To the future Dr. Freemans

Today we remember Egas Moniz, the first Portuguese national to receive a Nobel Prize. He won this honor in 1949 for this work in neurology, specifically as the developer of a procedure called cerebral angiography. He is also regarded as one of the founders of modern psychosurgery. He was a great man in his time.

But history has not been kind to Moniz’s legacy. Bill Bryson captures the problematic nature of Moniz’s work in this 2019 book, “The Body: A Guide for Occupants”:

Moniz provided an almost perfect demonstration of how not to do science. He undertook operations without having any idea with damage they might do or what the outcomes would be.

And this

He didn’t select patients with care and didn’t monitor outcomes closely afterward.

Yet he was feted around the world and, of course, was a Nobel laureate, awarded to “those who, during the preceding year, have conferred the greatest benefit to mankind.” What was his contribution to science and mankind?

The lobotomy.

But there’s more….

One of his enthusiastic acolytes was Walter Jackson Freeman. Freeman took Moniz’s idea and ran with it. He believed that mental illness was related to overactive emotions and that, by cutting the brain, he cut away these feelings. Towards that end, he “perfected” the procedure with the use of an ice pick. On a tour of the country, he lobotomized 225 in 12 days. Some of his patients were as young as four.

Let’s assume Egas Moniz had the best of intentions. Let’s assume Dr. Freeman began his lobotomy spree that way. But Freeman was extolling and performing these procedures well into the 1960s. The 1960s!

Even in 2002 the Oxford Companion to the Body described them this way,:

For many people the term ‘lobotomy’ conjures up images of disturbed beings whose brains have been damaged or mutilated extensively, leaving them at best in a vegetative state without personality or feelings. This was never true.

Except it was.

But this could never happen again, right? Medical professionals are “following the science”. They are conducting controlled studies to ensure safe outcomes. They carefully vet study participants. They closely monitor for any unanticipated side effects. They are ethically bound to “first, do no harm”, especially where children are concerned.  

Into this space steps Boston Children’s Hospital and their series of videos on supporting transgender children (a horrible expression). Boston Children’s provides a full suite of surgical options for transgender teens and young adults. Videos cover topics like what is phalloplasty, what is vaginoplasty and what to expect with these surgeries. All are presented against bright colored backgrounds with cheery music playing in the background and upbeat medical professionals directly addressing the camera.

As to eligibility for surgery, we’re assured that Boston Children’s Hospital is following the WPATH standards of care. A double mastectomy can be performed on children as young as 15.  It’s recommended (but not required) that the patient have been on hormones for a year. And they must provide two letters—one from their primary care physician, another from a behavioral health provider. For removal of genitals/hysterectomies, these surgeries can be done starting at age 17 but the patient must also provide a letter from a behavioral health professional stating the patient understands they are eliminating future fertility potential. (One wonders if a note from the parent might be in order?)

And when does a child know they are transgender? According to Boston Children’s, the child often knows they are trans from the moment they have the ability to express themselves. Sometimes parents know from the minute the child is born. And what are the signs? They include playing with opposite gender toys and refusing to get a haircut.

How to respond to this? The first comparison to spring to mind is the lobotomy. What a tragic procedure it was - the destroyed lives left in its wake; the failure to recognize its dangers earlier; the insistence by its chief proponents that it is effective, despite no evidence and, in fact, much evidence to the contrary; the long-term impact on the patient’s ability to have healthy relationships and a family; the disinformation promulgated about it decades later.

Gender affirmation has all that in common with lobotomies. Yes, medical and surgical transition may help some. And there were some successful lobotomies. But these procedures share the wholesale disregard for medical science. We see what’s happening in Finland, Sweden, France and now the U.K. in regard to the gender affirmation model. How can the medical professionals at Boston Children’s Hospital not see this? How is it that Dr. Freeman was performing lobotomies in 1967?

Who would think that in the early decades of the 21st century, the acceptable treatment for children who are encouraged to believe they were born in the wrong sexed bodies is the removal of healthy body parts, life-long medicalization, and sterilization? It is beyond barbaric.

I fear for the children this is being done to. I tremble for the well-intentioned but misguided medical professionals who will be the future Walter Freemans. But I have the most sympathy for the parents who have been duped into believing this is best for their child. History is repeating itself on our watch.