The Lobotomy: A Brief History of Surgical Brain Trauma
In 1949, Dr. Egas Moniz won a Nobel prize for inventing a procedure which left nearly 100% of patients with undesirable side effects, ranging from incontinence and apathy to sudden-onset kleptomania. Why?
It made the mentally ill easier and cheaper to “deal with.”
It all began in a Lisbon hospital in 1935. Dr. Moniz had just returned from a conference where he saw two formerly violent chimpanzees become docile after having their frontal lobes removed. He wondered if mental illness in humans could be surgically treated.
Before the days of informed consent, it was easy for Moniz to obtain 11 female test subjects from the local asylum. Since they were mentally ill, they didn’t have to agree to the procedure.
Moniz used an instrument called a leucotome to divide the white matter in the frontal lobes, making the patients more compliant and, in his eyes, less ill. Enamored of his own results, he quickly published and distributed them.
Thus the lobotomy (originally called a leucotomy, after the surgical instrument) was born.
Lobotomy was a medical procedure which involved drilling holes in the skull and inserting a leucotome which was then swept from side to side in order to sever the connections between various parts of the brain, most notably the frontal lobe. Some doctors likened it to “putting a needle in the brain and stirring the works”.
The practice of drilling holes into patients’ heads wasn’t new. The procedure of drilling into the skull (trepanning) dates back nearly 7,000 years, and was used to relieve pain and as a medical means of releasing spirits.
The lobotomy, harkened as a medical miracle, was nearly as archaic in both its underpinnings and execution. It was theoretically rooted in a massive oversimplification of the brain, and is evidence that any “miracle cure” should be met with extreme skepticism.
Moniz’s patients relapsed into their mental illness, and one of the original chimpanzees became violent again, but it was already too late.
In 1947, 2,000 lobotomies were performed. After Moniz received his Nobel prize in medicine, that number jumped to 18,000.
It wasn’t until 1936 that the United States saw its first lobotomy, and soon after it spread across the globe. When it became mainstream, thousands of lobotomies were performed daily.
Some patients preferring the risk of getting a lobotomy to the likelihood of spending the rest of their lives in a mental institution; more often, it was patients’ families or the institutions themselves which pushed for the procedure. Instead of paying $35,000 a year to feed an house a patient in an institution, they could lobotomize him for $250 and send him home.
The term ‘lobotomy’ was coined by a doctor named Walter Freeman, who started his work on a Kansas housewife. Freeman’s medical opinion on what the lobotomy was fixing was different from Egas. Freeman believed that instead of connective tissues being the culprit, an overload of emotions was to blame—a popular accusation in the medical profession; see hysteria. He thought that cutting particular nerves could help relieve stress on the brain and stabilize the patient’s personality.
Likewise, Freeman believed that there was a more efficient and less intrusive way to perform a lobotomy. He went on to create the ice pick lobotomy which is performed without the use of drilled holes, but rather performed transorbital—through the eye socket. This is what we now know as the modern lobotomy. He first performed it in Washington, D.C in January of 1946.
Freeman was quite a showman, and often performed in front of audiences. He once performed an astounding 25 lobotomies in one day, and was known for his penchant for placing picks in both eyes of his patients.
While a significant number of patients were lobotomized against their will, many of Freeman’s clients were eager for the man to stick a pick in their brain. Before antipsychotic medication, those with serious mental illnesses were desperate for an effective treatment. Not surprisingly, the results were riddled with tragic accounts of brain trauma. Dr. Elliot Valenstein’s book Great and Desperate Cures recounts more deeply the state of mental health treatment in relationship to lobotomies.
It wasn't until 1967 that Freeman performed for the last time. He was banned from operating when it became common knowledge that he had performed three lobotomies on a single patient, the last of which resulted in the woman’s death.
Just as a diagnosis of hysteria was used to control women, and drapetomania was used to control African Americans, the lobotomy could be a means of rendering the vulnerable docile, albeit through literal brain trauma rather than societal stigma.
In 2006, NPR interviewed Howard Dully, who received a lobotomy from Freeman when he was only 12 years old. Duly said:
“I’ve always felt different—wondered if something’s missing from my should. I have no memory of the operation, and never had the courage to ask my family about it…”
Dully was not mentally ill. His stepmother took him to several doctors, who all said there was nothing wrong with him, until she found Freeman. Their justification for lobotomizing him? He was rebellious, daydreamed too often, and never wanted to go to bed.
Consider the case of Rosemary Kennedy. A daughter of the famous presidential family, she became an assertive nonconformist in her teen years. She began to sneak out from her convent school at night.
Doctors told Joseph P. Kennedy, Sr. that a lobotomy might help calm her mood swings and prevent embarrassing outbursts.
The procedure was not successful. Rosemary’s cognitive capacity was reduced to that of a two-year-old. She lost the ability to walk and speak, and became incontinent. She spent the rest of her life in various institutions, and her parents didn’t visit her. When her brother John F. Kennedy was campaigning for re-election, the family excused her absence by calling her first “reclusive” and then “mentally retarded.”
The lobotomy was outlawed in Japan and Germany in the 1950s, but the last case in the U.S. occurred in the late 1980s.
The U.S. performed more lobotomies than any other country, though the exact number has never been confirmed. The estimated total ranges from 40,000 to 50,000, with the majority of those procedures taking place in the 1940s and 1950s.
Though the lobotomy was a well-intentioned procedure which some volunteered for, it was also used as a means to enforce conformity. The psychiatric profession would do well to remember this dark period, and the human toll of using physiological treatment as a first line of defense.
Alex Greenway is a freelance writer with an interest in the obscure. She’s available for guest posts here.