What is a lobotomy? Uses, history, and more

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The word “lobotomy” refers to several brain surgeries that break connections between the frontal lobe and different parts of the brain. The frontal lobe is involved in many brain processes, including language, voluntary motion, and many cognitive abilities.

The different types of lobotomy include:

• topectomy, in which a surgeon removes parts of the frontal lobe
• leucotomy or leukotomy, in which a surgeon severs connections between the frontal lobe and the thalamus
• neuro-injection of sclerosing agents, in which a surgeon injects drugs that harden the fibers connecting the frontal lobe to the thalamus

According to 2017 research, lobotomies are rare today. Although the techniques have advanced and improved, most doctors consider the surgery obsolete.

However, lobotomies are still legal in some places. A 2019 study reports that after lobotomies became unpopular, most states enacted laws to regulate the use of surgery for mental illness. However, despite this effort, the laws across the United States are inconsistent.

Doctors developed the lobotomy in the late 19th and early 20th centuries, at a time when there were no drug therapies for mental health disorders, and psychotherapy was still in its early stages.

As there were no standardized or effective treatments, people with severe symptoms often lived in psychiatric hospitals and asylums. In Europe, many of these facilities were overcrowded, which led doctors to look for a solution.

Lobotomies in Europe

The inception of lobotomies dates back to 1891 when the Swiss psychiatrist Gottlieb Burckhardt performed surgery on several people with severe schizophrenia. He removed parts of their brains, and noted that after the procedure, those people were quieter.

Burckhardt intended for this treatment to be palliative. It was not a cure. Instead, it was a last resort for people whose conditions did not respond to other treatments. At the time, the medical community rejected his idea.

However, in the 1930s, some doctors revived the idea. The Portuguese neurologist António Egas Moniz collaborated with his colleague, Almeida Lima, to develop the leucotomy. The two began promoting the procedure across Europe, despite a lack of convincing evidence that it was beneficial.

Lobotomies in the U.S.

The popularity of the lobotomy in Europe led to its introduction in North America. Neurologist Walter Freeman and neurosurgeon James Watts modified the procedure to make it slightly less invasive than the European method.

At first, Watts was the member of the duo who performed the surgery. Later, Freeman “simplified” the surgery and began performing it in non-sterile conditions. In response, Watts severed his ties with Freeman due to concerns about the lack of sterility and the crudeness of the simplified procedure.

Lobotomies became a popular treatment in the U.S., with thousands of people undergoing the procedure. Around 1949, doubts increased about the safety of the procedure, as critics felt it did grievous harm.

When the schizophrenia medication chlorpromazine (Thorazine) came onto the market in the 1950s, lobotomies fell out of favor. The drug was a safer and noninvasive treatment option.

The main use of the lobotomy was to treat mental health conditions or reduce their symptoms. Burckhardt used it to reduce aggression in people with schizophrenia, believing that the frontal lobe was responsible for this symptom.

When Moniz and Lima revived the lobotomy in the 1930s, it was with the explicit goal of changing the disposition of people with mental health conditions. Often, the procedure made people quiet and docile, which they interpreted as a sign of success.

However, what doctors consider a mental health disorder has changed over time. Prejudice and biases also played a role in how doctors used the procedure.

In addition to people who meet current definitions for mental illness, practitioners also performed lobotomies on people:

• with intellectual disabilities
• who were gay
• who were in prison for crimes, which some blamed on “criminal insanity”

A 2018 study also states that most lobotomized people were women.

One analysis of a U.S. hospital revealed that out of 245 lobotomies doctors performed between 1947–1954, 84% were on women, despite the fact that the hospital had more men as patients, and more men had schizophrenia diagnoses.

Often, the reason doctors gave for this was that they needed to “maintain order” in the hospital. Other reasons included a lack of interest in child care and “strange behavior.”

Rarely, doctors used lobotomies in an attempt to treat physical conditions, such as ulcerative colitis or brain tumors.

Learn more about gender bias in medical diagnosis.

There was a range of approaches to performing lobotomies. The first lobotomies involved open brain surgery. When the procedure regained popularity in the 1930s, neurologists refined the technique to make it less invasive.

In the U.S., Watts promoted a technique that involved drilling or cutting a hole in the skull to sever the connection between the frontal lobe and the thalamus. This involved the participation of a surgeon and surgical assistants.

Later, Freeman altered the procedure. Instead of drilling a hole, he used an instrument similar to an ice pick to enter the skull through the eye socket and pierce the brain. This is known as the transorbital lobotomy.

Freeman claimed this method did not require surgical assistants, sterile operating rooms, or scrubs. According to him, doctors could perform lobotomies anywhere with very little equipment.

Later, doctors tried other techniques, such as injecting radioactive iridium through the eye socket.

Proponents of lobotomies thought that the procedure could address the root cause of mental health symptoms by cutting off the part of the brain they believed was responsible for them.

For example, Freeman theorized that psychosis stemmed from excessive self-reflection. He felt this was due to thoughts that circled repeatedly in the brain. In his view, lobotomies provided a literal way of cutting off these circling thoughts.

However, lobotomies do not treat the causes of mental health conditions. Instead, they reduce the functionality of the frontal lobe, resulting in:

• apathy
• distractibility
• lack of initiative
• lack of restraint, such as in social situations
• euphoria, a feeling of intense happiness
• significant changes in personality

In some cases, people’s symptoms did seem to ease as a result of the procedure, and some were able to return to work. However, the effects varied.

One of the criticisms of the procedure was that it was for the benefit of those looking after the lobotomy recipients rather than for the people themselves, by making them easier to manage.

Many people who underwent lobotomies experienced severe side effects and complications, such as:

• chronic headaches
• seizures
• intracranial hemorrhages, or bleeding inside the skull
• dementia, a condition that causes memory decline and personality changes
• brain abscesses
• death

A lobotomy is a surgical procedure that doctors developed as a treatment for mental health conditions in the late 19th and early 20th centuries. It involves breaking the connection between the frontal lobe and the thalamus.

While lobotomies caused some people with mental illnesses to become calmer, they also frequently caused significant changes in personality, such as apathy and social disinhibition. The procedure had very serious health risks, and doctors sometimes used it in ways that were unethical.