A lobotomy is a psychosurgical procedure that severs connections in the prefrontal cortex of the brain. Historically, it treated severe mental illness in the mid-20th century, aiming to alleviate psychiatric symptoms by disrupting neural pathways. Though now widely discredited, its history illuminates evolving medical practices and ethical standards.
Initial Rationale and Practice
In the early to mid-20th century, effective treatments for severe mental illness were largely absent, and mental asylums faced overcrowding. This environment spurred a search for new interventions. Portuguese neurologist Egas Moniz developed the prefrontal leucotomy, later known as the lobotomy, in 1935. His theory suggested mental illnesses stemmed from abnormal frontal lobe connections, which could be disrupted.
Moniz initially used alcohol injections, then refined the technique with a leucotome. American neurologist Walter Freeman popularized and modified the procedure, notably with the transorbital lobotomy performed through the eye socket. This simplified method led to its rapid adoption, with tens of thousands performed globally. Moniz received a Nobel Prize in 1949, despite controversies over the procedure’s efficacy.
Devastating Patient Outcomes
Lobotomies frequently led to severe and irreversible negative consequences for patients. Cognitive impairments were common, including apathy, loss of executive function, and significant personality changes. Patients often exhibited reduced spontaneity and initiative, appearing emotionally blunted. Walter Freeman even coined “surgically induced childhood” for the resulting “infantile personality.”
Physical side effects were prevalent, including epilepsy (in over a quarter of patients), intracranial hemorrhage, brain abscesses, and incontinence. Some patients experienced motor skill deficits and an inability to perform basic daily activities. While some individuals became more manageable, many suffered long-term functional impairments, losing their former identities and requiring continuous care.
Ethical and Societal Rejection
As devastating outcomes became apparent, significant ethical and human rights objections mounted. Concerns arose regarding the absence of genuine informed consent, especially for vulnerable patients. The procedure was often performed on institutionalized, marginalized, or coerced individuals, raising questions about its misuse for social control.
Public opinion turned against the practice, fueled by media portrayals and advocacy. High-profile cases, like Rosemary Kennedy’s lobotomy which left her permanently disabled, highlighted the risks. Many physicians and psychoanalysts criticized the experimental nature and lack of rigorous testing. This growing awareness contributed to widespread societal rejection.
Medical Discrediting and Formal Bans
The medical community gradually shifted its stance as evidence revealed lobotomies’ ineffectiveness and harm. Inconsistent results and severe side effects led to increased scrutiny. A turning point came with new psychopharmacological treatments, particularly antipsychotic medications like chlorpromazine in the mid-1950s. These less invasive alternatives offered a new paradigm for managing mental illness.
Formal prohibitions and restrictions began to emerge globally. The Soviet Union banned the procedure in December 1950, declaring it “contrary to the principles of humanity” and noting it could change an “insane person into an idiot.” Other countries, including Japan and Germany, also implemented bans or severe restrictions. While the U.S. never enacted a complete federal ban, the procedure largely fell out of favor by the 1970s due to medical consensus and ethical concerns.