A frontallobotomyis a psychosurgery that was used in the mid-1900s to treat mental and neurological illnesses, includingschizophrenia,bipolar disorder, andepilepsy.It involves severing the nerve pathways from the frontal lobe—the largest section of the brain—from the other lobes.
alex-mit / Getty Images
Frontal lobotomies have always been controversial, even when they were mainstream. The surgery was risky and permanently altered the patient’s personality. Many patients died and many more awoke with severe, life-changing side effects and disabilities.
This article discusses the history of lobotomies along with how they worked, why they were used, and what effects they had on patients with mental illness.
What Are the Frontal Lobes?Thefrontal lobesmake up one of four distinct sections of the brain. You have two frontal lobes, one on each side of your brain, right behind your forehead. The frontal lobes are involved in making decisions, movement, speech, and shaping your personality.
What Are the Frontal Lobes?
Thefrontal lobesmake up one of four distinct sections of the brain. You have two frontal lobes, one on each side of your brain, right behind your forehead. The frontal lobes are involved in making decisions, movement, speech, and shaping your personality.
Roadmap of the Human Brain
History
Lobotomies were part of a wave of new treatments forneurological diseasesin the early 20th century, including electroconvulsive therapy (shock therapy).
Dr. Moniz’s lobotomies were initially considered successful. His first 20 lobotomy patients all survived without serious side effects, leading neurosurgeons in Brazil, Italy, and the United States to begin performing lobotomies as well.
Dr. Moniz believed that patients with mental illness had abnormal connections between different regions in their brains, and that severing these “fixed circuits” could help. Part of his inspiration came from a research paper about chimpanzees who were described as calmer and more cooperative after having their frontal lobes removed.
This focus on neural circuits and connectivity, rather than on just one piece of the brain, remains relevant to 21st-century neuroscience.
Some forms of psychosurgery are still used in rare cases when a patient does not respond to other treatments.Deep brain stimulationis one such procedure used to treatParkinson’s disease,epilepsy, andobsessive-compulsive disorder(OCD).
An Overview of Deep Brain Stimulation (DBS) for Parkinson’s
Lobotomies in the United States
The initial procedure had to be done in anoperating room, but Dr. Freeman thought this would limit access to the procedure for those in mental institutions who could potentially benefit from a lobotomy.
The lobotomy was a mainstream procedure until it fell out of favor in the mid-1950s.Nonetheless, Dr. Freeman continued to perform the surgery until 1967 when he had his last lobotomy patient, a woman named Helen Mortensen. She died three days after the operation and Freeman was banned from performing lobotomies shortly after.
Recap
How Lobotomies Were Done
Two main techniques were used to perform lobotomies. The techniques differed in how the surgeon accessed the patient’s brain.
Prefrontal Lobotomy
Once the patient was sedated, the surgeon drilled twobur holesin their skull—one on each side of the head above the prefrontal lobes.
Next, the surgeon injected alcohol into the tissues that connect the patient’s prefrontal lobes to other parts of their brain, destroying them.
Years later, Dr. Moniz worked with another neurosurgeon named Almeida Lima to develop a needle-like instrument that resembled an ice pick. The instrument, known as a leucotome, had a retractable wire that Moniz would insert through the bur holes to cut through the frontal lobe tissues.
Transorbital Lobotomy
Dr. Freeman’s approach was different in several ways. For one, Dr. Freeman intended for the procedure to be done in doctors' offices and mental institutions, rather than an operation room.
Dr. Freeman also usedelectric shock therapyrather than general anesthesia to sedate patients. This made it easier for the procedure to be done in outpatient settings since ananesthesiologistdid not have to be there.
Instead of drilling bur holes through the skull, Dr. Freeman accessed the patient’s brain through their eye sockets. During the transorbital lobotomy, he would lift the patient’s upper eyelid and point the leucotome against the top of their eye socket.
Next, he would take a mallet and drive the instrument through the bone then five centimeters into the brain. The instrument would be used to remove tracts of brain tissues connecting the prefrontal lobes to the thalamus, a small structure inside the brain that sits just above the brain stem.
Side Effects
Dr. Freeman and Dr. Watts performed their first prefrontal lobotomy on a woman named Alice Hood Hammatt. When she awoke from the procedure, she reported that she felt happy. But six days later, she reported language difficulties, disorientation, and agitation. Nonetheless, Dr. Freeman considered her lobotomy a success.
In 1942, Dr. Freeman and Dr. Watts published their first case study on the effectiveness of their patients' lobotomies. Out of the 200 lobotomies they had done at the time, they reported that 63% of their patients showed improvements after their procedure, 23% had no change in symptoms, and 14% died or had severe complications.
In response to the study, a science writer named Tom Henry reported to theWashington Evening Starthat the lobotomy “probably constitutes one of the greatest innovations of this generation.”
That said, an estimated three out of every 10 people died from Freeman’s transorbital lobotomies. Many more came out of the procedure with permanent brain damage that left them physically and/or cognitively impaired.
A Controversial Medical Procedure
In 1950, the Soviet Union banned the practice, saying it was “contrary to the principles of humanity.”
In the United States, lobotomies were featured in many popular works of literature, including Tennessee Williams' “Suddenly, Last Summer” (1957), and Ken Kesey’s “One Flew Over the Cuckoo’s Nest” (1962).
In both novels, lobotomies are represented as frighteningly brutal. In culture and among the general public, the procedure increasingly became viewed as a kind of dehumanizing medical abuse.
In 1977, a special committee of the U.S. Congress investigated whether psychosurgery such as lobotomy was used to restrain individual rights. The conclusion was that properly performed psychosurgery could have positive effects, but only in extremely limited situations.
RecapLobotomies posed the risk of serious complications, including bleeding in the brain, dementia, and death. Medical ethics discussions eventually led to complete or virtually complete bans in many countries around the world.
Lobotomies posed the risk of serious complications, including bleeding in the brain, dementia, and death. Medical ethics discussions eventually led to complete or virtually complete bans in many countries around the world.
Summary
The lobotomy was a type of pscyhosurgery done in the mid-20th century on patients with mental and neurological illnesses, like schizophrenia, bipolar disorder, and epilepsy.
The procedure involved cutting tissues in patients' brains with a tool called a leucotome. In a prefrontal lobotomy, the brain was accessed through two holes the surgeon drilled into the patient’s skull. In a transorbital lobotomy, the brain was accessed through the patient’s eye sockets.
A Word From Verywell
The stormy history of the lobotomy serves to remind modern physicians and patients of the ethical dilemmas that are unique to medicine, particularly neurology.
What Is White Matter in the Brain?
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Caruso JP, Sheehan JP.Psychosurgery, ethics, and media: a history of Walter Freeman and lobotomy.JNS. 2017 Sep;43(3):1-8. doi:10.3171/2017.6.FOCUS17257Lovell B.Frontal lobotomy: a vanishing but important radiological finding.BMJ Case Rep. 2015 Aug;2015(1):1-2. doi:10.1136/bcr-2014-208767The Nobel Prize.Egas Moniz.Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:10.11622/smedj.2014048Yousaf A, Singh K, Tavernor V, Baldwin A.Psychosurgery: A history from prefrontal lobotomy to deep brain stimulation.J Geriatr Med. 2020 Aug;1(3):1-8. doi:10.30564/jgm.v1i3.1943Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA.Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation.Front Neurosci. 2019 Feb;13(1):108. doi:10.3389/fnins.2019.00108Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:110.11622/smedj.2014048Memento Mütter.Skull with transorbital lobotomy.Zacijek B.Banning the Soviet lobotomy: psychiatry, ethics, and professional politics during late Stalinism.Bull Hist Med. 2017;91(1):33-61. doi:10.1353/bhm.2017.0002
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Caruso JP, Sheehan JP.Psychosurgery, ethics, and media: a history of Walter Freeman and lobotomy.JNS. 2017 Sep;43(3):1-8. doi:10.3171/2017.6.FOCUS17257Lovell B.Frontal lobotomy: a vanishing but important radiological finding.BMJ Case Rep. 2015 Aug;2015(1):1-2. doi:10.1136/bcr-2014-208767The Nobel Prize.Egas Moniz.Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:10.11622/smedj.2014048Yousaf A, Singh K, Tavernor V, Baldwin A.Psychosurgery: A history from prefrontal lobotomy to deep brain stimulation.J Geriatr Med. 2020 Aug;1(3):1-8. doi:10.30564/jgm.v1i3.1943Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA.Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation.Front Neurosci. 2019 Feb;13(1):108. doi:10.3389/fnins.2019.00108Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:110.11622/smedj.2014048Memento Mütter.Skull with transorbital lobotomy.Zacijek B.Banning the Soviet lobotomy: psychiatry, ethics, and professional politics during late Stalinism.Bull Hist Med. 2017;91(1):33-61. doi:10.1353/bhm.2017.0002
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Caruso JP, Sheehan JP.Psychosurgery, ethics, and media: a history of Walter Freeman and lobotomy.JNS. 2017 Sep;43(3):1-8. doi:10.3171/2017.6.FOCUS17257Lovell B.Frontal lobotomy: a vanishing but important radiological finding.BMJ Case Rep. 2015 Aug;2015(1):1-2. doi:10.1136/bcr-2014-208767The Nobel Prize.Egas Moniz.Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:10.11622/smedj.2014048Yousaf A, Singh K, Tavernor V, Baldwin A.Psychosurgery: A history from prefrontal lobotomy to deep brain stimulation.J Geriatr Med. 2020 Aug;1(3):1-8. doi:10.30564/jgm.v1i3.1943Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA.Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation.Front Neurosci. 2019 Feb;13(1):108. doi:10.3389/fnins.2019.00108Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:110.11622/smedj.2014048Memento Mütter.Skull with transorbital lobotomy.Zacijek B.Banning the Soviet lobotomy: psychiatry, ethics, and professional politics during late Stalinism.Bull Hist Med. 2017;91(1):33-61. doi:10.1353/bhm.2017.0002
Caruso JP, Sheehan JP.Psychosurgery, ethics, and media: a history of Walter Freeman and lobotomy.JNS. 2017 Sep;43(3):1-8. doi:10.3171/2017.6.FOCUS17257
Lovell B.Frontal lobotomy: a vanishing but important radiological finding.BMJ Case Rep. 2015 Aug;2015(1):1-2. doi:10.1136/bcr-2014-208767
The Nobel Prize.Egas Moniz.
Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:10.11622/smedj.2014048
Yousaf A, Singh K, Tavernor V, Baldwin A.Psychosurgery: A history from prefrontal lobotomy to deep brain stimulation.J Geriatr Med. 2020 Aug;1(3):1-8. doi:10.30564/jgm.v1i3.1943
Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA.Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation.Front Neurosci. 2019 Feb;13(1):108. doi:10.3389/fnins.2019.00108
Tan SY, Yip A.António Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.Singapore Med J. 2014 Apr;55(4):175-176. doi:110.11622/smedj.2014048
Memento Mütter.Skull with transorbital lobotomy.
Zacijek B.Banning the Soviet lobotomy: psychiatry, ethics, and professional politics during late Stalinism.Bull Hist Med. 2017;91(1):33-61. doi:10.1353/bhm.2017.0002
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
