A Hole In The Head: The Grisly History Of Lobotomies

Walter Freeman invented the transorbital lobotomy, where an ice pick-like instrument called an orbitoclast was hammered into the patient’s eye socket. This procedure is where the term “ice pick lobotomy” comes from. Image Credit: Gaia Conventi/Shutterstock.com

In the mid-1900s, tens of thousands of lobotomies were performed worldwide. The procedure aimed to cut off connections to the frontal lobe of the brain, with the goal of treating symptoms of mental illness – or just making patients easier to manage. This was achieved by techniques ranging from injecting alcohol directly into the brain to hammering an ice pick into the eye socket.

We look on with horror now – but where did it come from, how did it become a medical "cure-all", and what did it do to the patients who had lobotomies, often without their consent?  

The Origins Of modern Psychosurgery

Gottlieb Burckhardt, a psychiatrist from Switzerland, is noted as one of the first to attempt modern psychosurgery in 1888, on patients with schizophrenia. Although he apparently had no surgical training, he decided to remove sections of his patient’s brains anyway in a procedure called focal cerebral cortical excision.

Six individuals had this open-brain surgery. One died from complications five days afterward, and another later died by suicide. Others experienced epilepsy, and weakness, and were unable to understand writing or speech (sensory aphasia). The surgery was considered a “success” in three patients, described as “quieted” by the procedure.

Burckhardt’s results shocked and horrified the scientific community, and his ideas of psychosurgery were shelved – although not for long.

The next well-known subjects of psychosurgery were actually chimpanzees named Becky and Lucy. In 1935, neuroscientists John Fulton and Carlyle Jacobsen presented a report on removing the foreparts of their frontal lobes. The chimps would become infuriated if they slipped up during tasks – but after the surgery this was not the case, with the chimps appearing calm and happy.

This fateful presentation at the International Neurological Congress inspired the man who went on to win a Nobel Prize for his development of the modern lobotomy (which many think should be taken back).

Who Invented The Lobotomy?

António Egas Moniz, a neurologist from Portugal, took great inspiration from the work of Burckhardt, Fulman, and Jacobsen. In the same year he saw the chimp results presented, he performed what is considered the first lobotomy on a human patient. At the time, the procedure was called a leucotomy.

"I decided to sever the connecting fibres of the neurons in activity," Moniz wrote. He did this by drilling two holes into his patient’s skull, then injecting ethanol into the white matter of her frontal lobes. This acted as a sclerosing agent, which cause irritation and irreversible injury in blood vessels, causing fibrous tissue to form and the vessel to be “obliterated”. This destroyed connections between the frontal lobe and the rest of the brain.

Moniz and colleague Almeida Lima, a neurosurgeon, performed this procedure on patients in a hospital in Lisbon. They later adopted a surgical approach instead, developing an instrument called the leucotome with a wire loop to slice lesions in the white matter. 

The results were considered promising, and Moniz was awarded the 1949 Nobel Prize in Physiology or Medicine.

America's first lobotomy

Over in the USA, a research partner of Moniz, a psychiatrist called Walter Freeman, took these results and ran with them – or more like sprinted. Accompanied by neurosurgeon James Watts, he performed America’s first lobotomy on a housewife from Kansas in 1936. Watts and Freeman later modified Moniz’s original technique so that only a tiny hole needed to be drilled into the zygomatic arch for the surgical instrument to be pushed into the brain.

Walter Freeman performing a transorbital lobotomy. Image Credit: Faria MA - Surgical neurology international (2013), (CC BY-NC-SA 3.0)
Walter Freeman performing a transorbital lobotomy. Image Credit: Faria MA - Surgical neurology international (2013), (CC BY-NC-SA 3.0)

However, as the years went on, Freeman got more reckless with his techniques. In 1945, he invented the transorbital lobotomy, where an ice pick-like instrument called an orbitoclast was hammered into the patient’s eye socket. This procedure is where the term “ice pick lobotomy” comes from.

Freeman sometimes used photographs of patients as “evidence” of the benefits of lobotomies. In one series of photographs, one picture was captioned “March 23, 1942 before operation. ‘Forever fighting….the meanest woman.’” The following photograph was captioned “April 4, 1942, eleven days after lobotomy. She giggles a lot.”

Freeman would end up whizzing around the country in his “lobotomobile”, performing up to 25 lobotomies daily. He ditched his colleague trained in neurosurgery, going solo. He also spurned surgical scrubs and gloves, plus any semblance of hygiene in his operating theater — reportedly chewing gum during surgery, not sterilizing his hands, and even operating in hotel rooms. A favorite trick of his was hammering instruments into both of a patient’s eyes simultaneously as a shock tactic.

Unsurprisingly, Freeman killed a patient in 1967, who died from a brain hemorrhage after a lobotomy, and Freeman subsequently was banned from performing operations.

The President's sister

One of the most notable lobotomy patients is Rosemary Kennedy, sister of former US President John F. Kennedy. During her birth, a nurse held her inside the birth canal for two hours, causing oxygen deprivation. Rosemary would go on to experience learning difficulties. In her early 20s, she was described as irritable and rebellious, and her father sought the advice of none other than Freeman and Watts.

At the age of 23, her father authorized her lobotomy. As Lyz Lenz wrote in Marie Claire: “The doctors had her recite poems as they cut—when she was silent, they knew the procedure was complete.”

The procedure left Rosemary with permanent physical and mental disabilities, completely unable to live independently up to her death at the age of 86.

How did lobotomies impact patients?

The popularity of the lobotomy seemed to arise not from a drive to improve patient quality of life, but from desperation arising from overcrowded mental health facilities. Lobotomies offered a cheap and long-term method to control “unruly” patients, reducing the cost and effort of caring for them. However, this came at an indescribable cost to patients (or victims), ranging from distress to death.

One patient who had a lobotomy in the UK in 1974 told the Guardian that “It felt like a broom handle was being pushed in my brain and my head was splitting apart.”

The youngest ever lobotomy patient – notably another patient of Freeman – was 12-year-old Howard Dully. Luckily he survived, but speaking to the Guardian, he remarked that “I was like a zombie; I had no awareness of what Freeman had done.” He also attributes his frequent eye infections to his tear ducts being “destroyed” by the transorbital lobotomy.

A 1996 report by the British Medical Journal details the Norwegian health department financially compensating all people who had ever had a lobotomy in Norway. The government recognized the long-term effects of lobotomies, “which include intellectual impairment, disinhibition, epilepsy, apathy, incontinence, and obesity.”

Neurosurgeon Henry Marsh explained to the BBC "If you saw the patient after the operation they'd seem alright, they'd walk and talk and say thank you doctor."

"The fact they were totally ruined as social human beings probably didn't count."

The mother of one lobotomy patient was quoted as saying “She is my daughter but yet a different person. She is with me in body but her soul is in some way lost.”

Do Lobotomies Still happen?

Lobotomies eventually fell out of favor with the rise of drugs like thorazine, which could subdue patients without the need for surgery. The Soviet Union banned lobotomies in 1950, but the practice continued into the 1980s in other parts of the world such as France and Scandanavia. 

There have been more recent documented cases, though. Scottish singer Lena Zavaroni, who was diagnosed with depression and anorexia, opted to have a lobotomy in September 1999, but died of pneumonia a month afterward.

However, in cases where all other treatment options haven’t worked and the patient can give informed consent, brain surgery for the treatment of mental disorders continues under the name of psychosurgery. These operations are rare – only four took place in the UK between 2015 and 2016.

A procedure called anterior cingulotomy involves tissue in the anterior cingulate cortex being destroyed with heat or an electrical current. This can help with chronic pain and obsessive compulsive disorder (OCD) symptoms. Another procedure called anterior capsulotomy is similar and can reduce OCD symptoms, but targets the anterior capsule, near the thalamus. A subcaudate tractotomy destroys part of the caudate nucleus, and can treat depression, anxiety, and OCD. Leucotomies still take place, considered a combination of subcaudate tractotomy and anterior cingulotomy and named a limbic leucotomy, used to treat OCD and major depressive disorder.

In fact, Gottlieb Burckhardt’s original procedure lives on to this day. Focal cortical resection is now used to remove damaged brain tissue that can cause seizures in children.

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