The strange, sad history of the lobotomy

If you thought that scene in Sucker Punch where the doctor gave lobotomies with an ice pick was artistic exaggeration - well, it wasn't. That's exactly how Walter Freeman, a popularizer of lobotomies in the 1940s, performed thousands of operations.

In the mid-twentieth century, the lobotomy was such a popular "cure" for mental illness that Freeman's colleague António Egas Moniz was awarded the 1949 Nobel Prize for Medicine for his role in perfecting the operation. While Moniz was treating patients in Europe, Freeman started using an ice pick-shaped instrument in America to perform up to 25 lobotomies a day, without anaesthesia, while reporters looked on. Freeman's crazy antics didn't scare off potential patients, though: John F. Kennedy's sister Rosemary got a lobotomy from Freeman, which left her a vegetable for the rest of her life. And she was one of many people whose "cure" was more like zombification than freedom from mental anguish.

How did the lobotomy ever become accepted medical practice? And why are people still getting them today, under the less-disturbing name "lobectomy"?

The strange, sad history of the lobotomy

Invention of the lobotomy

Moniz and Freeman are usually credited with inventing the lobotomy in the 1930s, though in truth their work was based on many other people's research going back to the mid-nineteenth century. They had read about the work of a European doctor named Gottlieb Burckhardt, who in the 1880s performed some of the first psychosurgeries on patients' frontal lobes as well as other parts of their brains. Though Burckhardt was derided by his colleagues, some of whom thought his work was barbarous, Moniz and Freeman were intrigued by the idea that the frontal lobe could be somehow separated from the rest of the brain. This would leave incurably schizophrenic patients relieved of their emotional distress, they believed. In experiments with dogs, they determined that cutting nerves between the brain and its frontal lobe - the so-called "seat of reason" - left the animals quiet.

And so Moniz, later followed by Freeman, began experimenting on patients. His first surgery, on a mentally ill woman, involved drilling two holes in her skull and pumping alcohol into her frontal cortex. Later surgeries involved "coring" several regions in the frontal cortex with hollow needles - literally sucking out parts of the brain to sever neural connections. All these surgeries were done blind, which is to say they rarely opened up a person's skull to see where they were cutting. Moniz just drilled into the skull and guesstimated where he should core or cut.

They published articles about their work in prestigious scientific journals, reporting that patients who had been horrific burdens on their families, violent or suicidal, were calmed down immeasurably by the surgery. In a 1942 presentation at the New York Academy of Medicine, Freeman and his research partner James Watts reported that after lobotomy, patients did sometimes become "indolent" or "outspoken." They were like "children," and loving families could simply dismiss their lack of social graces because now they were so much happier.

Moniz, in a 1937 article on the procedure, describes curing a woman from Lisbon whose husband took her to the Congo, where she was unhappy and became "incapable of running her household." So her husband forced her to go back to Lisbon alone, against her wishes, and she gradually became deeply upset because she was always "expecting horrible events" and believed people were out to kill her. In retrospect, it seems clear why she might have felt that way, but Moniz reports that after a frontal lobotomy she was cured, "though possibly a little reticent." Though many of Moniz and Freeman's patients became essentially catatonic, while others were unaffected, enough seemed "cured" that the lobotomy became standard practice in mental institutions in the 1940s and early 50s.

The strange, sad history of the lobotomy

The icepick cure

Freeman apparently found Moniz's techniques a bit stodgy, and he began experimenting with an outpatient procedure, where he would drive an icepick into his patients' brains near the top of their eye sockets. Once the pick was inside the brain, he would literally wiggle it around, cutting through the white and gray matter. It was not a precision surgery. Using a hammer and his pick, he boasted that he could do a lobotomy in 10 minutes and didn't even need anaesthesia (though usually he gave the patient shock treatment first, so they were unaware of what was happening). The icepick method was too much for Watts, who distanced himself from his former partner.

But Freeman became a big hit in America, where he toured hospitals performing the procedure and training psychologists to do it too. He even prescribed it for headaches. So many people wrote about Freeman's work - he was a showman who invited press coverage - that he managed to popularize the surgery further. Of course, the lobotomy always had its critics. Doctors, as well as the families of patients, protested that the surgery did nothing more than turn people into vegetables. Sure, they might be easier to take care of, but were they really being helped? Or just snuffed out?

In 2005 NPR did an interesting profile of a man who was given a lobotomy by Freeman in the 1950s, because his stepmother felt that he was "savage" and refused to go to bed. The man was traumatized by the experience, but seemed to have suffered no ill effects - though of course, it's impossible to know who he might have become if nobody had driven an icepick into his brain.

Rise of the lobectomy

These days, lobotomies are no longer performed on the mentally ill. The rise of drugs like thorazine make it easier to chemically lobotomize patients - no more messy ice picks. Though many doctors protest that these anti-psychotic drugs are just as bad as lobotomies once were, the justification for their use continues for the same reasons lobotomies were embraced 70 years ago. The patients often seem happier and more calm. Plus, they are less trouble to their families and caretakers.

A lobotomy-like procedure called the lobectomy, however, is on the rise. That's because it's actually an excellent way to treat extreme cases of epilepsy as well as other seizure disorders. Over time, epileptic seizures can cause irreparable brain damage, so it's often considered better to remove the anterior temporal lobe of the brain so that seizures simply can't happen. This is what lobectomies usually are, and ten years ago an article in the New England Journal of Medicine reported a that a randomized, controlled trial of epilepsy patients getting the surgery revealed that indeed it is probably the best treatment we have in these difficult cases.

Unlike Freeman's "go in through the eyes" technique, these surgeries are performed in a very precise way. They may leave patients with a slightly different personality, but they are able to return to normal life. They are also far more likely to survive without suffering from brain-damaging seizures.

And so, from a terrifying medical practice we've gotten at least one good form of therapy. And a reminder that one generation's Nobel Prize-winning cure is another generation's worst nightmare.

Additional reporting by Robert Gonzalez