When Howard Dully met the man who was to change his life for ever, he was not sure what to make of him. He was 11 at the time and paid little attention to the mysterious adult world that surrounded him, to the decisions taken without his knowledge or to the profound impact that Dr Walter Freeman would have on his pre-adolescent existence. Instead, with a child's eye, he noticed the small physical quirks - the round-rimmed glasses, the dapper suit, the well-trimmed goatee. 'It made him look a little like a beatnik,' Dully says. 'He was warm, personable and easy to get along with. Was I fearful? No. I had no idea what he was going to do with me.'
Dully was a withdrawn boy who liked riding his bicycle and playing chess. He occasionally fought with his brother, disobeyed his parents and stole sweets from the kitchen cupboards. He had a weekly paper round and was saving up to buy a record player. According to Dr Freeman's meticulous records, Dully was 62 inches tall and weighed 6½ stone. He was an average child, perhaps a little unruly but nothing that would strike one as exceptional for a boy of his age.
But Howard Dully would soon become exceptional for all the wrong reasons. Barely two months after this first meeting, his father and stepmother had him admitted to a private hospital in his home town of San Jose, California. At 1.30pm on 16 December 1960, he was wheeled into an operating theatre and given a series of electric shocks to sedate him. That much he remembers. The rest is murky.
When Dully woke the next day, his eyes were swollen and bruised and he was running a high fever. He recalls a severe pain in his head and the discomfort of his hospital gown, which gaped open at the back. He had no idea what had happened. 'I was in a mental fog,' Dully says. 'I was like a zombie; I had no awareness of what Freeman had done.'
What he didn't know was that he had been subjected to one of the most brutal surgical procedures in medical history. He had undergone a lobotomy and no one, not his parents, not the medical community or the state authorities, had intervened to stop it. More disturbingly, there seemed to have been no obvious necessity for the operation.
If Dully appeared superficially vacant or mildly aggressive, there were some obvious explanations. His mother died of cancer when he was five and his father, Rodney, later remarried to a 'cold and demanding' woman called Lou, who found her new stepson's natural ebullience and physical strength almost impossible to control. Relations between the two deteriorated so that Dully grew up in an atmosphere of emotional abuse and casual neglect. He was given regular beatings and forced to eat meals on his own. Increasingly convinced that there was something emotionally wrong with her stepson, Lou started consulting psychiatrists and mental health experts before eventually being referred to Dr Freeman, a renegade physician disowned by the mainstream establishment, who ran a private practice in Los Altos, just outside San Francisco. Freeman diagnosed Dully as a schizophrenic.
'He is clever at stealing, but always leaves something behind to show what he's done,' Freeman recorded in his notes from October 1960. 'If it's a banana, he throws the peel at the window; if it's a candy bar, he leaves the wrapper around some place... he does a good deal of daydreaming and when asked about it he says, "I don't know." He is defiant at times - "You tell me to do this and I'll do that." He has a vicious expression on his face some of the time.'
Discarded sweet wrappers, daydreaming spells and the odd glimpse of youthful defiance - it would appear to be a relatively innocuous list, but it was enough for Freeman. Eight weeks after the doctor first saw him, Dully came round from his operation in a state of numbed confusion. The hospital report stated that he had been given a 'transorbital lobotomy. A sharp instrument was thrust through the orbital roof on both sides and moved so as to sever the brain pathways in the frontal lobes'. Dr Freeman's bill came to $200. Dully was his youngest-ever patient; extraordinarily, he survived.
'People freak out when they realise the person they are talking to had a lobotomy,' he says now, 47 years later, sitting under the corrugated iron awning outside his trailer home on the outskirts of San Jose. 'They expect me to be drooling.'
Over the years, the lobotomy has become almost a caricature of itself, a cultural shorthand that immediately conjures up images of zombies or dribbling madmen. Even the word itself sounds freakish and unwieldy, like an ill-judged verbal joke. For most people, it remains indelibly associated with dramatic invention: with the dazed, incoherent character of Catherine in Tennessee Williams's Suddenly Last Summer or with Jack Nicholson's Oscar-winning performance as a deranged asylum inmate in One Flew Over the Cuckoo's Nest
But for a time in the 1930s and Forties, the procedure was at the forefront of neurosurgery, viewed by the medical establishment as a cutting-edge treatment for mental illness. Before the introduction of antipsychotic drugs or the popularisation of psychotherapy, the lobotomy was touted as a miracle cure for anything from schizophrenia to postnatal depression - and not just in the United States. Neurologists in the UK are estimated to have carried out 50,000 variants of the operation, until the late 1970s.
Derek Hutchinson, a 62-year-old grandfather, underwent a lobotomy in 1974 - without his consent, he says - at the hands of surgeon Arthur E Wall while a patient at the High Royds Asylum near Leeds. Unlike Dully, Hutchinson was awake throughout his operation, which a psychiatrist had insisted would curb his aggressive tendencies.
'What did it feel like?' he says from his home in Leeds. There is a long exhalation of breath on the end of the phone, halfway between a gasp and a sigh. 'It's a situation you should only go through once in your life and that's when you're dying. It felt like a broom handle was being pushed in my brain and my head was splitting apart.'
Originally developed by Portuguese physician Antonio Egas Moniz in 1936, the lobotomy involved drilling two small holes in either side of the forehead and severing the connecting tissue around the frontal lobes. The hope was to dull the symptoms of psychiatric illness by reducing the strength of emotional signals produced by the brain. Although Moniz won the Nobel Prize for his pioneering work in 1949, he insisted that it should only be used as a last resort, in cases where every other form of treatment had been unsuccessfully tried.
Dr Walter Freeman, a neurologist and Yale graduate, brought the procedure to America in the late 1930s. Freeman's first job after medical school was as head of laboratories at St Elizabeth's Hospital in Washington DC, a sprawling mental institution that housed 5,000 inmates in near-Victorian conditions. At the time, the state legislature paid a pitiful $2 a day per patient to cover their upkeep, a sum that included staff salaries, catering, accommodation and treatment.
Spurred on by his first-hand experience of the horrors of state-run mental institutions and determined to make his name as a medical pioneer, Freeman developed a version of Moniz's procedure that reached the frontal lobe tissue through the tear ducts. His transorbital lobotomy involved taking a kitchen ice pick, later refined into a more proficient instrument called a leucotome, and hammering it through the thin layer of skull in the corner of each eye socket. The pick would then be scrambled from side to side in order to damage the frontal lobe. The process took about 10 minutes and could be performed anywhere, without the assistance of a surgeon.
Over the years, Freeman developed a reckless enthusiasm for the operation, driving several thousand miles across the country to carry out demonstrations at asylums and hospitals. An instinctive showman, he sometimes ice-picked both eye sockets simultaneously, one with each hand. He had a buccaneering disregard for the usual medical formalities - he chewed gum while he operated and displayed impatience with what he called 'all that germ crap', routinely failing to sterilise his hands or wear rubber gloves. Despite a 14 per cent fatality rate, Freeman performed 3,439 lobotomies in his lifetime.
For the survivors, the outcomes varied wildly: some were crippled for life, others lived in a persistent vegetative state. Rose, John F Kennedy's sister, was operated on by Dr Freeman in 1941 at the request of her father. Born with mild learning difficulties, she was left incapacitated by the procedure and spent the rest of her life in various institutions, dying in 2005 at the age of 86. Yet occasionally, the operation appeared to have a calming, desensitising effect on the mentally ill. The lobotomy's mixed success rate was a symptom of its imprecision: it was a hit-and-miss procedure developed at a time when little was known about the very specific nature of the brain's structure.
Dully's almost total recovery is thus an anomaly. To look at him, you would never guess that he underwent such brutal surgery. There is no slowness of speech, no telltale squinting of the eyes, none of the lack of social inhibition that characterises most lobotomy survivors. Now 58, he has a full-time job training school bus drivers and has been married to Barbara for 12 years. He has a son, Rodney, 27, and a stepson, Justin, 30, and a tabby cat called Princess who prowls on a parched flowerbed while we talk. His autobiography, My Lobotomy, co-written with journalist Charles Fleming, was published in the US last autumn and will be published in the UK in March.
'I don't feel physically different from anyone else,' he says. 'I get eye infections because I think they destroyed my tear ducts. About the most unusual thing you would notice about me is my size.'
Dully is a broad, bulky man and 6ft 7in tall. When he turns on his laptop to show me photographs of his operation, his hand completely covers the computer mouse. The pictures are disturbing in their very matter-of-factness. Freeman was a fastidious archivist and insisted on recording each stage of the operation on camera. In one black-and-white image, Dully lies unconscious, his mouth lolling open. The tip of a 12cm long leucotome has been pushed deep into his eye socket. How does he feel when he sees these photographs?
'I would describe it as a feeling of loss, like you've lost a whole part of your life.' As he speaks, he gulps intermittently on a mug of milky instant coffee. 'I like hazelnut-flavoured cream in my coffee - it makes life worth living,' he says, grinning through an enormous walrus moustache. On the surface, at least, his life is settled, but it has taken Dully the best part of four decades to be able to speak with such ease about his past.
'It was something I didn't talk about for years. I felt that I was the secret, the skeleton in the closet, the dirty laundry.' That changed in 2003 when he was tracked down by an American radio production company and asked to make a documentary about his life. It was the first time he had seen his medical files and the first time he had found the courage to confront his past and speak to his father.
'Lou [his stepmother] had died in 2001, so a lot of what happened died with her. I asked my dad about it and I don't think he meant any harm. He said he got manipulated by Lou. She threatened him with divorce if he didn't go ahead with it. My dad said he only met Freeman once.'
Dully breaks off and leans back in his chair, arms folded across his black polo shirt. 'You meet a guy once and you're going to let him drive spikes in your son's head?' he asks, incredulously.
His father, now 83, has never apologised, but Dully remains astonishingly sanguine about the operation and the chequered legacy it left him. For years after the lobotomy, he was in and out of mental institutions, jails and halfway houses. He was homeless, drug-addicted and alcoholic, a petty criminal with little concept of how to live a normal life.
'I think I was angry at society for a long time, but I went through that and now I don't think there's any point in dwelling on it. I blame everyone for what happened including myself. I was a mean little ruffian. Lou was looking for a way to get me out of the house, for a solution to the problem, and Freeman was looking for a subject. Both of them came together... and whoopa-dee-doo.
'I don't think Freeman was evil. I think he was misguided. He tried to do what he thought was right, then he just couldn't give it up. That was the problem.'
In many ways, Walter Freeman was shaped as much by human frailty as his patients. Born in Philadelphia in 1895, he was driven from a young age to be exemplary, growing up in the long shadow cast by his grandfather, William Keen, an exceptional surgeon who was the first American successfully to remove a brain tumour. 'He was motivated partly by interest in the well-being of his patients and then also by this very urgent need to feel like he was someone who was accomplishing great things,' explains Jack El-Hai, author of The Lobotomist, a biography of Freeman. 'As he grew more personally attached to the lobotomy, he became more irrational.'
The more the mainstream medical establishment derided Freeman's methods - with the advent of Freudian psychoanalysis and antipsychotic drugs such as Thorazine in the mid-1950s the lobotomy fell out of favour - the more defensive Freeman became. He took pride in what he called 'shrink-baiting' and wrote disobliging limericks about his professional enemies, once saying he would 'rather be wrong than be boring'. By the time Freeman operated on Dully in 1960, he was working exclusively from a private practice - no state hospital would touch him.
Freeman's home life unravelled alongside his professional reputation. His wife, Marjorie, was an alcoholic and Freeman had numerous affairs. In 1946, Freeman had witnessed the horrific death of his 11-year-old son Keen on a camping holiday in Yosemite national park. Keen was bending down at the top of waterfall to fill up his flask when he lost his footing and was swept over the brink. It was an experience that must have affected Freeman greatly, although he made sparse mention of it in later life. But perhaps it was telling that, 14 years after the event, when he first met 11-year-old Howard Dully, Freeman suggested that the two of them should go hiking.
'My sense with Howard is that Freeman thought he was treating a family problem rather than just a boy's psychiatric problems,' says El-Hai. 'But by the standards he used in earlier years, what he did was completely unjustifiable.'
Although Freeman ended up causing unforgivable harm, he was not, essentially, a bad man. After he died of complications arising from an operation for cancer in 1972, his four surviving children - Walter, Frank, Paul and Lorne - became staunch defenders of their father's legacy. Two of them have carried on the familial medical heritage: Paul is a psychiatrist in San Francisco and the eldest, Walter Jnr, is now professor emeritus of neurobiology at the University of California.
Walter Jnr's twin, Frank, 80, is a retired security guard, living in a modest, second-floor apartment in San Carlos, just half an hour's drive from Howard Dully's home. He is a friendly giant of a man, dressed smartly in a double-breasted, dark blue suit and burgundy tie, kept in place by a thin gold clip. 'He was a marvellous father,' Frank says, sitting in a room filled with crossword dictionaries and Dick Francis novels. 'He loved his children and always made time for us out of his busy schedule, taking us camping every summer all across the country.'
Frank recalls being invited to observe a lobotomy when he was 21 and vividly remembers hearing 'a little crack as the orbital plate fractured. It only took about six or seven minutes and Dad kept up a running commentary.' Indeed, the original ice pick used for the first transorbital lobotomy came from the Freeman family kitchen drawer. 'We had several of them,' says Frank, cheerfully. 'We used to use them to punch holes in our belts when we got bigger. I'm enormously proud of my father. I do think he's been unfairly treated. He was an interventionist surgeon, a pioneer and that took guts.'
But however well-intentioned his interventions, Freeman's life-long quest for self-glorification meant that he failed to acknowledge when his methods were doing more harm than good. I ask Frank whether he thinks Freeman was justified in operating on the young Howard Dully, a boy on the brink of adolescence, whose brain had barely begun its transformation to maturity?
'Well...' he pauses, the palms of his hands resting on his knees. 'I've had a couple of chats with Howard [when Dully interviewed him for the 2003 radio broadcast] and he said that growing up, he hated his stepmother and she was afraid of him. He was belligerent and unco-operative, frightening if you like, and I'm convinced that if he'd gone on like that he would have ended up in jail or a mental institution. Frequently, people like Howard have a lobotomy and sooner or later they straighten out. Howard's been self-supporting for a number of years and he's married, in a very pleasant relationship.'
It is impossible to say how Dully's life would have panned out if he had not walked into Walter Freeman's office one long-ago autumn day. Perhaps it would, like Frank says, have been incalculably worse or perhaps it would have carried on much the same. But it could have been better, too, and the true sadness is that Howard Dully will never be able to find out one way or the other.
Mind-boggling: a history of lobotomy
1890: German scientist Friederich Golz experiments with removing the temporal lobe from dogs and reports a calming effect.
1892: Gottlieb Burkhardt, a Swiss physician, performs a similar operation on six schizophrenic patients. Four exhibited altered behaviour. Two died.
1936: Portuguese neuropsychiatrist Antonio Egas Moniz develops the leukotomy, but advises using the operation only as a last resort.
1945: American surgeon Walter Freeman develops the 'ice pick' lobotomy. Performed under local anaesthetic, it takes only a few minutes and involves driving the pick through the thin bone of the eye socket, then manipulating it to damage the prefrontal lobes.
1946: First lobotomy performed in Britain at Maryfield Hospital, Dundee. The procedure is used for 30 years.
1954: Antipsychotic drug Thorazine licensed for the treatment of schizophrenia, causing the lobotomy gradually to fall out of favour.
1960-70: Lobotomies come under scrutiny by sociologists who consider it a tool for 'psycho-civilising' society. They were banned in Germany, Japan and the Soviet Union. Limited psychosurgery for extreme medical cases is still practised in the UK, Finland, India, Sweden, Belgium and Spain.
· Howard Dully's autobiography, My Lobotomy, co-written with journalist Charles Fleming, will be published in the UK in March at £10.99. To order a copy for £9.99 with free UK p&p, go to observer.co.uk/bookshop or call 0870 836 0885