The surgery that Charlie undergoes in Flowers for Algernon is purely fictional, although surgical techniques in the treatment of the mentally ill were being used at the time that the novel's action takes place. Presumably, Charlie had one of the procedures common at the time when he was treated with electroshock by Dr. Guarino, although it is not clear from the context of the novel precisely what that procedure is.
In addition, crude surgical techniques called frontal lobotomies were performed by doctors who believed that removing the part of the brain thought to be associated with various types of mental illness would cure the problem. Tragically, these early techniques were crude and removed too much brain tissue, leaving many patients in a worse state than they were before the surgery. These early surgeries called into ethical question whether any brain surgery should be done for the purpose of improving mental performance. For example, Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest, made into a movie in 1975, explores the treatment of the mentally ill during the decades following World War II.
One group of patients for whom brain surgery was unquestionably necessary had certain types of epilepsy characterized by uncontrolled, recurrent seizures that involved both halves of the brain. Surgery to cut the connection between the brain halves and thus control or minimize the seizures resulted in a great deal of "left brain, right brain" research, identifying which half of the human brain appeared to "control" which types of activities. Electroencephalography, a technique for recording the electrical activity of the brain, enabled researchers to pinpoint trouble spots characterized by too much or too little brain activity.
More precise surgical techniques developed in the 1980s resurrected the debate over excising portions of the brain to control behavior and mental performance. Again, people with certain types of epilepsy responded positively to the removal of small, precisely measured amounts of brain tissue. Their seizures were minimized or eliminated altogether with few or none of the tragic effects of the early frontal lobotomies.
As more sophisticated imaging techniques such as CAT scans, magnetic resonance imaging, and PET scanning were developed, brain mapping became more precise. Some medical researchers suggested building on the techniques used with epileptic patients to remove snippets of tissue from the area of the brain thought to control aggression in order to make prison inmates less likely to re-peat their crimes. Pharmaceuticals such as Prozac were developed to enhance and manipulate brain chemistry, opening the debate still wider concerning the ethics involved in physically manipulating the brain.
Much of the debate involves defining both medical and scientific ethics and the rights of individuals. For example, ethicists question what traits are part of an individual's core personality that should not be tampered with? Who determines what behaviors are "normal" or abnormal? To what degree are variations in brain chemistry and personality characteristics necessary for each person's best intellectual and creative development? Many great artists and writers like Edgar Allen Poe and Vincent Van Gogh had problems with depression and other mental disorders. Would the world have lost their genius if such surgeries and medications had been available during their lifetimes? Is it right to deprive a person of the benefits such surgeries could bring the individual at the supposed cost of creative genius? What could be the unforeseen consequences of attempts at intellectual and behavioral engineering using chemical and surgical techniques? And what of the human subjects who undergo such procedures? What are their rights? How able are they to make informed decisions regarding such treatments and the necessary experimentation that precedes their widespread use?
Keyes' Flowers for Algernon was ahead of its time in holding these issues up to scrutiny. No doubt the scientists responsible for Charlie's surgery have good intentions. They want to fulfill the wish of Charlie's mother to remove the stigma from learning disabilities and mental disorders by eliminating the disorder — in effect, forcing Charlie through surgery to become like everyone else or better. They intend to do no harm, but they have no appreciation of the value of Charlie before the surgery, before they make him smarter. Was the original Charlie worth knowing? Alice Kinnian thought so. Charlie's fellow workers at the bakery thought so, even if they did make fun of him at times.
The questions which we are left with are even more relevant today as medicine enjoys unprecedented understanding of the workings of the human brain and ways to influence it. And the most fundamental question of all is to what degree does our "brain power" influence our humanity. And when we tamper with the brain, do we also tamper metaphysically and emotionally with a human being in ways that cannot be known or understood?
Charlie's disability is the result of an untreated physical disorder called phenylketonuria; most babies born with this condition today would be treated early enough to prevent the type of learning disability that Charlie experiences. But many other children and adults have learning disabilities and mental disorders that are not easily treated but that can be managed with patience and care. Following the surgery, Charlie wants to use his newfound intelligence to help others in his situation, always recognizing that he was a "human being before the surgery." The surgery does not make Charlie any more human than he was before the operation; it just makes him smarter. And we can wonder whether, as Charlie surpassed the people around him in knowledge and intelligence, he would have ultimately led a happier and more productive life had the surgery been as successful as expected.
Quality of life issues have become even more important than the mere fact of life as more and more people debate which level of life is worth living, and whether the resources exist to maintain life at a certain level or end it when it is no longer "productive." Charlie's story reminds us of the value of goodness and honesty and friendship, and that these qualities can be found in anyone, regardless of how intellectually intelligent a person is.
In a time when diversity, conformity, and individuality seem to war continually with each other in our culture, Charlie speaks to the right of each individual to be valued and respected for the per-son he or she is rather than for expectations of what that person could become.