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. 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.
History of the lobotomy
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).
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. Yale neuroscientist John Fulton and his colleague Carlyle Jacobsen had performed lobotomy-like procedures on chimpanzees in 1935. Moniz and his colleague Almeida Limaperformed 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. 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."
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.
Prevalence & effects
About 50,000 lobotomies were performed in the United States, and Freeman himself performed between 3,500 and 5,000.
Lobotomies have been reported to have detrimental effects on a patient's personality, initiative, inhibitions, empathy and ability to function on their own.
The practice started subsiding in the mid-1950s, as scientists developed antipsychotic and antidepressant medications that were much more effective. Lobotomy is rarely performed today; the removal of specific brain areas (psychosurgery) is only used to treat patients for whom all other treatments have failed.