The mid-20th century saw a desperate search for treatments to manage the overwhelming population of patients with severe mental illness in psychiatric institutions. Lobotomy, a form of psychosurgery, emerged as a radical and highly controversial medical procedure intended to alleviate profound psychological suffering. The medical community embraced this invasive intervention due to few other options for long-term care and symptom management, despite the immense and irreversible consequences for the thousands who underwent it.
The Initial Rationale for Lobotomy
The theoretical justification for lobotomy centered on the belief that severe mental disorders, such as chronic depression and schizophrenia, were caused by fixed, pathological emotional circuits in the brain. Portuguese neurologist António Egas Moniz pioneered the procedure in 1935, hypothesizing that severing the nerve pathways connecting the frontal lobes to other brain regions could break these damaging thought patterns. Moniz termed his procedure a “leucotomy,” focusing on the white matter tracts.
The approach was inspired by observations that brain surgery on aggressive chimpanzees resulted in calmer behavior. The goal of the surgery was to reduce extreme states of agitation, anxiety, and aggression, often making institutionalized patients easier to care for. American neurologist Walter Freeman championed the procedure, popularized it as the “lobotomy,” and developed the faster, non-surgical transorbital technique to make it more widely accessible. The intention was to replace emotional turmoil with emotional calm, even if it meant reducing the patient’s overall personality.
The Spectrum of Long-Term Patient Function
The reality for lobotomy patients was a wide and unpredictable spectrum of outcomes, with few experiencing a genuine “cure.” Many patients did see an end to their most severe symptoms of agitation and anxiety, which was often considered a success by the treating physicians and institutions. Studies showed that a portion of patients, in some cases up to 67%, improved enough to be discharged and live outside of institutional care, though these individuals often required significant support.
The dominant long-term result, however, was a profound emotional blunting and a loss of personal drive, sometimes referred to as an “infantile personality.” This personality defect was highly prevalent, reported in over 90% of patients assessed a decade after their surgery. Patients frequently displayed apathy, a flattened affect, and a reduction in initiative, struggling with tasks requiring executive function, planning, and abstract thought. In many cases, the reduction in emotional distress was replaced by listless dependency, with some estimates suggesting a majority of Freeman’s patients remained hospitalized or severely impaired.
The procedure also carried physical dangers, with an average mortality rate estimated at around 5% during the 1940s, and a long-term risk of complications such as epilepsy, which was reported in about 12% of patients. For the fortunate few, the surgery alleviated the worst of their suffering and allowed them to function at a basic level outside a hospital, but for many others, the lobotomy merely exchanged one form of debilitating illness for another, leaving them permanently altered and dependent.
The End of the Practice and Ethical Reckoning
The widespread use of the lobotomy began its rapid decline in the mid-1950s due to two major historical forces. The first was the introduction of effective psychotropic medications, particularly the antipsychotic drug Chlorpromazine, which arrived in the United States around 1954. This new class of medication offered a less invasive, reversible, and medically controllable way to manage the symptoms of severe mental illness, instantly making the irreversible nature of psychosurgery seem barbaric by comparison.
The second driver was the escalating public and professional ethical scrutiny surrounding the procedure. Reports of poor long-term patient outcomes, coupled with the realization that the surgery was being overused and sometimes misused, fueled a strong backlash. Critics highlighted the irreversible damage to personality and the lack of informed consent for many vulnerable patients. The Soviet Union banned the practice as early as 1950, citing its inhumane nature. The collapse of the lobotomy serves today as a cautionary tale, shaping modern ethical principles regarding patient autonomy and medical interventions on the brain.