DES MOINES - Nearly 60 years later, it's hard to understand why a doctor performed life-altering brain surgery on Dick Meredith, a young man with relatively mild mental problems.
Meredith, who died in a state institution in Clarinda in September, was one of the last survivors of what is now widely considered a barbaric medical practice. He was one of tens of thousands of Americans who underwent lobotomies in the 1940s and '50s.
Meredith's older sister, Cleojean Olson of Des Moines, said he started showing signs of anxiety and repetitive behaviors as a teenager. Her descriptions, bolstered by hundreds of pages of faded, typewritten medical records, portray a young man who today might be diagnosed with a moderate form of autism or a similar condition.
His family's recollections and the records, shared with The Des Moines Register, offer a rare view into how the now-scorned procedure forever robbed a patient of the ability to live independently and to have a coherent conversation.
As a teenager, Meredith liked playing basketball, reading books and singing along to Bing Crosby songs on the radio. He had a few friends, but he became increasingly shy. He usually looked at the ground when people spoke to him.
The young man also had several tics. He often made a repetitive, throat-clearing sound, his sister said. He would use a finger to rub his palm or his nose, over and over and over, until his skin cracked and bled. He also would recite incredibly detailed statistics about the Chicago Bears and other favorite sports teams.
High school urged institutionalization
Records recently retrieved by his family say that by 10th grade at Des Moines' Roosevelt High School, Meredith was having trouble in class and was not completing his homework. The records indicate he was unmotivated. A test determined his IQ score was 67, "which places him within the high moron classification of intelligence," someone wrote in his chart.
His sister disputes that conclusion, saying he was bright in unusual ways.
At the time, many families kept such people out of sight.
"They institutionalized anybody who was even a little off. That's just what they did back then," said Dana Vasey, who is Olson's daughter. "It was a time when people didn't want kids who had problems like that. It was embarrassing."
When Meredith was 16, his parents followed school officials' recommendation that he be placed in an institution, the records show.
When he was admitted to the state mental health system, a staff member wrote a report that now reads like it's describing a slightly troubled teen. "He is Protestant, likes basketball, track and has a good singing voice," the staff member wrote. "... This friendly, pleasant boy is an introvert and has no facial expression. The acne on his face the past year or two has caused him to become shy and embarrassed with children his age. ... It is believed that with proper institutional care, he will be able to live a normal life on a low level and it is recommended that he be placed in the Glenwood State School."
Meredith spent time at several institutions, and his treatment included numerous rounds of electroshock therapy, Olson said.
When the family visited him, Olson said, he would have his suitcase packed, and he would beg his parents to take him home. They sometimes would bring him back to Des Moines for Christmas, but that was about it.
Parents not asked about lobotomy
When he was about 24, Olson said, their parents received a letter from a state administrator, saying that a doctor had performed a lobotomy on him.
Their father was furious that he hadn't been consulted, she said.
The procedure left her brother even more passive than before, and unable to carry on any real conversation.
"It was just like they took the life out of him," she said. "He was like a zombie."
Olson recalled that after the operation, her brother had two black eyes, which were a telltale side-effect of the most popular lobotomy method.
A doctor would insert a sharp instrument, similar to an ice pick, into the top of the patient's eye socket. The doctor would tap the back of the instrument with a hammer, pushing the pick into the brain. He would rotate the pick in an arc, side to side like a windshield wiper, cutting nerve connections between the front and center parts of the brain. Then he would do the same thing at the other eye socket.
The procedure's main proponent, neurologist Walter Freeman of Washington, D.C., bragged that it was so simple to perform that it didn't require a surgeon or an anesthesiologist. It often was done by psychiatrists, who used mental hospitals' electroshock machines instead of anesthesia drugs to briefly knock patients out.
Freeman barnstormed the country in the '40s and '50s, teaching his method to doctors at mental hospitals, including in Iowa.
State records say Meredith's lobotomy was performed in 1955 by a Dr. Muehlig. That likely was a reference to the late Wilbur Muehlig, who was an Omaha neurosurgeon.
Use of procedure expands, then fades
Journalist Jack El-Hai, who wrote a biography of Freeman titled "The Lobotomist," has a newspaper clipping showing that Muehlig and two other Nebraska doctors learned the procedure from Freeman at a hospital in Lincoln. The 1948 article recounted how Freeman demonstrated it on a patient and then had the three local doctors perform it on others.
The article touted Freeman's version of the operation as "quicker and simpler" than the previous version, a full surgical procedure called a frontal lobotomy. "It takes only three minutes, compared to an hour for the frontal," the article said.
El-Hai estimates that 40,000 to 50,000 Americans had lobotomies. Most of the patients were residents of state mental institutions or Veterans Administration hospitals, he said in an interview.
"The objective was to get people out of hospitals, because so many hospitals were overcrowded," he said.
El-Hai believes most of the doctors who performed lobotomies had good intentions. The procedure usually was not meant to cure a patient's mental illness, he said.
"But it could blunt symptoms, and if enough symptoms were made to disappear, then maybe the patient could go home," he said.
At the time, there were no good medications to treat deep psychiatric problems.
At first, he said, the procedure was used on people with serious psychoses and other severely disruptive symptoms. "The uncontrollable patients needed controlling," he said, "and a lobotomy could make them much more passive."
But as time went on, Freeman and his followers performed the procedure in other types of cases, including many involving depression or obsessive behaviors. El-Hai said mental hospital administrators often would have a doctor do lobotomies on several residents in a day. If residents were considered wards of the state, he said, officials would not necessarily consult with families beforehand.
The procedure, which always was controversial, fell out of favor in the late 1950s, as new drugs were introduced to control psychiatric symptoms. Freeman eventually lost his medical license.
Sister: Treatment today must improve
Dick Meredith's lobotomy left him unable to ever live on his own. His older sister said her parents rarely talked about him after their initial anger wore off. One day, her mother told her that they would not have Dick come home for Christmas anymore.
"I said, 'How can we not have him home for Christmas?' " Olson recalled. "She said, 'It just upsets your father.' "
Their parents died years ago, but Olson continued to serve as Meredith's legal guardian and fierce advocate.
He died on Sept. 1 at age 82, after choking at the Clarinda institution. A state inspection report says a staff member mistakenly gave him a peanut butter sandwich, despite a doctor's orders that he only be given pureed food because he had a swallowing problem.
Vasey, who regularly went with her mother to visit Meredith at the state Mental Health Institute at Clarinda, remembers him as a large man with a sweet tooth who was wild about Hershey chocolate bars.
He would ask a simple question over and over, without any context. "Do you think I can?" he would say. "Do you think I can? Do you think I can?"
Vasey wrote a bittersweet obituary, which ran in the Register in mid-September. The piece was illustrated with a photo from the 1940s of a gentle-looking, bespectacled teenager. His niece wanted people to see who he really was, before a doctor cut away much of his personality.
"No one knows for sure what Richard may have accomplished in his life, that was taken away from him," Vasey wrote. "He was lost for a very long time in a broken mental health system." The obituary concluded with a commonly cited observation: "A society is ultimately judged by how it treats its weakest and most vulnerable members."
The family asked that donations be made to the National Alliance on Mental Illness, which pushes for reform.
Olson stressed that readers of this article should take little comfort from the fact that mentally ill people are no longer given lobotomies. Instead, she said, many of them are being left to wander the streets homeless or are imprisoned for behaviors that cry out for treatment.
"This isn't just an interesting story about something that happened in the past," she said. "I want people to know how crazy the system is — still."