When Rosemary Kennedy died of natural causes on January 7, 2005 at the age of 86, it marked the end to a long and tragic life that was all the more heartbreaking since it began with such promise.

Born in 1918, Rosemary was the oldest daughter of Joseph P. Kennedy Sr. and Rose Fitzgerald Kennedy and, as such, was expected to lead a charmed existence. Her father was one of America's wealthiest businessmen and would later serve as ambassador to Great Britain just as World War Two broke out. Her mother was a member of one of the oldest political families in Massachusetts and the daughter of a former mayor of Boston. Born into wealth and high society, Rosemary should have become a socialite like her mother. Unfortunately, the intellectual disabilities that grew increasingly worse as she grew older would ensure that her entire life would be spent away from public scrutiny.

The only details of Rosemary's early childhood come from what her mother and siblings would provide in later years but the problems in Rosemary's motor and cognitive development were clear enough, especially compared to her two older brothers, Joseph Junior and Jack. Her concerned parents tried taking her to numerous specialists for treatment but none of them could provide any answers. While Rosemary started school at the age of five in a regular kindergarten class in Brookline, Massachusetts, it became quickly apparent that she couldn't keep up with the other children in her class. As her mother would later write in her autobiography, "Her lack of coordination was apparent and she could not keep up with the work."

Withdrawn from regular school, Rosemary was eventually sent to the Sacred Heart Convent in Providence, Rhode Island when she was fifteen. After receiving special education involving private tutoring, she eventually learned to read and write at a basic level. Still, she was kept apart from the other children and, aside from occasional social outings, including a tea dance with her brother Jack serving as her escort, Rosemary was kept well-hidden from public. When she was seen at all, it was in carefully controlled settings that kept her "differences" out of the public eye. Though she was presented to the Queen along with her other siblings, Rosemary was otherwise raised and educated separately.

Due to the terrible stigma surrounding intellectual disabilities in children, especially in an era in which eugenics advocates routinely declared intellectually disabled children to be "genetically unfit", only the closest family friends were allowed to know about Rosemary's condition. To most other visitors to the Kennedy family home, Rosemary's failure to interact the way her siblings did was put down to her "shyness."

Rosemary tried her best and apparently functioned as borderline normal for most of her childhood. It was only when she reached her early twenties that her condition grew worse. Whether due to grief at being unable to live up to her parents expectations or for other reasons, she began acting out and became more difficult for her family to control. Along with gaining a great deal of weight, she had also become sexually mature and the "shy child" excuse no longer worked. Not only was Rosemary unable to "pass" as a normal child, but she was also prone to violent tantrums, including throwing objects and physically assaulting family members. In the summer of 1941, she even assaulted her grandfather, John J. (Honey Fitz) Fitzgerald

John and Rose Kennedy began searching for a solution to deal with their disturbed daughter. Not only were they worried about her violent acting out, but her sexual maturity meant the increasing possibility of a scandal that might damage the future political careers of the other Kennedy children. Even then, John Kennedy Sr. had every intention of seeing one of his sons as President of the United States in time and the stigma that Rosemary brought to the Kennedy name was a particular concern. John Sr. and Rose also had the concern that all parents of children with intellectual disabilities have. Unfortunately, even for the rich and powerful Kennedy family, actual resources for dealing with these kind of problems were almost nonexistent in the 1940s.

Finally, based on the medical advice provided by the costly specialists they consulted, the Kennedys reached a decision. At that time, Rosemary was living in a convent school in Washington, D.C. though reports of her late-night wandering worried her parents even more. The nuns who ran the school even suggested that she might be picking up men and had become sexually promiscuous; something that terrified both her parents. In the fall of 1941, not long after the incident with her grandfather, Rosemary was admitted to Saint Elizabeth's Hospital in Washington, D.C. for what her mother would later describe as a "certain form of neurosurgery." In other words, a prefrontal lobotomy.

In 1941, the prospect of curing mental patients with a simple brain operation must have seemed like the answer to the prayers of parents such as Rose and Joseph Kennedy. Unfortunately, the reality was far more horrible than anyone really realized.

Though not the first surgeon to operate on the human brain. it was Portuguese neurologist Antonio Egas Moniz who first popularized lobotomies as a humane alternative to the often brutal asylums that were used to house the mentally ill in most places. By severing the neural connections between the brain's prefrontal areas and the rest of the brain, Moniz hoped to suppress the violent behaviour of many mental patients and make them more manageable. This procedure involved drilling two holes in the skull and inserting a thin surgical instrument known as a leucotome. By carefully rotating the leucotome, the surgeon could carefully severe the brain fibers. It was extremely delicate surgery which could only be done by skilled neurosurgeons. Beginning with his first successful operation in 1935, Moniz' research results earned him an international reputation as well as the 1949 Nobel prize in medicine.

Moniz' procedure proved to be extremely popular despite the complex nature of the operation. Lobotomies began to be carried out in numerous countries to treat a wide range of psychiatric conditions. Still, it was American neurologist Walter Freeman who really launched the psychosurgery movement in the United States. By modifying what Moniz had done and developing a more streamlined procedure known as a transorbital lobotomy, Freeman would transform the lives of thousands of patients (if not in the way that was originally intended).

Freeman's new procedure involved inserting a tool similar to an icepick beneath the eyelid and hammering it into the brain through the thin bone of the eye socket. By manipulating the surgical tool, it was possible to sever key brain fibers much in the same way Moniz had done. Not only was Freeman's new procedure much simpler, but Freeman suggested that it could be carried out in virtually any hospital or prison. It could even be done under a local anesthetic with the patient being awake during the operation. After conducting the first of these operations on a live patient in 1936, Freeman became the chief advocate of using lobotomies on any potential violent patient or inmate.

Though other neurologists were leery of brain surgery of this magnitude, the prospect of curing previously untreatable patients with a simple operation helped overcome any resistance. Beginning in 1943, the U.S. government adopted Freeman's procedure to deal with thousands of problem patients. The Veterans' Administration endorsed the operation as well and more than two thousand U.S. veterans would be lobotomized over a twelve-year period. As well, lobotomies were performed on prisoners, mental patients, and anyone else who could presumably be helped based on Freeman's own enthusiastic pronouncements about how well his procedure worked, By 1951, more than 18,000 patients would be lobotomized in the United States alone despite warnings from Freeman's critics that his magical operation was too good to be true.

And so it proved with Rosemary Kennedy. It is still unclear who persuaded her parents to allow the operation or what they had hoped to accomplish with it. Some sources suggest that it was Joseph Kennedy alone who authorized the surgery though Rose indicated in her own memoirs that she agreed to it as well. While exact details of the lobotomy performed on Rosemary aren't available, the profound effect that it had on her were apparent from the very beginning. The original purpose of the operation had to curb Rosemary's aggressive behaviour and, in that respect,the lobotomy was a success, but at a horrible price. Rosemary was no longer the mildly retarded young woman her family knew.

As Rose Kennedy would describe later, her daughter had been reduced to a "childlike level" which left her completely incapable of caring for herself. Not only was she unable to speak more than a few words, but she had to learn to walk all over again. While she had formerly led a semi-autonomous life at the convent school where she had been living, this was no longer possible for her. Acting on the advice of Cardinal Richard Cushing, a trusted advisor of the Kennedy family, Rosemary's parents sent her to St. Coletta's convent in Wisconsin where she would spend the rest of her life. And it was there that she was reportedly abandoned by her family. Not only did her mother not visit her for many years afterward, but she become virtually forgotten as far as the rest of the world was concerned. Her father scarcely mentioned her at all in his private correspondence once she went to the convent.

Not until her brother John became President in 1960 would anyone in the family publicly acknowledge Rosemary's disability. Up to that time, her disappearance was put down to her being a recluse or even working as a teacher for the disabled. When Rosemary's disability was finally revealed, she was referred to as mentally retarded with no mention of the lobotomy. Still, her brother John visited her secretly as he was running for President and it was during his term in office that the first Presidential Panel on Mental Retardation was established. Despite this public acknowledgement, Rosemary was confined to the convent. It was only after her father's death in 1969 that her family allowed her to leave the convent on brief visits to the family home in Cape Cod.

Following Rose Kennedy's stroke in 1984, it was Rosemary's sister, Eunice Kennedy Shriver, who took over as her primary caregiver while the rest of her family continued to visit her as their busy schedules allowed. When Rosemary finally died of natural causes in a Fort Atkinson, Wisconsin hospital in 2005, Senator Edward Kennedy and all of his surviving sisters were at her beside. The family statement included in her obituary described her as a "lifelong jewel to every member of our family, From her earliest years, her mental retardation was a continuing inspiration to each of us and a powerful source of our family's commitment to do all we can to help all persons with disabilities live full and productive lives."

Even today, biographers continue to question the motivation behind Rosemary's lobotomy. Despite her parents' concerns about their daughter's behavioural problems, there seems little doubt that her borderline intelligence would have allowed her to function well enough to have a chance at a regular life, if not to the high expectations of her family. "Joe had two principal concerns about Rosemary," wrote Barbara Gibson and Ted Schwarz in their book, Rose Kennedy and Her Family: The Best and Worst of Their Lives and Times. "She was not the competition-oriented ideal of Kennedy womanhood, and he thought her sexuality was too intense and untempered by the moral strictures to which the other daughters had adhered. Joe destroyed a portion of her brain rather than risk what she might become if allowed to follow her own path in life."

Though neither of her parents realized the profound effect that the lobotomy would have on Rosemary, the guilt over what happened to her likely stayed with them for the rest of their lives. This was especially evident by the enormous financial contribution that made to support research into the causes of mental retardation. In 1946, Rosemary's father established the Joseph P. Kennedy Jr. Foundation which established research centres across the United States to promote greater awareness of intellectual disabilities. Along with research funding for brain researchers, the Foundation has provided special care facilities to help intellectually disabled children and adults live more independent lives. Eunice Kennedy Shriver became a lifelong activist for mentally disabled children and helped found the Special Olympics.

Though she lived her entire life hidden from the public eye, Rosemary Kennedy's legacy remains profound, both as someone born with intellectual disabilities and as a victim of the lobotomy fad that swept the United States during the 1940s and 1950s. She will be remembered.