Book Review

Janet Sternburg’s White Matter is a disquieting read. How could it not be? In it, Sternburg explores her family’s decisions to lobotomize not one but two family members—her mother’s brother Bennie in 1940 and mother’s sister Francie in 1958—and the repercussions of those decisions. White Matter is part memoir and family history; part reporting on Sternburg’s research on lobotomies drawn both from the media and from scholarly books; and part what she terms “scrupulous imagination,” fictive renderings of her relatives’ conversations and thoughts.

Sternburg’s mother’s family lived in an apartment in the Roxbury neighborhood of Boston in the first half of the twentieth century. Both parents were Jewish immigrants from Eastern Europe; their six children were born between 1904 and 1920. By the mid-1920s, it was clear that fourteen-year-old Bennie, the only son, had changed “from a bright-eyed boy to a stranger who dropped a neighbor’s cat from a roof, who stood frozen then ranted, spewing out words that made no sense.” A family acquaintance, the neurologist Abraham Myerson, diagnosed Bennie with what was then commonly labeled “dementia praecox,” now known as schizophrenia. Soon after, Bennie attacked his younger sisters with a knife and was committed to a state insane asylum. Bennie cycled in and out of asylums for years: in when he became violent, out again because of his mother’s anguish at his situation in state asylums, which were then overcrowded, understaffed, and with too few and inadequate treatment options for the seriously mentally ill. In 1940, Bennie’s sisters, apparently without much input from either parent, made the decision to have their brother lobotomized. “It was the times,” Sternburg’s aunt Minna says.

“The times,” it turns out, are inseparable from the story Sternburg tells. What were the times?

In The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness, Jack El-Hai explains that at the Second International Neurological Congress in London in late July 1935, Yale neurophysiologist John Fulton presented his research on an aggressive, agitated chimpanzee that calmed after the removal of its frontal lobes. In attendance at Fulton’s lecture were two neurologists who took Fulton’s research from chimpanzees to humans with psychiatric illness: Portuguese Egas Moniz and American Walter Freeman. In November 1935, Moniz performed his first “leucotomies” on inmates of a Lisbon insane asylum and wrote about the results in a paper that appeared in the spring of 1936. Almost immediately after Freeman read Moniz’s paper, he began to operate. By the end of the year, he had performed twenty lobotomies—the word “lobotomy” itself is Freeman’s invention—with his colleague neurosurgeon James Watts and had begun to report on the procedure to the scientific community and the press. In an article titled “Surgery Used on the Soul-Sick,” published in the New York Times on June 6, 1937, William Lawrence wrote about “a new surgical technique, known as ‘psycho-surgery,’ which, it is claimed, cuts away sick parts of the human personality, and transforms wild animals into gentle creatures in the course of a few hours.” “Psycho-surgery” spread to Boston when neurosurgeon W. Jason Mixter performed one lobotomy in 1938 and a second in 1939 at Massachusetts General Hospital, as described in Jack D. Pressman’s Last Resort: Psychosurgery and the Limits of Medicine.

This would make Sternburg’s Uncle Bennie one of the first to receive a lobotomy in Massachusetts. “In 1940,” she writes, “Abraham Myerson knocked at our family’s door once again.” Sternburg, born in 1943, does not know exactly what it was Myerson told the family to convince them that a lobotomy was Bennie’s best, or perhaps last, option. She imagines the sisters’ conversation as they made their decision, and writes, “My mother and aunts were caught in something they couldn’t fully comprehend, invented by men far away from them in geography and status, hampered in their decision by believing they weren’t good enough. They brought to the decision all the tangled strands of their lives”: their exhaustion and longing for normalcy after many years of fear and anxious uncertainty provoked by having Bennie in the family; their respect for Myerson’s authority as doctor and scientist; their sense of responsibility as siblings to do the best thing available for their brother.

Gaps in Sternburg’s narrative make one wish to know more—both about their particular family history and the far wider context of medical history within which the family was caught—to understand how this decision was made. Sternburg precedes the account of Bennie’s lobotomy by describing his violent outbursts, in particular one against her four-year-old cousin; but that episode was in 1934, six years before Bennie’s lobotomy. What happened to Bennie in those intervening years? Why was it Bennie who was recommended by Myerson for this early lobotomy, and what role did Myerson play in the rush to embrace lobotomy as a solution to chronic mental illness? Was it Mixter, Boston’s lobotomy pioneer, who performed the surgery? After the lobotomy, “[Bennie] looked more or less the same. But he was not as he had been. He didn’t speak. He walked slowly, and once he sat down he barely moved. He didn’t react to anything or anyone around him.”

El-Hai points out that despite the American Medical Association’s 1941 statement that it was “inconceivable that any procedure which effectively destroys the function of this portion of the brain could possibly restore the person concerned to a wholly normal state,” and despite the fact that Freeman himself apparently thought after a decade’s worth of lobotomies that they “benefitted about one third of those who underwent it and thus left 67% just as badly or worse than before surgery,” the number of lobotomies performed in the United States dramatically increased during the forties and fifties. A year after Bennie’s 1940 lobotomy, John F. Kennedy’s sister Rosemary was lobotomized by Freeman, a procedure that left her needing care for the rest of her long life. In the years following World War II, almost two thousand veterans with psychiatric illness were lobotomized in VA hospitals across the country, as pointed out by Michael M. Phelps’s excellent online report in the Wall Street Journal. In 1946, Freeman developed a new procedure called the “transorbital lobotomy,” or “icepick lobotomy,” a rapid method that could be performed by a psychiatrist, like Freeman himself, instead of a neurosurgeon, and used electroconvulsive shock instead of anesthesia. In the years that followed, Freeman traversed 11,000 miles and visited 53 hospitals in 23 states, a traveling salesman for transorbital lobotomy. When in 1949 Egas Moniz received a Nobel Prize in Medicine “for his discovery of the therapeutic value of leucotomy in certain psychoses,” lobotomies received further legitimization. According to El-Hai, twenty thousand people in the U.S. had lobotomies in the four years after the Nobel announcement.

In 1958, following three years of suicide attempts, hospitalizations and shock treatments, Sternburg’s aunt Francie, Bennie’s sister, was lobotomized. Although we learn that Francie begged her doctors to stop the shock treatments and did not want to be lobotomized, Sternburg only begins to imagine what Francie, a woman who seems to have been conscious of her fate and would have had her lobotomized brother in mind, might have been thinking. She imagines Francie sitting at night on the edge of her hospital bed while her sisters and brothers-in-law discuss her fate in Minna’s living room; she imagines Francie visited by an apparition of Bennie:

She looks at him silently, at the face without expression that haunts her. She is seeing what she may become. Knowing he can never answer, she cannot ask: “My brother, what should I do?”

For the writer as well as for her readers, it is perhaps too painful to visualize, then render in writing, the thoughts of a relative on the eve of her lobotomy.

It is this second lobotomy that raises Sternburg’s most searing questions. In writing White Matter, Sternburg has taken personal torments and thrown them back to the rest of us, among them:

How had my aunts found ways to live with what they’d done? For that matter how do any of us go on after facing up to the damage we’ve inflicted?

And what if we don’t face up? Is there something we can do with guilt so it doesn’t just stop inside and start to eat away at our compromised hearts?

White Matter is a reckoning with that snarl of emotions the family lobotomies left entangled in Sternburg: the horror at the operations themselves; the worry of the child growing up in a family that had condoned these lobotomies; the blame; and, ultimately, some measure of loving understanding for the mother and aunts who thought they were doing what was best. Like Sternburg and presumably over twenty thousand other families of lobotomy recipients in the United States alone, readers will remain troubled that what was done was unalterably done.