As a young girl in the early 1900s, Rosemary Kennedy—the eldest daughter of the auspicious Kennedy family—was beautiful, affectionate, and mild-mannered. But her life story pivots on what became perhaps the centuryc's most chilling manifestation of the fear, shame, and ignorance that surrounds mental health: the lobotomy.
Two books out this month weave the lobotomy's horrific turn as a "cure" for mental illness with a uniquely and totemicly American family: the Kennedys. Kate Clifford Larson's biography Rosemary: The Hidden Kennedy Daughter and Elizabeth Koehler-Pentacoff's The Missing Kennedy: Rosemary Kennedy and the Secret Bonds of Four Women each render in painstaking and heartbreaking detail the story of JFK's intellectually disabled oldest sister, her efforts to fit in to the ambitious Kennedy clan, and the lobotomy that left her permanently incapacitated at the age of 23. And although mental illness remains shrouded in shame for many, to read Rosemary's story is to be reminded of how the perception and treatment of mental illness has evolved over the past 70 years.
In the early 1940s, the lobotomy was being aggressively marketed in America by Dr. James Watts, and his associate, Dr. Walter Freeman. Despite the fact that they were both psychiatrists at the George Washington University Medical School, not surgeons, the duo considered themselves qualified to perform lobotomies, which required severing the connective tissue from a patient's frontal lobes to the rest of the brain.
The procedure had been pioneered by a Portuguese neurologist, Antonio Egas Moniz, who had experimented with drilling into the skull to access the brain. (He would later win the Nobel Prize in medicine for his procedure, which he called the leucotomy). Watts, Freeman, and a handful of other doctors claimed that a surgery like this could be used to treat a wide range of mental illness, including major depression, schizophrenia, obsessive compulsive disorder, and acute anxiety. The pair had begun performing lobotomies in the 1930s, picking test patients up at sanitariums and taverns, to experiment on a part of the brain that was not widely understood.
Early 20th century attempts to cure mental illness included such cringe-worthy variants as opium-induced comas; the removal of thyroid glands, ovaries, tonsils, or teeth; the injection of horse blood; and carbon dioxide inhalation sessions.
Watts and Freeman, who once experimentally performed a lobotomy with a pick-axe through a patient's eye sockets, were masters of public relations. The duo garnered favorable mentions in TIME, LIFE, and Newsweek—despite the American Medical Association's warning that "serious defects" had been noted after the surgery, among them complete loss of cognition and death.
And yet, it is not difficult to see why the lobotomy was seized upon as a potential miracle cure: People were desperate for one. The stigma attached to mental illness and the guilt cast upon the parents of intellectually or mentally disabled children combined with the insufficiency of the solutions presented created an opening for hucksters like Watts and Freeman. As Koehler-Pentacoff chronicles, early 20th century attempts to cure mental illness included such cringe-worthy variants as opium-induced comas; the removal of thyroid glands, ovaries, tonsils, or teeth; the injection of horse blood; and carbon dioxide inhalation sessions.
Desperate families unsure of how to help their children were encouraged to send them to sanatoriums and mental hospitals. These institutions were often difficult to staff, and were consequently manned by criminals and others with abusive tendencies. Conditions often actually resembled prisons, with patients kept in appalling sanitary conditions with little fresh air, exercise, or even access to natural light.
So it is no surprise that the lobotomy—hailed as a miracle cure for all varieties of mental illness—received such a warm reception. It was a solution to problems like Rosemary Kennedy.
The Kennedys were keen to project and protect the veneer of effortless perfection and vitality they cultivated. Especially at a time when intellectual disability was not well understood, Rosemary's stain on their reputation made the family anxious. Family patriarch Joe P. Kennedy censored his daughter's letters home when he was the American Ambassador to the Court of St. James, lest the press see her juvenile handwriting. The family forbade anyone outside an immediate circle of family and close confidants from knowing the extent of her disabilities, and her mother, Rose, neglected even to tell Rosemary's tutors, aides, and teachers about her daughter's disability. Her brothers passed along news to their father about what their classmates thought of Rosemary, indicating as positive news that no one could tell she was disabled.
To be slower—both mentally and physically—than the other eight siblings was particularly difficult for Rosemary, according to personal accounts cited in each of the new biographies. After stints in multiple special schools with extensive extra tutoring and assistance had failed to progress Rosemary beyond fourth or fifth grade, she briefly found bliss at a school run by nuns in the English countryside while her father was working as an ambassador in London. But World War II ruined the idyll, and after returning to America, Rosemary's condition deteriorated. She grew increasingly frustrated with her inability to partake in the same activities as her siblings. Increasingly tense and irritable, she would often fly into rages. Frequent convulsions suggest that she may have developed epilepsy in her late teens.
At his wits end over what to do with Rosemary, and concerned that she would unwittingly embroil herself and the family in scandal and jeopardize the family's political aspirations, Joe turned to a drastic and largely untested procedure: the lobotomy.
Joe sent Rosemary to the "experts" Watts and Freeman, who shaved her curls and strapped her to an operating table to perform the surgery. But the procedure was a disaster. While Rosemary had simply been slower than average before the surgery, she was left completely incapacitated afterward. She couldn't walk or talk for months following the procedure, and needed extensive therapy to regain even some of her facilities in either area. In her telling of the story, Larson writes that the nurse who attended Rosemary's surgery was so horrified by its result that she left the medical profession entirely.
Traumatized by what he had done to his daughter, Joe tried to hide the extent of Rosemary's debilitation from his family. She was institutionalized—first, a few hours north of New York City at the same sanatorium where Zelda Fitzgerald spent time in the 1930s; then at a Catholic school for "exceptional children," in Wisconsin, where her father built her a cottage tended to by nuns, where she lived for the rest of her life.
Much of Rosemary's life—and especially the horrors of her young adulthood, post-lobotomy—has been covered up. In her biography, Larson notes that hundreds of documents from Rosemary's life appear to be missing from the Joseph and Rose Kennedy Papers at the Kennedy Library in Boston. As the Kennedy family ascended to American royalty, Rosemary was largely forgotten.
Roughly 50,000 lobotomies were performed in the United States, mostly on women. Freeman alone performed 3,439 lobotomies, despite a 14 percent fatality rate. By the mid-1950s, due to its poor success rate, the lobotomy was largely replaced with the emergence of psychiatric drugs.
In the 1960s, both Rose and her daughter Eunice became advocates for the mentally disabled, and gradually began to speak more publicly about what had happened to Rosemary. Society had become increasingly concerned with humane treatment of the mentally disabled, in part through President Kennedy's championing of legislation on behalf of the intellectually disabled. The Kennedys chose to dedicate their foundation and its considerable resources to children with mental disabilities; the Special Olympics and Best Buddies International are both Kennedy initiatives that advocate for those with intellectual and developmental disabilities.
Mental illness in America is still not properly addressed or understood. Cures for mental illnesses, when sought, often prove too elusive or expensive to make a difference. But the fact that living history saw one of the most well-connected and well-heeled families in the country lobotomize their daughter in desperation, and that such a thing will never happen again, is the glimmer of positivity in Rosemary's grim story.
Follow Elizabeth Nicholas on Twitter.