For many, the word lobotomy conjures up images of an operation performed indiscriminately using crude instruments, leaving patients drooling vegetables. You may have even heard tales of a mad doctor traversing the country offering the procedure from his four-wheeled “Lobotomobile.” That story, of course, is a mix of fact and fiction—one that befits the eccentric creator of the procedure, Walter Jackson Freeman II.

Despite his grim legacy today, Freeman came from a family long respected for its work in the healing profession. His father was a noted otolaryngologist, and his maternal grandfather was a Civil War surgeon who went on to treat six U.S. presidents, including then-future president Franklin Roosevelt in the early years of his paralysis from polio.

Freeman’s academic career was promising, too. Graduating from Yale in 1916, he enrolled at the University of Pennsylvania to study medicine, earning his degree and completing an internship there before traveling to Europe to study neurology. Upon return, he took a position as laboratories director at Saint Elizabeths Hospital, a prominent Washington, D.C. psychiatric facility.

Freeman was deeply affected by the troubling conditions he witnessed at Saint Elizabeths. Before the appearance of Thorazine and other effective psychiatric drugs in the mid-1950s, mental hospitals were often massively overcrowded, and many patients were held for decades on end. In Freeman’s native Philadelphia, for instance, the state hospital was known to house roughly 75 percent more patients than its approved capacity. In 1948, writer Albert Deutsch described a visit to the hospital that reminded him “of the pictures of the Nazi concentration camps,” describing rooms “swarming with naked humans herded like cattle and treated with less concern.”

While at St. Elizabeths, Freeman came to dismiss the reigning psychoanalytic approach—in which mental illnesses were seen as arising from the unconscious—as particularly useless in institutional settings. He believed that mental disorders had a well-defined physical cause, and increasingly embraced the idea of psychosurgery (brain surgery as a means of psychological treatment). His research in the field led him to the work of Portuguese neurologist Egas Moniz, who in 1935 found some success relieving mental maladies with the leucotomy, a procedure in which neural connections were severed by coring out tissues of the prefrontal cortex. Freeman was so impressed by this procedure that in 1944 he nominated Moniz for the Nobel Prize, which was awarded to the Portuguese neurologist five years later.

Because Freeman’s background was that of a neurologist rather than a surgeon, he enlisted the help of a neurosurgeon named James Watts to modify Moniz’s technique, which he renamed “lobotomy.” (The extent to which Freeman modified Moniz's procedure—which the latter had continued to refine—versus adopting it wholesale is a matter of debate.)

Freeman and Watts would perform their first lobotomy in September 1936 on a Kansas housewife named Alice Hood Hammatt. The results were encouraging: Although she had previously been diagnosed with "agitated depression" and was prone to laughing and weeping hysterically, she awoke from the operation with a "placid expression," according to her doctors, and was soon unable to remember what had made her so upset. Hammatt's husband, who later wrote to Freeman to thank him, called his wife’s post-surgery years “the happiest of her life.”

By 1942, Freeman and Watts had performed the surgery on over 200 patients (reporting improvement in 63 percent of them), and the practice had been taken up by other surgeons. Freeman reportedly felt that the lobotomy was “only a little more dangerous than an operation to remove an infected tooth.” But he still hoped for a procedure that could be more readily available to the thousands of patients languishing in mental hospitals—one that would be faster, more effective, and require fewer resources and specialized tools.

After learning of an Italian doctor who used the eye socket to access the brain, Freeman developed his transorbital lobotomy. This "improved" technique involved an instrument that slid neatly between a patient’s eyeball and the bony orbit housing it in the skull. The pick was then hammered through the bone and wiggled about with the goal of severing neural fibers connecting the frontal lobes and thalamus. The process was then repeated through the opposite eye. Sometimes called the "ice pick" lobotomy, early surgeries actually used an ice pick from Freeman's kitchen.

While the prefrontal lobotomy required over an hour of the surgeon’s time, this new procedure could be completed in 10 minutes. No drilling into the skull or dressing of post-surgery wounds was required. Freeman hoped that institutional psychiatrists, untrained in surgery, would one day be able to perform the procedure.

Like the prefrontal lobotomy, early surgeries seemed to be a success. The operation was first performed in 1946, on a housewife named Sallie Ellen Ionesco. Angelene Forester, her daughter, remembers her mother as “absolutely violently suicidal” before the surgery. After Freeman’s hammering and probing, “It stopped immediately. It was just peace.”

Under the slogan "Lobotomy gets them home," Freeman began touring the country promoting his startling new ideas. His crusade was aided by his cocky, larger-than-life persona. Watts later recalled to the Washington Post that when lecturing, Freeman was “almost a ham actor,” so entertaining that "people would bring their dates to the clinic to hear him lecture." Freeman’s fanatic advocacy of the lobotomy, however, eventually became too much for Watts, leading to a parting of ways in 1950. "Any procedure involving the cutting of the brain tissue is a major operation and should remain in the hands of the neurological surgeon,” Watts later wrote. He explained to the Post: "I just didn't think somebody could [spend] a week with us and go home and do lobotomies."

Everything Freeman did was geared toward economy, speed, and publicity. In 1952 he performed 228 lobotomies in a two-week period for state hospitals of West Virginia; charging a mere $25 per operation, he worked without surgical mask or gloves. During marathon surgery sessions, he would often talk to journalists he’d invited in to promote his crusade, occasionally showboating with a “two-handed” technique, hammering picks into both eye sockets simultaneously. In 1951, one patient in an Iowa hospital died during the procedure when Freeman allowed himself to be distracted by a photo op for the press.

Freeman advocated the transorbital lobotomy for a broad spectrum of patients, including children as young as seven. But with the reduction of unwanted symptoms could come a tragic deadening of all emotion. A shocking number of those who received the procedure were left utterly debilitated and unable to care for themselves. This had been true of the prefrontal lobotomy, too: Notably debilitated patients included Rosemary Kennedy, sister of the late president, as well as Rose Williams, sister of playwright Tennessee Williams. Of the approximately 3500 lobotomies Freeman performed himself, 490 resulted in fatalities.

In 1967, after a patient succumbed to cerebral hemorrhage during surgery, Freeman decided to stop performing lobotomies. But he did not give up his advocacy, taking to the road in a camper van (which later writers dubbed the "Lobotomobile") to visit former patients and document his successes. (Although popular myth has Freeman performing the surgeries from his van, that was never the case.)

By then, the medical community had little use for Freeman’s triumphalism. In the mid-1950s, a new generation of more effective psychiatric medications had started sidelining Freeman’s efforts, and the very notion of psychosurgery increasingly carried a stigma. By 1950, the lobotomy had been outlawed in the Soviet Union, with Germany and Japan soon following suit. In the U.S. today, the procedure as performed by Freeman is extinct, if not technically illegal. However, some scholars note that Freeman's work paved the way for forms of neurosurgery still used in cases of severe psychiatric illness, as well as procedures such as deep brain stimulation, used to treat neurological conditions like Parkinson's.

Walter Freeman died of cancer in 1972 at the age of 76. Despite the dark associations that remain around the operation he pioneered, he believed himself a humanitarian pioneer until the very end.