Megan McArdle on the Oedipus Trap
Mar 20 2023

lobotomy-tools-300x300.jpg When physician Walter Freeman died in 1972, he still believed that lobotomies were the best treatment for mental illness. A pioneer in the method, he was a deeply confident and charismatic man who eagerly spread the technique in America, long after the rise of alternative treatments that were less destructive. Listen as journalist Megan McArdle and EconTalk's Russ Roberts discuss what McArdle calls the "Oedipus Trap": mistakes that no one can live with, even if they were innocently made, and how admitting such mistakes to ourselves is nearly impossible. They also discuss the complexity of the credo, "follow the science."

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Explore audio transcript, further reading that will help you delve deeper into this week’s episode, and vigorous conversations in the form of our comments section below.


Kevin Krisher
Mar 20 2023 at 10:43am

Wonderful podcast, as always. Thanks to Ms. McArdle and Mr. Roberts.

I was surprised that there was no discussion about the current use of extensive hormonal and surgical treatment for patients with sexual body dysmorphia, most of whom could probably also be referred to as transsexual people. Such treatments are sometimes called gender affirming care or sex change therapy, but it would be more precise to describe them as extensive and irreversible cosmetic procedures that are intended to relieve psychological pain or discomfort by altering healthy tissue to create resemblances to the other sex.

To the extent that body dysmorphia can be considered a mental illness – as it consistently was in the past – these treatments are similar to lobotomy. Both were quickly accepted with, it seems, a minimum of due caution, especially for pediatric patients. There is even interest in trying to legally ban less radical types of psychological therapy, characterizing them as “conversion therapy.”

These treatments also have an interesting metaphysical dimension: Many of their proponents argue that their patients “really are” members of the other sex, although this is obviously something other than a medical determination.

This may be an interesting topic for Miss McArdle’s next appearance on EconTalk, which I hope will be soon. Thanks again.

Mar 21 2023 at 12:51pm

I had the same thought (re gender dysphoria treatments) while listening. I suspect Russ and Megan prudently avoided that minefield topic since there can be severe negative outcomes for those who wade into that discussion, e.g. JK Rowling, Graham Linehan, etc.

Mar 23 2023 at 4:06pm

Sorry, Kevin, but my comment below was meant to be a Reply to yours. My statement “Very well said.” was in reference to your own comment.  (However, technical difficulties ensued.)

Dion Wall
Mar 20 2023 at 5:11pm

Was I the only one thinking that everything said might also apply to “gender-affirming care”?

Ron Spinner
Mar 22 2023 at 3:56am

If you search gender dysphoria and lobotomy on Google you will find that you are not the only one linking the two. Econtalk might want to interview Miriam Grossman on the connection.

Mar 20 2023 at 6:01pm

Electroconvulsive therapy, as your discussion said, is very different today than it was in the past (and was shown in One Flew Over the Coocoo’s Nest). My spouse is a retired physician as a resident had some patients that were severely depressed and other treatments had failed were given ECT. The patients are sedated and the procedure is painless. Most importantly, it can help.

As for Truman and the atomic bomb decision, the estimates for Allied casualties for the invasion of Japan was 1 million, but casualties included dead and wounded. The estimates were that about 250,000 would be killed. The estimates for Japanese casualties were higher. This was based on past experiences in invading islands that were strongly defended by the Japanese. In some of those campaigns, the Japanese inflicted huge casualties. In addition, the defense of Saipan and later Okinawa by the Japanese had a profound effect on US military and civilian leaders. When the end of the battle was in sight, the military engaged in mass suicide attacks and the civilian population also engaged in mass suicides. The Japanese government exalted these actions and made plans to implement them in defense of Japan.

All this led to the decision to drop the bomb by Truman. All I have seen indicates that he had no regrets about the decision.

As for scientists fighting against a novel theory, look at the resistance to the evidence that gastric ulcers are caused by a bacterial infection and not stress, diet, etc.

Stephen Clark
Apr 6 2023 at 4:28pm

“As for Truman and the atomic bomb decision, the estimates for Allied casualties for the invasion of Japan was 1 million, but casualties included dead and wounded. The estimates were that about 250,000 would be killed. The estimates for Japanese casualties were higher.”

Curtis LeMay, Hap Arnold and Operation Meetinghouse: Estimated Japanese dead for one night, one incendiary raid on Tokyo: 90k+. The operation was considered a success.

Professor Roberts worries about estimates of US dead being treated as “facts.” Does he think that US military planners were inexperienced or prone to exaggeration in estimating combat casualties after four years of often brutal combat against the Imperial Japanese Army and Navy? Where is the evidence for that? Here is a fact: Roosevelt and Congress declared total war on Imperial Japan. The US was not prepared to accept anything less than total surrender. There is no record of consideration in the Roosevelt or Truman administrations of negotiating an end to the war at that point. The plan for the invasion called for a series of preliminary incendiary strikes on the whole of the Tokyo industrial basin that would dwarf Operation Meetinghouse. Is there anyone prepared to defend the claim that this would not have been pursued? In light of these plans and the “success” of Operation Meetinghouse is anyone then prepared to deny US estimates at the time of total Japanese dead topping well over a million – multiples of the total dead at Hiroshima and Nagasaki?

While not being established “fact” – thank heavens – there has been no serious challenge to the estimates of American and Japanese deaths that would have followed from the planned invasion of the Japanese home islands. Among the realistic alternatives to choose from, the atomic bombings were the least bad option. Even the Japanese understood then and now that tradeoff. As hoped, the intended shock pierced the bubble encasing Hirohito and led quickly to the war’s end. No realistic scenario has ever been proposed that would have achieved the same outcome with less death.

Peter Sibley
Mar 20 2023 at 7:06pm

My father was a neurologist who spent his early career in the 1950s and ’60s at Columbia University in New York and at Western Reserve University in Cleveland. The lobotomy procedure was so quickly performed, he said, that one of his colleagues “could do a dozen of them before lunch.” Not sure if he was referring to Freeman or one of Freeman’s acolytes. When I asked him how the metal instrument was used, he raised a finger and did a “windshield wiper” movement.

Fred Giertz
Mar 20 2023 at 7:10pm

Counter example: Robert McNamara and Vietnam

McNamara wrote in a 1995 memoir that his own behavior in shaping the war was “wrong, terribly wrong,” but, to many—including then-editor of the Times Howell Raines—that confession was too little, too late.

Shalom Freedman
Mar 20 2023 at 9:12pm

I am not sure that the conversation made completely clear the point that ECT is still used as an important tool of last resort in treating Depression and other forms of Mental Illness. It is a safer procedure than it was in the fifties. Lobotomy is on the other hand a wholly discredited procedure.

The most well-known example of the beneficial use of ECT is the case of Sherwin B. Nuland the neurosurgeon whose doctors had given up on  completely except for one resident who insisted a last try be made with ECT. Nuland came out of the Depression and not only returned to Neurosurgery but went on to a distinguished literary career which included the masterwork ‘How We Die.’

The human capacity for self-deception and the dishonesty involved in searching for distinction and greatness illustrated by the career of Freeman is a well-known theme in Life and Literature. And Megan McArdle’s showing the other side of the villain of the piece, his great caring for his patients is a good illustration of the complexity of human character. Russ Roberts and McArdle thus underline a frequent theme of ‘Conversations for the Curious’ that the Realty is not a simple ‘Either/Or’ but often a complicated Both/And.’

It may be difficult for many ambitious people to admit their errors at the end of their lives.
But there are also very many who regret what they have done and even more so what they have not done. “Of all sad words of tongue or pen, the saddest are these, “It might have been.”

Mar 21 2023 at 5:29am

Very well said.

The Oedipus Trap will make it hard for proponents to acknowledge that harm is being done.  Nevertheless, whistleblowers such as Jamie Reed are doing for our time what Dr. Semmelweis attempted to do for his time.  If anyone doubts that harm is being done or that these practices merit comparison with using lobotomies to treat mental illness, please see Jamie Reed’s article, which appeared just 10 days before this episode was recorded.

I Thought I Was Saving Trans Kids. Now I’m Blowing the Whistle.
There are more than 100 pediatric gender clinics across the U.S. I worked at one. What’s happening to children is morally and medically appalling.
By Jamie Reed
February 9, 2023

Megan McArdle was right to point out that children “cannot form informed consent”.  That is especially true when an experimental procedure is promoted to them as a solution to their distress. Thankfully, the voices of those with transition regret are beginning to be heard.  Also, Reed points out:

“Sweden and Finland, too, have investigated pediatric transition and greatly curbed the practice, finding there is insufficient evidence of help, and danger of great harm.”

For further reading, another resource is the book Irreversible Damage: The Transgender Craze Seducing Our Daughters by Abigail Shrier.

One relevant aspect not considered in this EconTalk episode is the economic conflict of interest of the practitioners.  For example, consider the factual misrepresentations by the clinic that Reed had worked for.

Mar 23 2023 at 4:04pm

Sorry that my Reply didn’t link together properly with the original comment, but my statement “Very well said.” was meant to be a Reply to the comment above by:
Kevin Krisher
Mar 20 2023 at 10:43am

Todd M
Mar 21 2023 at 8:57am

I wonder if Treasury Secretary Yellen is in an Oedipus Trap when she says that large deficit spending had nothing to do with inflation. I’m sure that it would be hard to admit that as a Fed Chair and Treasury Secretary, you were wrong about a major economic pathology like inflation.

Mar 21 2023 at 1:33pm

I recommend the Martin Scorsese movie “Shutter Island,” to Russ, Megan, and anyone else who enjoyed this conversation.


The movie is relevant to the Oedipus Trap theme and also lobotomy. One of my all-time favorite movie quotes is at the very end when Leonardo DiCaprio says to Mark Ruffalo, “Which would be worse: To live as a monster, or to die as a good man?”

Heather Chapman
Mar 21 2023 at 5:28pm

Wonderful interview! Ms McArdle has brilliantly described the problem when experts become over-impressed with their own brilliance and develop a savior delusion. But it was a bit maddening hearing you two discuss all this, but with no mention of the current medical scandal regarding what is euphemistically called  “affirmative care” for children, adolescents and adults under 25 who are coming into gender clinics complaining of mental distress because their gender identities do not match their bodies’ biological sex. The long-term health implications for use of puberty blockers, cross-sex hormones, and radical cosmetic surgeries (top and bottom surgery) on these young people is under-studied and what studies that exist are of low quality. Growing numbers of youth are put on the medical transition track just on the strength of the patient’s self-diagnosis as “trans,” often after just a single consultation with the doctor (and I know this happens from personal experience.) There is a long history of medical malfeasance surrounding the use of artificial hormones, which is well-covered in Bob Ostertag’s Sex Science Self:A Social History of Estrogen, Testosterone, and Identity. So, no, actually. In practice, we have not evolved very much when it comes to “informed consent” – at least when it comes to gender-related medicine and the (also not adequately understood) endocrine system.

Mar 21 2023 at 11:25pm

The Dormouse and the Doctor
A.A. Milne
Short vignette from the author that brought us Winnie the Pooh

I think the vignette both poignant and childlike, speaking to the themes discussed in this episode

Check it out.

I enjoyed listening to the discussion.


Mar 23 2023 at 4:19pm

I second your very good suggestion.

(The A.A. Milne poetry books are excellent.  They were a staple for read aloud for our children.)

Mar 22 2023 at 5:55am

Made me think of how hard it would be for a virologist to conclude that the gain-of-function research they or their friends had been doing was in fact unacceptably risky relative to the practical benefits it would provide, and they’d made a well-meaning mistake in gambling with causing a new pandemic.

Warren Platts
Mar 22 2023 at 12:49pm

if a scientist has gone wrong the results would be too horrific to contemplate those are the parts where you should trust the science least

Adding to what Rob said above, the problem wasn’t just a scientist or two that had gone wrong, it was the entire science of virology (and indeed science generally) who had come to “the scientific consensus” that dangerous gain-of-function research was necessary in order to prevent the next global pandemic, and yet it turned out that their research caused the next pandemic that killed around 6 million people! A clear case of a result too horrific to contemplate. Hence the frantic, pathetic resort to “natural origins” papers & speculation should be taken with a grain of salt.

The same could be said for the Chinese government who’ve denied any responsibility and concoct conspiracy theories that the virus was actually planted by American soldiers at the military Olympics.

Mar 23 2023 at 6:43am

An interesting episode, which is related to a question I’ve been thinking of in light of our national experience with COVID: are people (particularly groups of people) who have paid a high price for an idea less able to reconsider that idea in light of new information?  Ms. McArdle suggests that the horror of what Dr Freedman did makes it impossible for him to reconsider it, and that seems plausible. My question is whether there’s any analogy to the millions of people who dutifully locked themselves into their homes, missed all manner of human contact, and somehow have now concluded that the problem is that the restrictions were not severe enough (my own priors are showing). In any event I’d be interested in an exploration of this topic perhaps including civilian populations in nations that lost a war .

Raymond March
Mar 26 2023 at 4:02pm

The “we had no better treatment options” story for why the lobotomy was popular isn’t sufficient. Ineffective treatments were discontinued prior to the lobotomy boom. Electro-shock treatment and psycho-analysis are still used today. My co-authors and I think the way lobotomies were financed in public asylums is a better explanation. Here’s the link to the published paper:

H Dramm
Apr 2 2023 at 6:22pm

This was a great podcast.  Engaging and thought-provoking throughout.  The Oedipus-trap is a really interesting dilemma and a great way to link history of deeper thought and experimentation (i.e. science) to our contemporary day as well as seeding considerate thought for its natural evolution (funeral, by funeral).

Nearing the age of 50, I am grateful of the reminder of the value of humility and why I shouldn’t rely (solely) on the next generation to question my assumptions.

Acknowledging that it is early in the year, this is the current front-runner for best episode.

Thank you!

H Dramm
Apr 2 2023 at 6:24pm

P.S.  Not exactly a world-leader (but potentially more influential), Robert McNamara never apologized for his Viet Nam war policies, but he did express regret later in life.  That is more than most.

Earl Rodd
Apr 3 2023 at 6:31pm

I found the discussion of Freeman and lobotomy quite edifying. I was aware of his work, but not his persistence in claims of its effectiveness. As discussed somewhat on the podcast, mental illness treatments are probably especially prone to this phenomena because no highly interventionist treatments have anything close to universal success and are in fact plagued with dramatic failures. Both my experience as a NAMI volunteer and in reading have examples of people with seemingly similar situations and the same drug treatment with radically different outcomes (“saved my life – life is worth living again” vs. “worst thing that every happened to me – I’ve never recovered.”)

One comment on something quite peripheral to the main topic: Dropping the atomic bombs to end WWII. I have to admit I have “a horse in the race”  – my father’s division was slated for retraining for the invasion of Japan when the war was ended early. However, my comment is about an effect of dropping the bombs that I think is important but never mentioned: Actually dropping the bombs in war, not just in tests, I think “scared the daylights” out of civilization and thus contributed to their not having been used since. What if the first use in war was with the far more powerful bombs available only a few years later? I know this is heresy in academia (my experience teaching at an American university in the 2000’s was that it was generally taught students that the US use of the bombs on Japan was the most immoral act ever committed in the history of mankind), but I really think that in addition to avoiding an invasion of Japan, the use of the bombs stunned the world into a commitment to not use them again.

Steve Waas
Apr 4 2023 at 10:03am

The critical thing about the Oedipus Trap is not after-the-fact apologies and expressions of regret.  The critical thing is persisting with the flawed approach in the face of contrary evidence.  Unfortunately, evidence is usually contradictory and confusing for tough issues (that’s what makes them tough) and may only clarify with the passing of time (rather than at the moment when decisions have to be made).

This is not to excuse falling into the Trap.  Awareness of it seems essential for any truth seeker. But knowing when you cross that line – maybe not so easy.

Will Anderson
Apr 11 2023 at 6:51pm

What a great conversation! I have known about Freeman’s story for years, mainly from reading Eliot Valenstein’s book Great and Desperate Cures.  I am a hospice doctor, and the idea of “the Oedipus trap” resonates with me.  Many of the cancer patients I see could have had improved quality of life in their final months, had their oncologists not insisted upon additional, futile courses of chemotherapy with toxic drugs that should never have been approved by the FDA.  They are analogous to the patients Freeman and others recklessly lobotomized more than once.  Today, as in Freeman’s prime, truly informed consent is more honored in the breach.

Like Megan McArdle, I am an admirer of Richard Feynman, but another of his sayings is my favorite: “Science is the belief in the ignorance of experts.”

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TimePodcast Episode Highlights

Intro. [Recording date: February 19, 2023.]

Russ Roberts:

Today is February 19th, 2023, and my guest is journalist and author Megan McArdle of the Washington Post. This is Megan's seventh appearance on EconTalk. She was last here in December of 2021 talking about belonging and national identity.

We're going to start our conversation today talking about lobotomies and mental illness, but the overarching topic is about confronting our errors, professional and personal, the challenge of confirmation bias.

I want to warn parents with young children that this episode will likely deal with a number of adult themes, including those related to Oedipus.

That's a pretty good teaser, I thought. Megan, welcome back to EconTalk.

Megan McArdle: Thanks for having me, Russ.


Russ Roberts: We're going to talk, to start with, about a recent column you wrote in the Washington Post, which centered on Walter Freeman, a doctor who was, until your column, obscure to me, and a biography written in 2007 of Walter Freeman that you wrote about. So, tell us who Walter Freeman was. Tell us how you got interested in Dr. Freeman.

Megan McArdle: Well, let's start with the second question because I came across a reference--it was a glancing reference in an article about something else. And, in fact, I don't even remember what the article was. But this really stuck with me. It was a reference to the fact that Walter Freeman died in the early 1970s still believing in lobotomy. And, that was shocking to me because I think--and I think we're going to talk about this later in the podcast--you can kind of understand how lobotomy happened in the context of a world where there were just no good treatments at all for mental illness, for most kinds of mental illness, where, especially, severe things, like schizophrenia, the alternatives were Freudian pseudoscience that didn't work. And, doctors were desperate, and they did a bunch of desperate things of which lobotomy was the most horrifying, but the others were pretty villainous themselves.

Russ Roberts: And, tell our listeners what a lobotomy is.

Megan McArdle: A lobotomy is, you basically--so, the prefrontal lobes of the brain, they control a lot of things, like impulse control. They are personality and desire. You basically stick an instrument into the prefrontal lobes and you kind of take bits of the brain out and leave a scar. That was the original operation.

And then, Walter Freeman's advance, if you can call it that, was that he would take a pick-like instrument--originally, actually, an ice pick was how he started, how he got the idea originally--and he would insert it next to your eye through the eye socket, and the bone is very thin at the back of the eye socket. And, he would just tap force it through the bone into the prefrontal lobe. And then he would just wiggle it around, for want of a better term.

And that, of course, would leave some pretty serious scars in your brain. And it produces an effect--it makes people apathetic. Actually, I shouldn't say it does anything, because this was so unscientific. They had no idea what they were doing. When they started, they didn't have any idea what the lobes did. And so, it actually really depended on where they happened to hit and how much damage they did. But, it frequently left people quite apathetic, which if you're treating an anxiety disorder, it looks sort of confusingly like a cure.

And, I mean, Walter Freeman, himself, did thousands of these. He started in the 1930s. He did not actually invent the procedure. That honor goes to a Portuguese doctor named Egas Moniz, who received the Nobel Prize for it in 1949, by the way. Never rescinded--which is sort of tragic because, in fact, he deserved the Nobel Prize for his work on angiograms. But, what he got it for was this horrific operation, partly--due largely, perhaps--to the lobbying of Walter Freeman.

But, Walter Freeman was the American entrepreneur who picked up the operation. And, it went out of favor, basically, as soon as the first antipsychotics were developed in 1954. And, as you started to get Lithium and Thorazine and all of these other drugs that were--even if you were part of the movement that says that psychiatric drugs are bad, all you're doing is sedating patients, and so forth--they're definitely better than just hacking around on someone's brain.

And so, the operation starts to fall out of favor very quickly with the medical establishment, which had always, by the way, been somewhat queasy about it. But, Freeman never--he never gave up on it. In 1968, just a few years before he died, he is telling people, 'I think this is a great operation, and it's due for revival when surgeons make their mind to it.'

And so, that captivated me. I thought, 'How could you be so wrong about something so obvious and not realize it?' And so, I started reading about his life and the procedure.

Russ Roberts: And, in 1967, he performed the last lobotomy in the United States. The patient died. And, the biography that you draw on, mostly, is by Jack El-Hai. Is that his name?

Megan McArdle: That's correct.

Russ Roberts: Okay.

Megan McArdle: I also read a couple of other books, including something called The Lobotomy Letters, which is fascinating--it's very academic, so I wouldn't necessarily recommend it as light reading. And, indeed, I will say that this project has taken me a year and a half to produce one column, and the reason it took so long was that every time I got through a description of the procedure, I would have to take a two-week break.

Russ Roberts: Yeah.

Megan McArdle: It's really, really difficult, unsettling reading.

Russ Roberts: Yeah.

Megan McArdle: But, it's fascinating to see how the letters between him and patients, between him and other people, to see how he thought about the procedure, but also about how they thought about the procedure, which was not at all how we would assume that they did.


Russ Roberts: So, talk about that, and talk about how he, at the end of his life, was talking to patients he had operated on.

Megan McArdle: So, he maintained throughout his life a voluminous correspondence with his patients. They exchanged Christmas cards. And, I think some of this--he was not a particularly warm man. He was not really, I'm going to be honest, a particularly likable man. I would like to make this into a tragedy of this wonderful man who just made one mistake, but this is not the case. He was vain and over-ambitious and had decided that lobotomy was his route to being a bonafide medical--pioneering medical hero. Which is part of how he did go so wrong.

I don't think that's all that happened there. He genuinely did care about his patients and did believe he was helping them. But, when he first proposes doing this procedure, there's quite a mixed reaction. And, a sort of elder statesman of the field, who is--by the way, I think one of the reasons that this caught on is that he had support from people, older people, in the field. He was also fantastic at getting press, in a kind of gross way, and to see how big a role the media played in creating the social support for a lobotomy was pretty disturbing.

But, this guy who stands up and says, 'No, I think this is'--when people say, 'Are you kidding? You're just going to start rooting around in people's brains? Are you mad?'--this guy stands up and says, 'No, I think this is really interesting, but you should take detailed case histories.' And so, his whole life, he's taking extremely detailed case histories; he's following up with the patients.

And, I went into this with the stereotype that basically everyone has, which is the Ken Kesey-'this is a means of social control'--and, I don't want to say that it wasn't ever a means of social control. It absolutely was. There were absolutely tragic cases of people who were lobotomized because it was in some way more convenient for the caregivers. And, I think that we do have to--

Russ Roberts: The Ken Kesey reference is a reference to the book, One Flew Over the Cuckoo's Nest.

Megan McArdle: [SPOILER ALERT!] Yes, I'm sorry. One Flew Over the Cuckoo's Nest, where, famously, the troublemaking patient, who is not mentally at all, who has gotten himself into an asylum as a way to avoid prison, he gets lobotomized at the end of the book. [END SPOILER ALERT!]

And, that happened.

But also, I mean, we do have to understand the context. You have people who cannot live in the community because they are violently psychotic, because they are delusional, because they are so anxious that they're hurting themselves by washing their hands 97 times a day. Those people are ending up in institutions. The institutions are horrible.

There's a really sad story of a surgeon whose son had always been prone to violent fits. And, this is--I mean, this is still a common problem that parents deal with of severely disabled children: is that you have a little kid who, yeah, might be prone to violent fits, but it's pretty easy for the teachers to deal with them.

Then, if it's a boy and it goes through puberty, that child gets very large, and you can't just grab him and hold his arms. And, what this surgeon is looking at is, like, 'I'm afraid that the alternative is my son spends his life in a straitjacket.'

And so, we assume that there was no informed consent. No: these patients were often thinking deeply and thoughtfully about it, and not just about: 'Is it going to be more convenient to have my disabled child sitting quietly on the couch than going out and making trouble?' Although, there is also some of that, right? One of the things that comes out of a lobotomy is a different idea about informed consent.

So, he's following up with these patients. And then, as he gets older, this operation goes out of favor. He moves to California. He still continues operating, but at a reduced level. And then, in 1967, as you say, he killed a patient who was actually someone he had operated on before. She died on the table, and that's the end of his career. But, even before that, he was always someone who loved road trips. Even in the 1940s, he would go. And, in fact, tragically, one of his sons died on a road trip falling into a waterfall.

But, from about 1956 to 1969, he just goes on these frantic road trips. He's doing 25,000 miles in his car. In 1967, he buys a camper bus. Really, I mean, at this point, he's got cancer. He is badly wasted. He is missing a big chunk of his colon, and he just goes on the road and he is just collecting as many patient histories as he can. He called these his head-hunting trips. Which, I mean, as I said, he could be quite grizzly. He used to call those, when he would go on the road and do a bunch of lobotomies--he would demonstrate it to other doctors. He was not just responsible for the 3,000 that he did. He was responsible for a lot of other doctors doing a lot of other lobotomies. He was a tireless entrepreneur promoting this horrific procedure.

But, now his head-hunting trips switched to just finding people, taking case histories, figuring out where they are. And, the thing is that, in a lot of cases, they're very happy to see him. There were people who were satisfied with their operations.

And so, first of all, there were people who went on to have--not a lot--there were people who went on to have really quite high-powered careers. There's someone who finished her math Ph.D. after her lobotomy, and went on and got a job as a professor. There were lawyers and doctors and important people with important jobs who had lobotomies. This is, by far, not the majority. But then, Walter Freeman's defense would be, 'Well, that wasn't the majority of people,' which is somewhat fair, I guess. And so, he goes on these trips, and there were people who would recommend lobotomies to people that they knew. It'd be like, 'This was great for me. I'm going to recommend this to my friends and family.'

So, our understanding of lobotomy is this thing where you just end up with this zombie vegetable who does what they're told is not correct. That said, it was a horrific procedure. The side effects were terrible. It did, it produced apathy. It could produce incontinence. It could produce seizures. I mean, a stunning number of his patients died on the table or shortly thereafter. I'm not defending lobotomy. But, it wasn't what I thought it had been. And so, that was a really, really interesting thing to learn.


Russ Roberts: So, when he went on the road--I mean, obviously, you couldn't get on a Zoom call with him in 1968. But, he wanted to do more than write them a letter, evidently. He could have written them a letter. I guess he knew where they were. So, he went on the road--

Megan McArdle: Well, some of them--he really tracked them down. Like, he would just track them down through, like, changes of name and a job and address. Because, you remember, any woman who got married would change her name back then. So, it was really quite an impressive bit of detective work to have tracked down as many as he did.

Russ Roberts: And, do we have any sense--and I'm stunned that anybody thought it was a good idea, any patient, or that any patient went on to a successful career of some kind--do we have any feel for the overall impact of at least the thousands that he did? I mean, it's one thing to say, 'Yeah, there were some people who survived it and did well.' Or: Most of the people, a lot of them died. Do we have any feel for what the landscape looked like?

Megan McArdle: I don't think there's been a systematic study done. I mean, that I'm aware of--which a reader may write in to correct me. And, I would be very happy to learn that there is a more systematic--I think part of it is that what they were doing was so variable.

Russ Roberts: Right.

Megan McArdle: Going in through the eye socket, you can't see where you're going. Today, if they do brain surgery, they're imaging the brain. They're doing these extremely precise [?]--because they will still, sometimes, do things to the prefrontal lobes because, for example, you have a brain tumor there. But, they're taking extreme care to be extremely precise about where they're hitting and to minimize the damage to surrounding brain tissue. And, that's not what they were doing. They often did two or more lobotomies. They would follow up, and, 'Well, it wasn't satisfactory, so let's do another one,' which is insane.

So, I don't know what the systematic effect was. I think that the general perception is that it was not good.

Russ Roberts: Yeah.

Megan McArdle: It left people apathetic. It damages your impulse control. So, some people would go on alcoholic benders, or they would otherwise disappear. People wrote in to me, actually, interestingly, after I wrote this column and said, 'Yeah, no, I had an aunt who this happened to, or I had an uncle who this happened to, and I remember them as a quiet person who did a menial job and didn't say much.' Or people would be home and they would be cared for until they died. The median outcome, I do not think, was you got a math Ph.D.

Russ Roberts: Yeah.

Megan McArdle: I don't think that's close to the median outcome.

Russ Roberts: I understand.

Megan McArdle: It was mostly an extremely damaging operation.

I think what the doctors would say is that the people that they were dealing with were often in institutions, and that Freeman, at least, maintained that the majority--early on, at least--the majority of the people he worked on were out of institutions after he worked on them. And, that that was better than where they'd been before. He was not under any illusion that this was side-effect free. But, I do think that he was looking for it to work, right? And, he was looking so hard that he saw what he wanted to see. You saw the evidence that it was good, and you didn't pay attention to the evidence that it was bad.

Russ Roberts: That reminds me of shock treatments, a similar shot in the dark to try to help people who were otherwise, I want to say, unable to integrate themselves into the normal pace of life.

Megan McArdle: Yes.

Russ Roberts: I mentioned--

Megan McArdle: And, which, by the way, is still done for severe depression.

Russ Roberts: Really?

Megan McArdle: Yeah. So, I said earlier on that lobotomy was just one of this array of terrible treatments. So, there was one--oh gosh. I've never pronounced this word--it was metrazol, I think. It was a convulsive. They've discontinued it because it kept killing patients.

But, they had a number of convulsive treatments. Electric shock was one. They would put people into diabetic comas. They would use this convulsant drug.

Now, most of those we don't do. But, the electric shock is still done for extremely refractory depression. If you are severely depressed, and you cannot get over it, and you basically have no quality of life, and drugs don't work, they will try electric shock. And, it actually does seem to work. We do it much more humanely. I mean, back then people used to break their legs from the shocks. And, one thing, actually, early on that Freeman would use ECT--electroconvulsive therapy--he would use the electric shocks to anesthetize the patients. Which is insane. And, they would break their legs. I mean, it was terrible.

Really just barbaric, this whole thing. But, they were also dealing with these incredibly barbaric asylums, and they didn't know what else to do with people. And, we have better alternatives, and we should remember that it is easy to pass judgment when we have alternatives.


Russ Roberts: I think there are many disturbing aspects to the story. One of them is the fear that if you convince yourself that it helps people, you could start changing the population you think it's appropriate for. I think I mentioned on the program before that John Nash, the Nobel Laureate in Economics, when he was in the worst of his delusions and challenges mentally, he was a very unpleasant person for his family to be around. And, they often did things to him that were against his will. But they never gave him shock treatments, because they did not want to damage his brain. They knew and recognized that he had an extraordinary cognitive tool, that--whether it could be used for good or not was not the question. There was something precious and rare about it. And so, they limited their damage to him to incarceration--physical constraints, and other things. But, not shock treatment. I don't think they lobotomized him either. I'd be pretty confident. I don't remember, but I'm pretty sure they didn't.

Megan McArdle: No, I feel like I would remember that part.

Russ Roberts: Yeah.

Megan McArdle: It has been a while since I read the book.

Russ Roberts: Me, too.

Megan McArdle: But, I feel like it actually would've been mentioned because the most famous person to have been lobotomized was John F. Kennedy's sister--

Russ Roberts: Oh--

Megan McArdle: that I'm aware of. I mean, there are some cases that are famous for their lobotomies. But, as far as I know, the most famous person to have been lobotomized was John F. Kennedy's sister, who was somewhat mildly brain-damaged during birth, is my understanding. I don't actually know the details, but I think she had some mild cognitive disability. And, I don't know if this is true. So, one telling of the story--one thing that you will hear a lot--is that Joseph Kennedy was afraid she would become sexually active, and therefore had her lobotomized. I don't know that that's the truth of it. I do know that the lobotomy did not go well, his wife never forgave him, and that Rosemary spent the rest of her life in an institution. Which--

Russ Roberts: Joseph--

Megan McArdle: I mean goes to this was a horrific operation that should not have been done.

Russ Roberts: Joseph being John F. Kennedy's father-.

Megan McArdle: Yes. Sorry.

Russ Roberts: who had some unattractive aspects. I'll just say that, and we'll move on.


Russ Roberts: But, the point is that there are people who have unbearable burdens in either trying to survive those in an institution, which is a terrible challenge in the first half of the 20th century and before. And then, there are people who are just unpleasant or difficult to deal with. And, I think in any of these treatments--and these include pharmaceuticals, as well--the temptation to change where you decide this person is beyond the pale of consideration that we would give a, quote, "normal" human being--I think that's the challenge. And, I don't have anything to say on that other than to that would be the issue I would worry about in this case. And, I don't know if Walter Freeman drifted over the course of his life in terms of recommending the procedure for people that, maybe 20 years before, 10 years before, he wouldn't have. That's what I'd be interested in.

Megan McArdle: Well, I mean, I think that definitely you see early on you have this thing, and you just start recommending it for more and more things. This is a really common phenomenon in medicine.

But, it's also, at least my read on it--and I'm not a neuroscientist--is that things were so pre-scientific then. They had no theory. I mean, it's just shocking how little theory they had of what they were doing, right? They didn't understand what the lobes did.

Russ Roberts: Yeah.

Megan McArdle: And often, doctors would mix up this bizarre Freudian theory with the lobotomy. Or, people would find Freudian therapy afterwards, which we also know doesn't work. But, you're piling treatments that don't work on each other. And, actually he was mad about the Columbia math Ph.D. because she credited psychoanalysis with fixing her problems. He was extremely angry that she didn't credit the lobotomy he'd given her.

But, there was definitely mission creep. There was also the fact that people would end up in asylums because they were difficult, right?

But, then there's another question that I think you have to think about, which is, and again, I think something caregivers still grapple with today. So, for example, you will frequently read articles on how nursing homes are oversedating patients with dementia. And, the thing about patients with dementia is that they can reach a point where they just scream all day, and it's really unpleasant for the caregivers. And, if you sedate them, they stop screaming. Now, are they feeling better?

Russ Roberts: Tough question.

Megan McArdle: Right? But, it makes things easier for the caregivers.

Russ Roberts: Yeah.

Megan McArdle: It might be easier, as a caregiver, to have someone who is quiet and who is apathetic--

Russ Roberts: Docile. Docile.

Megan McArdle: than to have someone who is extremely anxious and pestering you all day about their obsessions.

Russ Roberts: Yeah.

Megan McArdle: Is that person better off? I would not say that stirring their brains in order to make them more pleasant to be around--right? These are the deep questions, and why we have evolved our conception of informed consent to say, 'No, it can't just be that the family thinks.' Right? With children, we say the family makes the decision appropriately because a 10-year old cannot form informed consent. We should try to make sure the 10-year old understands what's happening, but they are not adults. They cannot picture the future. They do not have the grasp on the trade-offs that they're making. And so, families make those decisions. But, with adults, it can't just be that your caregiver is tired of having you be noisy.

But, that said, we still do, in fact, use drugs that have sedating effects because it makes life easier for the caregivers, right? We still do. And, we tell ourselves that we're helping the patients, and maybe we are.

Russ Roberts: Yeah.

Megan McArdle: I am by no means an expert on these things. So, I don't want to opine. I'm not going to get into the questions over what appropriate treatments are. What I'm going to say is that I think we need to be conscious of the fact that the caregivers and the treaters have their own incentives.

Russ Roberts: Yeah. That's all. That's enough said.

Megan McArdle: And, that it is easy to convince yourself that the thing that's good for you is good for the patient, too. And that it's very easy to do; and I think we all have to be aware of that problem.

Russ Roberts: And, you call them caretakers in, say, an old age home that includes people with dementia. It also includes classrooms. Regular modern--

Megan McArdle: Yep.

Russ Roberts: public school, private school classrooms where kids, many times, are difficult, and they are sedated. Not literally turned into docile, sleepy creatures, but they are molded and changed by the drugs that are recommended for them in their own name. Sometimes, perhaps they are. Sometimes, I worry they aren't.


Russ Roberts: But, let's come back to Freeman, because I think this is the most poignant and powerful insight of your piece. The story so far is interesting, and for people who don't know about the history of this type of treatment for mental illness, I hope of value. But, you suggested in your piece, and I assume you take it from the biography, that Freeman wasn't just accumulating data about his former patients. He was looking for comfort that what he had done was right.

Megan McArdle: Yeah. I think that's quite clear. I mean, first of all, this is a man who, as I think I said earlier--he was extraordinarily vain. In a way that I understand, right? I want my work at the Washington Post to not merely be workaday columns that people read, and then they're forgotten. I want to be writing deathless and immortal prose.

And in the same way, he, as a doctor, wanted to be doing vital, lifesaving, world-changing work and not merely slightly improving the lives of some patients. And so, that had always been a thread at the beginning of his life. And then, he had the misfortune. You know--he becomes quite famous. He's the head of multiple medical societies.

And, a thing that I'm going to just stop and interject here, even though it's not strictly relevant, is one thing that I think people would probably find surprising. He, as the head of the DC Medical Society, led the charge to desegregate it. And, I think this goes, again, to the ways in which my expectations of what a lobotomist would be like we're not met by Dr. Freeman. He was a more complicated figure than that.

But, he saw his own reputation wane in his lifetime. There had always been people who were queasy about the procedure. But, after 1954, it starts to fall into disrepute, and he sees this reputation that he has accumulated--he sees it slipping away. And, especially in the 1960s when people were really starting to ask a lot of questions about lobotomies; and he wants to prove to people, 'No, this was a good operation. It is a good operation.' Not even: It was a good operation. Right? I mean, that, at least I think, would have been more defensible: to say, 'Well, we did this because we didn't have anything else. And, it was not great. Once upon a time, we used to do operations we don't do anymore because we got antibiotics.' Or, 'We did treatments that we don't do anymore.'

I mean, here is an actual good example of something that sounds totally barbaric and worked and was probably the best alternative. For syphilis, there was a treatment for syphilis that involved--one treatment, which was made famous by Isak Dinesen, the author of Out of Africa, was an arsenic-based treatment that worked, but, I mean, had crippling side effects. And, another was literally giving patients malaria because the incredibly high fevers of malaria kill the syphilis spirochetes. Well, that's probably better than having syphilis, but it's not as good as penicillin. And so, I think doctors in that position can just say, 'Yeah, it was not great, but it was all I had at the time, and I'm glad that we don't have to do that anymore.' Right?

But, that's not what he is saying. What he is saying is, 'It's still good. We should still be doing this.' And, he is on a salvage mission at the end of his life. And, he really was. By the time he finished his last trip, he weighed 140 pounds, down from, I think, 200. He had already had his colon resected. He'd had a colostomy. I don't know if he still had it when he was on the trip, but he was really sick. His cancer had metastasized. He knew he did not have that long. And, there he is on his road trips. I think just, genuinely, part of it is he was a lonely man who liked to drive and liked to go on road trips. But, I think a lot of it was, yeah, he was trying to salvage his reputation.

He was trying to find evidence that: 'Look how great this worked.'

Russ Roberts: How do we know that? How do we know that, other than--how do we know it was something other than just he needed something to do at the end of his life? or he liked his patients and wanted to see them? Why do you feel that he was cherry-picking his case histories?

Megan McArdle: I don't think he was cherry-picking. I mean, this is the thing. Again, we want him to be a pseudo-scientific barbarian, and he wasn't. He did more careful patient histories than most. Right? I'm not sure any other 20th century physician went to such great lengths to follow up on his patients. And, I don't think it's one or the other. How do I know this? I am reading--I mean, I think his biographer agrees with me. He praised my column. So, that's one aspect.

Russ Roberts: That's valuable.

Megan McArdle: But, I mean, I'm reading the fact that he's still telling people that this operation is good. I'm reading the ways he is. I'm reading who he was. His whole life--his whole life--he wanted to be a great man and not just a doctor. Right? He wanted to be a pioneer. He was, for a while, kind of the only game in town. By the way, he was not a surgeon. He was neurologist. Which is one thing that people were very angry that he was effectively doing surgery: because, he started working in partnership with a neurosurgeon. And then the neurosurgeon--and then he invented this new procedure that you didn't really need to know how to do surgery for, because it's basically an outpatient procedure. But, the surgeons were very jealous. And this is the dumb thing, right? The surgeons are right that it's a bad operation, but it comes off as, like, professional jealousy: 'How dare you be doing surgery?' rather than, 'This whole operation doesn't work, whether or not you open someone's skull.'

And so, you know, I can't prove that it was a salvage operation, but I think that it's clear to me that he was very eager to resurrect--he's telling people--that this is a good operation, and it's due for a revival. And, he thinks--every time he takes a case history, he thinks he's got proof of how great this is. Right? That is the thing: is he really thinks he's piling up evidence, and he can't see it. He cannot, as I said in the column--

Russ Roberts: Well, a little selection-bias there.

Megan McArdle: Yeah.

Russ Roberts: He's not visiting the ones who died. I don't know what that number was, but--

Megan McArdle: I think his mortality rate was, I think, between one and 3%. It was quite high. Not unheard of for an operation.

Russ Roberts: It seems low to me. I'm surprised.

Megan McArdle: I could be wrong about that. I would have to go back and look that up.

Russ Roberts: Okay.

Megan McArdle: I could be wrong, but I think it was in the single digits. But, it was significant, and a lot more people were left debilitated, right? And, those people were not necessarily easy to find, right? They're not writing back to you if they're mental vegetables.

Russ Roberts: Yeah.

Megan McArdle: Although their families might, right? He's often writing to the families. He's often speaking to the families. And, some of them, by the way, are really angry at him. Some of them really think that this did not go well, and they're very angry. And, others think it was great. And others are mixed on it. It is a mixed bag. I don't want to over-present that. He violated, as I said in my column, Richard Feynman's great First Principle of Science: 'You must not fool yourself, and you are the easiest person to fool.'

Russ Roberts: Put him in [inaudible 00:35:44].

Megan McArdle: Yeah. And I think that that's--yeah. He believed--he believed--that he was accumulating evidence for how wonderful this operation was. He sincerely believed that. And, that is what has always haunted me about his life: is that, at the end of his life, he still couldn't see he had made this tragic mistake, and he still believes that there is some way that this is going to turn around.

Russ Roberts: A quick Google search suggests it's about 5%, the mortality rate. So, until further notice--

Megan McArdle: Sorry about that.

Russ Roberts: That's okay.

Megan McArdle: I am a bad--

Russ Roberts: You don't have it at your fingertips. That's okay. Neither do I. I just use Google. It might be wrong.


Russ Roberts: But, I want to talk about the more interesting case--more interesting point to me--which is your description of this quest and what you call the Oedipus trap. So, give our listeners a little background on Oedipus, and why you use that phrase for Dr. Freeman. And, the morally psychological aspect of this challenge.

Megan McArdle: Yes. So, this is not, by the way, the Oedipal complex, although they're rooted in the same Greek myth, which is that Oedipus was--as an infant, he was prophesied to kill his father and marry his mother. And so, in true ancient Greek fashion, they decided that the solution of this was to expose the infant so that he would not be around to do this. And, of course, as this frequently happens, he is picked up. He ends up in Corinth, and he hears the same prophecy. And so, he leaves. He leaves his town, and he goes out, meets a man on the road; in a fit of road rage kills him; goes into the city and meets Queen Jocasta, marries her, and she is his mother. He has killed his father, her husband. He does not know that the man he killed on the road was her husband. He certainly doesn't know that that was his father.

A plague comes upon the city, and, eventually, the truth is revealed. Whereupon Jocasta--

Russ Roberts: Wait a minute. And, he doesn't know that he has married his mother, either.

Megan McArdle: No, he doesn't know any of this. He does not know who these people are. He thinks that his adoptive parents are his parents. Right? So, he is completely unaware that he has fulfilled the prophecy in an attempt to evade it. And, when the truth is revealed, his mother hangs herself. And then he grabs pins from the dress that is still hanging on her body and gouges own eyes out.

And, there's obviously a lot of things that you can draw from this. What Freud drew was the idea that all boys are secretly fixated on marrying their mothers.

But, what I drew from this was that there are some mistakes that no one can live with, even if they were made innocently.

And, the trap is that, if you have made one of those mistakes, it is obviously much better not to know that you have done so.

And so, when you add in just normal human confirmation bias--I would like my scientific theory to be true; I would like the way I raised my children to have worked, and so forth--that if you have made a mistake of this caliber, you will do everything in your power to avoid recognizing that you've done it, just out of psychological self-protection. And, as Richard Feynman says: 'You are the easiest person to fool.'

And so, I think it is a personal tragedy for Walter Freeman that he got trapped in this way. Because I was reading--I read the initial thing--to go back to what I said at the beginning, I got interested in this because I read some throwaway reference to Walter Freeman just never getting over his love affair with lobotomy.

And so, eventually, it just stuck with me. And, a few months later, I went back, and I looked it up. And, I'm reading this, and I thought, 'How could he? How could he have been so blind?'

And then, I thought, 'No, but how couldn't he have been so blind?'

If you have inserted a pick-like instrument into the brains of thousands of patients and irreparably scarred the seat of their consciousness and personality, how could you ever let yourself know that you did that? How could you ever let yourself know that it was a bad idea? Because, how could you live with yourself afterwards?

And so, I think of it as both a personal tragedy and just a fascinating story--a terrible, terrible story.

But, I also think of it as a great warning to other people, first of all, to avoid such traps wherever possible, and to really ask yourself when you're going to do something, 'If this went wrong, could I even stop myself? Could I go back? Will I be able to live with myself if I have made the wrong decision?'

And, sometimes you have to make those decisions because you also couldn't live with yourself if you didn't do it, right?

Foreign policy is one of those things where, often, you have to make really big decisions, and they could go really wrong in a really terrible way. And, could you live with that decision? Maybe both things are things that you couldn't live with if they went too terribly wrong.

But then, if you do have to make that kind of decision--I think medical situations are the same thing. If you look at what we do for cancer patients, we will often pump--the standards for a drug to treat cancer patients are so much lower than a drug to treat almost anything else, precisely because doctors, like, 'Well, what's the alternative? Just go home and die.' Right?

So, sometimes you do have to make those decisions. But, if you do, you need a lot of safeguards to make sure that you don't end up in an Oedipus Trap where you cannot recognize that what you have done was a mistake.

And, he didn't put any of those safeguards. And, he and his partner read about this procedure, get super-excited about it, and they set themselves a goal of doing 20 in four months; and they hit it. And, they killed one patient--at least--and they had scarred the brains of 19 more. And, even by then, I wonder if his fate wasn't kind of sealed. Because, do you--what do you say? 'Oh, that was a bad idea.' No. Every time, every lobotomy you do increases your need to believe in the lobotomy.


Russ Roberts: Yeah. There's so many--it's hard to think of a politician--I mean, I can't think of one: it doesn't mean there aren't any--but I can't think of one who made a significant decision and regretted it publicly. Publicly.

One obvious example would be dropping the atomic bomb. I'm sure--I shouldn't say I'm sure. I don't know if Truman ever expressed regret for that decision or unease. I've heard many justifications for it. It's an interesting, an uneasy moral question. I'll just say that.

Megan McArdle: Yeah. I think that's a really good example of something where the alternative, if we hadn't dropped the bomb, was a really, really, really bloody invasion.

Russ Roberts: Yeah. And, the claim was a million American soldiers would die. And, it's funny how that claim--when I was younger and I guess a little more confident about things, when people would talk about the atomic bomb, I'd say, 'Yeah, but a million soldiers would have died.' Like it's a fact. It's not a fact. It's not even an estimate.

Megan McArdle: We don't know. Right? It could have been that maybe Japan would have surrendered [inaudible 00:44:20]. We'll never know.

Russ Roberts: And, maybe it's--

Megan McArdle: Right?

Russ Roberts: Well, the fact that they didn't surrender after the first atomic bomb was dropped is--

Megan McArdle: Fair enough--

Russ Roberts: alarming. It gave some credence to the claim. But, I'm just talking about the million number.

Megan McArdle: Yeah.

Russ Roberts: I was somewhat of a patriotic American in my youth--maybe 'jingoistic' is a better term--who is less patriotic now because I don't live in America anymore: I live in a different country. I live in Israel. I look on that, and I think, 'Why did I think that number was so comforting for that decision?' And, the answer was because--well, a lot of reasons, but--it's a bad number. It's just a big number. It's a round number. And it's the kind of order of magnitude that kind of ends all arguments. If you think it's true.

But, of course, it's not true--

Megan McArdle: Right--

Russ Roberts: It's a guess, an estimate: I don't know what else to call it. But, the people who were involved in that--Paul Tibbitts, who flew the Enola Gay--later in his life certainly showed no moral unease with that decision. I'm not suggesting he should have. I'm just saying, consistent with what you're saying: People who make what we would sometimes think of as, difficult ethical decisions in informed policy that often result in tens or hundreds of thousands, if not millions, of deaths, rarely, if ever, say, 'You know? I wish we hadn't gone into ____' fill in the blank, 'and invaded ____' fill in the blank. 'I made a mistake. I misunderstood what was at stake. I overestimated this. I underestimated that. I regret it.' It's pretty rare in world leaders.

Megan McArdle: The only example I can think of is actually the President of Tanzania, who oversaw this big, like, back-to-the-country movement. He was a Communist; eventually did say, 'Yeah, that was a mistake. That didn't work.'

Russ Roberts: Huh.

Megan McArdle: And, it's literally the only one I can think of, of something of that magnitude, right?

Russ Roberts: Yeah. So, I don't know. Listeners can correct us. I'm sure they will. I'd be happy to hear, as you suggested earlier, alternative stories.

But, the point is this, and this is what I think is fascinating: It's imaginable that every foreign policy decision was correct. Unlikely, but imaginable.

Megan McArdle: Sure.

Russ Roberts: The part that's, what?

Megan McArdle: Sure.

Russ Roberts: Yeah.

Megan McArdle: Yeah.


Russ Roberts: But, the point that's interesting is how hard it is to imagine that something that one did that resulted in thousands, hundreds of thousands, tens of thousands, millions of deaths was a mistake. Every fiber of one's being revolts at imagining that. And therefore, it's almost impossible to imagine it as an error.

You know, I've said this before. Let's be agnostic for a moment about whether OJ Simpson is a murderer. I believe he may have, if he were--if he is--a murderer, I could imagine he does not think he is. In that it's such a horrifying self-image for him. And that, a person could--and so what we're really talking about, can stand up publicly, and through their actions, continue to believe that what they did was okay. Or that they didn't even do it at all, in the case of OJ Simpson--

Megan McArdle: Yeah--

Russ Roberts: We have such a tremendous capacity as human beings for self-deception. And, again, I have no opinion on OJ Simpson. I wouldn't opine on it. But, all I'm saying is that we are the easiest people to fool ourselves.

Megan McArdle: Yep. Absolutely.

Russ Roberts: And, Walter Freeman seems to be an example of that.

Megan McArdle: There's a reason that the adage is that science proceeds one funeral at a time.

Russ Roberts: Yeah.

Megan McArdle: And, that's even when the stakes aren't that high. Right? That's when it's just my career, my status--

Russ Roberts: My reputation--

Megan McArdle: Yeah. But, when you add in the possibility that you've done something terrible to someone--I think this is especially true in medicine, for obvious reasons, right? You're dealing with, first of all, incredibly complicated systems that we don't understand very well. Second of all, it's extremely hard to experiment. For good reasons, we do not experiment on people the way we experiment on mice or dogs.

And, thirdly, the variance in the outcomes. I mean, the human body is--it doesn't react the way a physical system does where you build the large Hadron Collider, you're pretty sure what you're looking for, and you're pretty sure what the possible range of outcomes is. Right?

That's not the way the human body works. Just because you can't isolate one thing about the human body in a way that--it's not that the physical universe is less complicated than a human body, but it's easier to isolate one bit of it. Whereas, when you're dealing with the human body, you're kind of pumping stuff into a system, and then the system does this black-box magic, and then something pumps out at the other end. And, we still don't understand how a lot of those systems work very well. We certainly understand better than we did in 1936 when Walter Freeman started operating. But we still--much is a mystery.

And so, you can get--I mean, this is part of it--is a thing that got cut. So, that column that you read was cut down from 1600 words originally.

Russ Roberts: From how many?

Megan McArdle: 1600 words. That's where I started. That was my first draft. I often just write long drafts, and then try to cut them down.

Russ Roberts: And, it ended up at what?

Megan McArdle: About 850, I think.

Russ Roberts: Okay.

Megan McArdle: Which is the length we run columns at.

So, there are a lot of things that I liked that I had to cut out. And, one of them was with people, the stupidest treatment you can imagine, whatever--stroking caterpillar fur at midnight, or coffee enemas, to take an example of something that people actually do--will, if you pump it into enough people, produce at least some apparent improvements in any condition that you're trying to treat. Right? Simply because the human body is extremely complicated, and sometimes cancers spontaneously heal and sometimes depression lifts.

And, with mental health, there's a particular problem, which I think if people who have ever had their own problems with depression can probably attest. If you are really depressed, and you think that something's going to help you, there's a shot that it'll help you just because you think it does.

Russ Roberts: The placebo effect, sure.

Megan McArdle: Right? Like, I think that moving across the country to California, I'm going to be in the sunshine, and I'll be happy there. Now, lots of people have done that, and often what happens is they're lonely and the sunshine seems bleak and unfriendly. But, some of them get better just because they moved across country because they thought they were going to get better, right? And now, that's more of a mild affective[?] disorder that's probably unlikely to--this is probably not going to treat your severe persistent depression. That said, it might produce a temporary lift, which, to a doctor who is looking for, 'Oh, look,' will think, 'Oh, moving to California fixes your problem.'

And so, these problems are enormous [?] medicine, and make it even easier to fool yourself than in other kinds of science. And, when you combine that with the fact that the stakes are emotionally higher, you've got a real recipe for potential disaster.

Russ Roberts: And, in most of those cases, the other thing that happens is moving to California, it's just the passage of time.

Megan McArdle: Yep.

Russ Roberts: Random things are going on inside the chemical cauldron of your soul and heart and brain. And, you get better.

Megan McArdle: Even schizophrenia. I mean, John Nash was among, as my understanding, was that there are some schizophrenics who just--their schizophrenia recedes in late middle-age.

Russ Roberts: Yeah.

Megan McArdle: And John Nash was among them.

Russ Roberts: Yeah. No one pretended that something that was done 20 years before was the thing that made the difference. Just time passed. And, he was lucky.

Megan McArdle: But, if you were a doctor who didn't have that information, and you happened to be the person who did something to John Nash right around the time he started to get better, you might think, 'Well, this is a wonderful new treatment,' right?

Russ Roberts: Yeah.

Megan McArdle: It's just these incredibly complicated systems that you're dealing with--

Russ Roberts: For sure--

Megan McArdle: that offer rich opportunities to fool yourself.


Russ Roberts: Now, when we were prepping for this episode via email, I asked you for another example, and you came up with someone I think has come up a few times on this program I find one of the saddest and most poignant chapters of the history of medicine, which is Semmelweis. Talk about Semmelweis.

Megan McArdle: Semmelweis basically realized--he was an early pioneer in the germ theory of disease. He was working with a hospital in which there were two wards for women who were giving birth. Two wards for women who were giving birth. One was attended by doctors and the other was attended by midwives. And, what he noticed was that the mortality rate on the midwife side was better.

And, what he eventually decided was that what was happening was the doctors are working on corpses. They're dissecting corpses. And, this is just going to horrify--it horrifies us now to think about this--a badge of honor for a doctor, at that point, was to have a really bloody jacket. Right? Because it proved that you were doing a lot of really hard work as a surgeon. And they would go from operating rooms on other patients straight to the--

Russ Roberts: Morgue--

Megan McArdle: to maternity ward.

Russ Roberts: Well, they'd go to the morgue, where they had looked at women who died in childbirth to try to learn about it, and then go back to do some more deliveries.

Megan McArdle: Right. And here's the thing, is that, like: the womb after birth is basically an open wound, right? I mean, a lot has gone on there. There's just a lot of abrasions inside the vaginal canal. And so, of course, if you then stick your germy hands in that area, it's a huge risk for infection.

So, Semmelweis realizes this, figures out that if you just douse yourself in carbolic acid, your mortality rate goes way down.

And it does not go well for him. People think this is crazy. And I think the Oedipus Trap has given me a new way--as I understand it, he died in an insane asylum having been a roundly abused by his medical colleagues. And, the Oedipus Trap gave me a new way to think about that. Because the normal story is, like, 'Gosh, those dumb surgeons.' But then, think about it. If you're a surgeon, you got into this probably because you want to help people, right? You think you're helping them; and here's some guy who comes along and tells you, 'Oh, actually, you've been killing all your patients in your attempt to help them. And, every patient that you operated on--that you autopsied in an attempt to figure out what had gone wrong--actually made you kill more patients because you were spreading their germs, the sepsis.' Could you allow yourself, right? It had to be younger doctors who had not done that.

Russ Roberts: Yeah, women were dying of puerperal fever, which was an infection. And, as I think I've mentioned a long time ago. It's been a while since I talked about it on the program.

But, Semmelweis did a study to prove his point, and it was very small. The number cases, the n, was very small--because he knew he was right, for better or for worse. That was a different kind of overconfidence and fooling yourself. He knew he was right. So, he didn't make such a great study, and it was very easy for the doctors of his day to dismiss it--which they did. And, they had alternative theories. Windows, air, open windows, bad air coming in and killing the women. I'm sure there is more than one. That was, I know, a common one. And, the horrible tragedy is we--'we,'--a person, Ignaz Semmelweis, understood that you should wash your hands before you do childbirth.

Now, here's the double tragedy. So, yes, it was really hard for physicians to concede that their own actions had killed their own patients. But, the cost of the alternative--of washing your hands--was so small. Right? To entertain the possibility that this--and Semmelweis was not an easy person, which is the other part of the tragedy. He was difficult, and he was probably arrogant. And so, the idea that this person was right? Okay, so he probably wasn't, but all you had to do was wash your hands. And, they couldn't bring themselves to do that for N reasons.

But, one of them is yours, and it's a huge one, which was: What if it worked? What if, by washing your hands, your patients didn't die in childbirth anymore. And, you think that would be overwhelmingly seductive. Why wouldn't you try it? But, they couldn't.

And, thousands of women died after Semmelweis figured this out because his colleagues--around the world, by the way. This isn't just one hospital. He didn't just try to fix this hospital. He wanted to save the world--

Megan McArdle: Right--

Russ Roberts: like Walter Freeman. And he was right, in this case. History has judged him correctly. His reputation is immortal, but not as immortal as it might have been had he had a different way of making his case, if he had had a different kind of personality, if--something.

Megan McArdle: So, that's a very rich point. And, I would say two things is: One, I mean, I hadn't thought about this exactly right, is that what was being asked of them was tiny. And, they couldn't even do that tiny thing because it conceded the possibility that they were mass murderers, right? Accidental mass murderers, completely innocent mass murderers: in no moral way--

Russ Roberts: Oedipal--

Megan McArdle: can you blame--right? Yes.

Russ Roberts: Just like Oedipus. That's the incredible part of the story.

Megan McArdle: Just like Oedipus. You couldn't blame a physician who killed his patients inadvertently, but it was still impossible to contemplate.

But, the other point is--I mean, I think this is really important--is that people who are telling you, 'You are wrong,' are actually--they tend to be disagreeable people. To say to surgeons, like, 'You've been killing people,'--what kind of personality does it take to make people that unhappy? It takes being a kind of disagreeable person.

The agreeable people just do what the other people are doing. They don't study the thing that is going to make their colleagues feel bad. Right?

We forget that our urge to make the people around us feel good, there are really important reasons that we are that way.

But the problem, then, is that the people who can resist that pull and see the thing that is true, even if it is going to be socially costly for them, and psychologically costly for all of the people around them, they're not pleasant people.

I mean, like, over and over again, I've had this experience with, like--I remember, like, people will say to me, 'But, this person who is suggesting this story is a deeply unpleasant person, and they're crazy, and they're an ideologue, and they're obsessed with some idealist.' And, I'm, like, 'But, that's everyone who has ever given me a story no one was reporting on. They're all like that.'

Russ Roberts: By definition, almost.

Megan McArdle: By definition you have to be kind of crazy and a little bit antisocial and willing to buck. The people who are pleasant, nice people to be around, can't see it, because--for the same reason that their colleagues can't, right? Like: We are adept at fitting ourselves in, as a species.

And so, that is a problem that the people who do see these things almost always are actually not very good advocates for it. Precisely because--and, it takes someone else who comes along and sees it--sees what the first person has seen, and is a little bit more diplomatic about it, is a little bit less obstreperous--to actually go, and then sell these innovations to other people. And, it often takes the older generation, like, dying and leaving science, so that the new thing can come in.

Russ Roberts: Well, I'm reminded of an episode in 2018 with Charlan Nemeth. Her book was called In Defense of Troublemakers, and we had a conversation along these lines. I think it's a tremendous insight that dissenters--'troublemaker' is kind of a pejorative term. A 'contrarian'? That's kind of nice. 'Swims against the tide,' somewhat of a compliment. But 'troublemakers,' not such a compliment. And, 'weirdo,' 'crazy,' 'conspiracy theorist,' definitely not a compliment.

And, the problem is that most of them are wrong. Those crazy people who had theories about puerperal fever being whatever they were--witchcraft. I'm sure there was some horrible, incorrect theories. Poor Mr. Semmelweis, or bless Mr. Semmelweis, Dr. Semmelweis, had the right theory. And, his colleagues, when confronted with it, were happy to lump him together with the crazies because of the Oedipus trap.

Megan McArdle: Yep.

Russ Roberts: And, they were much happier in the dark, much happier going forward in ignorance.


Russ Roberts: Let's close with the challenge this poses for all of us when we think of the phrase, 'Follow the science.' This is a phrase that has become popular in recent years. I'm not that much of a troublemaker. This was Megan's suggestion, and it's in her column, I think. So, don't blame me for using that phrase because I want to just go along with the herd. But, I don't like that phrase, 'Follow the science.' I find it--

Megan McArdle: I don't either--

Russ Roberts: despicable.

Megan McArdle: It's unscientific.

Russ Roberts: That's the problem. So, anyway, talk about why, what, 'Follow the science,' how it relates to Mr. Freeman.

Megan McArdle: Well, look, I think there was a point at which Freeman could have said, 'Follow the science. Look at all these wonderful case histories I've done.' Now, I think that, even then, it would've been much more contested than he would've suggested. And, that's often true when people are telling you to follow the science. One of my questions often is, which scientist?

Russ Roberts: Yeah, whose?

Megan McArdle: Right? And, scientific consensus is important. I don't want to end up as a crank. Usually, I follow the scientific consensus.

But, I also respect the fact that if someone says it's wrong, that's not prima facie evidence that they're a lunatic I should ignore, right? I'm a Bayesian about this. My prior is that normally the scientific consensus is more likely to be right than some random person, right? That's the reasonable prior, because I believe in the scientific method. That said, I think we should be, for example, especially conscious of--in areas where the stakes are high, I am less likely to follow the science. Right?

Because, what are the personal stakes for the scientists here? First of all, I mean, before we get to anything serious, one personal stake is reputation. And, something that you see over and over again is that scientists who have their reputation staked on something will act so as to block. Senior scientists will try to block junior scientists who are saying they're wrong. Not always. There are admirable cases in scientific history of people being like, 'My gosh, I've been wrong for 30 years. You're amazing. That's fantastic. Good job, guy,' right? But, there's also a lot of cases of older scientists fighting like hell to block off a compelling new theory that contradicts them.

Because we all do. I don't want to say like, 'Ooh, scientists: bad,' right? Everyone does this. Everyone wants to believe. You think about the decades of denial that followed Iraq and Afghanistan, and I'm not even going to talk about whether--to go back to the Oedipus trap--whether the initial decision, could we have made a different decision. I think in Iraq we could have. I think in Afghanistan that it's more complicated.

But, here is a thing that I think is definitely true, which is that things weren't going well, and they kept not going well. And, we kept being like, 'No, they're going much better than we think.' And, no, they weren't. They were not going better than we thought. As soon as we left, Afghanistan fell to the Taliban with incredible speed. We had accomplished nothing that we thought we were accomplishing there.

So, that's one thing I think is important to think about: that we all do this, that we all see what we want to see, especially when our reputation is on the line. And, when I think about--in my column, I said, 'Best thing to do, avoid Oedipus traps.' And, how do you do that? I think, number one, if the stakes are really high, you go in super-cautiously. You do four--you follow up for a few years, you see how they did. Because, the faster that you move, the more likely you are to just rush past the point of no return. Again, not always an option, but try.

The second thing is, I think, if you have taken one of these decisions, you just have to set up and pre-commit to, 'I'm going to keep checking back and see if this was a wrong decision, and I've got to move even if it's bad. Even if it's bad, I have to see it.'

And, one way to avoid doing that is don't stake your reputation on it, which is something that Freeman did. He didn't just do these operations. He became the face of lobotomy in the United States. He was incredibly adept at--it was really disturbing, as I said at the beginning, to realize he did a ton of press interviews. And, every press interview brought more people saying, 'Can you do a lobotomy?' Right? Like, 'I have this problem. My sister has this problem,' etc. And, the press, of course, had no way to assess this. They were totally uncritical. And, there were some critical pieces later, but early on: Miracle medicine--which is a very common genre in our own day.

And then, the third thing is--and I think this goes back to Semmelweis--is, in extremis, you just have to say to yourself, no matter how shattering it would be to realize that I had done this, it would be even more shattering to keep making the mistake. And, I think that's where the surgeons--Semmelweis' surgeons--fell down. They didn't want to know, and they didn't consider, like, 'I'm going to kill more people so that I don't have to know that I've killed a lot of people already.' Right?

But, we're bad at that. We are bad at it. And so, I think this is always going to be a problem. This is always going to be something. Anytime when there are big stakes--and I'm sure we can all think of examples of this today. COVID stuff comes to mind; and watching that 'follow the science'-narrative of COVID has been really appalling to me. And, look, to be clear, I was an advocate for lockdowns. I was an advocate for masks. I was an advocate for vaccine mandates. This was before. I think, now, that the vaccines do not seem to have enough impact on transmissibility for me to be willing to impose a mandate, except on maybe healthcare workers, and military personnel for a different reason, which is that it's just better if they're--for military readiness, I think it's entirely fair to impose that mandate. But, generally, I don't think that it's enough of an inhibitor of transmission to justify it as a public health intervention.

So, this is not coming from a place of, like, I'm a radical skeptic about this stuff. I'm going to go get my next booster. I believe in vaccines. I believe in all of it. That said, I believe masks work when used properly, which is not the same as saying that I think mask mandates work because I'm not sure about that. But, that said, my side keeps saying 'follow the science.'

And, there's a great example of this. The blogger, now newsletter writer, Scott Alexander, had a back and forth with a guy who basically chided him for writing a long piece exploring all of the evidence about Ivermectin and COVID. And, I agree with Scott Alexander that Ivermectin probably does not work. And, the reason that it kind of looked like it worked was, a). artifact of small studies, and b). possibly that in countries with a high parasite load, it actually helps by killing your intestinal worms or other things that are sapping your health--which also, by the way, can be immunosuppressive--but not by doing anything to COVID.

But, I think that that was, at one point, an open question. And, I think that the way that you address that open question is by doing exactly what Scott Alexander did: Deep dive into the evidence, expressing the uncertainties, showing why he ended up where he did. And, he was chided because this is giving credibility--you're giving credibility--to the conspiracy theorists. And, I think that this is a fundamentally anti-scientific attitude. You cannot do this because you are depleting our precious ability to just say that people have to accept what we say on faith because we're scientists. And, like: That's not science. I don't care--like, I understand that the way you got the answer may have been scientific, but demanding that the rest of society just kneel before Zod every time you wave your scientific credentials is--A). It doesn't work. It fundamentally, I think, does not work. I think it depletes trust in science rather than enhancing it.

And look, I get it. I got so tired of arguing with bad conspiracy theorists during COVID. I'm still tired of arguing with them. Periodically, I'll just be like, 'Look, you're making me really mad, and I'm going to nope out of this conversation. I'm just done with it for now. I don't have the energy.' Right?

At the same time, I think you have to argue with them. And, yes, you're not going to convince some of them, because some of them just want to be mad. What they really want is not even a theory of COVID. They just want to be mad at liberals and this gives them something--like--and so, yeah, you're never going to convince those people. Fine. You've still got to make the argument. And, I think that this idea that there is--'In this house, we believe in science'--science is--what do you mean, you believe in science?

This is like: 'I believe in trees.' I've seen them, right? They exist, yes. But like, that doesn't imply anything about policy other than recognize--we need to recognize that trees exist.

And, that whole thing, the way that science has become, like, an identity, is the exact opposite of science.

And, I noticed this even, like, 10, 15 years ago when I used to occasionally--because I'm an unpleasant person--enjoy, kind of, getting a little rise out of people who made fun of creationists by asking them to explain various evolutionary phenomena. And, it turned out, of course, they had no idea. They didn't know anything about how evolution worked. All they knew was that they believed it because someone had told me it was true. Right? I was, like--which is fine. We all have to do this.

I basically accept most of what I do every day on faith. I accept that--like, I have no idea how my plane works. I get on the plane, I assume it's going to fly. I assume that, like, aerodynamics is a thing. I assume those guys know what they're talking about. Because I can't--you cannot, and our society is too complicated.

But then, you need to be epistemically humble and understand that you can't get bonus points for having accepted the correct theory on faith. Right? That's not a virtue. It's more of almost an accident. And you always have to be open to the possibility that something has gone hideously wrong.

And, I think, but especially--especially when you look at these questions where if a scientist or a politician has gone wrong--the results would be too horrific to contemplate, those are the parts where you should absolutely trust the science least, follow the science least. Because that's the part where the scientist is going to be working hardest to fool themselves. It's the part where the politician is going to be working hardest to fool themselves. And, you have to take that with the biggest grain of salt.

Russ Roberts: My guest today has been Megan McArdle, who is actually, I think, a nice person, as far as I know. Megan, thanks for being part of EconTalk.

Megan McArdle: Thanks for having me.

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