The flashbacks come late at night. First comes the recollection of intense physical pain, as if the bones in his arms are being snapped like twigs. Then he hears the voice of the neurosurgeon applying an electric current to metal pins implanted in the tissue of his brain. "How do you feel, Derek?" the surgeon Arthur E Wall asks, while peering into Derek Hutchinson's eyes to see if his pupils have yet dilated with fear.
When Hutchinson swears at the surgeon, Wall administers another electric shock to nerve centres located in the hypothalamus at the centre of his patient's brain. At this, Hutchinson's pupils dilate and he screams: "You're going to kill me, you bastard!" Hutchinson's medical records, written by Wall over 30 years ago, confirm that his patient "felt funny - as if he was dying". But as he screamed, Hutchinson recalls Wall leaning in close to his face and leering: "And I thought you were a bit of a tough guy."
His next recollection is of Wall giving orders for surgical implements to be passed. Hutchinson feels the metal pins inserted through nylon balls lodged in cavities bored into the front of his skull being replaced by thicker electrodes he says felt like "broom handles". "After that I started, I start to feel warm all over and quickly feel as if I have fallen into a vat of molten metal, as if I am, quite literally, frying," says Hutchinson, tellingly confusing tenses as he describes the brain surgery he underwent in 1974 yet still relives up to a dozen times a day and in frequent nightmares.
Throughout the surgery, Hutchinson was kept conscious; his head held in a brace, his hands and feet strapped to the operating table. Hutchinson, a 27-year-old father of three at the time of the operation, says he had not given his written consent to the operation being performed; neither had his wife - his next of kin. Instead his mother, an alcoholic, had been visited at home, in the late evening, after she had been drinking, and had been asked to sign the form. "My mother thought doctors were gods," Hutchinson says. "She'd have signed anything they asked."
Hutchinson's excruciatingly detailed recollections are a rare testimony of someone still lucid and intensely angry about a type of brain surgery to which he was subjected - he contends illegally - commonly referred to as a lobotomy. In strict medical terms, a lobotomy - or leucotomy, as the procedure became known in this country - involved the removal of part of the frontal lobes of the brain or the severing of neural fibres connecting the frontal lobes to the limbic system - the part of the brain concerned with emotional response and functions not under conscious control.
From the mid-1930s until the early 1960s this form of "psychosurgery" was heralded as a miracle cure for the mentally ill, before psychotherapy came into vogue and drugs to treat many mental-health problems became widely available. It was pioneered by a maverick Portuguese neurologist, Egas Moniz, who was awarded the Nobel prize in 1949 for developing and promoting the procedure. Lobotomies were seen as the solution to a wide range of mental disorders ranging from profound depression, schizophrenia and advanced neurosyphilis to mild retardation, at a time when half of all hospital beds in many countries were occupied by the mentally ill, and mental institutions were often places of humiliation and horror.
At the height of its popularity in the 1940s and 50s, particularly in the US, some of the most enthusiastic proponents of the procedure promoted it as a way of controlling large numbers of those considered society's worst misfits, including communists and homosexuals. Neurologists, not just in the US but in Japan, Britain and elsewhere, carried out variations of the procedure on tens of thousands of patients - an estimated 50,000 in the UK alone.
Little attention was paid to what happened to those subjected to lobotomies after surgery. John F Kennedy's temperamental sister Rose, who underwent the operation at the age of 23, for instance, spent the next 60 years of her life out of sight in a mental institution. Francis Farmer, the rebellious Hollywood actress and political activist whose outspoken behaviour was also "cured" by a lobotomy, quickly drifted into oblivion and ended her days as a hotel clerk.
But as the number of lives wrecked by such surgery became more widely known, its effect was gradually exposed - most famously in Milos Forman's 1975 film, One Flew over the Cuckoo's Nest. But also earlier, in the 1958 play Suddenly Last Summer, by Tennessee Williams. A close friend of Williams, whose sister Rose was lobotomised as a teenager, recalls how the playwright talked of his sister as "fragile and gentle", someone hurt by "the harshness of life".
"Things alarmed Miss Rose that would not even be noticed by someone less sensitive. She was just awakening to sexuality and knew almost nothing about it… Rose came home from school one day and said the nuns were using altar candles for self-abuse. She told mother this," the playwright once confided to his biographer Dotson Rader. To the siblings' mother, known even to her children as "Miss Edwina", human sexuality was "the great unmentionable". She promptly took her daughter to the doctor, demanding the "filth" be cut out of her brain: "Cut it away! Miss Edwina ordered. "Make it clean!" "And he did," recalled the playwright, who said his mother never showed any remorse about reducing her daughter to a human vegetable.
Some now consider such practices to be among the most egregious medical crimes of the last century and have called for Moniz, who was later shot in the back by a dissatisfied patient, to be posthumously stripped of his Nobel prize. The Nobel Foundation rules this out, maintaining that all of its awards can be justified within the historical context that they are given.
By the time Hutchinson had his operation in 1974, the scale on which psychosurgery was being performed was drastically reduced, with more and more mental disorders being treated with drugs and psychotherapy. Crude frontal lobotomies, of the type Moniz promoted, had been phased out. Surgery became targeted at more specific parts of the brain as the neurobiology of emotion became better understood. The surgery performed by Wall on Hutchinson's hypothalamus, for instance, was intended to curb his aggression.
Since then, psychosurgery has become even more refined, the parts of the brain targeted and destroyed to control behaviour ever smaller. Though the name lobotomy persists, the medical profession now refers to any such procedure as NMD (neurosurgery for mental disorder). But Britain is now one of the few countries where this sort of surgery is still permitted. Even here it is only performed for persistent severe depression and anxiety and obsessive-compulsive disorder (OCD) in two places: University Hospital of Wales in Cardiff, and Ninewells hospital, Dundee. Patients must consent to the surgery and ethical and clinical standards committees subject each case to rigid scrutiny before it goes ahead.
