The Glass Menagerie launched Tennessee Williams’ Broadway career. You may remember the character Laura, the abnormally shy, dreamy sister of Tom, the protagonist. She spent her time escaping from life, drawn into a world of glass figurines. It’s a largely autobiographical play, featuring a domineering mother, an unstable sister, poverty, and Tom, who is working at a shoe factory. At this time Tennessee was still called Tom (his given name). Earlier in his life, he had spent three years working at a dead-end job in a shoe factory, before having a nervous breakdown. Much of this play is drawn from this time.

But what you may not know is that this play was written in 1943-44, after Tennessee’s real-life sister Rose had a frontal lobotomy for schizophrenia. Rose seemed fine, by all accounts, during her early years, and she and Tennessee were close companions and best friends. She did have a few quirks, such as collecting the labels from tomato soup cans (the only soup she would eat), and ritualistic repeating of the phrase, “Tragic, just tragic.” By the time she was in high school, she was anxious, shy, became easily agitated, and could not function in school. She was sent to a boarding school but spent most of her time sick with “nerves” and abdominal pain. She left school, unable to cope with the outside world, and returned home. She developed eccentricities, like carefully placing a pitcher of ice water on the floor outside her bedroom each night. She was hyper focused on playing with the dog. Her hospital stays increased in duration. She became violent, had delusions that people were trying to kill her or rape her, so she was moved to a sanitarium, and then a state hospital. In 1943, her doctors performed a prefrontal lobotomy. She was never able to live independently after that, and remained institutionalized. Tennessee never forgave his parents, or himself, for allowing the surgery to happen. It was the great tragedy of his life.

Frontal lobotomies have a dark history. We mostly know about them because of the award-winning 1975 movie One Flew Over the Cuckoo’s Nest. Set in 1963, it involves the character McMurphy, played by Jack Nicholson. He is a felon who feigns mental illness, is disruptive in a mental institution and has a lobotomy against his wishes.

It is important to understand the situation in the 1930s. There were no psychiatric medications, and mental institutions were vast, squalid, and overcrowded. Many people who were institutionalized remained there the rest of their lives. Electroshock therapy, insulin shock therapy were tried with mixed results. Doctors were frantic to find some way to help these patients who seemed beyond reach.

Lobotomy seemed to be the answer. Pioneered in 1936 by Portuguese neurologist Egas Moniz, lobotomy consisted of cutting the white fibers in the frontal lobes, to disconnect the frontal lobes from the rest of the brain. Frontal lobes are responsible for behavior, emotions, executive functions, and personality. Patients who had lobotomies were usually docile, placid, less violent, and easier to manage in an institutional setting. Initial data was encouraging; two-thirds of patients were remarkably better. The procedure quickly became popular in the US, with over 60,000 procedures performed over the 1940-50s. Dr. Moniz received the Nobel Prize in 1949 “for his discovery of the therapeutic value of leucotomy in certain psychoses.”

However, the procedure became more controversial as time passed. Results were highly variable, depending on the surgeon, the exact fibers cut, and the patients’ diagnoses. Many patients were shadows of their former selves, and could not live independently. The death rate was a substantial 10-15%. And some high-profile failures (like Rosemary Kennedy, sister of President John Kennedy) led to a decreasing appetite for this surgery. Groundbreaking Thorazine, the first antipsychotic drug, was developed in 1954, followed by Haldol in 1958, ushering in the era of psychopharmacology, and ringing the death knell for psychosurgeries like lobotomies. Lobotomy fell out of favor, and is viewed as an embarrassing part of medical history now.

And what of Rose and Tennessee? Rose remained institutionalized. Tennessee remained appalled and horrified by what had happened to her, and spent much of his life obsessing and writing about the theme of insanity, delicate, flawed women, and withdrawal from life. In his play Suddenly Last Summer, a matriarch schemes to have her daughter lobotomized to prevent her from revealing the secret of her son’s homosexuality (Tennessee was homosexual). In A Streetcar Named Desire, the unstable Blanche Dubois is carried off to a mental institution, to “…rely on the kindness of strangers…”. Night of the Iguana includes themes of insanity and nervous breakdowns. Elia Kazan (who directed many of Tennessee’s greatest successes) said of Williams: “Everything in his life is in his plays, and everything in his plays is in his life.”

He spent much of his income from his successful plays on Rose’s care, and arranged to have her moved to a private hospital as soon as he could afford it. He said in an interview that his work on his sister Rose’s behalf was “probably the best thing I’ve done with my life, besides a few bits of work”. In his will he left the bulk of his estate in a trust for her continued care.

He himself had a lifelong fear of going insane. Later in life, he had significant depression and increasing drug use, which resulted in several hospitalizations and commitments to mental institutions. He was never able to shake his dependence on prescription drugs. At age 71, he died alone in a New York City hotel, from an overdose of Seconal, a barbiturate.

Want to know more? Read the Tennessee Williams plays mentioned in this article, and the fascinating book My Lobotomy, by Howard Dully and Charles Fleming.