The lobotomy was a psychosurgical procedure used to calm violent patients. This controversial intervention represents a significant chapter in the history of medical attempts to alleviate severe mental distress. For a period, it was considered a solution for individuals with various psychiatric conditions, especially when few effective alternatives existed. Its widespread application and the ethical questions it raised about brain manipulation and patient welfare define its historical significance.
The Procedure’s Genesis
The lobotomy originated with Portuguese neurologist Egas Moniz, who in 1935, began operations on individuals with mental illnesses. Moniz, awarded the Nobel Prize in 1949, conceived of the procedure, then called leucotomy, to treat psychoses by severing connections in the brain’s frontal lobes. His rationale was that mental illness stemmed from abnormal neural connections, and disrupting them could alleviate symptoms. As Moniz lacked neurosurgical training, his colleague Almeida Lima performed the initial procedures.
Before the lobotomy, effective treatments for severe mental illness were largely unavailable, and mental institutions were often overcrowded. This limited context contributed to the procedure’s initial acceptance. In the United States, neurologists Walter Freeman and James Watts popularized and refined the lobotomy. They performed the first U.S. lobotomy in 1936 and developed the “Freeman-Watts standard lobotomy.” Freeman later developed the transorbital lobotomy, a less invasive but equally controversial approach.
Anatomy of a Lobotomy
The lobotomy involved various techniques to sever neural connections in the frontal lobes, primarily targeting the prefrontal cortex and its pathways to the thalamus. The two main types were the prefrontal lobotomy and the transorbital lobotomy. In a prefrontal lobotomy, surgeons drilled holes into the skull, typically on each side above the frontal lobe. Instruments like a leucotome were inserted through these holes to cut brain tissue or inject alcohol to destroy nerve fibers.
The transorbital lobotomy, popularized by Walter Freeman, offered a quicker and less invasive method. This technique involved lifting the patient’s eyelid and inserting an instrument, initially an ice pick and later an orbitoclast, through the thin bone of the eye socket. Once inside the brain, the instrument severed connections between the prefrontal cortex and the rest of the brain, particularly the thalamus. This method did not require a sterile operating room or general anesthesia, making it more accessible but also more prone to misuse.
Observed Patient Changes and Ethical Debates
Lobotomies aimed to reduce agitation and severe distress, and many patients showed a decrease in these symptoms. However, the procedure frequently led to irreversible changes in personality and cognitive function. Patients often experienced a reduction in initiative, spontaneity, and emotional responsiveness, along with a flattening of affect. Other alterations included apathy, impaired ability to plan and organize thoughts, and changes in social behavior and impulse control. Walter Freeman coined the term “surgically induced childhood” to describe the resulting infantile personality.
These observed changes, though sometimes seen as “successes” in calming patients, fueled ethical debates. Concerns arose regarding patient autonomy, as the procedure altered an individual’s identity. The lack of rigorous follow-up studies further compounded these concerns, making it difficult to fully assess the long-term consequences. Many medical professionals and the public questioned whether the effects of a lobotomy were worse than the conditions it aimed to treat, especially given serious complications like intracranial hemorrhage, seizures, brain abscesses, and even death.
The Procedure’s Discontinuation
The practice of lobotomy began to decline in the 1950s due to several factors. A primary reason was the advent of effective psychopharmacological treatments, such as antipsychotics like chlorpromazine. These offered less invasive and often more effective alternatives for managing severe mental illness, providing a safer way to alleviate symptoms without the irreversible brain damage associated with psychosurgery.
Alongside new drugs, public and professional outcry increased against the ethical issues and negative outcomes of lobotomies. The significant alterations in personality and intellect, coupled with instances of misuse, led to growing disapproval. A shifting understanding of mental illness also contributed to its abandonment, moving towards more humane and scientifically grounded treatments. The lobotomy’s legacy serves as a reminder of the importance of ethical considerations and rigorous scientific evaluation in medical interventions, particularly those involving the brain.