world over – cannot understand why some music is made to be ugly. Fiercely angry, violent and dark genres – from heavy metal to industrial, dirty techno and even the earliest punk – seem to be a curiosity of the past fifty years. Certainly most cultures on earth have come together with mourning rituals, and channelled their anger and rage collectively with the drums of war – this medieval military beat wouldn’t sound remotely out of place in certain modern metal tracks. But peacefully coming together to revel in angry music without any violent results seems to be a modern phenomenon.
Perhaps that’s the point: sometimes music is supposed to be dark, because sometimes life is dark – even when you’re not a frustrated teen. And maybe we find music like this – from thudding German krautrock to angry Scandinavian metal and screaming Japanese punk bands – in developed countries that have most erased physical discomforts from daily life.
For a full 90 minutes, it can be a bit much. But if you’re a fan – which clearly pretty much everyone in the room was – it seemed pretty intoxicating. And weirdly, rather cheering. It may have sounded like it belonged in a room of scowling kids with hair in their faces, but you could see smiles everywhere.
It was decreed “the worst idea on the mind” in history in a public debate at the Royal Institution in 2006. Yet it seemed like such a good idea at the time—so good, it won its devisor the Nobel Prize. Portuguese neurosurgeon Dr Egas Moniz—whose gout-scoured face one graced the 10,000 Escudo banknote—won the most prestigious award in science in 1949 for developing the “leucotomy”.
Better known as “lobotomy” (a new label conjured up by American psychiatrists), the revolutionary technique seemed to be the first way psychiatrists could dramatically alleviate madness and suffering in people thought to be incurably deranged, violent, and psychotic. Extreme but—in its way—effective, the technique involved slicing tiny slivers through the frontal lobes of the brain, which surgeons reached through holes bored in the top of the skull.
Grim it may sound, but before antipsychotics, sedatives, and all the other ingredients in our pharmaceutical repertoire, psychiatrists had few options to treat any form of severe mental illness. Moniz theorized that obsessive, depressive, and delusional behaviours were caused by excessively tight associations between neural circuits, which could be alleviated by slicing through the deep white matter of the frontal cortex, “soft as warm butter”.
Today, the word “lobotomy” is synonymous with “butchery”—a form of neurological oppression used to sedate and immobilize the sick and troublesome. An extreme form of punishment, made famous by the surgical fate of Randle P McMurphy in One Flew Over The Cuckoo’s Nest.
The truth, as always, is more complex. Lobotomy was widely thought of (if only for a few years) as truly revolutionary. In a 1937 story, New York Times reporter William Laurence lauded it as a “surgery for the soul”. Some 40,000 Americans underwent the procedure, peaking at 5,000 annually in 1949. So popular, hundreds of people volunteered to have surgical tools inserted into their brains twice—and a handful, three times.
“Most people don’t know about this chapter in our history because it’s ugly, and truthfully, psychiatrists have an interest in hoping that people don’t know too much about it,” said Jack El-Hai, author of The Lobotomist, a biography of Walter Freeman, who performed 3,500 lobotomies and spurned other medics across the globe to embrace the procedure.
Freeman outlined the “prefrontal lobotomy” in full detail in a 1942 paper in the Bulletin of the New York Academy of Medicine. The Nobel Prize winner’s biggest fan, Freeman sought to rebrand and reinvent the surgery by coming up with a way to enter the brain from below, rather than drilling in through the top. Why bother with an expensive, intrusive and dangerous hospital procedure, requiring heavy anesthetics and a long hospital recovery, when a different tactic could achieve the same result in less than ten minutes?
Hoping for a safer, gentler option, Freeman came up with a radical alternative: driving a surgical tool into the brain by hammering it through the bony case of the eye just above the eyeball, just under the eyelid. His instrument of choice: an ice pick, plucked from the family’s kitchen drawers. Instead of general or local anesthetic, Freeman opted to immobilize his patients with electroshock therapy.
Freeman took pride in the fact many patients could walk out of his office within hours of a treatment (albeit with bruised eyes). In the end, roughly a third of the lobotomies performed in the US were achieved through the eye socket, not the skull.
In Freeman’s mind, the root of a broad spectrum of mental ailments—from depression to schizophrenia and the symptoms we would today categorize as autism—lay in the same culprit: an excessive number of connections between the thalamus (an integral component of the brain’s emotional hubs), and the frontal cortex (thought of as the seat of consciousness and self-awareness). Animalistic, emotional urges overwhelmed reason and rationality. Slicing through those excessive connections with an ice pick with the same motion as beating an egg could relieve the oppression of emotion over reason, alleviating anxiety and misery.
Freeman became increasingly evangelical about his procedure, travelling across America to perform up to 25 treatments in a day at the nation’s overcrowded mental institutions (often ungloved). He transitioned from thinking of the therapy as a last resort to advertising it as an early intervention, enthusiastically doling it out for post-partum depression, sadness in the terminally ill, and even 19 children under the age of 18, including one four year old.
One of these children was Howard Dully, whose stepmother paid Freeman $200 to lobotomize the 12-year-old boy in 1960 for his strange behaviour, which spanned from daydreaming to a reluctance to go to bed.
“I’ve always felt different—wondered if something was missing from my soul,” Dully, who has no memory of the surgery, told NPR.
“I went into the project thinking he was probably a monster, but what changed my mind was seeing all the correspondences he had with his patients,” says Freeman’s biographer El-Hai. “He stored boxes and boxes of letters from them and their families, thanking him for his help, inviting him over for dinner. Some of his patients and their families really thought of him as family. It seemed something much deeper was going on.”
On one infamous occasion at the Langley Porter Psychiatric Institute in San Francisco, he poured out a box of more than 500 cards his lobotomy patients had sent him.
Freeman spent much of the last 20 years of his life travelling across America in an old green Ford, visiting former patients and documenting their histories—progress, deteriorations, deaths and all.
On a professional level, Freeman maintained correspondence because he was keen to prove that he had produced real and lasting improvements. That he hadn’t butchered the vulnerable and the sick, but actually changed their lives for the better, allowing many to go home, return to work, and live relatively normal lives. Though most lobotomy patients—two thirds by most accounts—remained institutionalized, roughly 30 per cent could be deinstitutionalised, according to El-Hai’s book. Freeman loved to showcase the handful of extraordinary patients who returned to sparkling careers, including a psychiatrist, a symphony violinist, and a physician who not only could practice again, but also received his license to pilot aircraft.
Freeman took a particular interest in the sex lives of his patients. One notable man, who had expressed no interest in intercourse for two decades, developed such an appetite that he complained “the girls cost him more money than he could afford”. In a more traditionally American manner, Freeman noted that 28 patients married after surgery (a small number of 2,454 treatments, granted), and 62 children were born.
Far from an arrogant butcher drunk on hubris, Freeman truly felt he was doing what was best for his patients, performing lobotomies for just $25 for those in the most desperate and impoverished circumstances. In his mind, the procedure was a social good: he thought a quick slice through the brain—even if it diminished intellect or cauterized some portion of a patient’s personality—was far better to a miserable life incarcerated in the nation’s overcrowded mental asylums. Before WWII, more than 400,000 people lived in 477 asylums—and half the country’s beds were occupied by psychiatric patients.
“I don’t blame Freeman for exploring the potential of lobotomy as a solution to the mental asylum issue in the US, but I do blame him for refusing to explore pharmaceutical treatments when they became available in the 1950s and 1960s,” said El-Hai.
As lobotomy faded in popularity, Freeman continued to preach the virtues of the treatment, clinging to it right to the end. It was only when a patient seeking her third lobotomy, Helen Mortensen, died on the operating table in 1967, that he was stripped of his medical license.
Good intentions aside, and despite the small number of dramatic improvements, thousands suffered acutely, ranging from paralysis to intellectual ablation and early deaths. Ten years ago a small number of the relatives of these victims—mostly, their children—began a campaign to have the Nobel Prize withdrawn. But their efforts were meager and shortlived.
For good or ill, the brief love affair with the lobotomy did leave us with a few legacies. One is the refinement of standardized ethical guidelines, which were threadbare during Freeman’s time. Another is how the lobotomists of the world drew attention to the biology of the brain itself as the seat of mental illness.
Perhaps most striking though: an unintentional illustration of the remarkable resilience and the plasticity of the brain: what today we call neuroplasticity. That the human brain can survive the swirling of an icepick through its very core and still have a chance of retaining the capacity for mathematics, language, emotions, and creativity is perhaps the most remarkable legacy of all.