Lobotomy Encore (Part II)
While doing research for my dissertation which would become the research for A Hole In One, I met a person who told me that his mother had pursued getting a lobotomy for a long time until eventually she succeeded. Having always assumed that all people who were lobotomized were forced to undergo this treatment, I was stunned to hear about someone whose conscious desire led them to pursue this mode of treatment. Through further research I learned that there existed a small but significant number of people who had not been lobotomized against their will but who had actively sought out a lobotomy, often successfully. I was struck by the existence of such a group because it appeared to blur the line between lobotomy and contemporary pharmaceutical products. I became aware of how lobotomy was actively promoted by the physician who invented it as an almost miraculously simple and foolproof treatment for mental illness. This had led some people to find themselves in the cure just as people today often ask for pharmaceutical products after they see the treatments advertised as representing “the cutting edge” or after they read about them on social media.
Anna (Michelle Williams) finding the grave of her brother marked only with a number in the cemetery of a psychiatric hospital in my first feature fiction film A Hole in One (2004).
A Hole In One is about Anna (Michelle Williams), a young woman in 1953 who wants a lobotomy and her homicidal boyfriend, Billy (Meat Loaf), a small-time hood who doesn’t want her to get one. The story takes place in a fictional place named Icetown, symbolized by a celestial ice pick. Besides Anna and Billy, the story also involves a small number of other characters; these include: a traveling neurologist, Walter Ashton (Billy Raymond), who performs transorbital lobotomies; a traumatized Korean War veteran (Tim Guinee), who falls for his boss Billy’s girlfriend Anna; Billy’s daughter (Merritt Wever) who is set upon discovering the wonders of jello; Anna’s brother Bobby (Jonathan Watton) a veteran who dies in a V.A. psychiatric hospital, two henchmen of Billy (John Paul Tremblay and Robb Wells of the Trailer Park Boys) and Dan, a Black taxi driver who is less than sanguine about Anna’s suggestion that lobotomies might help Black people to adapt to integration (Wendell Pierce).
From the perspective of narrative fiction I was intrigued by the possibility of creating, on the one hand, a protagonist whose goal would repel an audience, disturbing any reductive identification with her, and, on the other hand, an antagonist who was repulsive despite his wish that his girlfriend not get a lobotomy.
Another of the clinical groups, besides the Payne Whitney History of Psychiatry Section, with which I came into contact while doing research for my doctoral dissertation was a Lacanian psychoanalytic association. One of the first seminars I attended was on Lacan’s Seminar XXEncore. On the cover of the French edition is Bernini’sEcstasy of Saint Theresa. I was struck by this visual image in relation to the brilliant and beautiful psychoanalyst giving the seminar. Lacan focuses in this seminar on Feminine Enjoyment (a kind of “Jouissance” only existing on the female side of the graph Lacan proposes, although this does mean it is assigned by biology). This combination of a beautiful woman who is also intellectually brilliant elaborating Lacan’s enigmatic seminar on feminine sexuality and a kind ofjouissancethat is outside the logic of the phallus was totally irresistible. I may have been doing Lacan’s work a terrible injustice by my aphoristic style of starting to make sense of it, but I was diving right in–not starting at the beginning–and was immediately hooked.
I also learned at this time that Lacan had referred to psychosis as a hole in what he calls the symbolic order of language. One day, I visited a psychiatric hospital in Far Rockaway for elderly psychotic patients. I visited with a friend who was a retired psychiatrist who had been for many years on the staff of the Payne Whitney Psychiatric Clinic and a member of the History Section of this clinic where I learned so much. We went to visit her aunt who had been living there as a patient for many years. At the time of her initial psychotic break, her aunt had been working as what her aunt called “a taxi dancer.” “Taxi dancers,” I learned, was a slang term for women who worked at dance halls and were paid to dance with men. The term refers to the women “driving” the men around the dance floor. As we stood beside her, her aunt looked out the window of the psychiatric hospital beyond the crumbling road along the shore to the Atlantic Ocean and talked about the danger posed by all the holes in the ground. Listening to Lacan’s seminarEncore, I also was fascinated by the homophony between “whole” and “hole.” Although not in a way I could formalize, these associations filtered into my work on the screenplay and are retained in the different ways I heard the film’s titleA Hole In One. It was at this time that I began to write a screenplay about a woman who wants a lobotomy.
Freud’s concept nachträligkeit is sometimes translated into English as “retroactivity.” Simply put, the idea is that future actions change the past. It was only after making the feature fiction film Adieu Lacan, 19 years later, in 2022, that I began to think of the work of Lacan as influencing all of my films, including the two films I would make next Ikonophile Z (2023) and especially V13 (2024).
In the course of location scouting for A Hole In One, I became aware that decommissioned psychiatric hospitals are regularly used as locations for low budget films. While our film has only a few scenes that take place in a psychiatric hospital I was enthusiastic about using such a location. It would provide an historical link for the cast and crew to the subject of our film. We found such a hospital outside of Halifax Nova Scotia, Canada. The production designer Bill Flemming did an extraordinary job of building the sections of Icetown that we see in the film in different parts of the grounds of the hospital. As cast and crew arrived during pre-production I gave regular tours of the grounds of the hospital. It even had a surgical theater that was presumably used for psychosurgery. In the film you can see this theater. In it Anna (Michelle Williams) is being readied to receive electroshock as a form of anesthesia in preparation for being lobotomized by Doctor Walter Ashton (Bill Raymond). In our movie he practices the new form of lobotomy that at the time of our story was getting great buzz in the press—strategically orchestrated by its inventor—and sweeping the country, the transorbital lobotomy.
The transorbital lobotomy came in at a really great price point in the 1950s. During World War II, the American military discovered its own brand of cathartic treatment for what we now callPost Traumatic Stress Disorder(PTSD), then known as “shell shock.” They conceived of their unique brand of cathartic treatment as derived from psychoanalysis. For a few years during and after WW2, military clinicians were largely convinced that it was successfully providing alleviation of symptoms after a short period of treatment. During the treatment a veteran who suffered from shell shock was coaxed into speaking about his symptoms and earlier traumatic events in his life, sometimes using drugs to make it easier for him to speak. You can see this form of treatment being practiced in John Huston’s filmLet There Be Light (1946). Huston’s film was shot on Long Island at Pilgrim State Hospital, whose asbestos-filled remains I have visited. The hospital was one of many large psychiatric hospitals built as the war ended in a burst of optimism and government spending on the state and federal levels. As seen in Huston’s film clinicians were confident that a large number of patients could be cycled in and out of such institutions after a short period of treatment like cars or tanks turned out on an assembly line. However, the hospitals soon filled with patients who had become permanent residents. The individual states that were on the hook for financing these hospitals and for their upkeep were in search of a less expensive solution. Eventually the answer was dumping prior hospital residents into imagined “communities,” which were in many cases neighborhoods being dismantled under what was called “urban renewal.” The justification was that the arrival of miracle pharmaceutical products alone was sufficient to treat severe forms of mental illness, absolving the states of any responsibility for not only maintaining large psychiatric hospitals but also for providing any kind of supportive housing. The first of these drugs was Thorazine. Transorbital lobotomy arrived just before Thorazine. It reportedly could be performed–and often was–using an icepick. No surgical training was required. You lined up the icepick with the angle of the nose, inserted it near the eye, pierced the orbital cavity of the skull with a tap of a hammer on the back of the icepick andaway went troubles down the drain–or so it was reported in theNew York Times,LifeMagazine and countless other media of the time. The inventor Walter Freeman often helped write the articles and provided photos. We use many of the headlines from the period in the film, including “Easier Than Getting A Tooth Pulled” (a headline which also made it intoSuddenly Last Summer(1959). What really made transorbital lobotomy successful–far beyond previous forms of lobotomy–was that it did not require rendering the patient unconscious using general anesthesia, which was expensive and time-consuming. Instead, electroshock was used. Electroshock was another go-to treatment of the period for many forms of mental illness, including schizophrenia, and was therefore readily available at psychiatric hospitals. It did not require advanced medical degrees in order to administer it—far from it, any underpaid orderly with no medical training could administer it and often did. The use of electroshock to prepare a patient for a lobotomy radically reduced the cost and amount of time required to perform a lobotomy and–from the point of view of hospitals looking to cure the bottom line–it appeared to be a miracle cure in every sense of the word. The one completely executed transorbital lobotomy to which the audience is treated inA Hole In Onematches shot-by-shot a short film Dr Freeman made exclusively for a medical audience—you’ll understand why exclusively if you see my film.
For around a year after I finished A Hole In One I was like the ancient mariner in Samuel Coleridge’s eponymous poem: Almost any conversation with any complete stranger I seemed to somehow segue easily into talking about transorbital lobotomy. I remember one couple at a party who had come for a few drinks and some light banter and were sucked into learning that the icepick first used was one made by the Uline Ice Company and that I had found it in a cardboard box stored in a library’s archive...
The action of A Hole In One takes place during Mental Health Week in June of 1953. I fictionalized the precise period of time when this actual week-long celebration took place so that it coincides with the electrocution of the Rosenbergs. I basically sought to show Anna in an insane world in which her bouts of sanity are a major handicap.
I am grateful that Michelle Williams chose to accept the lead role. When we spoke by phone the first time she told me the night before she had dreamed she was reading Freud. It was an auspicious beginning. Her commitment to her role—to a grueling schedule while she did our film and met her commitment to a television series—inspired everyone involved with the film.
The penultimate scene of the film shows Anna and Tom visiting a graveyard with identical round markers, each grave differentiated from the others by a sequential number stamped on it. Comparing the stamped numbers to the one she has scrawled on a piece of paper, Anna and Tom find the grave of her brother. This scene was added based on a discovery I made early in the process of location scouting. Among the first decommissioned psychiatric hospitals I visited was the Hudson Valley Psychiatric Hospital. During my visit I was guided by a representative of the town. For generations the hospital had offered steady employment to the people living around it. Since its closing, it had become a burden to the same town and a visual eyesore along the main highway running through it. Once upon a time, as a boy being driven by my father to a private boarding school (the one attended by Colin DeLand and myself), I had observed patients sitting outside on the benches and their attendants standing nearby. For years now the buildings of the hospital had stood without lights or people. As the tour of the immense cavernous buildings connected by underground tunnels circled back to where we had started, the town’s representative suggested that we conclude my visit, unless I wanted to see the cemetery—adding that no one had ever asked her to see it. I requested that we visit it. We traveled by car through a golf course where the representative explained the patients had once caddied for the doctors. We came to a rusting arch with letters made from metal cables that read “Gate of Heaven.” It defined the entrance of an area surrounded by stone walls and covered by brush and weeds. Despite this covering, it was possible to make out approximately an acre covered by identical round cement markers, each one topped by a metal disk into which a number was stamped. This is where those who had died at the state psychiatric hospital had been buried. Later I learned this was a widespread practice at psychiatric hospitals, reportedly in order to protect families from the shame associated with mental illness. Seeing me work my way through the weeds covering these monuments, the face of the representative seemed to me to change, as if she were becoming conscious for the first time of what this place signified for those buried beneath and their loved ones. My mother had, consciously or not, made me curious enough that I had spent years uncovering what had happened to her brother Richard and here I was analogously pulling back thorn bushes from these neglected graves. I used this graveyard as in inspiration for the scene at the graveyard near the end of A Hole In One. I also returned here with director of photography Steve Kazmierski after making A Hole In One and made a short documentary video about it.