Sometimes people make mistakes that are so horrendously destructive, that no one could ever live with the realization, no matter how innocent was the original mistake. And so it is better for one’s own wellbeing to simply never discover such a consequential error. This is what Megan McArdle calls an Oedipus Trap: mistakes that no one can live with.*
The Greek story goes that Oedipus, king of Thebes, unwittingly killed his father, Laius, and then married his mother, Jocasta. These were innocent mistakes in that no one involved were aware of their kinship. Yet when the maternal relation was inevitably discovered, Jocasta hanged herself and Oedipus took two pins from her dress and gouged out his own eyes. Again, they had not intentionally sinned and potentially could have lived the rest of their lives none-the-wiser. But when their perverse relation came to light, they could not live with the knowledge of what they had done.
McArdle, a Washington Post columnist tells the story of Dr. Walter Freeman, a man who literally wanted to rid the world of mental illness, and America’s foremost practitioner and promoter of lobotomies. Though the procedure is now justifiably in disrepute, prior to the production of psychiatric drugs, lobotomization was for a time seen as the only viable treatment for those suffering from severe mental or neurological torment, such as schizophrenia.† Previous treatments inspired by Freudian pseudoscience had failed in this pursuit.
Dr. Freeman was such a believer in his misbegotten remedy that he continued to perform it for more than a decade after effective antipsychotic drugs became available in 1954. Even after he performed his last lobotomy in 1967, he continued to insist the practice was sound.
According to his biography, The Lobotomist, written by Jack El-Hai, Freeman kept in close contact with many of the patients he lobotomized. One could say he had a “near compulsive desire to assemble case histories” and he reportedly displayed an “almost paternal” fondness for his former patients.*
But his patients, as McArdle reminds us, “were people whose brains he had mutilated — inserting a ‘picklike instrument’ through the eye socket, piercing the thin bone, and jamming it into the delicate tissue of the prefrontal lobes, leaving permanent scars on the very seat of personality and consciousness.”* A lobotomy removes parts of the brain that govern a person’s personality, desires and impulse control. It tended to leave subjects apathetic, which to some psychiatric experts at the time appeared to be a “cure” for anxiety disorders.‡ Though he didn’t invent the treatment,§ Dr. Freeman performed thousands of lobotomies throughout his long career. And he organized demonstrations of the procedure for thousands of other doctors who went on to perform thousands of procedures themselves. He loved giving press interviews where he could advertise the procedure to the general public … and he got results. People volunteered themselves and their loved-ones for his mythical treatment.
Freeman never relented in his conviction that the practice was “safe and effective” as the phrase goes. “I believe it’s due for adoption when the surgeons make up their mind for it,” he reportedly said just a few years before he died. “I think they’re missing a good bet.”* Yet, he had to be well aware that the practice he endorsed was rapidly falling into disrepute, even among his contemporaries, long before he died. He knew his legacy was slipping away. His “compulsive desire” to followup on his former patients suggests a desperation to find any evidence at all that could justify what he had done to so many people. He was on a “salvage mission” to save his reputation.
He did not defend lobotomy as the best practice of its time, or as the only thing available before more modern treatments arose. He forever defended lobotomy as the best practice to treat the psychotic, as a standard of care.
Freeman was an extraordinarily vein and hubristic man. But he wasn’t a pseudoscientific imposter. He was the head of multiple medical societies. He also had good intentions. He even led the effort to desegregate the DC Medical Society. He wanted to be a great man. But his final legacy is one of mass destruction and lives destroyed.
“In his zeal to change the world,” writes McArdle, “Freeman had ended up violating the first principle of science, as laid out by the physicist Richard Feynman: ‘You must not fool yourself, and you are the easiest person to fool.’” In the end, Freeman served humanity “only as a usefully bad example of how far astray we can go when we let hope triumph over experience—and how hard it can be to bring ourselves back.”*
The lesson here to be learned is that progress must move by inches, not by leaps, especially when the stakes are high. Crossing the point of no return is the commitment that binds one’s innocent mistake to an irreversible cascading tragedy. The faster one moves, the more likely one is to cross that point without even realizing it. In times of great fear and/or moral panic, this likelihood increases exponentially.
And once one’s reputation becomes part of those stakes, your sanity is then on the line as well. Dr. Freeman didn’t just perform lobotomies, he was the most prominent public advocate for them. This guaranteed that when lobotomies as a practice fell into disgrace, so too did its foremost practitioner and promoter. Never tie yourself to a ship that could sink, and never fool yourself into thinking that the ship could never sink. This lesson applies to those who practice and promote new novel procedures or ideas as well as those who receive them.
Yet till the end, Dr. Walter Freeman clung to his faith in himself, waiting for just one more case history, one more piece of missing evidence that “might somehow turn an atrocity into a triumph,” as Megan McArdle concludes: “In his desperation to become a medical hero, he had become a hero out of Greek tragedy: consigned to ignominy by his own hubris, and doomed to struggle against a fate that was inevitable.”* This was the story of a man who had to keep destroying people’s lives, one lobotomy at a time, if only to keep himself from ever discovering that he had indeed destroyed thousands of people’s lives.
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* See “Megan McArdle on the Oedipus Trap,” EconTalk, March 20, 2023
Also see Megan McArdle, “What the world can learn from a lobotomy surgeon’s horrible mistake,” Washington Post, February 14, 2023
† It should be noted that while many saw the procedure as having potential benefits for patients’ health, often the procedure was used as a mode of social control, for problem patients, because it made the jobs of caregivers easier.
‡ In addition to apathy, a lobotomy could also produce incontinence, seizures, and immediate death. When an initial lobotomy resulted in an undesirable outcome, the solution was to do another.
§ The inventor of the lobotomy was the Portuguese neurologist António Egas Moniz, who along with Walter Rudolf Hess, won the 1949 Nobel Prize for this invention. Ironically, Egan Moniz should have been awarded the Nobel Prize for developing cerebral angiography, but in part due to Dr. Walter Freeman’s lobbying, the prize was awarded for lobotomy instead.