This is how a lobotomy was performed in the early 1900’s. In case you didn’t already know, a lobotomy is when doctors severed the frontal cortex from the rest of the brain. They believed they could calm a person’s emotions & stabilize their personalities. We now know lobotomies were more harmful than helpful.
One method was the “ice pick” method. Doctors used an orbitoclast, that resembled an ice pick, to go through the top of the eye socket. They could enter the brain just by tapping lightly on the orbitoclast with a hammer to break through the thin layer of bone. Then they would twirl it to cut through the fibers. After pulling out the orbitoclast, the procedure was repeated on the other side. The transorbital lobotomy took 10 minutes or less. (Source & More Information)
Morgue and autopsy theatre at St. Elizabeths Hospital, designed by Walter Freeman. Before he became famous for inventing the transorbital lobotomy, Freeman was the medical director at this, the only federal insane asylum. He was obsessed with the organic roots of mental illness, and commissioned Blackburn Laboratory in order to further study it. This autopsy theatre is now abandoned in the basement. The jars in the rear to the left used to contain the largest collection of human brains in America; when the morgue was abandoned they were donated to another institution. After leaving St. Elizabeths, Freeman would tour the country in his “lobotomobile”, performing thousands of lobotomies at other asylums in order to demonstrate the supposed effectiveness of his technique. He was ordered to stop after killing a patient. Freeman was never, in fact, a licensed medical doctor.
Between 1939 and 1951, mental asylums were flooded with patients due to World War II. During this time, in the United States alone over 18,000 lobotomies were performed on veterans, prisoners, rebels/political opponents, and even misbehaving children.
At the age of 12, Howard Dully was subjected to the unnecessary procedure of a lobotomy, thanks in part to his stepmother, who couldn’t handle a normal pre-teen boy. Dr. Walter Freeman claimed that Howard had childhood schizophrenia, when other doctors that have seen him never came to that diagnosis. It has taken Howard decades to recover from the surgery. He lived his life in institutions, he was incarcerated, homeless and even an alcoholic. He finally sobered up and got a college degree. He has since researched what happened to him and has even written his memoirs, with the help of Charles Flemming. He is now a talk show host on National Public Radio, where he speaks to other lobotomy victims.
Today, the word “lobotomy” is rarely mentioned. If it is, it’s usually the butt of a joke.
But in the 20th century, a lobotomy became a legitimate alternative treatment for serious mental illness, such as schizophrenia and severe depression. Physicians even used it to treat chronic or severe pain and backaches. (As you’ll learn below, in some cases, there was no compelling reason for the surgery at all.) There’s a surprising history of the lobotomy for its use in mental health.
A lobotomy wasn’t some primitive procedure of the early 1900s. In fact, an article in Wired magazine states that lobotomies were performed “well into the 1980s” in the “United States, Britain, Scandinavia and several western European countries.”
In 1935, Portuguese neurologist Antonio Egas Moniz performed a brain operation he called “leucotomy” in a Lisbon hospital. This was the first-ever modern leucotomy to treat mental illness, which involved drilling holes in his patient’s skull to access the brain. For this work, Moniz received the Nobel Prize in medicine in 1949.
The idea that mental health could be improved by psychosurgery originated from Swiss neurologist Gottlieb Burckhardt. He operated on six patients with schizophrenia and reported a 50 percent success rate, meaning the patients appeared to calm down. Interestingly, Burckhardt’s colleagues harshly criticized his work at the time.
The Lobotomy in America
In 1936, psychiatrist Walter Freeman and another neurosurgeon performed the first U.S. prefrontal lobotomy on a Kansas housewife. (Freeman renamed it “lobotomy.”)
Freeman believed that an overload of emotions led to mental illness and “that cutting certain nerves in the brain could eliminate excess emotion and stabilize a personality,” according to a National Public Radio article.
He wanted to find a more efficient way to perform the procedure without drilling into a person’s head like Moniz did. So he created the 10-minute transorbital lobotomy (known as the “ice-pick” lobotomy), which was first performed at his Washington, D.C. office on January 17, 1946.
(Freeman would go on to perform about 2,500 lobotomies. Known as a showman, he once performed 25 lobotomies in one day. To shock his audiences, he also liked to insert picks in both eyes simultaneously.)
According to the NPR article, the procedure went as follows:
“As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient’s eyeball through the orbit of the eye, into the frontal lobes of the brain, moving the instrument back and forth. Then he would do the same thing on the other side of the face.”
Freeman’s ice-pick lobotomy became wildly popular. The main reason is that people were desperate for treatments for serious mental illness. This was a time before antipsychotic medication, and mental asylums were overcrowded, Dr. Elliot Valenstein, author of Great and Desperate Cures, which recounts the history of lobotomies, told NPR.
“There were some very unpleasant results, very tragic results and some excellent results and a lot in between,” he said.
Lobotomies weren’t just for adults either. One of the youngest patients was a 12-year-old boy! NPR interviewed Howard Dully in 2006 at the age of 56. At the time, he was working as a bus driver.
Dully told NPR:
“If you saw me you’d never know I’d had a lobotomy,” Dully says. “The only thing you’d notice is that I’m very tall and weigh about 350 pounds. But I’ve always felt different — wondered if something’s missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it…”
The reason for Dully’s lobotomy? His stepmother, Lou, said Dully was defiant, daydreamed and even objected to going to bed. If this sounds like a typical 12-year-old boy, that’s because he was. According to Dully’s father, Lou took her stepson to several doctors, who said there was nothing wrong with Dully, and he was just “a normal boy.”
But Freeman agreed to perform the lobotomy. You can check out the NPR article for Freeman’s notes on Dully and more from his patients’ families. (There’s also lots more on lobotomies on their website.)
In 1967, Freeman performed his last lobotomy before being banned from operating. Why the ban? After he performed the third lobotomy on a longtime patient of his, she developed a brain hemorrhage and passed away.
The U.S. performed more lobotomies than any other country, according to the Wired article. Sources vary on the exact number but it’s between 40,000 and 50,000 (the majority taking place between the late 1940s and early 1950s).
Curiously, as early as the 1950s, some nations, including Germany and Japan, had outlawed lobotomies. The Soviet Union prohibited the procedure in 1950, stating that it was “contrary to the principles of humanity.” (How ironic.)
The lobotomy is a type of neurosurgery, or surgery performed on the brain, known as psychosurgery. The idea behind psychosurgery is that severe forms of mental illness can be treated by changing the way that the brain works. Doctors believed that by severing the connections that the frontal lobes, or prefrontal cortex, had to the rest of the brain, they could calm patients’ emotions and stabilize their personalities without doing away with their intelligence and motor functions.
The prefrontal cortex serves a number of complex functions in the brain, usually called executive functions. (Higher-level decision making and planning, reasoning and understanding, personality expression, creativity and behaving in a socially acceptable way all fit under this category.) The prefrontal cortex is connected to many other regions of the brain, including the thalamus, which receives and relays sensory signals.
The brain is essentially composed of two different types of matter: gray and white. Gray matter includes the neurons, or brain cells, along with their blood vessels and extensions. White matter comprises the axons, or nerve fibers, that connect the areas of gray matter and carry messages between them through electrical impulses. So a lobotomy was intended to sever the white matter between different areas of gray matter. (Another name for lobotomy, leucotomy, means “slice/cut white” in Greek.)
In the United States, about 50,000 patients were lobotomized, most of them between 1949 and 1956. The man who perfected what became the standard of lobotomies, Dr. Walter Freeman, called them “soul surgery” and claimed that they could be used to treat not only schizophrenia, but depression, chronic pain and other mental and physical conditions. Freeman, and other doctors who performed lobotomies, believed that they could relieve suffering. In some cases, they did.