A Brief History of Lobotomy
I know so many bad jokes.
At least I didn’t invent them. Jimmy McKenzie was a bloody pest at the mental hospital because he went around shouting back at his voices. We could only hear one end of the conversation, of course, but the other end could be inferred in general terms at least from: “Away tae fuck, ye filthy bastard!”
It was decided at one and the same time to alleviate his distress and ours, by giving him the benefit of a leucotomy. An improvement in his condition was noted.
After the operation he went around no longer shouting abuse at his voices, but: “What’s that? Say that again! Speak up ye buggers, I cannae hear ye!”
R.D Laing. “The Bird of Paradise.”
1890 – Friederich Golz calms dogs by cutting their brains.
1935 – Following demonstration by Jacobson and Fulton that frontal lobe
mutilation produced a “calming effect” in monkeys, Antonio Egaz Moniz cut the frontal
lobes of 20 of his psychiatric patients and reported a similar “calming” effect.
1936 – Walter Freeman and James Watts introduce a surgical technique for frontal
lobe lobotomy into the U.S.A. Early ‘technique’ involved drilling burrholes, later Freeman developed his famous transorbital approach pushing literally an icepick into the brain via the eye sockets.
1942 – The icepick lobotomy has spread worldwide and by now approximately 5000
people are lobotomised each year during the 1940’s!
1949 – Egaz Moniz wins Nobel prize for his lobotomy techniques.
Lobotomy a thing of the past? According to Kaplan and Sadock (1997), we have the following ‘facts’:
- “The major indication for psychosurgery (lobotomy) is the presence of a debilitating, chronic mental disorder that has not responded to any other treatment.”
- “A reasonable guideline is that the disorder should have been present for 5 years…”
- “Chronic intractable major depressive disorder and obsessive-compulsive disorder are two disorders reportedly most responsive to psychosurgery.”
- “The presence of vegetative symptoms and marked anxiety further increases the likelihood of a successful therapeutic outcome.”
- “When patients are carefully selected, between 50 and 70 per cent have significant therapeutic improvement with psychosurgery.”
- “As measured by intelligence quotient scores, cognitive abilities improve after surgery…”
Rosemary Kennedy, sister of J.F. Kennedy was given the miracle cure of the frontal lobotomy to help cure her of her “aggressive impulses”. The operation was a complete success and Rosemary was rendered off to a convent for care owing to the small detail that she was totally unable to care for herself. The image below depicts the original burrhole lobotomy approach prior to the procedure’s ‘refinement’ by Walter Freeman.
Rose Williams, sister of Tennessee Williams also had a lobotomy in 1943 following a series of ‘mental breakdowns’ and a diagnosis of schizophrenia. The operation was considered to be a failure and Rose was disabled for life. Tennessee Williams went on to become an alcoholic.
Walter Freeman found that the easiest method of lobotomy would involve only a local anaesthetic and a slight tap of a hammer to get the icepick through the eye orbit and into the skull. A swift swishing motion would render the patient somewhat subdued, permanently! Modern techniques claim to be more efficient and less damaging, involving radioactive implants, proton beams, cryogenesis and ultrasonic waves to create the lesions.
Between 1939 and 1951 over 50,000 lobotomies were performed in the US alone. The enthusiasm for lobotomies in Europe provided a great many more surgically adjusted brains and thus more adjusted and model citizens. The Japanese recommended it for difficult children and many countries ‘offered’ the procedure to convicts. The lobotomy ‘cures’ the most difficult people very efficiently indeed.
It is often said in the defence of lobotomy that the vigour with which it was taken up reflects the desperation the medical profession had for finding a cure for so many chronically ill psychiatric patients. Hmmmm….
The earliest procedures involved open operations with excision of both frontal lobes (frontal lobectomy) or disconnection of the frontal lobes from the remaining brain using a blunt instrument (frontal leucotomy – named after the instrument used). Despite technical differences, these operations were generically referred to as frontal lobotomy and were associated with a high complication rate including primarily intellectual impairment, personality change, seizures, paralysis and death.
Walter Freeman, himself with no qualifications for surgery, recorded details of 3,439 lobotomies that he carried out himself. Freeman performed his last lobotomy in 1967 which resulted in a fatality when he ruptured a blood vessel and the patient inevitably bled to death. Freeman died from cancer on May 31, 1972, at the age of 76.
Probably fewer than 20 psychosurgical operations are now carried out each year in the United States to treat psychiatric disorders. For these lucky 20 people, the procedures are not strictly “lobotomies” because laser or radiation is used to produce tiny lesions in the cingulate gyrus region of the brain, which has been connected with the development of obsessive-compulsive disorder (OCD). Based on Fulton’s ideas, Moniz proposed to cut surgically the nerve fibres which connect the frontal and prefrontal cortex to the thalamus which is responsible for relaying sensory information to the cortex of the brain. Moniz suggested that an interruption of this pathway would inhibit repetitive thoughts allowing a more normal life for the psychotic.
Moniz, who developed many neurological techniques, including cerebral angiography, took early retirement after being confined to a wheel-chair after he was shot in the spine by one of his less-than-grateful patients.