About Lobotomy

There are nerves that connect the frontal lobes to the rest of the brain. The idea behind psychosurgery, later proven to be invalid, was that these nerves were somehow malformed or damaged, and if they were severed they might regenerate into new, healthy connections. Contrary to popular conception, the operation was not used only on psychiatric patients. Many people were lobotomized for “intractable pain”, such as chronic, severe backaches or agonizing headaches.

The three common versions of psychosurgery were prefrontal leucotomy, prefrontal lobotomy, and transorbital lobotomy.

A leucotomy basically involved drilling holes in the skull in order to access the brain. Once visible, the surgeon would sever the nerves using a pencil-sized tool called a leucotome. It had a slide mechanism on the side that would deploy a wire loop or loops from the tip. The idea was to be able to slide the “pencil” into the pre-drilled holes in the top of skull, into the brain, then use the slide to make the loop(s) come out. The surgeon could sever the nerves by removing “cores” of brain tissue, slide the loop back in, and the operation was complete.

A lobotomy also utilized drilled holes, but in the upper forehead instead of the top of the skull. It was also different in that the surgeon used a blade to cut the brain instead of a leucotome.

The infamous transorbital lobotomy was a “blind” operation in that the surgeon did not know for certain if he had severed the nerves or not. A sharp, ice-pick like object would be inserted through the eye socket between the upper lid and eye. When the doctor thought he was at about the right spot, he would hit the end of the instrument with a hammer.

There were other types of lobotomy as well … as many varieties as there were imaginative neurosurgeons.

Despite the fact that there was extensive evidence that psychosurgery was not therapeutic, operations continued unabated for decades. This was because it was considered unprofessional to criticize another physician in public, so many doctors who knew that psychosurgery was a farce did not make their opinions known. This allowed the psychosurgeons to continue unchecked from the late 1930s through the 1970s.

Egas Moniz, the First Psychosurgeon

Egas Moniz, an ambitious Portuguese neurosurgeon, invented the lobotomy in 1935 at a hospital in Lisbon. The first procedure was called “prefrontal leucotomy” and the instrument he used was named a leucotome, from the Greek leuco, meaning “white matter”, and tome meaning “knife”.

Moniz yearned to win a Nobel Prize. He felt that he had been cheated out of winning one for his earlier work in cerebral arteriography, and he constantly scanned the medical horizon for a promising area which might provide the opportunity to try for another. His chance came when he attended the Second International Congress of Neurology in London, where he met a doctor named Walter Freeman. The two attended a symposium devoted to Drs. James Watts and Carlyle Jacobsen of Yale University, who described their experiments that involved destroying the frontal lobes of two chimpanzees. They reported, not surprisingly, that the animal’s learning capacity was severely diminished, but they also related that their emotional states had been seriously altered.

Dr. Moniz rose and asked, “If front lobe removal prevents the development of experimental neuroses in animals and eliminates frustrational behavior, why would it not be feasible to relieve anxiety states in man by surgical means?” The shocked audience listened as Dr. Watts managed to say that it would be a “formidable undertaking” in a human being.

As soon as Moniz returned to Lisbon, he began to select convenient psychiatric patients to attempt psychosurgery upon. He need to hurry if he was going to be the first to find a useful brain operation and have a shot at the Nobel. Hastily he tried different operations before publishing breathless articles trumpeting his imaginary cures. Within months the prefrontal leucotomy and variations thereof were being performed all over the world.

In 1949 Egas Moniz’s long desired dream came true and he was awarded half of the Nobel Prize.

Walter Freeman, American Lobotomist

Dr. Walter Freeman of George Washington University and Dr. James Watts of Yale brought Moniz’s leucotomy to the US and immediately began to select and experiment on humans, leaving many disabled patients in their wake. They kept encountering problems like the knife breaking off in people’s brains, unexplained seizures, and total disorientation. After experimenting on many people they finally formulated the “Freeman and Watts Standard Lobotomy” and began touting it in the medical community.

This operation did not satisfy Freeman. He knew that an immense contribution to medicine would be a cheap, quick, and effective treatment for mental illness and pain. To this end he developed the transorbital lobotomy, at first using an actual dime-store ice pick and a rubber mallet. Again, the problem of breakage occurred. Freeman persevered and was soon performing the brain operation for every complaint imaginable and anywhere he happened to be, even in his own office. Watts was not happy with this state of affairs, telling Freeman that he must “stop doing brain surgery as an office procedure” or Watts would sever their partnership, which is what he eventually did.

Walter Freeman began to travel around the nation in his own personal van, which he called his “lobotomobile”, demonstrating transorbital lobotomy in any hospital that would have him. He even performed a few in hotel rooms, lobotomizing children as young as thirteen for “delinquent behavior” and housewives who had lost their zeal for domestic work.

Freeman had his critics, but they generally confronted him privately with comments like, “You are simply substituting brain damage for madness.” Freeman would hear nothing of it, certain he had found the cure for most mental illness and chronic pain.

He lost his medical license at the end of his career when he killed a patient who was seeing him for her third transorbital procedure. Freeman defended himself and his creation until the end of his life, but his ideas were soundly rejected, particularly in the face of new pharmaceutical options that had become available. However, he occupies a place of honor at GWU to this day.

In the end, at least fifty thousand people were lobotomized by the psychosurgeons. The transorbital patients were often the most functional since there was a reasonable possibility that the doctor had missed their nerves all together. The less fortunate victims were warehoused in institutions, or they returned to families who were often unable to cope with such severely disabled people.

No one in the medical establishment has ever apologized to the victims of this travesty.