Did Lobotomies Actually Work?


Lobotomies, once hailed as a revolutionary treatment for mental illness, were far from the miracle cure they were once thought to be.

In fact, the procedure, which involves severing connections in the brain’s prefrontal cortex, had controversial and often devastating effects on patients’ personalities, mental abilities, and overall quality of life.

It’s a stark reminder of how medical understanding and ethics evolve over time.

But there’s more to this story than just the grim reality of a bygone medical practice. How did lobotomies rise to prominence, and who was behind this notorious procedure? What finally led the medical community to turn its back on such a drastic approach?

Buckle up as we journey through the twisted corridors of medical history, uncovering tales of ambition, desperation, and the relentless pursuit of understanding the human mind.

Historical Context

In the realm of psychiatric treatment, the advent and subsequent decline of lobotomy as a medical procedure is a story of rapid rise and dramatic fall. It reveals the interplay between experimental surgery and the desperation to find treatments for mental illness.

Development of Lobotomy

The lobotomy was developed by the Portuguese neurologist Egas Moniz in the 1930s. He theorized that mental illnesses were related to problems in the connections between the frontal lobes and the rest of the brain.

In 1935, Moniz introduced the prefrontal lobotomy, which involved severing these connections. Moniz was awarded the Nobel Prize for Physiology or Medicine in 1949 for his work in developing this procedure, reflecting the initial optimism surrounding the lobotomy’s potential.

Rise and Fall in the US

In the US, lobotomies really took off when Walter Freeman, a major advocate, started doing them in the 1940s. Freeman put his own spin on it, creating the transorbital lobotomy, which folks often called the “ice-pick lobotomy.”

Pretty grisly stuff — it involved jabbing a sharp tool through the eye socket to get to the frontal lobes.

By the time the 1950s rolled around, a whopping 40,000 lobotomies had been done in the United States.

But the plot thickens. As new antipsychotic drugs hit the scene and people started to see the serious downsides of lobotomies, like major personality shifts and brain fog, the procedure began to lose its appeal.

Big media publications, like The New York Times, started shining a light on these scary side effects. This kind of coverage played a big role in lobotomies falling out of favor with the medical community.

Lobotomy Procedure Details

The lobotomy procedure was developed with the purpose of altering a patient’s mental state by manipulating brain tissue, primarily in the frontal lobe region. These surgical techniques were performed by neurosurgeons to alleviate severe mental disorders.

Surgical Techniques

A frontal lobotomy, often referred to as a prefrontal lobotomy, was a form of psychosurgery that involved severing connections in the brain’s frontal lobe.

Neurosurgeons traditionally accessed the brain through the patient’s eye sockets using an instrument called a leucotome. The European variant, known as leucotomy, typically involved drilling holes in the skull to reach the brain tissue.

The surgical goal was to target the white matter connecting the prefrontal cortex, which is involved in complex behaviors and personality, to the thalamus, an area associated with processing sensory information.

Standard Procedure:

  • Drill hole in the skull or use eye sockets for access
  • Sever white matter to disconnect the prefrontal cortex from the thalamus
  • Use leucotome to cut brain tissue

Biological Implications

By targeting the cortex and its underlying white matter, these procedures had profound and often unpredictable effects on the patient’s mental and emotional state.

The prefrontal lobotomy was thought to work by altering neural pathways, dampening intense emotional responses and erratic behavior. The notion was that by disrupting these connections, symptoms of psychosis and other severe mental illnesses would be mitigated.

However, this often results in many additional neurological deficits and personality changes, as the frontal lobe is critical for cognitive functions and emotional regulation.

Biological Outcomes

Frontal lobe: Cognitive deficits, personality changes

White matter: Disrupted neural pathways

Thalamus: Altered emotional and sensory processing

Effects and Efficacy

Lobotomies were once performed with the intention to alter mental health by modifying connections in the brain, but they often resulted in a range of side effects. This section explores the variable outcomes patients experienced.

Intended Outcomes

Lobotomies aimed to alleviate severe psychiatric conditions by severing connections in the prefrontal cortex, believing it would improve personality, behavior, and thoughts.

In some cases, patients demonstrated a reduction in symptoms such as agitation, aggression, and chronic pain, which were considered signs of improvement.

However, the procedure’s efficacy in achieving these intended outcomes was highly inconsistent among patients.

Side Effects and Complications

The procedure also led to numerous side effects and complications, which included:

  • Seizures
  • Memory issues
  • Significant changes in personality. Patients frequently exhibited apathy or indifference and, in some cases, exacerbated agitation or hallucinations.
  • Problems with bodily functions, such as incontinence and a decline in intellect

The risks associated with lobotomy were significant, and while some patients showed signs of improvement, others suffered irreversible damages that severely affected their affect and capacity to function independently.

Case Studies and Notable Figures

In the history of lobotomies, certain individuals stand out for their experiences. These case studies and stories of noted figures provide insights into the practice and its impact.

Rosemary Kennedy

Rosemary Kennedy, the sister of President John F. Kennedy, underwent a prefrontal lobotomy at the age of 23. The procedure was arranged by her father in hopes of controlling her mood swings and potential embarrassment to the family.

Unfortunately, the operation did not have the intended outcome; instead, it resulted in severe mental impairment, leaving Rosemary unable to speak clearly and necessitating long-term institutional care.

Howard Dully

At the age of 12, Howard Dully became one of the youngest recipients of a lobotomy. The operation was performed by Walter Freeman, the same neurologist who conducted Rosemary Kennedy’s procedure.

Dully’s stepmother sought the surgery as a solution to his alleged behavioral problems. Decades later, Dully chronicled his experience and the operation’s lifelong effects in a memoir.

His story is a rare first-person account that sheds light on the controversial procedure and offers a personal perspective on its ramifications.

Modern Perspective and Alternatives

The surgical procedure known as lobotomy is now obsolete, having been replaced by advanced mental health treatments that emphasize patient safety, effectiveness, and ethics.

Evolution of Mental Health Treatment

In the mid-20th century, a significant shift occurred with the introduction of antipsychotic medication such as chlorpromazine, which provided a non-surgical option to treat symptoms associated with mental illnesses like schizophrenia and bipolar disorder.

The reliance on invasive psychosurgery methods like lobotomy decreased as medications and psychotherapy gained prominence for managing conditions including anxiety, depression, and OCD.

Advancements in the field led to the development of targeted surgical interventions like cingulotomy, still used as a last resort in severe cases of mental illness when all other treatments have failed.

A key factor in these procedures is their refinement over the decades, focusing on minimizing risks and improving outcomes.

Contemporary Practices and Ethical Considerations

Today’s therapeutic landscape employs a wide range of medications, including antidepressants and mood stabilizers, as primary lines of intervention for various mental health conditions.

Psychotherapy remains a cornerstone, providing patients with coping mechanisms and strategies to address their mental health.

In more severe cases, where medication and psychotherapy are not effective, electroconvulsive therapy (ECT) is used under strict ethical guidelines. It works by inducing controlled seizures to provide relief from severe depression and other mental health challenges.

The treatment decisions in the modern sphere are made with a strong emphasis on ethical considerations, always prioritizing the patient’s best interests and informed consent.

A better understanding of mental health conditions has led to comprehensive approaches that integrate medical, psychological, and social support systems.

The Lobotomy in Popular Culture

The lobotomy procedure emerged as a controversial medical practice that reflected broader societal attitudes towards mental health and sparked significant ethical debates.

Public Perception and Media

In the United States, lobotomy was once seen through a relatively positive lens, largely due to the advocacy and public showmanship of neurologist Walter Jackson Freeman.

He and his partner, James Watts, performed numerous procedures, often with dramatic claims of curing severe mental illnesses. \

This positive public perception was influenced by a lack of effective treatments for psychiatric patients at the time, which included individuals exhibiting mania, catatonia, or suicidal tendencies.

In Europe, a different ethos prevailed. Portuguese neurologist António Egas Moniz, along with his colleague Almeida Lima, pioneered the lobotomy, but their approach was initially more cautious. Europe, in general, was more skeptical about this radical intervention.

Original experimentation by Swiss psychiatrist Gottlieb Burckhardt had earlier been met with criticism within the medical community, and European practitioners typically performed fewer lobotomies than their American counterparts.

Media portrayal often mirrored the scientific community’s understanding and public sentiment of the time. Early successes led to optimistic reporting; however, the narrative shifted as complications and criticism mounted.

Key figures like John Fulton, who was influential in neuroscientific circles, helped to lend credibility to the procedure initially but could not shield it from growing scrutiny.

The media’s role cannot be understated in shaping the public’s perception of lobotomy. They were instrumental in both heralding its perceived successes and later exposing the tragic outcomes, including cases of increased lethargy and other negative side effects.

Over time, the procedure, once performed out of desperation, became synonymous with the mistreatment of the mentally ill, a testament to society’s conflicted relationship with radical approaches to psychiatric care.