Walter doesn't generally talk about other people as if they're real the way he is real. He talks about them -- in his autobiography, and in the letters of his that I've read -- more as if they're fictional characters in a soap opera he watches. This is very appropriate for a lobotomist, as the narrative of lobotomy is that people are malleable, and if you don't like who you are you can change. This also happens to be the narrative of America, which is why Walter had to be American, even though the guy who invented the procedure was Portuguese and the guy who refined it was Italian. Doesn't matter. It could only have been an American to run with it the way he did, because lobotomy presented a very sensible obverse to the American dream.
All our lives we are told that if we work hard enough and want what we want enough we can have it, whatever it is. No mention is made of the fact that some people are stupid or poor or morally bankrupt or plain unlucky or have the cards stacked against them for any one of a hundred other reasons. Not everyone can become a doctor or an astronaut; not everyone who wants a family gets to have one; some people die young or go crazy or have some other horrible fate. Some people just lose. The story America tells itself is one in which losers must be either ignored or demonized. But lobotomy was for losers. Lobotomy and its prophet Walter Freeman said Look, your pain is real. You exist. You have been lied to from the beginning by people who said life would be worth living and after all your effort what did you get? This shitty life with this shitty brain that doesn't work the way it's supposed to. But the American dream can still be true for you because there is something you can have if you want it enough. There is a way you can be different and it's not some airy-fairy bullshit thing, it's a knitting needle in your brain. You won't achieve greatness afterward, but let's face it, you're not going to achieve greatness anyway. You might as well take the consolation prize.
This particular panel is going to go after this comic, which is immediately preceded by this one. Hilarious, isn't it, to think that One Flew Over the Cuckoo's Nest presented lobotomy as something forced on the primal masculine by the castrating feminine? Ken Kesey, you wacky funster!