Dr. Walter Freeman - The Lobotomist

That didn't work, and people were horrified," he says.

But the tide may be turning. In the past two years a few neuroscientists have planned or carried out research into an entirely new form of psychiatric surgery, one that uses an implanted "pacemaker" and small electrodes to stimulate an area of the brain that might house the circuitry responsible for OCD and some forms of depression. (Ironically, Freeman's grandfather Keen used primitive electrical stimulation more than 100 years ago to treat behavioral disorders.) The region of the brain frequently targeted is the thalamus, the same area that Freeman held responsible for the emotional over-excitement that he theorized was a cause of mental illness.

Today's researchers view the thalamus differently. They see it as a coordinator and regulator of neural activities in the cerebral cortex, the part of the brain that accomplishes many of our highest mental functions. We can move, speak and plan our lives because of intricate teamwork between the thalamus and the cerebral cortex. If neurons in small regions of the thalamus shut down, current neuroscientific theory holds, the corresponding parts of the cerebral cortex run uncontrolled, producing Parkinson's disease, OCD and other problems. Electrically stimulating those neurons can restore them to wakefulness and rein in the cerebral cortex.

The surgery required to implant the electrodes is not dangerous, but researchers believe the public is frightened of it. "I definitely believe that there is a very important public stigma attached to surgical treatments for psychiatric disorders, and that this is for good reasons," says Bart Nuttin, a researcher at the Laboratory of Experimental Neurosurgery and Neuroanatomy, Catholic University of Leuven in Belgium. "I am convinced that in the past this kind of surgery has been abused."

Nuttin and his colleagues surgically in- stalled electrodes in the brains of four patients with cases of OCD that did not respond to standard treatments. Three experienced relief of their symptoms when the electrical current was on. One of these patients, a 39-year-old woman with a long history of untreatable OCD, felt "an almost instantaneous feeling of being relieved of anxiety and obsessive thinking," the team reported in the British medical journal the Lancet in 1999. About 90 percent of her symptoms vanished.

Because brain stimulation, which the Food and Drug Administration recently approved as a treatment for Parkinson's tremors, causes no permanent changes in the brain and can easily be shut off, Nuttin says it is in some ways similar to drug therapy. Yet this is a form of brain surgery, and Freeman's lapses of the past have left their mark.

An ethics committee oversees the use of brain stimulation, to ensure that patients are not taken advantage of and subjected to unsafe therapy. "My greatest fear is that some surgeons would start using this technique in a less controlled way than we have," Nuttin says. "There remains a need for strict official control of this kind of treatment."

Belgium's Catholic University is one of a handful of research centers that have investigated brain stimulation as a treatment for psychiatric disorders, or plan to. Another is the Cleveland Clinic. Ali Rezai, who heads the section of stereotactic and functional neurosurgery at the Cleveland Clinic, has mixed feelings about Freeman. "In some ways he was a pioneer, but in others he did a disservice and slowed the pace of development by being too much of a cowboy and acting too exuberantly without scientific foundation," he says.

Freeman also spooks federal funding for this kind of research. The National Institute of Mental Health does not currently fund any research on psychiatric surgery and hasn't for many years. Although a spokeswoman for NIMH says that psychiatric surgery is not barred from funding consideration, Elliot S. Valenstein, a University of Michigan neuro-psychologist and author of the psychosurgery history Great and Desperate Cures, believes there is a political bias at work. "I think they're really concerned about the reaction to the [perceived] notion that the government is supporting brain operations and that there may be a resurgence of lobotomies in this country," he says.

Rezai hopes that his institution's brain stimulation research, set to begin this year, will win NIMH funding. He emphasizes that this therapy, if it works, will be best suited as a last resort for a small number of OCD patients: those for whom all other treatments have failed. But it also holds future promise for people with untreatable depression, speech disorders, multiple sclerosis and chronic pain.

Lobotomy also raised high hopes in its day. During the late 1950s, when the new tranquilizing drugs had grown popular in state hospitals, Freeman wrote letters to his psychosurgical colleagues around the world, praying for a time when brain operations would again gain wide favor in the battle against mental illness. It didn't happen in his lifetime.

Now that it might happen in ours, Freeman's presence is unwelcome. He flits around, a pesky spirit looking for the recognition he believes he is due, an unwanted ghost causing sighs and regret.