Rosemary: The Hidden Kennedy Daughter (21 page)

Shared views among a relatively few psychiatrists across the country fed a system that lacked or disregarded formal protocols, systematic analysis of medical procedures, and standards to define acceptable and unacceptable risks. There was no consensus as to which underlying disease or illness would benefit the most from
lobotomy. With few options, some psychiatrists and neurosurgeons looked to the lobotomy as a possible miracle cure for mentally ill, depressed, and disabled patients. One patient subgroup included habitual criminals and juvenile offenders, but most were individuals whose behavior simply defied conventional norms and conservative boundaries. Lobotomies and other psychosurgical procedures were performed on patients who suffered from not only crippling depression but also undefined violent behavior, schizophrenia, obsessive-compulsive disorder, chronic pain, and bipolar and other mood disorders. The procedure was also used to treat perceived defective personality traits that included homosexuality, nymphomania, criminal behavior, and marijuana and drug addiction.
Freeman would later describe potential patients as society’s “misfits.”
Women, in particular, made up the largest group of lobotomy patients. Women who were depressed, had bipolar illness, or were sexually active outside the range of socially and culturally acceptable limits of the day—including single women exhibiting typical sexual desire—were considered candidates.

At McLean Hospital in Belmont, Massachusetts, one of the premier psychiatric hospitals in the nation, women represented eighty-two percent of the total number of lobotomy patients from 1938 to 1954.
In hospitals across the country, women constituted between sixty and eighty percent of all lobotomy recipients, in spite of the fact that men comprised the majority of institutionalized patients.

Without informing Rose or the other children, Joe ordered the procedure to be done on Rosemary as quickly as possible. Joined by Freeman’s unbridled and unethical eagerness to perform the surgery, Joe’s desperate need to control Rosemary drove him to make the decision on his own.

Sometime between November 10, 1941, when Thomas Moore at Saint Gertrude’s wrote to Joe about continuing problems with Rosemary, and November 28, when Joe said in a letter to a friend that he was heading to Washington to “visit with my two youngsters who are there”—he actually had three children living in the city, Jack, Kick, and Rosemary—twenty-three-year-old Rosemary was admitted to George Washington University Hospital.
Rosemary would be one of twenty-eight patients Freeman and Watts would operate on during the last nine months of 1941, and one of fewer than eighty patients they had treated surgically up to that time.

Did Joe tell his daughter she was going to have a surgery? Did she ask him questions about it, and did he answer them truthfully? Did he convince her that it was her decision but that he wanted her to do it? Joe knew Rosemary loved her “Daddy” and would not want to disappoint him. Did he tell her that her behavior had disappointed him, and that her mother and sisters and brothers were concerned and frightened by her? What did she think? We can only imagine.

Soon after Rosemary arrived at the hospital—whether it was Joe, or Eddie and Mary Moore, or a Saint Gertrude’s staff member who accompanied her has not been recorded—the doctors and nurses would have explained to her that she would need to have her hair shaved off. Rosemary, who loved to be told how pretty she was, who loved to look attractive, would have her head shaved. Did she say no, as one of Freeman’s other patients did when she heard she would lose her beautiful hair? Patient Case 10, Freeman would later write, gave “exaggerated attention” to her curls, preventing her from submitting to the surgery. Only after repeated assurances that Dr. Watts would make “every effort . . . to spare these curls” did the patient acquiesce. Freeman
thought such concerns were frivolous, because the surgery would erase patients’ “undue” attention to physical appearance and they would afterward “go about or talk with others quite oblivious to the fact” that their heads were shaved.

Rosemary would have been strapped to a table and given local anesthesia to numb the area of the skull near the temples where Watts would bore two holes. Sedation, according to Freeman and Watts, was used only when a patient was highly agitated and in a “panicky state,” a reaction that would have only increased as the procedure continued.
Lobotomies had to be performed with the patient wide awake, allowing the physician to monitor the effects of each surgical cut to the brain. Freeman and Watts noted that most patients were anxious and fearful about the surgery. Patients, they wrote, underwent “unnamed tortures when having their hands and feet strapped to the operating table, their heads shaved to the vertex [top of the skull], and the outside world masked from view by the towels and drapes.” Next came the “rattling of the instruments, the noise of the suction apparatus, and the menacing spark of the electro-cautery.” Some patients told them they wanted to die right then and there. Others called for help. These terrifying moments were useful, the doctors assured their colleagues, as the patients’ distress was often so great that the “additional trouble caused by the operation passes almost unnoticed.”

Watts followed Freeman’s instructions, drilling holes on both sides of Rosemary’s head, near the temples. She would have heard the whir of the surgical tool drilling the “burr holes” into her skull. “Apprehension becomes a little more marked when the holes are drilled,” the two men wrote of patients, “probably because of the actual pressure on the skull and the grinding sound that is as distressing, or more so, than the drilling of a tooth.” No
doubt she felt the pain from the “leucotome,” the small, modified surgical instrument Watts and Freeman developed specifically for lobotomies, “produced by contact with the Dura,” the outermost membrane covering the brain.
Watts later recalled that with Rosemary he followed the procedure he normally used with his other patients: “I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch.”
Through the openings on the sides of Rosemary’s head, Watts inserted a specially made quarter-inch-wide flexible spatula into her cranium near the frontal lobes, turning and scraping as he moved deeper into her brain.
Freeman asked Rosemary to sing a song, recite common verses, tell him stories about herself, count, and repeat the months of the year.
At this point in the surgery, patients generally felt little pain, but their fear was palpable, their breathing rapid. Some tried to wrest their hands from the restraints or grab the nurse’s hand with “painful intensity.”
Watts claimed Rosemary complied with their requests to recite simple songs and stories. Encouraged, Watts boldly cut more of the nerve endings from her frontal lobes to the rest of her brain. With the fourth and final cut, however, she became incoherent. She slowly stopped talking.

It would not take long—a few hours at the most—before the surgeons recognized that the surgery had gone horribly awry. Rosemary would emerge from the lobotomy almost completely disabled. Freeman claimed the procedure would produce a more docile, less moody Rosemary. The operation did far more than that. She could no longer walk or talk. It would take months of physical therapy and constant care before she would be able to move around, and then only with limitations. She would never recover the full use of her limbs. She walked with one leg and foot turned awkwardly in, creating a labored stride. She would
have only partial use of one of her arms. She could speak only a handful of words. The operation destroyed a crucial part of Rosemary’s brain and erased years of emotional, physical, and intellectual development, leaving her completely incapable of taking care of herself. The nurse who attended the operation was so horrified by what happened to Rosemary that she left nursing altogether, haunted for the rest of her life by the outcome.

In the hours, days, and weeks following lobotomy, patients like Rosemary experienced a wide array of postoperative reactions and symptoms. They vomited uncontrollably. Incontinence plagued some for weeks or months or longer. They were alternately restless and inert, many with expressionless faces, their eyes transfixed or drowsy-looking. Many picked at the surgical dressing on their head. Confused and frightened, many became extremely agitated and cried or laughed uncontrollably. Some would require help feeding, cleaning, and dressing themselves, as Rosemary would.
Kennedy niece Ann Gargan, who lived with the family during the 1960s and later came to know Rosemary, recalled, “They knew right away that it wasn’t successful. You could see by looking at her that something was wrong, for her head was tilted and her capacity to speak was almost entirely gone.”

Rosemary’s was one of several dozen case studies the doctors used in their volume on their research on prefrontal lobotomies published a year later, in 1942.
Her case number remains unknown—none of the patients’ names are revealed in the study—and her outcome, like the other failures, is relegated to footnotes and vague references. Freeman, Watts, and their university research colleague Dr. Thelma Hunt showed statistically few positive results—improved mood and less depression, less compulsive or destructive personal behavior, and fewer fears and anxieties—and, more important, they did not highlight the majority of
long-term debilitating side effects of the lobotomies. According to their own records and published papers, many of their patients became more belligerent, more caustic, and less able to engage in positive social interactions. Many became more forgetful and self-absorbed, and often lacked emotion, even to the point of being uncaring toward loved ones around them. Some experienced heightened sexuality, even nymphomania. Binge eating, childlike behavior, insomnia, weepiness, and compulsive disorders emerged in some patients for the first time. Some began having epileptic-type seizures. Incontinence, catatonia, and the inability to walk, to use their hands and arms, or to take care of themselves plagued another subset of patients. Yet the research report concluded that “63% of the cases have resulted satisfactorily,” while “in only 14% of the survivors can the results be considered bad.” The authors obliquely reported that nine percent of their patients had died as a result of the surgery, and they did not mention which “bad” results affected the remaining fourteen percent. Two patients were still so “problematical” as of the research project’s completion, in December 1941—just a month after Rosemary’s lobotomy—that they could not be categorized.
Such disastrous results did not sway Freeman and Watts. Incredibly, they and Hunt claimed,

Most of the patients are able to live fairly active, constructive lives, free from the harassing doubts and fears that characterized their illnesses, with their intelligence intact and their interests diverted outward. Many of them are better adjusted than they have ever been in their adult period of existence. Some of them are taking on new responsibilities and are equipped with sufficient energy and imagination to drive forward unhampered by the restraining influences that reduced them previously to vacillating insecurity. Al
most all of them find existence more pleasurable, and they can adjust better in their environment.

Tens of thousands of patients would be forced to undergo lobotomies in the United States over the next two decades, and not until antipsychotic and antidepressant medications appeared in the 1950s was the surgery slowly replaced. Watts eventually abandoned his work with Freeman, but Freeman continued at a more feverish pace. A showman who craved attention and had an almost messianic belief that he could change people’s lives with the procedure, he kept experimenting even while other physicians and medical specialists argued for more restraint and oversight. Determining that he could perform the surgery as well as a neurosurgeon, Freeman developed altered surgical instruments to reduce the time it took to complete a lobotomy. Over the next twenty years, he performed lobotomies on thousands of individuals—sometimes twenty or more a day—using a modified ordinary household ice pick that he would insert through the eye socket into the patients’ frontal lobes.

8

J
OE AND ROSE
had decided earlier that fall to sell their Bronxville home and divide their time between Hyannis Port and Palm Beach. With Rosemary physically recovering at George Washington University Hospital; Eunice, Pat, Bobby, Jean, and Teddy in school; Joe Jr. in the service; and Jack and Kick in Washington, Rose was left to supervise the packing and moving of their furnishings over the Thanksgiving holiday. “The house was no longer a necessity,” Rose wrote from the Plaza Hotel in New York City on December 5, in a letter sent to the children. Though they “all grew up there very happily, romping over the lawns in the spring and fall, and coasting down the sloping hill in the winter . . . I feel quite relieved and very free with nothing on my mind except the shades of blue for my Palm Beach trousseau.” But Joe could not have kept the truth from her for very long. And it is clear that, even in those early days, Rose knew enough to decide on a stunning departure from her habit of writing a single letter, which included news about every family member and was copied and sent to each child. Rose in this letter did not include Rose
mary’s name. Rose’s blithe tone would be remarkable for a mother who fully understood Rosemary’s surgery or its outcome; perhaps she did not. Before, as Rose later reported, she “usually wrote to [the children] weekly [and] I conceived the idea of writing a letter with all the general family news on the first two pages. The general letter was typed by a secretary,” and a “paragraph or two of news” about each child was included. A handwritten note specific to each child was then added by Rose, and the letters were mailed.
For the next two decades, however, Rose never referred to Rosemary in her frequent, lengthy letters to all the other children and to family friends.
Granddaughter Amanda Smith observed, while researching her book on Joe Kennedy, that during this time any mention of Rosemary ceased, “except obliquely in surviving family letters and papers.”