A lobotomy was a surgical procedure performed primarily during the mid-20th century to treat severe mental health conditions. This historical medical intervention involved severing connections in the brain’s frontal lobes. While the procedure itself is no longer used, understanding the patient’s experience offers insights into its profound impact, covering physical sensations during surgery, immediate aftermath, and lasting changes.
The Physical Process
The physical experience of a lobotomy varied depending on the technique employed. Two main methods were common: the prefrontal lobotomy and the transorbital lobotomy. In a prefrontal lobotomy, surgeons would drill holes into the skull, typically on each side above the temples, to access the brain. Through these openings, instruments like a leucotome—a narrow shaft with a retractable wire loop—were inserted to cut nerve fibers connecting the frontal lobes to other brain regions.
Patients undergoing this method often received general anesthesia, rendering them unconscious and unaware of the physical manipulation of brain tissue. However, some accounts suggest local anesthesia was used, meaning a patient might have been awake during parts of the procedure, potentially perceiving pressure or sounds rather than sharp pain, as the brain itself does not contain pain receptors. Walter Freeman popularized the transorbital lobotomy, which involved a different approach. An instrument resembling an ice pick, called an orbitoclast, was inserted above the eyeball and hammered through the thin bone of the eye socket into the frontal lobes.
This “ice pick lobotomy” was often performed with the patient conscious, sometimes after electroconvulsive therapy to induce unconsciousness, but not always with deep anesthesia. Patients might have been strapped down, with doctors observing pupil dilation as the instrument was manipulated. While direct pain from brain tissue was unlikely, the invasive nature of hammering through bone and the sensation of pressure within the skull were likely distressing for conscious patients.
Immediate Aftermath
Immediately following a lobotomy, patients often exhibited a range of profound and unsettling changes in their mental and emotional state. Disorientation and confusion were common as they emerged from the effects of anesthesia or the direct impact of the brain alteration. Patients might appear lethargic or stuporous, indicating a significant disruption to normal brain function.
A notable immediate effect was emotional blunting, or a “flattening” of affect. This meant a diminished capacity to express or feel strong emotions, leading to detachment from their surroundings and internal experiences. Some observed a reduction in spontaneity and initiative shortly after the procedure.
Patients might also develop an increased appetite and gain considerable weight in the immediate post-operative period. While the intent was to reduce agitation or severe distress, the immediate psychological landscape for many was one of apathy and a general sense of being muted. This initial period set the stage for the more lasting alterations that would define their future lives.
Living with the Changes
The long-term consequences of a lobotomy extended far beyond the immediate recovery, fundamentally altering an individual’s personality, emotions, and cognitive abilities. Many patients experienced profound and often irreversible personality changes, with loved ones reporting that the person they once knew seemed to vanish. A common outcome was a marked reduction in emotional depth, making it difficult for them to experience joy, sorrow, or empathy.
This emotional blunting often manifested as a lack of initiative and spontaneity, contributing to a passive existence. Patients might struggle with impaired judgment, reduced concentration, and significant memory and learning difficulties. Tasks that were once simple could become challenging, requiring immense effort.
Impulsivity and inappropriate social behavior were also documented, indicating a disruption in the brain’s ability to regulate conduct. Some patients were described as having an “infantile personality” or being reduced to a “household pet,” highlighting the severe loss of self-awareness and independent functioning. While a small percentage showed some improvement in specific symptoms, many were left with permanent impairments that hindered their ability to live independently and form meaningful relationships.
A Look Back at Lobotomies
Lobotomies rose to prominence when effective treatments for severe mental illness were scarce. Before their widespread use, individuals with profound psychiatric conditions often faced long-term institutionalization in overcrowded facilities. The procedure, first developed in 1935, aimed to alleviate severe agitation and distress by severing frontal lobe connections.
Despite initial claims of success and a Nobel Prize awarded for its development in 1949, the practice eventually faced widespread condemnation. Poor patient outcomes, high mortality rates, and devastating, irreversible side effects became apparent. The development of antipsychotic medications in the mid-1950s provided less invasive and more effective alternatives, contributing to the decline of lobotomies.
Ethical concerns also played a significant role in its abandonment. The irreversible nature of the brain damage, the profound alterations to personality and cognitive function, and instances of procedures performed without informed consent raised serious questions about patient autonomy and human rights. Today, lobotomies are rarely performed and are widely regarded as an unethical and obsolete medical practice.