What Is a Lobotomy?

Reasons why lobotomies were performed

Verywell / Alex Dos Diaz

In the mid-20th century, the lobotomy was a popular “cure” for mental illness. It was part of a new wave of treatments for neurological diseases, including electroconvulsive therapy (ECT).

Lobotomies were typically performed on people with the following three conditions:

The aim of this procedure was to sever nerve fibers in the brain that connect the frontal lobe—the area of the brain responsible for thinking—with other regions of the brain.

History

Let's discuss a few of the prominent types of lobotomies that were practiced during the mid 20th century.

Egas Moniz's "Leucotomy"

The world's first lobotomy was performed in 1935 by a Portuguese neurologist by the name of António Egas Moniz. His original method involved drilling holes into the skull and pumping absolute alcohol into the frontal cortex, essentially destroying brain tissue.

The operation was deemed a success.

He thought that damaging the connection between the front of the brain and other parts of the brain, would stop "abnormal" behaviors and distressing thoughts.

Later, Moniz began to use an instrument of his own design, called a leucotome, to remove chunks of tissue from the frontal lobes.

Moniz was awarded the 1949 Nobel Prize for Physiology or Medicine for his discovery of the prefrontal lobotomy as a radical therapy for mental disorders.

The "Ice Pick" Lobotomy

Within a year of Moniz's procedure, neurologist Walter Freeman and neurosurgeon James Watts performed the first prefrontal lobotomy in the United States. Although Freeman found this procedure great, he wanted to develop a procedure that would be faster, more effective, and require fewer resources and specialized tools. 

But Freeman wanted lobotomies to be a more streamlined process. So, in 1946—10 years after performing his first lobotomy in the U.S.—Freeman developed a new method called the transorbital lobotomy. 

Instead of drilling into the skull to sever the connections in the frontal lobes, Freeman used a hammer to drive an ice pick into his patients’ brains through their eye sockets.

Once the ice pick was inside, he literally wiggled it around, severing the nerves connecting the prefrontal cortex to the thalamus. This adapted procedure became known as an “ice pick lobotomy.”

Though his first transorbital lobotomy was done with an ice pick, Freeman later made his own instrument based on the ice picks design—the orbitoclast.

While the prefrontal lobotomy took over an hour, Freeman's transorbital lobotomy could be done in 10 minutes or less. Because it didn't require anesthesia—patients were knocked out before the operation using ECT—it could be performed outside of the hospital.  

Prevalence and Effects

Shortly after doing his first ice pick lobotomy, Freeman began traveling the country performing lobotomies on all who were willing. Though lobotomies were initially only used to treat severe mental health condition, Freeman began promoting the lobotomy as a cure for everything from serious mental illness to nervous indigestion.

About 50,000 people received lobotomies in the United States, most of them between 1949 and 1952. Freeman himself is said to have performed about 3,500 patients, including 19 children. The youngest was just 4 years old.

Notable Lobotomies

Freeman reportedly felt that the lobotomy was “only a little more dangerous than an operation to remove an infected tooth.” Unfortunately, this was not the case for the majority of patients. In many instances, lobotomies had negative effects on a patient's personality, initiative, inhibitions, empathy, and ability to function on their own.

Here are a few people who underwent lobotomies and the impact the operation had on their lives.

Alice Hood Hammatt

Freeman and Watts performed the first lobotomy in the U.S. on Alice Hood Hammatt, a woman diagnosed with agitated depression

When Hammatt awoke postoperatively, she stated that she was “happy."

Six days after the operation, Hammatt experienced transient language difficulties, disorientation, and agitation. Nevertheless, Freeman considered the outcome a success.

Rosemary Kennedy

Probably the most notable person to have undergone a lobotomy is Rosemary Kennedy, sister of U.S. President John F. Kennedy.

As a child and young adult, Kennedy has mild developmental delays that impaired her performance in school. As Rosemary got older, she reportedly began to experience violent seizures and temper tantrums, lashing out at those around her.

Seeking a treatment to ease her outbursts and fearing that Rosemary's behavior would create a bad reputation for herself and for the whole family, Rosemary's father arranged a lobotomy for Rosemary when she was 23 years old.

Throughout the entire procedure, Rosemary is said to have been awake, speaking with doctors, and reciting poems to nurses. Doctors knew the procedure was over when she stopped speaking.

Following the procedure she became severely disabled. She was unable to function independently, and was institutionalized for the remainder of her life. 

Why Were Lobotomies Performed?

The lobotomy is considered one of the most barbaric treatments in the history of modern medicine. Even in the 1940s, lobotomies were the subject of growing controversy. But despite it's ethical issues regarding the procedure, it gained widespread popularity for several reasons:

  • Absence of effective treatments: Antipsychotic drugs were not available until the mid-1950s. was available. People were desperate to do something, anything to help those with severe mental illness.
  • Overcrowded institutions: In 1937, there were more than 450,000 patients in 477 mental institutions. Lobotomies were used to calm unruly patients and make them easier to manage.
  • Media: At this time, media was able to influence surgical indications. The lobotomy was seen as “magic and heroic.”

Are Lobotomies Still Performed?

Performing lobotomies to address symptoms of mental disorders began to subside in the mid-1950s when scientists developed antipsychotic and antidepressant medications that were much more effective. They are rarely, if ever, performed today, and when they are you can rest assured that ice picks and hammers are not involved.

Moniz' and Freeman's work paved the way for other forms of psychosurgery such as the anterior cingulotomy, as well as procedures such as deep brain stimulation which is used to treat severe MDD and OCD, and neurological conditions like Parkinson's disease.

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5 Sources
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