A frontal lobotomy, sometimes called a leucotomy or leukotomy, refers to cutting the connections between the prefrontal cortex and the rest of the brain. At one time, lobotomies were the treatment of choice for institutionalized patients in the United States. They were heralded as a great cure.
In reality, the 1940s to the 1950s, the time of so-called assembly line lobotomies" was a period of great shame for the mental health care system in the United States.
The Development of the Frontal Lobotomy in Europe
The modern lobotomy got its start in Europe. It was the brainchild of Dr. Egas Moniz, who was impressed by the docile behavior of lobotomized chimpanzees. His procedure called for drilling holes in either side of the patient's skull and injecting alcohol into the patient's frontal lobe, thereby destroying the tissue.
Dr. Moniz advocated this treatment for patients with a wide variety of psychiatric conditions ranging from depression to schizophrenia. He estimated that 70% of his patients greatly or moderately improved, while 30% exhibited no change.
To his credit, Dr. Moniz always believed that a lobotomy should be a doctor's last resort. He was rewarded for his work with a Novel Prize in 1949.
Lobotomies Come to the United States
American psychiatrist Walter Freeman read of Moniz's work and was impressed. He teamed up with neurosurgeon James Watts. In 1936, they performed the first lobotomy in the United States.
Freeman, however, did not think frontal lobotomies should be a last resort. He thought they offered great hope to institutionalized patients. His one regret was that the lobotomy as it was currently practiced required an operating room, general anesthesia, and the intervention of a surgeon. He wanted to make the procedure more accessible.
Ice Pick Lobotomies
Freeman located some work by European colleagues who theorized it would be possible to reach the brain through the eye socket rather than by drilling holes in the skull. He immediately began experimenting on cadavers.
The procedure he developed called for a slender instrument, like an ice pick, to be inserted under the eyelid. A mallet or hammer was then used to drive the instrument into the brain. The doctor moved the ice pick back and forth to destroy nerve connections to the frontal lobe. The procedure was then repeated on the other eye. An ice pick lobotomy could be performed under local anesthetic. Furthermore, it did not require a surgeon and could be done quickly so that a doctor could perform several such procedures in an hour.
Freeman first performed his ice pick lobotomy on a live patient in 1946. He hawked his discovery aggressively, and by 1949, about 5,000 patients per year were undergoing lobotomies. Watts, disgusted by the modifications made to the procedure, broke ties with Freeman.
Mental Health in the Age of Lobotomies
Mental health as it is now was very different from mental health practiced in the 1930s through the 1950s. Instead of trying to keep mentally ill people out of institutions, those with mental illness often spent years, if not an entire lifetime, in a mental hospital. Overcrowding was vast and doctors were overwhelmed by the sheer number of patients and the severity of their symptoms.
Talk therapy took years to work, if it ever did, and psychotropic medications had not yet been developed. Many doctors embraced radical therapies like electroconvulsive therapy, insulin shock therapy, and lobotomies, because through their use, they could gain control of a patient's behavior quickly.
Frontal Lobotomies Fall Out of Favor
During the heyday of assembly line lobotomies, proponents of the procedure claimed a whopping 75% success rate. However, even as early as 1947, the Columbia-Greystone Project failed to turn up any positive effects from lobotomies.
Then, there were the acknowledged side effects. Lobotomized patients tended to develop seizure disorders. Many of them lost interest in their lives and became apathetic. Others lost all ability to control their impulses. They would make inappropriate remarks and often eat to the point of obesity.
In the mid 1950s, the first antipsychotic drugs were introduced, and doctors found they could manage their patients' disturbing behaviors without having to resort to psychosurgery. The popularity of the frontal lobotomy slowly declined.
In 1977, the U.S. Congress formed the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research. The committee did not ban lobotomies outright, but it did advise that their usefulness was "extremely limited."
Related Information
While lobotomies are seldom, if ever, a part of the modern psychiatrist's arsenal of mental health treatments, another procedure used during the same era, electroconvulsive therapy does remain in limited use today. For more information see Electroconvulsive Therapy (ECT) - The Pros and Cons.
Sources:
Boree, C. George. A Brief History of the Lobotomy. (Accessed 6/20/10).
Sabatini, R.M.E. The History of Lobotomy (Accessed 6/20/10).
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