A lobotomy severs the connections in the brain's prefrontal lobe, the area highlighted in this illustration.
Credit: decade3d | Shutterstock
Lobotomy, also known as leucotomy, is a neurosurgical operation that involves severing connections in the brain's prefrontal lobe, according to Encyclopaedia Britannica. Lobotomies have always been controversial, but were widely performed for more than two decades as treatment for schizophrenia, manic depression and bipolar disorder, among other mental illnesses.
Lobotomy was an umbrella term for a series of different operations that purposely damaged brain tissue in order to treat mental illness, said Dr. Barron Lerner, a medical historian and professor at NYU Langone Medical Center in New York.
"The behaviors [doctors] were trying to fix, they thought, were set down in neurological connections," Lerner told Live Science. "The idea was, if you could damage those connections, you could stop the bad behaviors."
When lobotomy was invented, there were no good ways to treat mental illness, and people were looking for "pretty desperate" kinds of interventions, he said. Even so, there were always critics of the procedure, he added.
Doctors first began manipulating the brain to calm patients in the late 1880s, when the Swiss physician Gottlieb Burkhardt removed parts of the cortex of the brains of patients with auditory hallucinations and other symptoms of schizophrenia, noting that it made them calm (although one patient died and another committed suicide after the procedure), according to Encyclopaedia Britannica.
The Portuguese neurologist António Egas Moniz is credited with inventing the lobotomy in 1935, for which he shared the Nobel Prize for Physiology or Medicine in 1949 (later, a movement was started to revoke the prize, unsuccessfully).
Yale neuroscientist John Fulton and his colleague Carlyle Jacobsen had performed lobotomy-like procedures on chimpanzees in 1935. Moniz and his colleague Almeida Lima performed the first human experiments later that year. The frontal lobes were targeted because of their association with behavior and personality.
Moniz reported the treatment as a success for patients with conditions such as depression, schizophrenia, panic disorder and mania, according to an article published in 2011 in the Journal of Neurosurgery. But the operations had severe side effects, including increased temperature, vomiting, bladder and bowel incontinence and eye problems, as well apathy, lethargy, and abnormal sensations of hunger, among others. The medical community was initially critical of the procedure, but nevertheless, physicians started using it in countries around the world.
The first procedures involved cutting a hole in the skull and injecting ethanol into the brain to destroy the fibers that connected the frontal lobe to other parts of the brain. Later, Moniz introduced a surgical instrument called a leucotome, which contains a loop of wire that, when rotated, creates a circular lesion in the brain.
Italian and American doctors were early adopters of the lobotomy. The American neurosurgeons Walter Freeman and James Watts adapted Moniz's technique to create the "Freeman-Watts technique" or the "Freeman-Watts standard prefrontal lobotomy," according to Encyclopaedia Britannica.
The Italian psychiatrist Amarro Fiamberti first developed a procedure that involved accessing the frontal lobes through the eye sockets, which would inspire Freeman to develop the transorbital lobotomy in 1945, a method that would not require a traditional surgeon and operating room. The technique involved using an instrument called an orbitoclast, a modified ice pick, which the physician would insert through the patient's eye socket using a hammer. They would then move the instrument side-to-side to separate the frontal lobes from the thalamus, the part of the brain that receives and relays sensory input.
Freeman wasn't just a neurologist, he was a showman, Lerner said. "He traveled around the country, doing multiple lobotomies in a day," he said. "He absolutely did this for way too long."
Prevalence & effects
About 50,000 lobotomies were performed in the United States, and Freeman himself performed between 3,500 and 5,000.
While a small percentage of people supposedly got better or stayed the same, for many people, lobotomy had negative effects on a patient's personality, initiative, inhibitions, empathy and ability to function on their own.
"The main long-term side effect was mental dullness," Lerner said. People could no longer live independently, and they lost their personalities, he said.
Mental institutions played a critical role in the prevalence of lobotomy. At the time, there were hundreds of thousands of mental institutions, which were overcrowded and chaotic. By giving unruly patients lobotomies, doctors could maintain control over the institution, Lerner said.
That's exactly what happens in the 1962 novel and 1975 film "One Flew Over the Cuckoo's Nest," in which Randall Patrick McMurphy, a rambunctious but sane man living in a mental hospital, is given a lobotomy that leaves him mute and vacant-minded.
"Usually things in movies are exaggerated," Lerner said. But in this case, it was "disturbingly real," he said.
The practice started subsiding in the mid-1950s, as scientists developed antipsychotic and antidepressant medications that were much more effective. Nowadays, mental illness is primarily treated with drugs. In cases where drugs are not effective, people may be treated with electroconvulsive therapy, a procedure that involves passing electrical currents through the brain to trigger a brief seizure, according to the Mayo Clinic.
Lobotomy is rarely, if ever, performed today, and if it is, "it’s a much more elegant procedure," Lerner said. "You're not going in with an ice pick and monkeying around." The removal of specific brain areas (psychosurgery) is only used to treat patients for whom all other treatments have failed.
- Nobelprize.org: Controversial Psychosurgery Resulted in a Nobel Prize
- PsychCentral: The Surprising History of the Lobotomy