You have to wonder about Henry Brill's sanity. A Yale-educated psychiatrist, he was director of Pilgrim State Psychiatric Center from 1958 to 1974. During the latter stages of his tenure at the world's largest mental hospital, he was a national leader in the fight against marijuana. Head of the state's Drug Abuse Commission, he railed against the evil impact that marijuana had on people's brains.

Big talk from a guy who, when he was just another doctor at the huge and creepy hospital in West Brentwood, personally oversaw the lobotomies of hundreds of helpless human beings.

About 2,000 Pilgrim patients were lobotomized in the '40s and '50s, according to later reports in the New York Times and elsewhere. Though lobotomies probably were performed at mental hospitals in Central Islip and Creedmoor, among other places, one out of every 25 lobotomies performed in the United States took place at Pilgrim, making it undoubtedly the scariest place on Long Island.

The king of lobotomies was Walter Freeman, another Ivy Leaguer, a Barnumesque neurologist who didn't let his lack of surgical credentials stop him from drilling into the noggins of hapless patients at state hospitals, where officials were always seeking ways to cut costs and control violent inmates.

It's not known whether Freeman performed his infamous "icepick" lobotomies at Pilgrim. Using only electric shock as an "anaesthetic," Freeman would insert an icepick into the corner of an eye of a patient, hammer it in and twist it up and down, severing neural fibers with abandon and turning patients into obedient zombies. The more standard procedure was a prefrontal lobotomy, in which doctors drilled holes in a person's skull and, using little more than guesswork, removed goops of gray matter.

Freeman's technical manual Psychosurgery (regurgitated in an April 1980 Washington Post story) tells the tale of an early '40s prefrontal lobotomy— while it was happening— on a 24-year-old schizophrenic laborer named Frank in a West Virginia state hospital:

Doctor: How do you feel?

Frank: I don't feel anything, but they're cutting me now.

Doctor: You wanted it?

Frank: Yes, but I didn't think you'd do it awake. Oh, gee whiz, I'm dying. Oh, doctor. Please stop. Oh, God, I'm goin' again, oh, oh, oh, ow (Chisel.) Oh, this is awful. Ow. (He grabs my hand and sinks his nails into it.) Oh, God, I'm going, please stop.

Four years after the operation, Freeman and his partner James Watts wrote, Frank's brother "reported that he had lost all sense of time, spending four to six hours a day washing his hands but nevertheless going around with dirty clothes." He later was re-admitted to a state mental hospital. Still, as the Post noted, Freeman and Watts looked at this case as a triumph. "Fortunately, except for drinking too much," they wrote in their book, "he presents no aggressive misbehavior. It apparently requires some imagination, as well as some emotional driving force, to bring about misbehavior at the legally reprehensible level and this the patient is incapable of."

But a lobotomy can be inspiring as well. The most famous person lobotomized at Pilgrim was Allen Ginsberg's mother, Naomi. She was a troubled soul, and Allen himself, at the time a 21-year-old graduate student, authorized Pilgrim to perform a lobotomy on her in 1947. Two days after she died in 1956 at Pilgrim, according to later press reports, he received a letter from her that said: "The key is in the window, the key is in the sunlight in the window— I have the key— get married Allen don't take drugs. ...Love, your mother." Ginsberg didn't follow his mother's advice— or Brill's warnings— regarding dope, but in 1959, Ginsberg performed his first public reading of Kaddish for Naomi Ginsberg (1894-1956). The poem, which brought him worldwide acclaim, reads in part:

Strange now to think of you, gone without corsets & eyes, while I walk on the sunny pavement of Greenwich Village, downtown Manhattan, clear winter noon, and I've been up all night, talking, talking, reading the Kaddish aloud, listening to Ray Charles blues shout blind on the phonograph the rhythm, the rhythm— and your memory in my head three years after — . . .

Tennessee Williams was likewise inspired by his sister, Rose, who collected little glass figurines of animals— a menagerie— before she was lobotomized in a hospital down South. Jackie Kennedy used to visit her husband John's lobotomized sister, Rosemary, at a hospital in Wisconsin. And Frances Farmer, by some accounts, was transformed from film actress to vegetable by an icepick lobotomy perhaps performed by Walter Freeman himself at a mental hospital outside of Tacoma, Washington, in the late '40s.

Lobotomies were highly controversial in the medical community back then, but the press didn't cover that conflict. The horrors were detailed in scientific journals, in typically dry and stilted jargon. In a 1949 article in Psychiatric Quarterly, Brill and two cohorts proudly recounted the 350 prefrontal lobotomies they performed on naughty, troubled Pilgrim patients from May 13, 1947, to July 8, 1949.

Yes, the place was a nut house. But it was the doctors who were nuts for performing the barbaric procedures. The lobotomists were, in part, yielding to pressure to do something about moving long-term patients out of the nation's overcrowded mental hospitals. The directors of places like Pilgrim were always hounded by their staffs to make unruly patients more obedient. In some cases, patients' families pleaded for doctors to perform lobotomies so that the victims— mostly women— would stop worrying so much and do their housework or so they would quit having homosexual thoughts.

Freeman certainly was an inspiration to Brill and his colleagues, Harry J. Worthing and Henry Wigderson. Pilgrim's first lobotomy was performed on March 20, 1945, after the hospital's "Department of Mental Hygiene" okayed the travel of a senior staffer to observe Freeman and Watts in action. Contrary to recent press reports on the horrifying lobotomy era, the procedure wasn't necessarily a "last resort" when "all else failed." As the three Pilgrim docs noted, "...the best results are obtained when treatment is instituted as early as possible." And the people who were lobotomized weren't necessarily schizo. Many of them were simply "neurotic" or unmanageable— or they didn't respond to repeated "treatments" of electric shocks and insulin-induced comas.

Pilgrim's first lobotomy, the docs said, was performed on a man who was a "severe chronic schizophrenic, markedly negativistic and refusing food." "Massive defect persisted" even after the lobotomy, but that didn't stop his madness or theirs. One thing was almost certain: Most of the lobotomized patients were much easier to control after their brains had been drilled— most became zombies. "Assaultiveness and negativism are most strongly affected [by lobotomies]," they wrote, "while idleness and unproductivity are least improved."

Wigderson did the cutting and drilling, but Worthing and Brill got top billing for selecting patients and supervising. Astoundingly, the Pilgrim trio persisted even after they themselves said that lobotomies didn't even improve the patients most of the time. "The chief disadvantage of the procedure," they wrote, "seems to be that it fails to produce any improvement in about 25 percent of the operated cases and produces only a limited improvement in somewhat less than half of the patients." But it was better than nothing. "In spite of its limitations," the docs wrote, "the operation seems to be therapeutically active and fills a real need while we await a better treatment."

While they waited for something better— drug therapy started in the '50s— they referred to these human beings they experimented on by case numbers. Here are some highlights from their reports:

CASE NO. 4 Woman, 49 at the time of her lobotomy, "assaultive and noisy; she wet and soiled and was a feeding problem." Lobotomy on June 10, 1947. "She is now obese, quiet, smiling, friendly, does a small amount of work. There is massive regression and chronic hallucinations, but she is clean."

CASE NO. 6 Man, 28, IQ of 88. "He was assaultive, regressed, had filthy habits but did not wet or soil." Years of drug-induced coma therapy and electroshock treatments. Lobotomy on June 30, 1947. Released from Pilgrim on Sept. 7, 1947, "free of hallucinations, quiet, odd, bashful, manneristically polite...able to work as a delivery boy...a basic intellectual limitation also was obvious."

CASE NO. 24 Woman, 39, "had 'adequate' shock treatment without response and remained highly disturbed. She was physically powerful and a serious problem." Lobotomy on Oct. 22, 1947. "She was disturbed afterward and had electric shock with good response." Released on March 28, 1948. "She seems to be recovered. Her husband finds no trace of difference from her 'normal' level."

CASE NO. 33 Woman, 34, hospitalized at Pilgrim on March 11, 1947. "She was highly disturbed and suicidal. There was a homosexual conflict. She gnawed off the anterior part of her tongue. Shock treatment was without effect." Lobotomy on Dec. 6, 1947. Released from Pilgrim on Feb. 29, 1948. "Apparently in complete remission. She is working with no trace of defect."

CASE NO. 49 Man, 25, "actively hallucinating for more than a year." Lobotomy on Feb. 19, 1948. "Striking improvement." Released April 18, 1948. "He was well-adjusted, working, without any apparent residual defect; but he began drinking and is said to have indulged in marijuana. There was a full relapse and he was re-certified [insane]."

CASE NO. 50 "Mentally-defective man," 28, became "regressed, wetting and soiling, and was destructive." Lobotomy on Feb. 19, 1948. Released July 18, 1948. "Well-behaved at home, he worked in a protected location as a stone-cutter. He had a disturbed episode with return to the hospital on May 10, 1949. Here he is quiet, clean, withdrawn, does some work on the ward, and is not hallucinated."

CASE NO. 114 Woman, 26, "diagnosed as a tension neurotic" but "was not influenced by shock treatment." On re-admission to Pilgrim, diagnosed as "psychoneurotic." She was "disturbed, with rapid deterioration of her physical condition, and compulsive screaming; she beat herself against the walls." Lobotomy on July 2, 1948. Released Sept. 19, 1948. "She is again visiting a psychiatrist, complains that the lobotomy should not have been done, 'the effect did not last,' but she is keeping house again for her husband."

CASE NO. 130 Man, 44, with a "history of epileptoid seizures." At Pilgrim, "he was consistently hallucinated, delusional, withdrawn, irritable and assaultive on little or no provocation. He fractured the nose of a physician attending him for a physical ailment in 1936. ...He remained neat and a good worker." Lobotomy on July 30, 1948. "Since the operation, this patient has been mild, pleasant and quiet. He continues to be a good ward worker and is no longer under 'explosive paranoid tension.'"

CASE NO. 169 Woman, 28, had a "psychotic attack" at age 22. "Electric shock was without benefit; her behavior was disturbed....The patient became a ward worker." Lobotomy on Oct. 26, 1948. "She is making a good adjustment with some mild personality loss."

CASE NO. 231 Man, 57, with "delusions of persecution, economic incapacity, withdrawal from the family, letters to authorities." Admitted to Pilgrim in 1947. "In the hospital, he was furiously resistive, actively hallucinated, resentful, grandiose, unapproachable....he went on a hunger strike for several months." Lobotomy on Feb. 8, 1949. "The patient admitted that he had been 'imagining things.' He became friendly and approachable. On close examination, residual psychotic content was noted. There was cessation of paranoid letter-writing." Released June 4, 1949. "He was comfortable, but economically dependent. He was well-behaved. 'No loss of intelligence in conversation' was observed, but 'no will to work.'"

CASE NO. 236 Man, 29, "had a psychotic attack [at age 19] and responded satisfactorily to 44 insulin comas." Admitted to Pilgrim at age 20. "In the years which followed, this patient was consistently one of the most severe behavior problems, aggressively homosexual, out of contact, noisy, disturbed, overactive; he wet and soiled." Lobotomy on Feb. 15, 1949. "Slow improvement. He was clean, pleasant, but mentally defective— a moron. He speech was clear but brief. On the insistence of his parents, he was released on June 15, 1949 but returned after a few weeks because of restlessness and poor judgment. There is no severe behavior problem, but he is hebephrenic— silly. He is now clean, quiet, passive, well-behaved, probably hallucinated, speech brief but rather scattered, but he is well-informed on current baseball scores, etc."

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