A Brief History of the Lobotomy

Dr. C. George Boeree

The idea of brain surgery as a means of improving mental health got started around 1890, when Friederich Golz, a German researcher, removed portions of his dogs’ temporal lobes, and found them to be calmer, less aggressive.  It was swiftly followed by Gottlieb Burkhardt, the head of a Swiss mental institution, who attempted similar surgeries on six of his schizophrenic patients.  Some were indeed calmer.  Two died.

One would think that that would be the end of the idea.  But in 1935, Carlyle Jacobsen of Yale University tried frontal and prefrontal lobotomies on chimps, and found them to be calmer afterwards.  His colleague at Yale, John Fulton, attempted to induce “experimental neurosis” in his lobotomized chimps by presenting them with contradictory signals.  He found that they were pretty much immune to the process.

It took a certain Antonio Egaz Moniz of the University of Lisbon Medical School to really put lobotomy on the map.  A very productive medical researcher, he invented several significant improvements to brain x-ray techniques prior to his work with lobotomy.  He also served as the Minister of Foreign Affairs and the Ambassador to Spain.  He was even one of the signers of the Treaty of Versailles, which marked the end of World War I.

He found that cutting the nerves that run from the frontal cortex to the thalamus in psychotic patients who suffered from repetitive thoughts “short-circuited” the problem.  Together with his colleague Almeida Lima, he devised a technique involving drilling two small holes on either side of the forehead, inserting a special surgical knife, and severing the prefrontal cortex from the rest of the brain.   He called it leukotomy, but it would come to be known as lobotomy.

Some of his patients became calmer, some did not.  Moniz advised extreme caution in using lobotomy, and felt it should only be used in cases where everything else had been tried.  He was awarded the Nobel Prize for his work on lobotomy in 1949.  He retired early after a former patient paralyzed him by shooting him in the back.

Walter Freeman, an American physician, with his colleague James Watts, performed his first lobotomy operation in 1936.  He was so satisfied with the results that he went on to do many thousands more, and in fact began a propaganda campaign to promote its use.  He is also famous for inventing what is called ice pick lobotomy.  Impatient with the difficult surgical methods pioneered by Moniz, he found he could insert an ice pick above each eye of a patient with only local anesthetic, drive it through the thin bone with a light tap of a mallet, swish the pick back and forth like a windshield wiper and -- voilà -- a formerly difficult patient is now passive.

Freeman recommended the procedure for everything from psychosis to depression to neurosis to criminality.  He developed what others called assembly line lobotomies, going from one patient to the next with his gold-plated ice pick, even having his assistants time him to see if he could break lobotomy speed records.  It is said that even some seasoned surgeons fainted at the site.  Even Watts thought he had gone too far.

Between 1939 and 1951, over 18,000 lobotomies were performed in the US, and many more in other countries.  It was often used on convicts, and in Japan it was recommended for use on “difficult” children.  There are still western countries that permit the use of the lobotomy, although its use has decreased dramatically worldwide.  Curiously, the old USSR banned it back in 1950 on moral grounds!

In the 1950s, people began getting upset about the prevalence of lobotomies.  Protests began, and serious research supported the protesters.  The general statistics showed roughly a third of lobotomy patients improved, a third stayed the same, and the last third actually got worse!

There have been a few famous cases over the years.  For example, Rosemary Kennedy, sister to John, Robert, and Edward Kennedy, was given a lobotomy when her father complained to doctors about the mildly retarded girl’s embarrassing new interest in boys.  Her father never informed the rest of the family about what he had done.  She lived out her life in a Wisconsin institution and died January 7, 2005, at the age of 86.  Her sister, Eunice Kennedy Shriver, founded the Special Olympics in her honor in 1968.

To learn more about lobotomy, try these sources:

Jack Pressman,  Last Resort (1998).

Elliot Valenstein, Great and Desperate Cures (1986).

Renato Sabbatini, "The History of Psychosurgery" (Brain and Mind, June 1997).  A selection from this article is available at http://www.epub.org.br/cm/n02/historia/lobotomy.htm.

© Copyright 2001 by C. George Boeree