The patients who received the most lobotomies in the United States during the procedure’s peak years in the late 1940s and early 1950s were patients in state psychiatric hospitals — public institutions that were chronically overcrowded, understaffed, and desperate for anything that might reduce the management burden of severely ill patients who had failed to respond to available treatments. These patients were predominantly poor. Many were people of color. Many were women. Many had no family members who could effectively advocate for them or whose advocacy would have been heard by physicians and hospital administrators.
Walter Freeman’s traveling demonstrations at state hospitals — in which he performed multiple transorbital lobotomies in a single day, sometimes dozens in a week — were partly driven by the genuine humanitarian impulse of a man who believed he was offering relief to people who had no other options, and partly driven by an ego that needed to see itself as a pioneer. The patients in those state hospital demonstrations had even less information about the procedure, even less ability to refuse, and even less protection against its consequences than Rosemary Kennedy had.
The gender dimension of lobotomy history is also worth noting. Women received lobotomies at higher rates than men throughout the procedure’s peak years. The behaviors that lobotomy was promoted as treating — agitation, emotional volatility, social non-conformity, refusal to conform to expected roles — were behaviors that the medical establishment of the era was more likely to pathologize in women than in men. A man who was angry and difficult was a man with problems; a woman who was angry and difficult was a psychiatric case.