In the middle of the twentieth century, tens of thousands of lobotomy were performed all over the world. The procedure aims to cut off the connection to the frontal lobe of the brain, with the goal of treating symptoms of mental illness — or just make it easier for patients to manage. This has been achieved through techniques ranging from injecting alcohol directly into the brain to methods of puncturing the ice into the eye socket.
We look on in horror now – but where did it come from, how did it become a “medicine for all”, and what did it do to patients who had lobotomy, often without their consent?
The origins of modern psychiatry
Gottlieb Burckhardt, a psychiatrist from Switzerland, is known as one of the first to attempt modern psychosurgery in 1888 for patients with schizophrenia. Although he apparently had no surgical training, he decided to remove parts of his patient’s brains anyway in a procedure called focal cortical resection.
Six individuals underwent open brain surgery. One died of complications five days later, and another later died by suicide. Others suffered from epilepsy and weakness, and were unable to understand writing or speech (sensory aphasia). The surgery was deemed ‘successful’ in three patients, whom the operation described as ‘calm’.
Burckhardt’s findings shocked and stunned the scientific community, and his thoughts on psychosurgery were put off – though not for long.
The next famous people in psychosurgery were actually chimpanzees named Becky and Lucy. In 1935, neuroscientists John Fulton and Carlyle Jacobsen reported on the removal of the frontal segments of the frontal lobes. Chimpanzees may get angry if they slip during tasks – but after surgery this was not the case, as the chimps seem calm and happy.
This fateful presentation at the International Neurological Congress inspired the man who went on to win a Nobel Prize for his development of a modern lobotomy (which many believe should be returned).
Who invented lobotomy?
Antonio Egas Muniz, a neurologist from Portugal, drew great inspiration from the work of Burckhardt, Vollmann and Jacobsen. In the same year that he saw the results of the chimps, he performed what is considered the first lobotomy on a human patient. At the time, the procedure was called a leukotomy.
“I decided to cut the fibers connected to the neurons in activity,” Muniz wrote. He did this by drilling two holes in his patient’s skull, then injecting ethanol into the white matter of her frontal lobes. This acted as a hardening agent, causing irritation and irreversible injury to the blood vessels, causing the formation of fibrous tissue and “obliterating” the blood vessel. This destroyed the connections between the frontal lobe and the rest of the brain.
Moniz and colleague Almeida Lima, a neurosurgeon, performed the procedure on patients at a hospital in Lisbon. They later adopted a surgical approach instead, developing an instrument called a wire-loop leucotome to cut through lesions in the white matter.
The results were considered promising, and Moniz was awarded the 1949 Nobel Prize in Physiology or Medicine.
The first surgery in America
In the USA, Muniz’s research partner, a psychiatrist named Walter Freeman, took these findings and ran with them – or more like a sprint. Accompanied by neurosurgeon James Watts, he performed America’s first lobectomy on a Kansas housewife in 1936. Watts and Freeman later modified Muniz’s original technique so that only a small hole would need to be drilled in the zygomatic arch for the surgical instrument to be pushed into the arch. brain.
However, as the years passed, Freeman became more reckless with his techniques. In 1945, the transorbital incision was invented, in which an ice-like instrument called an orbitoclast was hammered into a patient’s eye socket. This procedure is where the term “ice lobotomy” comes from.
Freeman sometimes used photographs of patients as “evidence” of the benefits of lobotomy. In a series of photos, one of the photos was captioned “March 23, 1942 before the operation. “Fighting forever …. the stubborn woman.” She laughs a lot.
Freeman would end up touring across the country at Lopotomobel, performing as many as 25 surgeries a day. He dumped his fellow neurosurgeon trainee, and set out on his own. He also refused scrubs and surgical gloves, as well as any semblance of hygiene in his operating room – he is said to chew gum during surgery, not sanitize his hands, and even work in hotel rooms. His favorite trick was to knock the tools into both the patient’s eyes simultaneously as a shock tactic.
Unsurprisingly, Freeman killed a patient in 1967, who died of a cerebral hemorrhage after lobular surgery, and Freeman was subsequently banned from the surgeries.
Rosemary Kennedy, sister of former US President John F. Kennedy, is one of the most prominent lobectomy patients. During her birth, a nurse held her inside the birth canal for two hours, depriving her of oxygen. Rosemary will continue to experience learning difficulties. In her early twenties, she was described as irritable and rebellious, and her father sought advice other than Freeman and Watts.
At the age of 23, her father authorized her to have an operation. As Liz Lenz writes in Marie Claire: “The doctors would recite her poems while she was being cut—and when she was silent, they knew the procedure was complete.”
This action left Rosemary with permanent physical and mental disabilities, completely unable to live independently until her death at the age of 86.
How did lobotomy affect patients?
It appears that the popularity of lobectomy did not arise from a drive to improve a patient’s quality of life, but from the desperation caused by overcrowded mental health facilities. Lobotomy has offered a cheap and long-term way to control “unruly” patients, reducing the cost and effort involved in their care. However, it came at an unspeakable cost to patients (or victims), ranging from distress to death.
One patient who underwent surgery in the UK in 1974 told the Guardian: “It felt like a broom handle was being pushed into my brain and my head was splitting.”
The youngest patient ever—notably another Freeman patient—was 12-year-old Howard Dooley. Fortunately, he survived, but speaking to the Guardian, he said, “I was like a zombie. I had no awareness of what Freeman had done.” He also attributes his frequent eye infections to the “destruction” of his tear ducts by orbital lobotomy.
A 1996 report from the British Medical Journal details that the Norwegian Ministry of Health financially compensates all people who have had surgery in Norway. The government has acknowledged the long-term effects of lobster, “which include intellectual disability, dehydration, epilepsy, apathy, incontinence, and obesity.”
Neurosurgeon Henry Marsh explained to the BBC: “If you see the patient after the procedure, they will look fine, they will walk and talk and say thank you doctor.”
“The fact that they are totally destroyed because they are social humans probably didn’t count.”
The mother of a lobotomy patient was quoted as saying, “She is my daughter but she is a different person. She is with me in the body but somehow her soul is lost.”
Does Lobotomies Still Happen?
Eventually, lobotomy fell out with the advent of drugs like thorazine, which could conquer patients without the need for surgery. The Soviet Union banned lobotomy in 1950, but this practice continued into the 1980s in other parts of the world such as France and Scandinavia.
There have been more recent documented cases, though. Scottish singer Lena Zavaroni, who was diagnosed with depression and anorexia, opted for surgery in September 1999, but died of pneumonia a month later.
However, in cases where all other treatment options have not worked and the patient can give informed consent, brain surgery to treat mental disorders continues under the name of psychosurgery. These operations are rare – only four operations were performed in the UK between 2015 and 2016.
A procedure called an anterior cingulateotomy involves destroying tissue in the anterior cingulate cortex with heat or electric current. This can help treat chronic pain and symptoms of obsessive-compulsive disorder (OCD). Another procedure called anterior capsulotomy is similar and can reduce OCD symptoms, but it targets the anterior capsule, near the thalamus. Subasthmatic angioplasty destroys part of the caudate nucleus, and can treat depression, anxiety, and obsessive-compulsive disorder. Leukotomies, which are a combination of subtrochanteric and anterior cingulotomy and called limbic leukotomy, still occur and are used to treat obsessive-compulsive disorder and major depressive disorder.
In fact, Gottlieb Burckhardt’s original procedure continues to this day. Focal cortical ablation is now used to remove damaged brain tissue that can cause seizures in children.