Lobotomy: The rise and fall of a miracle cure

Overwhelmed is the mother of a daughter who previously identified as transgender. Her daughter is now comfortable being female.  Overwhelmed can be found on Twitter: @LavenderVerse


by Overwhelmed

If you look back at history, some appalling medical treatments were once uncritically accepted.  Of course, hindsight is 20/20. It’s easy to critique from the future, now that we know better. But in the thick of it, members of the public don’t know better. They rely on medical professionals to guide them. And things can get out of hand when doctors promote bad science, the press sensationally markets it as a miracle cure, and the medical establishment stays silent.

Prefrontal lobotomies were performed in the 1930s to 70s, but were especially prevalent in the late 1940s to early 50s. The procedure was popular in many countries, racking up a significant number of patients:

 In the United States, approximately 40,000 people were lobotomized. In Great Britain, 17,000 lobotomies were performed, and the three Nordic countries of Finland, Norway, and Sweden had a combined figure of approximately 9,300 lobotomies.  …In Denmark, there were 4,500 known lobotomies, mainly young women, as well as children with learning difficulties. In Japan, the majority of lobotomies were performed on children with behavior problems. The Soviet Union banned the practice in 1950 on moral grounds, and Japan and Germany soon followed suit.

In the United States, the lobotomy pioneer and leading practitioner was Dr. Walter Freeman, a neurologist based in Washington, D.C. His story is featured in the hour-long 2008 PBS documentary, “The Lobotomist,” which I will quote from throughout this blog post. Here is the full transcript of the program.

freeman

Freeman believed that mental illnesses were caused by physical defects in the brain. In the spring of 1936 he came across a study conducted by Egas Moniz, a Portuguese neurologist, who took small corings from the brains of 20 patients with anxiety, depression and schizophrenia. Moniz claimed that the procedure eliminated symptoms in a third of them

Freeman built on the work of Moniz. He thought that disrupting the connections in the brain’s frontal lobes would bring patients relief from intense emotions and reset their personalities. Freeman didn’t have a license to perform surgery so he hired neurosurgeon James Watts. Later in 1936, Watts, under the direction of Freeman, performed their first lobotomy. He made incisions on the patient’s head, drilled holes through the skull, inserted a small spatula-like instrument into the brain and sliced through neural fibers connecting the frontal lobes to the thalamus.

Narrator: Four hours later, Alice Hammatt, the first patient to receive a lobotomy in the United States, opened her eyes. “Her face presented a placid expression,” Freeman noted, “By evening she was quite alert, manifested no anxiety or apprehension.” Excited by their results, Freeman and Watts began to do more lobotomies, acquiring patients from Freeman’s private practice.

After just a dozen operations, Freeman was ready to declare the lobotomy a success. He was confident in the procedure even if some patients relapsed (which prompted second, and sometimes third, operations). And even if there were some troubling side effects.

Edward Shorter, Medical Historian: Freeman’s definition of success is that the patients are no longer agitated. That doesn’t mean that you’re cured, that means they could be discharged from the asylum, but they were incapable of carrying on normal social life. They were usually demobilized and lacking in energy. And they were that on a permanent basis.

 Eventually Freeman sought an easier, quicker way to lobotomize patients. By 1946 he devised a new method to access the brain using simple tools—an ice pick and hammer. (The first ice pick was actually taken from Freeman’s kitchen drawer. But modifications were made over time. The tip on earlier versions occasionally broke during the procedure.)

lobotomy-instrumentAndrew Scull, Professor of Sociology: Freeman would peel back each eyelid, insert his ice pick and with a hammer tap through the brain, wiggle it about, sever the frontal lobes, withdraw it. And when the patient came to, he or she would be given dark glasses to hide the black eyes they’d been given.

 Freeman did the procedures himself, sometimes in his office. It took only a matter of minutes. He did not require an operating room and the equipment was portable, which made it convenient for travelling to mental asylums. (It was at this point that Freeman and Watts—who had grave concerns about the “ice pick” lobotomy being performed by those without formal surgical training—parted ways.)

lobotomy-eyeball

Initially Freeman’s procedure was heralded in the press as a miracle cure and correspondingly there was a rise in patients receiving lobotomies. But after the advent of antipsychotic medications and the poor outcomes noted in the first clinical trials, the procedure was recognized as barbaric and Freeman himself downgraded in the public eye to a charlatan. The history of medical fads (lobotomy being only one of them) tells us that pioneering doctors, and the medical establishment that embraces them, can fail in their duty to “Do No Harm.” That people, even those possessing medical degrees, are imperfect and can champion poor science.

Back in 1987, Dr. Valenstein (at the time a professor of psychology and neuroscience at the University of Michigan), reminded attendees at a science meeting that it was important to remember the history of the lobotomy. He warned that ”all the major factors that shaped its development are still with us today.”


valenstein

A few years ago, I believed that drastic treatments like the lobotomy could never again gain widespread acceptance. But I was wrong. It was quite a shock to realize how enthusiastic professionals were to medically transition young people like my daughter.

At initial glance, it may appear that lobotomies (which target assumed defects of the brain) and the medical transition of gender dysphoric children (which target assumed defects of the body) have little in common. But if you look past which body parts are “corrected,” you see that both are psychological conditions which were/are being treated by drastic, irreversible medical interventions. There are a number of parallels I’ll discuss in this post.

Desperate times call for desperate measures.

Both lobotomies and now the medical transitioning of young people were/are more easily accepted because of the environment in which they originated. A sense of hopelessness paired with yearning for a cure leads people to take chances they wouldn’t normally.

In the 1930s, anti-psychotic drugs weren’t yet invented. People suffering from severe mental illness were warehoused in overcrowded, underfunded mental asylums. The conditions were horrible. No one knew how to help these patients. Some were tied-up on benches. Others lay naked on the floor. Feces were sometimes smeared on the walls. And conditions became further strained with the return of shell-shocked World War II veterans. There was a huge impetus to find treatments to alleviate their symptoms and allow them to go home to their families. When lobotomies were introduced and touted as a cure, many chose to have loved ones undergo the procedure, rather than admit them to one of these terrible mental asylums– like the one exposed in this newspaper story:

pottstown

According to his son, Freeman felt justified in performing lobotomies because eliminating a patient’s intense suffering (and the associated high suicide rate) outweighed the loss of intellect and personality:

Walter Freeman III, son: …suffering the demons of mental illness. And he was trying to cure them of that, and the fact that they might turn into, let’s say, fat slobs afterwards was a small price to pay for the relief from this intense mental anguish. He pointed out repeatedly a very high rate of suicide of these individuals that they can’t stand this mental pain and he was helping them.

Currently, whenever a transgender-identifying child is discussed in the media, without fail a high suicide attempt rate is mentioned. It is implied by gender specialists that children will die unless fully “supported” in their chosen gender identities. We are told that proper pronouns, new clothes, a binder, puberty blockers, cross-sex hormones, mastectomies and genital surgeries may be necessary just to keep them alive.

This is just one of many examples found in today’s media coverage of trans-identifying children:

Neal found a therapist who told her and her husband to fully embrace Trinity’s female identity. She said that the therapist also gave strikingly blunt advice.

“She said, ‘Your daughter already knows who she is. Now you have to decide. Do you want a happy little girl or a dead little boy?'”

Gender specialists and trans activists continually scare parents with high suicide attempt statistics from a flawed survey study which did not ask whether suicide attempts occurred before or after transition; nor were co-occurring mental health problems controlled for in the study. Many highly publicized suicides of trans-identifying teens were young people who had been fully supported in their transitions by family, friends, and professionals (this phenomenon was discussed in this post, along with the risk of suicide contagion in vulnerable youth). One long-term study has shown that suicide rates, compared to those of the general population, are significantly higher in those who have medically transitioned.

If parents exclusively rely on distorted statistics or frank misinformation, it’s not surprising they would choose to medically transition their child. Nothing is worse than the prospect of losing a child to suicide.

 Someone other than the patient authorized/s treatment.

 During the lobotomy craze, many patients were not able to consent to the procedure themselves. Parents, spouses, and siblings were then called upon to make the decision. Many opted to have their loved ones lobotomized based upon a mental health professional’s recommendation. Some felt they were misled.

“I got the impression that it was no more serious than having a tooth extracted.”

There were family members who profoundly regretted their decision.

…her father opened up about the regret he felt about allowing the VA to lobotomize his brother. “The guilt came from the realization that it wasn’t as great as it was supposed to be and that he wasn’t able to be independent,” says Ms. Malzahn. “They thought it would make things all better, and it didn’t. In some ways, it made it worse.”

Currently, parents are responsible for approval of medical interventions for their under 18 year-old gender dysphoric children (although in Oregon it’s possible for 15 year-olds to get double mastectomies or other surgeries without parental consent). Based on media coverage, it appears quite a few children are undergoing gender-affirming treatment with parent approval.

A parent’s choice of what direction to take is highly influenced by the information sources they rely upon. Many gender specialists (and the media) paint a pretty rosy picture of what life can be like for gender dysphoric children if they are affirmed in their gender identity and given body-altering treatments so they can pass as the opposite sex. But this is an optimistic belief, based on opinion and anecdote, not solid evidence. Particularly since there is no media coverage of what life is like for those gender dysphoric children who are fully supported in being “gender nonconforming” but not endorsed in the idea that they are “really” the opposite sex.

Highly variable results.

Lobotomy outcomes were all over the map, which isn’t surprising if you consider the procedure itself was not exactly replicable. It was literally a “stab in the dark.” And Dr. Freeman’s patients—ranging from severely mentally ill adults to misbehaving children—had a wide variety of symptoms pre-treatment. Some suffered from a transient problem, which may have resolved by itself.

According to a Wall Street Journal article, lobotomy outcomes generally could be divided into three categories:

Drs. Freeman and Watts considered about one-third of their operations successes in which the patient was able to lead a “productive life,” Dr. Freeman’s son says. Another third were able to return home but not support themselves. The final third were “failures,” according to Dr. Watts.

Before and after lobotomy pictures (Case 121, 1942). Before: “Forever fighting…the meanest woman.” After: “She giggles a lot.”

lobotomy-before-and-after

 But the patients with successful outcomes still had concerning side effects. They often lost their ambition and weren’t able to make judgments or function well socially. Most were significantly changed, never to be the same person again.

A fellow 4thWaveNow parent, SunMum, shared this memory with me for this post:

It struck me a long time ago that my horror of surgical intervention for mental problems probably dates from my memory of seeing my mother’s best friend who had had a lobotomy. It was one of the tragedies of my mother’s life. She told me that her friend had been ‘brilliant and beautiful’. They were both unusual as female students at the London School of Economics in the 1930s. The friend had a breakdown after her husband left her for another woman. As her next of kin, it was the husband who gave permission for the lobotomy. The friend would come to London at Christmas and stay in a hotel. We would meet her for tea. She was capable of flat small talk but nothing else. She did not show any feeling.

 A few patients were fortunate enough to have no noticeable side effects. For them, having a lobotomy appeared to bring great relief. But these patients were relatively rare.

A significant number of post-op patients were reduced to a persistent vegetative state. And for others, the operation was fatal.

Narrator: At Cherokee state hospital in Iowa, three of Freeman’s patients died on the operating table, one after Freeman’s ice pick slipped while he was taking a photograph. Without pausing, he packed up and left for his next demonstration.

Statistics from the Veterans Administration (which performed approximately 2,000 lobotomies), kept track of how many died as a result of the procedure:

The VA did try to determine whether the benefits outweighed the risks. And the risks were severe. Overall, 8% of lobotomized veterans died soon after the operation, according to a 1947 document. One hospital reported a 15% fatality rate.

There are a variety of outcomes to medical gender transition as well. Some people say that transitioning is life saving. Some react poorly to cross-sex hormones or have surgical complications. Some decide to de-transition and/or re-identify as their natal sex. And some even die due to medical transition itself (here is an analysis of a 2014 Dutch survey study in which one patient died from complications of surgery).

Treatment based on theories, not solid evidence.

 As the patient caseload of Freeman and Watts grew, they gained confidence in their technique and wanted to share it with colleagues. They presented their findings at a Baltimore medical conference.

Andrew Scull, Professor of Sociology: Freeman got up to announce that they had a new cure for mental illness. This was a very dramatic and highly charged occasion. There were angry interjections from the audience. There were questions. There were attempts to even shout him down.

 Jack El-Hai, Writer: Some of them were simply astonished that he would even try such a thing, and a few were outraged that he would try an untested procedure like this.

 Narrator: Freeman begged his audience for time. It would take months, even years, he argued, to properly evaluate the progress of lobotomy patients. Meanwhile, he promised, lobotomy would remain ‘an operation of last resort.’ But Freeman knew that ultimately it didn’t matter how much other doctors might oppose him; their disapproval would never reach the outside world. 

Elliot S. Valenstein, Professor of Neuroscience: At that time, it was considered unethical to publicly criticize another physician. So people didn’t write critical articles, they may have talked among themselves, they may even have raised critical questions at a meeting. But they did not write anything that would stop him from continuing his work.

Freeman was undeterred by their criticism and plowed ahead, convinced that lobotomies were the best option for treating mental illness. Fellow doctors remained silent. The lobotomy craze was largely unchecked until the mid-1950s.

But even after the medical establishment turned against him and his procedure, Freeman moved to the west coast where he continued performing lobotomies until 1967. And maybe he would have kept operating if his hospital privileges had not been revoked. The hospital took this action only after one of Freeman’s patients died from a brain hemorrhage. (It was her third lobotomy.)

As has been discussed many times on 4thWaveNow, there is a dearth of research that backs up the medical transition of children. The current protocol being used in the United States is based on best guesses, not solid evidence. However, this has not been a barrier for children being treated with puberty blockers and cross-sex hormones, nor has it stopped them from receiving mastectomies, hysterectomies and genital surgeries.

In the United States, the first pediatric gender clinic opened its doors in 2007, and since then many similar clinics have popped up across the country. But it wasn’t until May of 2016, almost a decade later, that an NIH-funded study was launched to record the effects of puberty blockers and cross-sex hormones on gender dysphoric youth. The results won’t be published for years; and since the study follows patients for only 5 years, longterm outcomes won’t be know for decades . In the meantime, concerned professionals, for the most part, remain silent and it appears that medical transition of youth is proceeding at an accelerated pace.

The power of the press.

Dr. Freeman used the media as a promotional tool. He often had newspaper journalists and photographers waiting for him at mental asylums.

Narrator: Aware of the power of public relations, Freeman aggressively courted the press. Soon he was receiving glowing reviews in major publications. The Washington Star called lobotomy “One of the greatest surgical innovations of this generation.” The New York Times called it “surgery of the soul,” and declared it “history making.”

 In 1941, the Saturday Evening Post, described how patients felt before and after lobotomies: “A world that once seemed the abode of misery, cruelty and hate is now radiant with sunshine and kindness to them.”

saturday evening post.jpg

Robert Whitaker, Writer: We think of science as having this sober sort of process, something is introduced, it goes to a medical journal, it’s peer-reviewed there. Freeman sort of bypassed that process because he in fact knew he was going to get a lot of resistance and he brings the press into it right from the beginning. And the press — they’re always eager for miracle surgery, it sells papers and so, next thing you know, you start having this story out there, not of damaging the brain, but of plucking madness from the brain, and it’s such a story of progress.

 A 1999 study analyzed popular press coverage of the lobotomy and its potential influence on how quickly acceptance of the procedure spread. The Abstract:

 This study analyzed the content of popular press articles on lobotomy between the years 1935 and 1960. Both a qualitative and quantitative analysis provided evidence that the press initially used uncritical and sensational reporting styles, with the content of articles on lobotomy becoming increasingly negative through time. The initial positive bias occurred despite opposing views in the medical community, which provided a basis for more balanced coverage. These findings support the theory that biased reporting in popular press articles may have been a factor influencing the quick and widespread adoption of lobotomy as a psychiatric treatment.

I don’t know if you caught that, but there were “opposing views in the medical community” that journalists often omitted. In 1941, the American Medical Association issued “a warning about several negative effects on personality including apathy, inappropriate social behavior, and lack of initiative (i.e., the frontal lobe syndrome).”

Also of interest in the study were these statements: “In addition to sensationalizing the positive effects of lobotomy, articles during this time period rarely discussed risks involved in the operation.” and “…in most cases mention of negative side effects was either absent or cursory.”

Currently there are nearly daily examples of trans kid media stories. They tend to be pretty formulaic. From an early age, the child realizes they feel different from their peers. A girl that throws a fit when mom puts her in a dress; a boy that wants to wear a dress. In general, preferences in clothes, toys and haircuts are used to validate that they are transgender. The child (or parent) finds out about transgender through the internet, on the radio or television and latches tightly onto that explanation. They either want to avoid the “wrong puberty” (which brings puberty blockers into the discussion) or have struggled through puberty and want to correct their bodies with cross-sex hormones and surgeries. Parents sometimes admit that they didn’t immediately believe their child was transgender. But when they learn of the suicide statistics, then they get on board. To drive the point home, the article quotes a gender doctor or therapist, a purported expert in the field, who states unproven theories as if they were settled science.

There are in fact opposing views in the medical community; views based on years of experience and research in gender identity clinics. But reporters who churn out the celebratory articles about “trans kids” rarely mention contrary views, nor do they ask any inconvenient questions of the parents who unquestioningly “affirm” their offspring. Recently, troubling new questions have been raised about Lupron, a GnRh agonist, but the reporter covering that controversy omitted the fact that Lupron is the drug used most commonly (off label) to block puberty in “trans” kids. With few exceptions, journalists focus on the feel-good aspect of the child being accepted as the opposite sex, a triumph over adversity. Not much time (if any) is spent discussing the significant risks associated with medical transition. Biased media coverage like this is likely contributing to the rapid increase in children presenting to gender clinics.

Embraced by the medical community.

 Initially many of Dr. Freeman’s fellow doctors were reluctant to embrace the lobotomy as an acceptable treatment, but that soon changed. Thanks to favorable newspaper articles, Freeman became somewhat of a celebrity. The public believed that he had found a miracle cure. His services were sought after.

Additionally, state-funded mental asylums were overcrowded and seriously underfunded, some so financially strapped that they were on the verge of closing. Freeman began travelling to these institutions, promoting lobotomies as a cost-cutting measure. The more patients that were discharged, the greater the savings. The procedure was seen as a godsend by many overworked asylum doctors and administrators.

Freeman aggressively championed his cause, even convincing the federal government via the Veterans Administration to perform lobotomies on veterans.

In 1948 Freeman was elected president of the American Board of Psychiatry and Neurology. In 1949 Egas Moniz, whose work inspired Freeman’s procedure, was awarded a Nobel Prize for psychosurgery. (He was nominated by Freeman.) The lobotomy gained further credibility.

Narrator: By decade’s end lobotomy had won the acceptance of mainstream medicine. Lobotomies were being performed at Johns Hopkins, Mass General Hospital, the Mayo Clinic, and other elite medical institutions.

Currently, there appears to be widespread acceptance of medical interventions for gender dysphoric youth. Clinics all across the country, many of which are part of elite Children’s Hospitals, are providing gender care for kids. It is becoming more common to obtain insurance coverage for puberty blockers, cross-sex hormones and surgeries. And laws  have been passed in some states that forbid therapists from trying to change children’s gender identities. Many mental health professionals seem to believe their duty is to simply affirm children’s gender identities, not to explore why there is a mind-body disconnect.

Lambda Legal has a handy list of organizations (last revised in 2012) that declare support for transgender people in health care. Here are AMA and APA statements:

 

Expanding the patient base.

Dr. Freeman barnstormed mental asylums, operating on many patients in each location. He was frequently gloveless, mask-less and sometimes sleeveless. Once he performed 25 transorbital lobotomies in a single day.

gloveless-freeman

(He appeared to enjoy surprising his audience. On some occasions, Freeman would start out operating using his right hand, and half way through switch to using his left hand. Other times he would an insert ice pick under each eyelid and simultaneously lobotomize through both eye sockets. Sometimes doctors in the audience would faint, or even vomit.)

While at the institutions, he would train others in his craft.

Andrew Scull, Professor of Sociology: He was convinced this was an operation which could be replicated very easily. As he put it, “Any damned fool, even a hospital psychiatrist could learn it within an afternoon.”

Freeman trained one psychiatrist in Rusk, Texas who performed 75 lobotomies in one day.

Narrator: Spurred on by Freeman, the number of lobotomies performed annually soared from 150 in 1945 to over 5,000 in 1949. Despite the known side effects, there seemed to be an endless supply of willing patients.

The momentum of lobotomy enthusiasm was greatly slowed in the mid-1950s by the advent of a pharmaceutical and results published in medical journals. An antipsychotic drug called Thorazine, promoted as a “chemical lobotomy,” became increasingly used. Also, the first long-term clinical studies of lobotomies were assessed by the medical community. Now that doctors had published proof of lobotomy’s negative side effects, and there was a suitable alternative, the medical establishment quickly turned against Dr. Freeman and his procedure. He no longer felt welcome in Washington, D.C. and moved across the country to California.

Freeman did not give up on performing lobotomies. On the contrary, he cultivated new categories of patients to treat. Disaffected housewives, people with chronic headaches, and misbehaved children were all fair game.

Andrew Scull, Professor of Sociology: If housewives found their early 1950s existence too depressing for words, why Freeman had a solution that would get them through their day happy as little clams. If children were misbehaving, conditions we might now see being called hyperactivity disorder, why they might need a lobotomy.

Nineteen of Freeman’s patients were children under the age of 18. One was only 4 years old.

 For pediatric gender care, the actual patient numbers in the United States are difficult to determine. But based on the fast-paced expansion of gender clinics across the nation, the patient load has likely escalated similarly to what has been seen in the UK:

gender-clinic-stats

The first gender clinic in the US opened in 2007 in Boston. An October 2016 article states there are now more than 60. The demand is growing quickly, but there are still waiting lists for new patients. Based on this information, in conjunction with the growing number of 4thWaveNow parents (many who note the number of trans-identifying students in their local schools are multiplying), it appears that the cases of young people with gender dysphoria are skyrocketing.

Attempts to “cure” sexual orientation and gender non-conformity.

During the lobotomy’s reign, homosexuality was considered a mental disorder. Cruel “treatments” of this time period included chemical castration with cross-sex hormones, aversion therapy (using electrical shocks or vomit-inducing drugs) and masturbatory reconditioning. Lobotomies were also performed on patients like this gay man who was a patient at Pilgrim State Psychiatric Center in Long Island, New York.

CASE NO. 236 Man, 29, “had a psychotic attack [at age 19] and responded satisfactorily to 44 insulin comas.” Admitted to Pilgrim at age 20. “In the years which followed, this patient was consistently one of the most severe behavior problems, aggressively homosexual, out of contact, noisy, disturbed, overactive; he wet and soiled.” Lobotomy on Feb. 15, 1949. “Slow improvement. He was clean, pleasant, but mentally defective— a moron. He speech was clear but brief. On the insistence of his parents, he was released on June 15, 1949 but returned after a few weeks because of restlessness and poor judgment. There is no severe behavior problem, but he is hebephrenic— silly. He is now clean, quiet, passive, well-behaved, probably hallucinated, speech brief but rather scattered, but he is well-informed on current baseball scores, etc.”

At 4thWaveNow, we have repeatedly stressed that the majority of gender dysphoric children, if left alone, will grow out of their distress. Most mature into lesbian and gay adults. Sexology researcher Dr. James Cantor  posted a compilation of childhood gender dysphoria research going back many decades on his site Sexology Today:

In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

When seen from this perspective, it is difficult to ignore the impacts on children who would likely grow up to be homosexual. “Trans kid” media stories are full of “gender nonconforming” behavior, which is often a sign a child or teen is or may eventually be gay or lesbian. Frequently, a preteen or teen even admits that he/she is attracted to the same sex. But parents in these celebratory articles conclude that their child is transgender and needs irreversible medical interventions. (Strangely,  journalists never question it.)

Since puberty is often the time that gender dysphoria resolves (and sexual orientation begins to be self-recognized), the use of puberty blockers (along with the reinforcement from gender therapists that the child is in the “wrong body”) likely prevents many young people from ever becoming comfortable in their unaltered bodies. Further, the vast majority (some clinics report 100%–see here and here) of children on puberty blockers proceed to cross-sex hormones, irreversible sterilization, and possibly later surgeries.

Earlier interventions to prevent potential problems.

 Initially Freeman claimed that the lobotomy would be an operation of last resort. He once said, “I won’t touch them unless they are faced with disability or suicide.” But as time went on he altered his views. He started advocating for lobotomy earlier, as a way to prevent progression of mental deterioration. In a 1952 Time article (“Mass Lobotomies”), he is quoted as saying, “it is safer to operate than to wait.”

The push for early intervention is also seen in medical transition of “trans” kids. Initially it was reserved for gender dysphoric adults, but now children are increasingly being treated. The justification: if gender dysphoria is caught while they are young, they can avoid the years of misery that many older trans people report. It is assumed that treating children with puberty blockers, cross-sex hormones and surgeries will help them appear more convincingly as the opposite sex. This, along with consistent affirmation of their gender identity, is assumed to help these children avoid suicidality, depression, unemployment, sexually transmitted diseases, drug abuse and homelessness commonly found in the current adult transgender population. Gender doctors state they are saving these children from potential future problems (without acknowledging the significant risks introduced by treatment).

“These kids have a very high risk of depression, substance abuse, suicidal thoughts, and suicide attempts,” said Stephen Rosenthal, MD, a pediatric endocrinologist and medical director of the Child and Adolescent Gender Center at UCSF Benioff Children’s Hospital San Francisco …. “Not treating is not a neutral option.”

Ambitious doctors.

Freeman came from a prominent medical family. His grandfather William Keen was a famous surgeon, the first to extract a brain tumor from a living patient. He enjoyed being a showman, performing operations which were viewed by large audiences. Freeman looked up to his grandfather and wanted to be as successful.

Early in his career Freeman became determined to alleviate the mental anguish of patients in the overcrowded, horrible conditions of mental institutions. Early on he spent a great deal of time examining the brains of dead mental patients, trying to find a defect which could be corrected. But he was never able to find any.

He was thrilled to come across Portuguese neurologist Egas Moniz’s work, which became the basis for Freeman’s lobotomy procedure.

Jack El-Hai, Writer: Freeman almost went wild with excitement. He thought, ‘This may be it.’ He saw a vision of the future unfold, not only a future in the treatment of the mentally ill, but his own personal future.

He latched tightly onto lobotomies as a way to bring patients a sense of peace, and never let it go. Freeman appeared to genuinely believe he was helping people by lobotomizing them, but seemed blind to the negative impacts of his procedures. It was as if he was looking through rose-colored glasses.

Andrew Scull, Professor of Sociology: One of the characteristics of an enthusiast, and Walter Freeman was certainly that, is that they are able to overlook everything that contradicts their enthusiasm. And they concentrate on all the things they see that show they’re on the right path. So over and over again, we can see Freeman managing to dismiss the casualties of his surgical interventions.

On the medical transition front, Dr. Norman Spack, a pediatric endocrinologist, in 2007 co-founded the first US gender clinic for youth in Boston.

In media articles, Dr. Spack appears to be a compassionate person who is concerned about gender dysphoric children. Over and over again, he talks about suicide rates  He implies that kids desperately need medical treatment because otherwise many of them will kill themselves, especially if they are unable to avoid their natal puberty.

World trans authority Dr. Norman Spack, a pediatric endocrinologist (or hormone doctor for children), warned the dangers of failure to treat trans teenagers. He said almost one in three trans individuals will attempt suicide if they do not receive treatment until after puberty….

…‘If your neighbor is bleeding, you should not stand idly by,’ Spack said, quoting Jewish philosopher Maimonides, and adding: ‘For trans people, the inevitable conclusion is that puberty is noxious.’

 He is a big proponent of using GnRH-agonists (commonly known as puberty blockers) to pause the puberty of gender distressed children. “Safe,” “reversible” and “life saving” are often words that gender specialists use to describe these pharmaceuticals. But there have been severe side effects reported, especially when administered to children.

This June 2015 article discusses what inspired Spack to incorporate puberty blockers into his treatment protocol:

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

“I was salivating,” he recalled. “I said we had to do this.”

The puberty-blocking protocol gained legitimacy in 2009, when it was endorsed by the Endocrine Society, the leading association of hormone experts, on the recommendation of a task force including Dr. Spack.

 In August 2012, it was reported that Spack has trained many other gender professionals across the United States and in Canada.

Today, clinics for transgender kids in British Columbia, San Francisco, Los Angeles, Chicago, Denver, Minneapolis, New York, Hartford, Providence, and Washington, DC, have either been created or expanded. And in almost all of these places is a doctor that Spack has trained, mentored, or guided.

 And this October 2016 article states that Spack’s program has spread to over 60 pediatric gender clinics in the United States.

His program, copied in over 60 centers across the US, provides treatment including hormone blockers – ideally at the onset of puberty – and hormones for trans teens according to need and capacity to understand the implications of what was being done.

Spack says that treating gender dysphoric children is less complicated than it would seem:

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Many parents at 4thWaveNow are concerned that we may be in the midst of another disastrous medical fad. Our kids’ sudden change in gender identities has been easily accepted by their peers, schools, therapists and doctors. Puberty blockers, cross-sex hormones and surgeries are routinely encouraged as necessary next steps. The level of enthusiasm is stunning. There is an absence of caution. We don’t know how many young people will grow up to regret their permanently altered bodies. Which of them will wonder what their lives could have been like had they not taken this path? Some families in our community have witnessed their daughters or sons desisting from trans identity, and finding peace in their own skins—but in just the nick of time, and against the recommendations of enthusiastic gender therapists. These young people matter just as much as those who are being encouraged to believe they are the opposite sex and have begun medical transition. Who speaks for these desisters?

The no-holds-barred, uncritical championing of child transition now will eventually fizzle. Lessons will be learned. Science will evolve. And eventually books and documentaries may try to explain how things got so out of hand. How long that will take is anyone’s guess.

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