Recalibrate: What can we learn from Rosemary's lobotomy?

I was introduced to the powerful story of Rosemary Kennedy by a chance recommendation from the YouTube algorithm. This certainly kindled my interest in the history of lobotomies and, to put them in their wider context, the shift between surgery to pharmacology and onwards. I was inspired to learn how treatment of neuropsychiatric conditions has changed. Yet, what most interested me was not the impact of the surgeries on the brain, but how injustices were committed in the name of science and medicine.

A BRIEF HISTORY OF PSYCHOSURGERY

According to the Encyclopaedia Britannica, the lobotomy is a medical procedure which requires the removal of one area of the brain. This recalibrates the brain by severing certain nerve pathways from others.

Psychosurgery was first performed on humans in the latter end of the 19th century (late 1880s). Gottlieb Burkhardt, a Swiss physician, chose six seriously unwell inpatients from a mental asylum to trial the surgery. The aim of the lobotomy was supposedly to calm the patients, not to return them to sanity. Four of the six patients had more manageable symptoms afterwards; however, one of the patients died and another killed himself. This ought to have been enough to raise suspicions about the practice of lobotomising brains, but it was still relevant several years later.

A journal article in the Singapore Medical Journal stated that in 1935, António Egas Moniz, inspired by the work of American physiologists on chimpanzees, worked with a young neurosurgeon called Almeida Lima to invent a tool that could remove the frontal lobes without damaging the rest of the brain. Moniz believed that the frontal lobe contained the ‘abnormal neural connections’ that resulted in the aberrant behaviour of those with psychosis. This operation, in turn, influenced Walter Freeman and James W. Watts, the psychiatrists responsible for Rosemary Kennedy’s near-complete incapacitation.

THE BIOGRAPHY OF ROSEMARY KENNEDY

Rosemary Kennedy was born into the well-connected and cursed Kennedy family in 1918. The circumstances of her birth, followed by her harrowing lobotomy around two decades later, were caused by the unscrupulous actions of her mother’s gynaecologist. According to IrishCentral, Rosemary’s birth was complicated by the Influenza epidemic. Her mother’s doctor, Dr Good, was detained by his influenza patients. Reluctant to be deprived of his fee, he ordered the nurse to instruct Rose Fitzgerald Kennedy to keep her legs closed, withholding the supply of oxygen so important for Rosemary’s developing brain.

Though she was announced healthy at the time of her birth, later in her life her parents would recognize signs of the damage that this oxygen deprivation had caused. As a toddler, she was behind on her developmental milestones compared with her two elder brothers: she struggled with walking and had difficulty coordinating her limbs. At age 15, however, she took part in many of the activities that a daughter of an important family would be expected to. According to Lawrence Leamer, who wrote about the Kennedy women, when squired by her older brother John she did not appear to dance badly. On the other hand, her skills in arithmetic, reading, and writing were at the level of a child in primary school.

Rosemary’s parents tried to control the narrative, by censoring Rosemary’s letters home, lest they fall into strangers’ hands. When she was asked to interview with the Boston Globe, Rosemary painstakingly copied out a response which had been prepared for her by her father’s assistant. The limited knowledge there is about Rosemary’s perspective points to how frustrated how she felt that she couldn’t take part in the same activities to the standard of the rest of her siblings. In his autobiography, Tim Shriver, Rosemary’s nephew, mentioned that Rosemary’s intellectual impairment was hidden from Rosemary herself as well as from others. According to Shriver, her parents reasoned that Rosemary would be happier if she was unaware about her difference, yet this failed spectacularly. Could she have coped better had the nuns who had the charge of her education attempted to explain what happened at her birth? Would it have reduced her frustration and rage if she understood the causes behind her intellectual impairment?

In 1938, her father was named the American ambassador to Britain, and as a result stayed for 2 years there with his family. Rosemary was placed in a Catholic school run by nuns, who took the time and had the patience necessary to teach her. The nuns were training her to be a teachers’ aide, and had she stayed there, she could have flourished. However, when WWII started, Rosemary was sent back to America and was kept in a convent, which reportedly did not have the same benefits as the convent in Britain.

ROSEMARY’s LOBODOMY

In 1940, when she returned to America from the brief reprieve in the idyllic British countryside, her condition appeared to have deteriorated. At this time, she also suffered convulsions, which suggests that she may have developed epilepsy. Her intense frustration led to her inability to control her violent rages. Could her parents have had the compassion and patience to help her, her situation would have probably improved.

When her father, Joseph Kennedy, heard of the lobotomy cases, he felt that they would resolve Rosemary’s situation. He had understood that lobotomies, when done properly, calmed down patients’ violent urges. Without informing Rosemary’s mother or siblings, he paid for psychiatrists Dr James W. Watts and Dr Walter Freeman to operate on Rosemary.

During the lobotomy, the psychiatrists instructed Rosemary to sing the national anthem and the Lord’s prayer. They stopped the operation when she was unable to sing properly anymore. The results of the lobotomy were disastrous: they had led to the mental and physical incapacitation of Rosemary. One of the nurses who had assisted the doctors was so horrified, she left the profession.

However, despite this case of a lobotomy gone awry, psychiatrists and other doctors continued the trend. According to a Healthline article, lobotomies only began to fall out of favour in the 1950s, when patients could resort to pharmacologic medication, such as the first wave of typical antipsychotics.

CONCLUSION

Rosemary was in an unlucky and dangerous position: at the time, the knowledge about intellectual impairment was scarce, the solution to mental ill-health was to hide those who suffered in insane asylums, and her own parents feared greatly about their family’s reputation. Notwithstanding this, this lobotomy could be considered an awful solution to the station, even at that time. Rosemary was certainly reliant on other people before her lobotomy, but had they given her the patience and love that she needed, she wouldn’t have been completely dependent on them.

Outrage and indignation were certainly at the forefront of my mind when I was first studying her life. However, the perpetrators of these actions are long dead now. This opinion might indeed be at odds with my anger about the injustices committed under the aegis of medicine. On the contrary, I believe that the wider injustice is to dismiss those who have suffered as mere mistakes, or worse, martyrs. I hope it is possible that we can pass on the lessons that we have learned from Rosemary’s past.