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Author Jack El-Hai entertains a crowd at the Jack T. Stephens Spine & Neurosciences Institute at UAMS. Image by Evan Lewis

Author Jack El-Hai Discusses Books ‘The Lobotomist,’ ‘The Nazi and the Psychiatrist’

May 2, 2025 | May 02, 2025 | In 1995, a letter to the editor in the Sunday paper caught journalist Jack El-Hai’s attention.

In it, a woman complained about the treatment of her uncle, who despite never being diagnosed with a mental illness, had spent his entire adult life confined to a psychiatric hospital in Anoka, Minnesota — and had a lobotomy.

El-Hai, a Minneapolis journalist, began looking into the practice of lobotomies in Minnesota. Not only did he discover that the woman’s uncle had been committed simply because he had epilepsy, but he also began learning about the history of lobotomies in the United States, and in particular, about Walter Freeman, M.D.

Freeman began his medical career in the 1920s as a pathologist at St. Elizabeth’s Hospital in Washington, D.C., one of the largest psychiatric hospitals in the world. In an effort to determine if people who suffered from serious psychiatric disorders like schizophrenia died differently than other people, he began examining the brains of people who died there for a variety of reasons, many unrelated to mental illness, and found no correlation between them.

“He began thinking about all of the waste of human potential that he saw among the thousands of people at St. Elizabeth’s,” El-Hai told an audience at the University of Arkansas for Medical Sciences (UAMS), where on April 24 he presented a lecture entitled “Lobotomies and War Crimes: The Medical Paths of Walter Freeman and Douglas M. Kelley.”

The History of Medicine and Science lecture series at UAMS was sponsored by the UAMS College of Medicine departments of Neurosurgery and Psychiatry and the UAMS Jackson T. Stephens Spine & Neurosciences Institute.

El-Hai said Freeman began wondering why people who should be leading productive, happy lives were at the psychiatric hospital, and “began searching for different avenues to help people with psychiatric illnesses.”

In the 1930s, El-Hai said, Freeman moved to George Washington University, also in Washington, D.C., where he was a neurologist and a psychiatrist. At George Washington, he met a young neurosurgeon, James W. Watts. During this time, Freeman met Antὀnio Egas Moniz, a leading Portuguese neurologist who had begun focusing on targeted areas of the brain to treat psychiatric illnesses.

“Freeman got interested, and he and Watts began doing the same thing in the United States — not the same approach, but the same idea,” El-Hai said. The team initially performed Moniz’s prefrontal leucotomy (later known as the lobotomy).

The lobotomy is a surgical procedure designed to disrupt tracks of neural fibers connecting the prefrontal cortex and the thalamus of the brain. It was thought that disrupting these fibers would reduce signals causing symptoms observed in mentally ill patients.

Freeman “was very adept at working with the press” and “explained things clearly and engagingly,” El-Hai said. For decades, Freeman was the main advocate and developer of lobotomies in the United States.

“He used a sharp tool called a leukatome, which looked like an ice pick,” El-Hai said.  The idea for the leukatome originated from an ice pick in Freeman’s kitchen.

Starting in the mid-1940s, Freeman, along with his colleague James Watts, popularized the transorbital myotomy, which was a less invasive version of the procedure that could be performed using a surgical instrument similar to an ice pick. The tip of the surgical tool was inserted into the space between the eyelid and eye. With a gentle tapping of a hammer, it coursed through the thin orbital bone and was directed into the brain’s frontal lobe for six or seven centimeters.

“He went 20 degrees this way, 30 degrees that way, and performed the cuts completely blind, not knowing exactly what he was cutting,” El-Hai said. “But there was no surgeon necessary. Freeman did this himself. There was no anesthesiologist needed, because he shocked the patients into unconsciousness using the electro-convulsive therapy machines that all these hospitals by that time had, and so he performed thousands of transorbital operations this way over the next 20 years.”

Meanwhile, the predominant approach to psychiatry moved toward Freudian psychoanalysis and other kinds of talk therapy, and psychoactive medications became available, which led to lobotomies becoming obsolete. Freeman performed his last one in 1967; the patient died, and Freeman’s privileges were revoked.

In his 2005 book, “The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness,” El-Hai said he sought to understand what accounted for Freeman’s strong attraction to the procedure and why he continued to use it when he “had become a pariah in his specialties.”

Glenn Pait, M.D., director of the Jackson T. Stephens Spine & Neurosciences Institute, said it is important to realize that Freeman, Watts and Moniz were operating during a time when mental illness was poorly understood, and the options for treatment were limited.

“The lobotomy was viewed as a potential breakthrough that could provide relief for patients and families suffering from debilitating mental health issues,” he said. “Many patients were indeed helped. However, over time, the procedure was criticized for its ethical implications and severe side effects. leading to a decline in its use and the eventual abandonment of lobotomy as a standard treatment.”

El-Hai also discussed another of his books, “The Nazi and the Psychiatrist,” and the two books’ shared themes involving psychiatry, neurosurgery, history and ethics. “The Nazi and the Psychiatrist” has now been adapted into a film, “Nuremberg,” starring Russell Crowe and Rami Malek.

Douglas M. Kelley was a psychiatrist in the U.S. Army who during World War II focused on helping soldiers overcome what was then called “shell shock,” and what is now known as post-traumatic stress disorder, or PTSD..

After the war, the Allies asked Kelley to evaluate war criminals, including Hermann Gӧring, the second-highest ranking Nazi leader after Hitler and a key architect of the Third Reich, to understand the psychological makeup of individuals responsible for some of the worst atrocities in modern history. His task was to determine whether they were clinically insane, psychologically abnormal and mentally fit to stand trial in Nuremberg in 1945-1946.

“He examined these 22 prisoners up and down, every way, inside and out,” El-Hai said, because Kelley believed a “Nazi virus” must have led German soldiers to commit their heinous crimes and wanted to identify it — though ultimately he found that no such virus existed.

Gӧring was tried and convicted on charges of conspiracy, crimes against peace, war crimes and crimes against humanity, for which he was sentenced to death by hanging — though he committed suicide by taking cyanide the night before his scheduled execution.

But before his death, Kelley often spoke with Gӧring in his jail cell, and some of his observations were contained in a dozen banker’s boxes full of documents that Kelley’s surviving son, Douglas Jr., allowed El-Hai to study, after contacting him about writing a book about his father.

Years after his time at Nuremberg, Kelley spoke out against fascism and switched to the study of criminology, which he thought might answer the question of why the Nazis acted as they did, El-Hai said.

On Jan. 1, 1958, El-Hai said, Kelley got into an argument with his wife during a Rose Bowl gathering at the family’s home and, in front of their guests, ingested a container of powdered cyanide — dying within seconds, much as Gӧring had.

El-Hai said one reason he enjoys writing about subjects that explore the history of medicine is that “physicians and others working in the field come to their work as people. They’re human beings. Yes, they’re physicians, surgeons, whatever, but they bring their flaws and their virtues to their work, and I especially enjoying researching and writing about how those flaws and virtues express themselves in the practice of medicine.”

He said the research and writing sometimes present ethical challenges.

For instance, he said, most of his research for “The Lobotomist” came from the Walter Freeman and James Watts Archives at George Washington University.

El-Hai said he has been criticized in some book reviews for trying to humanize people like Walter Freeman.

He explained, “My books are not take downs. They’re not places for me to judge the people I’m writing about. What I’m trying to do is show the motivations of the characters and why they acted the way they did, to understand that. And if I can present that clearly, then readers can form their own judgments.”

The History of Medicine and Science Lecture series celebrates milestones, controversies and pioneers that have shaped our understanding of medicine, health, science and human progress, said Pait.

“Each year, a distinguished speaker presents a captivating story reminding us of how far we’ve come, what we have learned, and the challenges we still face,” Pait said. “From forgotten innovators and landmark discoveries to ethical reckonings, this lecture offers insight, inspiration and critical reflection for clinicians, scholars, students and the broader community.”