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What Is a Lobotomy?

Lobotomy, originally called psychosurgery by Gottlieb Burckhardt, is invasive procedure that was later named leucotomy by Antonio Egas Moniz. It was finally referred to as a lobotomy by Walter Freeman. No matter what it was called, the idea was the same, that mental health could be improved by physically severing nerves in the prefrontal lobes. Although many people now look back on the procedures as barbaric and cruel, many former patients and their family members are quick to point out that in the 1930s and 1940s, there were no other alternatives. The early success rates were low. However, the procedures offered hope for those suffering with severe schizophrenia, chronic depression, anxiety and panic disorders. The invasive procedure began to decline in popularity in the 1950s with the introduction of psychotropic medications.

What is Lobotomy?

Lobotomy, also known as leucotomy, is a neurosurgical operation that involves severing connections in the brain's prefrontal lobe. Lobotomies have always been controversial, but were widely performed for more than two decades as treatment for schizophrenia, manic depression and bipolar disorder.

Lobotomy was an umbrella term for a series of different operations that purposely damaged brain tissue in order to treat mental illness.

The behaviors that doctors were trying to fix, they thought, were set down in neurological connections. The idea was, if you could damage those connections, you could stop the bad behaviors.

When lobotomy was invented, there were no good ways to treat mental illness, and people were looking for desperate kinds of interventions. Even so, there were always critics of the procedure.

Methods

The first procedures involved cutting a hole in the skull and injecting ethanol into the brain in order to destroy the fibers that connected the frontal lobe to other parts of the brain. Later, Moniz introduced a surgical instrument called a leucotome, which contains a loop of wire that, when rotated, creates a circular lesion in the brain.

Italian and American doctors were early adopters of the lobotomy. The American neurosurgeons Walter Freeman and James Watts adapted Moniz's technique to create the "Freeman-Watts technique" or the "Freeman-Watts standard prefrontal lobotomy.

The Italian psychiatrist Amarro Fiamberti first developed a procedure that involved accessing the frontal lobes through the eye sockets, which would inspire Freeman to develop the transorbital lobotomy in 1945. This method would not require a traditional surgeon and operating room. The technique involved using an instrument called an orbitoclast, a modified ice pick, which the physician would insert through the patient's eye socket using a hammer. They would then move the instrument side-to-side to separate the frontal lobes from the thalamus, the part of the brain that receives and relays sensory input.

Prevalence & effects

About 50,000 lobotomies were performed in the United States, and Freeman himself performed between 3,500 and 5,000. While a small percentage of people supposedly got better or stayed the same, for many people, lobotomy had negative effects on a patient's personality, initiative, inhibitions, empathy and ability to function on their own.

The main long-term side effect was mental dullness. People could no longer live independently, and they lost their personalities.

Mental institutions played a critical role in the prevalence of lobotomy. At the time, there were hundreds of thousands of mental institutions, which were overcrowded and chaotic. By giving unruly patients lobotomies, doctors could maintain control over the institution.

Lobotomy is rarely, if ever, performed today, and if it is, "it’s a much more elegant procedure. The removal of specific brain areas (psychosurgery) is only used to treat patients for whom all other treatments have failed.