Rosemary: The Hidden Kennedy Daughter (20 page)

By the second week in November 1941, Dr. Moore was again expressing concerns about Rosemary’s behavior and her influence and effect on the other children at the school. A young woman, Miss Slavin, was hired to work with Rosemary and be a companion. “I trust that she will be able to help a great deal,” Dr. Moore assured Kennedy before boldly soliciting a $25,000 donation from him.
But the new companion made little difference, and Joe did not send a contribution to the school.

Joe had planned on taking Rosemary, Jack, and Kick to a Notre Dame–Navy football game in Baltimore on November
8, but it’s unclear whether Rosemary joined the others.
As Rose noted in her memoir,
Times to Remember,
she and Joe were coming to the conclusion that Rosemary was suffering from something other than intellectual impairment; “a neurological disturbance,” Rose would call it, that “had overtaken her, and it was becoming progressively worse.”

7

J
OE SR
., if not other members of the family, felt Rosemary’s behavior had now become a menacing disgrace to the Kennedys’ political, financial, and social aspirations.
Her late-night escapes from Saint Gertrude’s left her vulnerable to sexual exploitation and unsavory liaisons with unknown men. Joe, who had been mostly out of the political limelight since his return from London and his resignation as ambassador a year earlier, was focusing his energy on his businesses and investments and traveling frequently to New York and Washington, D.C. He was also beginning to chart his eldest sons’ political futures, and he could not risk the publicity from an unwanted pregnancy, venereal disease, or some other compromising situation. Family nurse Luella Hennessey believed that Joe “was so afraid of [Rosemary’s] getting into trouble or of [her] being kidnapped. It would be better for her not to be exposed to the general public in case she ran away.” But keeping her out of the public eye was proving impossible. “It would be better to almost ‘close the case,’” Hennessey recalled Joe Sr.’s attitude at the time. “Then there wouldn’t be any
more trouble.”
The latest reports from Saint Gertrude’s only further fanned Joe’s increasing anxiety over the family’s reputation and his deeply felt concerns about the mental and physical well-being of his daughter.

It has been suggested that Joe Sr. spoke with doctors about a very experimental brain operation for the treatment of serious mental-health conditions, leucotomy—popularly known as prefrontal lobotomy—while he was still in England. But in fact the procedure was not performed there until after he had left his ambassadorship, so it is unlikely he met with anyone there who had expertise.
It is more likely that it was through his many connections in Washington—possibly Thomas Moore at Saint Gertrude’s—that he learned about the pioneering psychosurgery then being performed at George Washington University Hospital by Dr. Walter Freeman and his associate Dr. James Watts, then the leading researchers in the field in the United States. Freeman and Watts were on the faculty of the George Washington University Medical School and were well known to the psychiatric and neurosurgical community in Washington. Moore had been collaborating on innovative approaches to the treatment of mentally ill children with psychiatrists from Saint Elizabeths Hospital, the city’s federal psychiatric facility and one of the leading mental-health institutions in the country. Both Freeman and Watts conducted research and observed patients at Saint Elizabeths, so a connection through Moore seems highly probable.

Joe approached Rose about the option as a potential “cure” for Rosemary’s disabilities and increasingly moody and unpredictable behavior. Rose and Joe may have read an article on lobotomies in the
Saturday Evening Post
in May 1941. Highlighting the work of Freeman and Watts, among others, the article mostly praised the potential of the surgery to make mentally ill patients
who were “problems to their families and nuisances to themselves . . . into useful members of society.” But the article also noted that some specialists in neurological disorders responded with “outright denunciation” of the technique.
In the twenty years that she had been seeking answers to Rosemary’s troubles from physicians, psychiatrists, teachers, and specialists of all sorts, Rose had encountered numerous suggestions and recommendations, including permanent institutionalization, medications, and other physical and psychological interventions, but none had done what she had hoped—to make Rosemary able to function in society appropriately and independently. The process had made Rose weary, and extremely wary.

Rose, nevertheless, enlisted Kick’s help to investigate the psychosurgical option.
By the spring of 1941, Kick had completed her studies in New York and moved to Washington, D.C., where she started working as a society columnist at the
Washington Times-Herald
for editor Frank Waldrop. There Kick met a reporter named John White. White later recalled to historian Laurence Leamer Kick’s intense interest in a series of stories he was researching during that summer and fall on mental illness and treatment at Saint Elizabeths Hospital.

Kick confided in White about her older sister’s intellectual impairments and more troubling mental-health issues. She asked him about the experimental brain surgery. The lobotomy procedure had been in practice in the United States for less than three years, and fewer than one hundred patients had undergone the surgery. Nearly all of them had been treated by Drs. Freeman and Watts at nearby George Washington University Hospital. White may have told Kick that Saint Elizabeths did not allow the experimental surgery in its own facility, in spite of its supporting Freeman and Watts with their research.
The surgery involved cutting
the white fibrous connective tissue linking the frontal lobes to the rest of the brain, relieving the violent rages and psychological and physical pain some severely mentally ill patients suffered. White told Kick that the results were “just not good”; he had seen for himself that after the surgery patients “don’t worry so much, but they’re gone as a person, just gone.”

Kick quickly reported her findings to her mother. “Oh, Mother, no, it’s nothing we want done for Rosie,” Kick apparently told her. “I’m glad to hear that,” niece Kerry McCarthy recalled Rose replying.

If Rose told Joe her misgivings about the surgery, he did not listen. She later told Doris Kearns Goodwin that “Joe took matters into his own hands.”
In keeping with his instinct to seek out the opinions and ideas of the most prominent specialist in whatever field of expertise he needed, he moved ahead and met with Dr. Freeman during the fall to discuss the doctor’s latest surgical results. It is not known whether Joe explored any other of the several therapy options available in 1941 for treatment of Rosemary’s perceived psychological problems, at a time when electric shock, insulin-induced coma, and other treatments were embraced as new miracle therapies by a small but growing group of psychiatrists and neurosurgeons. Luella Hennessey recalled years later that Joe had always asked her opinion about the children’s health issues, but this time he did not. “I think he knew what I would have said,” she explained.

Local and national media coverage of lobotomy research was quite limited at this time, in spite of the feverish advocacy with which Freeman presented his research to colleagues.
Notwithstanding the mostly positive report in the
Saturday Evening Post
that spring, in August 1941, the
Journal of the American Medical Association
warned against the use of lobotomy until further
research could be done. Freeman had participated in a panel at the annual American Medical Association meeting, in Cleveland, earlier that year on the efficacy of the prefrontal lobotomy. In response to Freeman’s presentation, the editorial board of the
Journal
argued that “in spite of these improvements in the mental condition of some patients this operation should not be considered [as] there is ample evidence of the serious defects produced.”
The
Richmond Dispatch
—one of the first newspapers to report on the AMA’s warning—informed its readers in August 1941 that “scientific knowledge is admittedly meager regarding the exact function of the . . . frontal lobes,” and that the operation “should be considered as in an experimental stage.”

Though the prefrontal lobotomy was not recommended for curing or treating intellectual and developmental disabilities, Freeman assured Joe of the efficacy of his experimental brain operation.
“The doctors told my father it was a good idea,” Eunice later told biographer Robert Coughlan.
It would, Freeman’s associate Watts argued, calm Rosemary’s “agitated depression.”
She would become docile, less moody.

It is instructive that at the time Drs. Freeman and Watts were teaching and performing their experimental psychosurgery at George Washington University Hospital, when nearby Saint Elizabeths Hospital, long a pioneer in the treatment of the mentally ill, refused the two men’s requests to perform lobotomies there. Saint Elizabeths was founded in 1855 by the federal government. Named the Government Hospital for the Insane, it became known as Saint Elizabeths during the Civil War, when the facility was called into emergency service to treat wounded soldiers who flooded hospitals in Washington by the thousands. After the war, and throughout the nineteenth and early twentieth centuries, Saint Elizabeths treated Civil War veterans and others
suffering from psychological and neurological trauma, becoming the largest and most prominent public institution of its kind. The hospital treated about seven thousand patients, and its research, psychiatric training, and chronic-care facilities had become models for clinical programs and institutions around the world. But the superintendent, Dr. William A. White, refused to allow Freeman and Watts to experiment on mentally ill patients at Saint Elizabeths. He believed that patients could not make an informed decision about the risky surgery, nor could their often-desperate families make the decision for them. Freeman and Watts’s research was limited to performing autopsies on deceased patients and observing mentally ill patients in the hospital’s wards.

Psychosurgery remained, at the time, a small field and was relegated to a few institutions in the United States. By the time Joe was meeting with Freeman, Massachusetts General and McLean hospitals, both in Massachusetts, and a few state psychiatric hospitals around the country, including those in Delaware, Pennsylvania, Minnesota, New York, Missouri, New Jersey, and Connecticut, were experimenting with a few patients. Only a handful of neurosurgeons in Europe and Asia were beginning to perform the surgery.
Dr. Freeman, moreover, was a psychiatrist, not a surgeon. He believed that surgical intervention into the brain to treat psychological disorders did not require the extensive surgical training that neurosurgeons spent years acquiring. Though neurosurgeons disagreed with Freeman, no certification process for the procedure had been established, and neurosurgeons were, at the time, powerless to stop him even if they had wanted to.
Freeman’s partner, Watts, a trained surgeon, performed most of the surgeries under Freeman’s direction, though by the mid-1940s, Freeman was performing lobotomies himself.

In the days before sophisticated scientific understanding of
mental development and the inner workings of the brain, Freeman and a handful of colleagues around the world were convinced that lobotomies were the much-longed-for cure for deep depression, mental illness, and violent, erratic, and hyperactive behavior. But the procedure was never meant to be used on intellectually disabled individuals. The physiological and psychological side effects of the surgery varied widely, but for the most part patients suffered tremendously. The positive outcomes and effectiveness of these therapies in treating a broad range of mental illnesses and intellectual disabilities were small, though claims by practitioners painted a far rosier picture than the collective results indicated.
Doctors like Walter Freeman and his colleagues publicized the few success stories and downplayed the failures—failures that ranged from tragic loss of cognition to fatalities—which occurred with frightening frequency. Professionals claimed these failures were the patients’ fault, a function of the deep flaws rooted in their compromised physical condition and damaged psychology.
Nevertheless, in the summer of 1941, when the AMA warned against the use of lobotomy and called for more studies, Freeman and Watts were scheduling more lobotomies.
“It is inconceivable,” the editors of the
Journal of the American Medical Association
wrote, “that any procedure which effectively destroys the function of this portion of the brain could possibly restore the person concerned to a wholly normal state.”
Given Joe’s reputation for assiduously gathering information to make informed decisions, he must have been aware of the risks involved, even if Freeman and Watts did not disclose the full details of the side effects and negative outcomes of the surgery.

Informed consent for such a potentially fatal and certainly debilitating operation had not yet been considered by the American medical or legal system. Under the laws of the day, a woman like
Rosemary could be forcibly hospitalized and treated without her consent. The legal requirement giving patients power and control over their own medical decisions would be decades more in the making. Women were most frequently institutionalized by the order of husbands and fathers, whose will and opinion superseded the women’s. A doctor’s legal and medical responsibility to fully inform a patient of the potential risks of treatment did not become a requirement until the 1960s and was still contested ground well into the 1970s and 1980s.

Freeman and Watts were using their patients as case studies; there were no protocols, safeguards, or protections, nor were standards required or instituted by or upon the physicians as they experimented on their patients. The first lobotomy had been performed in Europe in 1935 by a Portuguese neurologist, Egas Moniz. Greatly criticized, Moniz was nevertheless convinced of the efficacy of slicing and disconnecting the frontal lobes from the rest of the brain. His first patients suffered from paranoid schizophrenia and depression; the patients seemingly improved after the surgery, giving Moniz the sort of proof he wanted to continue his studies. In truth, the patients’ relief was only temporary. In time, the side effects of the surgery would become more troubling and more disabling to the patient than the initial illness. Ironically and tragically, by 1949, when Moniz received the Noble Prize in medicine, thousands of patients around the world had received the questionable treatment. Many were permanently disabled; some were dead.