Much of Robert Apter, on the other hand, is based on the real Walter Freeman II as depicted in the rich biography The Lobotomist by Jack El-Hai. Some of the details that I took from El-Hai’s book are that Freeman dressed to look like a nineteenth-century psychiatrist, including a signature goatee. He was an avid photographer who chronicled his patients in detailed photographs. He worked incessantly and needed very little sleep. He had a strained relationship with his father, an ear, nose, and throat specialist who hated medicine. He most admired his maternal grandfather, William Keen, who was a renowned doctor and surgeon and who encouraged Freeman to pursue medicine, using his connections and influence to help establish Freeman in the field. El-Hai attributes Freeman’s drive at least, in part, to a desire to follow in his grandfather’s footsteps.
Like Robert, Walter Freeman II was a neurologist and a psychologist but not a neurosurgeon, in spite of the fact that he performed lobotomies. He was a dramatic showman; his medical school lectures were apparently so entertaining that they were a date night activity for his students. He performed stunts to make his lobotomies more interesting for audiences—like using a carpenter’s mallet instead of surgical hammers, or driving both ice picks into the patient concurrently, with both of his hands （some say he was ambidextrous）。
The development of lobotomy and the people in my book are all real. The Second International Neurological Congress, the place where the seed of the idea for lobotomy was planted, did, in fact, take place in London in the summer of 1935 as described. It was one of the anchor dates for my timeline. The SS Manhattan was the official ship of the conference, the Metropole the official hotel, and the topics and presentations are from the official agenda. Freeman was stationed next to Egas Moniz, the Portuguese doctor who invented the original “leucotomy,” on the exhibition floor of the congress, and it is purportedly here that they began the professional friendship that would lead Freeman to adapt Moniz’s leucotomy in the US. Freeman was also responsible for nominating Moniz for the Nobel Prize in 1949.
The presentation at the Second Neurological Congress by Drs. John Fulton and Carlyle Jacobsen about their pioneering work on the frontal lobes of chimpanzees at the Yale primate lab was real and is said to have influenced Moniz and, subsequently, Freeman. （An interesting aside, Freeman was actually apparently responsible for overseeing the transportation of the chimpanzees used in the presentation.）
To the extent possible, I followed the actual timeline for the development and popularization of lobotomy in America, although I changed places and invented patients. Freeman lived and worked in Washington, DC, was the chairman of the Neurology Department at the George Washington University, and worked at Saint Elizabeths Hospital. I moved the location to New York and modeled Emeraldine Hospital partially on Bellevue. While I made up the specific New York Times article touting lobotomy in the book, there were many similar pieces when the treatment was first introduced in 1936.
Robert’s surgical partner, Edward Wilkinson, is loosely based on Freeman’s collaborator, neurosurgeon Dr. James Watts. Edward’s background and personality are fiction, but like Robert and Edward, Watts and Freeman pioneered the American prefrontal lobotomy together, with Freeman as the scientist and Watts as the surgeon. Freeman “invented” the new transorbital （“ice pick”） method a decade later to make lobotomy accessible to state mental hospitals across the country, and he supposedly used an actual ice pick in one of his first procedures. Even though this change enabled Freeman to perform lobotomy as an outpatient office procedure, Watts still believed lobotomy should be confined to a hospital setting. Their partnership dissolved in 1950, when Watts found Freeman photographing an in-process transorbital lobotomy in their private office. However, unlike Edward, Watts remained collegial with Freeman, keeping his criticisms of the new form of the procedure to himself.
Over the course of his career, Walter Freeman II lobotomized more than three thousand people and trained doctors responsible for thousands more. Between the late 1940s and mid-1950s, he traveled the country in a station wagon that he supposedly dubbed his “lobotomobile,” training hospital staff and lobotomizing patients like they were cars in an assembly line. “Operation Ice Pick” in the book was an actual trip that Freeman took to West Virginia in 1952, where he performed 228 lobotomies.