The rise & fall of the prefrontal lobotomy

Lobotomy (from the Greek lobos, meaning lobes of the brain, and tomos, meaning cut) is a psychosurgical procedure in which the connections the prefrontal cortex and underlying structures are severed, or the frontal cortical tissue is destroyed, the theory being that this leads to the uncoupling of the brain’s emotional centres and the seat of intellect (in the subcortical structures and the frontal cortex, respectively).

The lobotomy was first performed on humans in the 1890s. About half a century later, it was being touted by some as a miracle cure for mental illness, and its use became widespread; during its heyday in the 1940s and ’50s, the lobotomy was performed on some 40,000 patients in the United States, and on around 10,000 in Western Europe. The procedure became popular because there was no alternative, and because it was seen to alleviate several social crises: overcrowding in psychiatric institutions, and the increasing cost of caring for mentally ill patients.

Although psychosurgery has been performed since the dawn of civilization, the origins of the modern lobotomy are found in animal experiments carried out towards the end of the nineteenth century. The German physiologist Friedrich Goltz (1834-1902) performed ablations of the neocortex in dogs, and observed the changes in behaviour that occurred as a result:

I have mentioned that dogs with a large lesion in the anterior part of the brain generally show a change in character in the sense that they become excited and quite apt to become irate. Dogs with large lesions of the occipital lobe on the other hand become sweet and harmless, even when they were quite nasty before.

These findings inspired the physician Gottlieb Burkhardt (1836- ?), the director of a small asylum in Prefargier, Switzerland, to use ablations of the cortex to try and cure his mentally ill patients. In 1890, Burkhardt removed parts of the frontal cortex from 6 of his schizophrenic patients. One of these patients later committed suicide, and another died within one week of his surgery. Thus, although Burkhardt believed that his method had been somewhat successful, he faced strong opposition, and stoppedĀ  experimenting with brain surgery.

It was not until the 1930s that lobotomy was again performed on humans. The modern procedure was pioneered at that time by the Portugese neuropsychiatrist Antonio Egas Moniz, a professor at the University of Lisbon Medical School. While attending a frontal lobe symposium in London, Moniz learned of the work of Carlyle Jacobsen and John Fulton, both of whom were experimental neurologists at Yale University.

Jacobsen and Fulton reported that frontal and prefrontal cortical damage in chimpanzees led to a massive reduction in aggression, while complete removal of the frontal cortex led to the inability to induce experimental neuroses in the chimps. Here, they describe the post-operational behaviour of a chimp named “Becky”, who had previously got extremely distressed after making mistakes during the task she had learnt:

The chimpanzee…went to the experimental cage. The usual procedure of baiting the cup and lowering the opaque screen was followed…If the animal made a mistake, it showed no evidence of emotional disturbance but quietly awaited the loading of the cups for the next trial. It was as if the animal had joined the “happiness cult of the Elder Micheaux,” and had placed its burdens on the Lord!

On hearing the presentation by Jacobsen and Fulton, Moniz asked if the surgical procedure would be beneficial for people with otherwise untreatable psychoses. Although the Yale researchers were shocked by the question, Moniz, together with his colleague Almeida Lima, operated on his first patient some three months later.

On November, 12th, 1935, Moniz and Lima performed for the first time what they called a prefrontal leucotomy (“white matter cutting”). The operation was carried out on a female manic depressive patient, and lasted about 30 minutes. The patient was first anaesthetized, and her skull was trepanned on both sides (that is, holes were drilled through the bone). Then, absolute alcohol was injected through the holes in the skull, into the white matter beneath the prefrontal area.

In this way, two of the bundles of nerve fibres connecting the frontal cortex and the thalamus were severed. (The thalamus is a subcortical structure that relays sensory information to the neocortex, and the thalamo-cortical projections are called the corona radiata.) Moniz reported that the patient seemed less anxious and paranoid afterwards, and pronounced the operation a success. Subsequently, he and Lima used a knife, which, when inserted through the holes in skull and moved back and forth within the brain substance would sever the thalamo-cortical connections. They later developed a special wire knife called a leucotome, which had an open steel loop at its end; when closed, the loop severed the nerve tracts within it.

These procedures were “blind” – the exact path of the leucotome could not be determined, so the operations produced mixed results. In some cases, there were improvements in behaviour; in others, there was no noticable difference; and in yet others, the symptoms being treated became markedly worse. In all, Moniz and Lima operated on approximately 50 patients. The best results were obtained in patients with mood disorders, while the treatment was least effective in schizophrenics.

In 1936, Moniz published his findings in medical journals, and travelled to London, where he presented his work to others in the medical community. In 1949, he was shot four times by one of his patients (not one who had been lobotomized); one of the bullets entered his spine and remained lodged there until his death some years later. In the same year as the shooting, Moniz was awarded the Nobel Prize for Medicine, for his innovations in neurosurgery.

The American clinical neurologst Walter Freeman (1895-1972) had been following the work of Moniz closely, and had also attended the symposium on the frontal lobe. It was Freeman who introduced the lobotomoy to the United States, and who would later become the biggest advocate of the technique. With neurosurgeon James Watts, Freeman refined the technique developed by Moniz. They changed the name of the technique to “lobotomy”, to emphasize that it was white and grey matter that was being destroyed.

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Walter Freeman (right) and James Watts preparing to perform a lobotomy

The Freeman-Watts Standard Procedure was used for the first time in September 1936. Also known as “the precision method”, this involved inserting a blunt spatula through holes in both sides of the skull; the instrument was moved up and down to sever the thalamo-cortical fibers (above). However, Freeman was unhappy with the new procedure. He considered it to be both time-consuming and messy, and so developed a quicker method, the so-called “ice-pick” lobotomy, which he performed for the first time on January 17th, 1945.

With the patient rendered unconscious by electroshock, an instrument was inserted above the eyeball through the orbit using a hammer. Once inside the brain, the instrument was moved back and forth; this was then repeated on the other side. (The ice-pick lobotomy, named as such because the instrument used resembled the tool with which ice is broken, is therefore also known as the transorbital lobotomy.)

Freeman’s new technique could be performed in about 10 minutes. Because it did not require anaesthesia, it could be performed outside of the clinical setting, and lobotomized patients did not need hospital internment afterwards. Thus, Freeman often performed lobotomies in his Washington D.C. office, much to the horror of Watts, who would later dissociate himself from his former colleague and the procedure.

Freeman happily performed ice-pick lobotomies on anyone who was referred to him. During his career, he would perform almost 3,500 operations. Like the leucotomies performed by Moniz and Lima, those performed by Freeman were blind, and also gave mixed results. Some of his patients could return to work, while others were left in something like a vegetative state.

Most famously, Freeman lobotomized President John F. Kennedy’s sister Rosemary, who was incapacitated by the operation, which was performed on her when she was 23 years of age. And, on December 16th, 1960, Freeman notoriosly performed an ice-pick lobotomy on a 12-year-old boy named Howard Dully, at the behest of Dully’s stepmother, who had grown tired of his defiant behaviour.

My stepmother hated me. I never understood why, but it was clear she’d do anything to get rid of me…If you saw me you’d never know I’d had a lobotomy.

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.

So [recently] I set out on a journey to learn everything I could about my lobotomy…It took me years to get my life together. Through it all I’ve been haunted by questions: ‘Did I do something to deserve this?, Can I ever be normal?’, and, most of all, ‘Why did my dad let this happen?’

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Howard Dully during his ice-pick lobotomy, Dec. 16th, 1960. (George Washington University Gelman Library)

Dully’s mother had died when he was 5 years old, and his father subsequently remarried a woman named Lou. Freeman’s notes later revealed that Lou Dully feared her stepson, and described him as “defiant and savage-looking”. According to the notes:

He doesn’t react to either love or punishment. He objects to going to to bed but then sleeps well. He does a good deal of daydreaming and when asked about it says ‘I don’t know.’ He turns the room’s lights on when there is broad daylight outside.

Freeman recorded the events leading up to Dully’s lobotomy:

[Nov. 30, 1960] Mrs. Dully came in for a talk about Howard. Things have gotten much worse and she can barely endure it. I explained to Mrs. Dully that the family should consider the possibility of changing Howard’s personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband, that I would have to talk with him and make it stick.

[Dec. 3, 1960] Mr. and Mrs. Dully have apparently decided to have Howard operated on. I suggested [they] not tell Howard anything about it.

Following the operation, the notebook reads:

I told Howard what I’d done to him…and he took it without a quiver. He sits quietly, grinning most of the time and offering nothing.

Now in his late fifties, Dully works as a bus driver in California. About 40 years after his lobotomy, he discussed the operation with his father for the first time. He discovered that it was his stepmother who had found Dr. Freeman, after being told by other doctors that there was nothing wrong, and that his father had been manipulated by his second wife and Freeman into allowing the operation to be performed.

It was largely because of Freeman that the lobotomy became so popular during the 1940s and ’50s. He travelled across the U. S., teaching his technique to groups of psychiatrists who were not qualified to perform surgery. Freeman was very much a showman; he often deliberately tried to shock observers by performing two-handed lobotomies, or by performing the operation in a production line manner. (He once lobotomized 25 women in a single day.) Journalists were often present on his “tours” of hospitals, so that his appearance would end up on the front page of the local newspaper; he was also featured in highly popular publications such as Time and Life. Often, these news stories exaggerated the success of lobotomy in alleviating the symptoms of mental illness.

Consequently, the use of lobotomies became widespread. As well as being used to treat the criminally insane, lobotomies were also used to “cure” political dissidents. It was alleged that the procedure was used routinely on prisoners against their will, and the use of lobotomies was strongly criticised on the grounds that it infringed the civil liberties of the patients.

An excellent account of the effects of lobotomy, and of the ethical implications of the use of the procedure, can be found in Ken Kesey’s book One Flew Over the Cuckoo’s Nest. (This was made into a film in 1975, by Milos Forman, who received the Academy Award for Best Director. Jack Nicholson won the award for Best Actor in a Lead Role.)

The use of lobotomies began to decline in the mid- to late-1950s, for several reasons. Firstly, although there had always been critics of the technique, opposition to its use became very fierce. Secondly, and most importantly, phenothiazine-based neuroleptic (anti-psychotic) drugs, such as chlorpromazine, became widely available. These had much the same effect as psychosurgery gone wrong; thus, the surgical method was quickly superseded by the chemical lobotomy.

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69 thoughts on “The rise & fall of the prefrontal lobotomy

  1. I find it amazing that blindly damaging an area of the brain was done so freely. I would like to see what percentage of lobotomy patients ended up like Rosemary Kennedy, and an in depth before-and-after of a successful lobotomy patient’s personality and cognitive abilities.

  2. Its not quite fair to present Freeman as such a crazed maverick. While at the beginning he faced some friction as to his ideas, he largely won over the most respected neurologists of the day. Quite a few doctors adopted his techniques (much to the detriment of patients).

    What I mean is, yes, now we can say frontal lobotomies are mutilating, debilitating, dehumanizing. But hindsight is 20-20, so to speak. Surgeries to reduce cranial swelling or bleeding, or tumor removal, etc might well have been termed barbaric with the methodology employed today. Freeman’s true mistake was to be so reluctant to give up the lobotomy technique after modern anti-psychotics came about.

  3. Secondly, and most importantly, phenothiazine-based neuroleptic (anti-psychotic) drugs, such as chlorpromazine, became widely available. These had much the same effect as psychosurgery gone wrong; thus, the surgical method was quickly superseded by the chemical lobotomy.

    Fascinating. In most of the standard histories that you hear about these things (well, those I have read anyway), the introduction of Thorazine and the other drugs is depicted as a kind of miracle cure!! Could you go into this a bit more? What was so bad about Thorazine?? And what about many of today’s psychiatric drugs? For example, my brother—who is manic depressive and generally takes his meds very assidiously and sucessfully–often talks about Haldol as a “chemical lobotomy” or “zombie” drug that he would never take. Personally, I have serious doubts about the whole “business” (pun intended).

  4. “He doesn’t react to either love or punishment. He objects to going to to bed but then sleeps well. He does a good deal of daydreaming and when asked about it says ‘I don’t know.’ He turns the room’s lights on when there is broad daylight outside.”
    As for this bedtime behaviour, this is typical of my three year old, but I think we will pass on the lobotomy. The rest is pretty typical teenage behaviour. Tragic indeed.

  5. One day I was reading about the supporters of the Nazi’s sorted by a “professional class” domain in pre-WWII Germany. Lawyers were the least likely to support the Nazi’s, about 20% if memory serves me correctly. Doctors, OTOH, were the MOST LIKELY to support the Nazis, at about 80%. I actually found that shocking because, on my own, I would have gone the other way.

    The article went on to discuss some of the underlying reasons this may be so. And these underlying reasons made a lot of sense.

    So, while I’m not going to get into it; mostly because I don’t have the citations and I’m not really that interested in arguing the point, I will say that when I read that these things happen, and that the other doctors just followed right in line (allowing this to be “acceptable medical practice” without saying a damn thing… I’m not surprised. Not in the slightest.

    (And no, I’m not saying Dr.’s are Nazis. Rather that certain factors that attract people to medicine and the way medical training is conducted tend to select for authoritarian/compliant persons, versus law, which tends to attracts non-authoritarian/non-compliant persons.)

  6. The best book on this, to my mind, is Great and Desperate Cures, by Elliot Valenstein, the neuropsychologist. Freeman was a neuropsychiatrist and neuropathologist, and his commitment to psychosurgery left him isolated once treatments changed.

    I’ve seen a few patients, many years post-lobotomy/leucotomy. They have been passive, docile, with little initiation, just as you’d expect from someone with marked frontal lobe injury. As usual in these cases of isolated frontal injuries, reasoning is fine, memory is grossly normal, it’s initiation, intention, and conation that’s affected.

  7. What I mean is, yes, now we can say frontal lobotomies are mutilating, debilitating, dehumanizing. But hindsight is 20-20, so to speak.

    The data indicating how damaging the procedure was were available for decades before it became popular. Just how obvious does it have to have been before we can consider holding those who performed it responsible?

  8. I find these last few sentences puzzling:

    Secondly, and most importantly, phenothiazine-based neuroleptic (anti-psychotic) drugs, such as chlorpromazine, became widely available. These had much the same effect as psychosurgery gone wrong; thus, the surgical method was quickly superseded by the chemical lobotomy.

    Specifically, you say chlorpromazine and other early anti-psychotics ‘had much the same effect as psychosurgery gone wrong’ , but it had previously been my impression that the effects of early anti-psychotics were comparable (in the perception of psychiatrists of the time) to the best outcomes of lobotomies. Could you clarify?

    Separately, despite Shelley’s words, this account of Freeman’s work, like others that I have read, makes Freeman seem akin to an enthusiastic practitioner of alternative medicine; the focus on showmanship, and volume of patients, the belief that a treatment worked despite mixed results and lack of any clear theory as to why it should work, and most importantly, continuing to advocate a treatment long after the communities’ consensus was that it should be replaced.

  9. I wonder what medical techniques are currently done that will seem barbaric in 100 years time? Perhaps advanced drug eluting stents will replace bypass surgery. We are already seeing that laproscopy is replacing traditional surgical methods.

  10. Shelly, if 20-20 hindsight has its weaknesses (What is good history trying to do); there is much worse – no hindsight.

    Are modern anti-psychotics, Zyprexa, Stelazine, etc., significantly similar to an attack with ice picks in a medical setting, especially in terms of her does the administering? “True mistakes” is a new term for me, and it is pregnant with triplets.

  11. I’m sorry Shelley. It is clear from the accounts that Freeman was one very sick motherfucker. Being part of a trend doesn’t make it non-evil.

    Vigorously resisting going to bed, spacing out, and turning on lots of lights in the house in the middle of the day, despite ongoing contrary efforts on our part, is a regular feature with my 11 yo.

    Sick bastard Freeman just wanted to experiment to see if he could use his miracle technique to “cure” a routine case of preadolescent (lively) boyness.

    Lots more could be said about the disconnect between self-agrandizement and concern for individual well-being of the patient among those treating percieved mental illness…

  12. There is some evidence that people volunteered for the operation, too — “lined up around the block for it” as a friend of mine put it after a year of research. Among other things, these studies show the dangers of popular opinion.

    “Here, cue up for smack in the head with a 2-by-4!”
    “Sure! I can barely wait!”

    Listen to the entire radio program Mr. Dully put together. It’ll rattle you, if you’re sane.

    Now ask: What’s the 21st century equivalent of the transorbital lobotomy? How would we know?

  13. Oh good grief, I wasn’t defending his methodology, so just relax. I suppose my comment comes from the fact that I’m reading Freeman’s biography right now (“The Lobotomist”) and the author presents Freeman in a more humanizing light.

  14. Shelley – it wasn’t my intention to portray Freeman as crazy. But he was a maverick, and he was very enthusiastic about the lobotomy. Actually, he was way too over-enthusiastic. Unlike Moniz and Lima, Freeman did not exercize caution. He performed 3,500 lobotomies; that is just reckless.

    Stewart – unfortunately, I think Valenstein’s biography is now out of print (but here’s an interview he gave). The book mentioned by Shelley in the previous comment is by Jack Le-Hai.

    llewelly – neuroleptics are VERY HEAVY drugs which basically zombify people. I have a first-hand account of their effects from a very good friend who was prescribed chlorpromazine after a single schizophrenic episode some years ago. He took one and threw them away because he didn’t like what they did to him. Fortunately, he hasn’t had another episode since. The neuroleptics have also been described as a “chemical straight-jacket”.

    mirror – watch your language!

  15. “In 1949, he was shot dead by one of his patients (not one who had been lobotomized). “

    Are you sure about this?

    http://en.wikipedia.org/wiki/Egas_Moniz
    “Dr. Moniz was shot in 1939 by a psychiatric patient. He survived and recovered completely[citation needed]. The patient gave vague reasons for the shooting saying he was unsatisfied with the dose of a drug Dr. Moniz had prescribed. Dr. Moniz died in 1955, in Lisbon, Portugal, of natural causes[citation needed].”

  16. I can’t help being reminded of a comment made by a psychologist whom I saw for several years when I lived back East: “There are a lot of sadists in this field”.

    She was right. The “mental health” industry has historically had a truly ugly tendency to authoritarianism and a love of force and coercion, as well as being full of what the Germans call a “bicyclist”- people who, in the physical manner of a cyclist, nod deferentially at their “superiors” while treading on those below them in the social hierarchy.

    Freeman is just another example of how poorly the psychiatric industry does at weeding out the jeebers who aren’t fit to hold the position of chief dogcatcher, let alone wield physical power over others.

  17. I heard a segment on NPR about Freeman, several months ago. When they brought Duffy on, to tell his story, it was mindboggling. I actually wept when they had him talk to his dad for the first time, about the lobotomy. I am really looking forward to reading his book.

  18. >With the patient rendered unconscious by electroshock, an >instrument was inserted above the eyeball through the orbit >using a hammer.

    Electroshock can be used to induce unconsciouness? I thought it’s only application was as treatment for mood dysfunction.

  19. Mo,

    Do you know if anyone has studied the historical relationship between phrenology and lobotomy? Was the practice of lobotomy derived from the study of phrenology in say the victorian era?

    Fantastic post. This should have been in a science history journal or popular science magazine instead!

  20. I haven’t found anything to suggest any relation between the lobotomy and phrenology. But then, that’s not what I was looking for.

    As far as I can tell, the lobomoty is based on sound neurobiology. The thalamus is like a relay station for information going from structures in the limbic system (which are involved in emotion) to the frontal lobes.

    So, in theory at least, severing the thalamo-cortical projections would separate the emotions from intelligence.

  21. So, in theory at least, severing the thalamo-cortical projections would separate the emotions from intelligence.

    And that’s precisely what happens – motivation, reaction, and the ability to construct complex behaviors to answer basic desires and needs are all crippled. Everything needed for higher thought, in fact.

  22. But it seems like the the next step in the study of phrenology in the 1700s and 1800s might have been to experiment with the bumps on people heads to see if one could manipulate personality (as theorized by phrenologists) and correct for certain personality “disorders” as defined by victorians. I guess I can sort of see a natural evolution, in that respect, towards performing lobotomies.

  23. The famous post war (WW2) actress, Frances Farmer, was brought “under control” in the fifties by severing her fore-brain from the rest of her brain. She was robbed of part of her “mind.”

    Jessica Lange’s magnificent performance in the film, Frances, will give you the heebie jeebies about psycho surgery in modern times as well as psycho anything. Could the masterful psycho surgeon, Freeman, have done the dirty deed on Frances’s brain meat?

  24. llewelly – neuroleptics are VERY HEAVY drugs which basically zombify people. I have a first-hand account of their effects from a very good friend who was prescribed chlorpromazine after a single schizophrenic episode some years ago. He took one and threw them away because he didn’t like what they did to him. Fortunately, he hasn’t had another episode since. The neuroleptics have also been described as a “chemical straight-jacket”.

    I had thought that psychiatrists at the time thought lobotomies were at best comparable to this (often much worse), except that most (all?) of the effects of neuroleptics wear off after one stops taking them (an advantage lobotomy does not have.) That is to say, if you think chlorpromazine is psychosurgery gone wrong, I don’t disagree with you; instead I had thought that neuroleptics superseded lobotomies because psychiatrists in those bygone days saw them as comparable to the best that the psychosurgery extant at that time could do. You and I see chlorpromazine and so forth as ‘psychosurgery gone wrong’, but psychiatrists of those days I suspect did not, and in fact, many today would see chlorpromazine and other neuroleptics as less awful than lobotomy.

  25. Mo, you are one thorough and precise fellow. Give us more.

    I remember so clearly viewing the “This is your life” fiasco with fawning Ralph Whoever. As best I can recall, it was sometime about 1954, and I was in the ninth grade. Remembering it now makes me consider my own brain damage from fifties television. I never even considered that Frances DIDN’T have the alleged lobotomy until today. Much of what we are taught, learn, and come to believe as gospel is, indeed, pure nonsense and falsehood. Sad but true. Grazi.

  26. I just squandered more brain cells trying to decipher the actual date of my youthful dose of fifties tv flap and foo-foo. It appears that I must have viewed the Frances episode on the “This is your life” schmaltz show in 1958. Frances supposedly knew of her appearance on the tv show beforehand, and like most else, it was an engineered peeyar stunt to re-invigorate her career. Ralph Smooth and Saccharine, the host, was more foul than smooth. It is very powerful to recall my experiences here, because of all the flap and falsehood.

  27. It is quite frightening to read about how blindly these types of things were both done and accepted by the world.

    Chemical treatments might be a step up from poking around at the frontal lobe of your brain, however, having a relative that’s undergone a lot of chemical treatments in order to fix his mental state, I know that even that can be just as blind and dangerous as physically cutting into the brain itself.

  28. “he often deliberately tried to shock observers by performing two-handed lobotomies, or by performing the operation in a production line manner. (He once lobotomized 25 women in a single day.)”

    I wonder what percentage of his patients overall were female? This is just so frightening to contemplate. If you were an outspoken, independent woman who was recovering from abuse and had depressive symptoms someone could simply neuter your personality for you? Yech. I wonder how many “uppity” women he rendered docile and obedient. Sickening.

  29. The “nice” thing about lobotomy and electroshock is that they left no tell-tale marks. Somehow it became okay to murder a mind, so long as the basic functions remained. Eventually both were used to punish “incorrect” social behavior.

    Such attitudes towards the welfare of *others* — the good doctors never needing this kind of treatment — made possible experiments like Mengeles, the atomic veterans, the irradation of patients, giving syphilis to patients, etc. Even the gassing of millions became thinkable.

    Hard to fathom now. But that wasn’t so long ago. Hopefully we can keep those tides of fashion from rising again.

  30. I’m a little disturbed by the anti-psychiatry misinformation that’s being allowed to sit unchallenged on this page. Lobotomy is certainly barbaric by today’s standards, but the incentive to perform the operation is understandable to anyone who’s actually seen a few severely psychotic patients. How many of you have actually seen them? Most likely very few, if any, of you because society makes significant efforts to shield laypeople from it. The psychiatrists of Freeman’s era did what they could with the crude tools at their disposal, and it wasn’t very much.

    The statements made by several of you that neuroleptic drugs are “chemical straitjackets”, “zombify” people, or are equivalent to lobotomy are simply factually incorrect. Mo–your friend’s experience is hardly fair, since taking the first few doses of antipsychotics (especially the older ones, like chlorpromazine) is associated with nasty side effects, but those largely go away after a few doses. If we’re getting into anecdotes here, I have a friend who went psychotic during graduate school and was locked up for her own protection at an inpatient psych unit. She was put on antipsychotics, and now she’s finishing her second doctorate from an ivy league institution. The same thing happened to another friend of mine, and she was also put on antipsychotics (with some nasty side effects), and now she’s finished her masters and has a high-paying job in industry.

    A good analogy is cancer chemotherapy. Chemo is brutal, but most sensible people understand that it’s necessary because of how serious a disease cancer is. Well, serious psychotic illness (which most of you have never seen up close, and likely never will) is every bit as bad, and it’s much more common than most people think. Antipsychotic drugs are far from perfect, but they are absolutely necessary, and they make a huge difference in people’s lives.

  31. I’d heard (as an undergrad, from my physiological psychology professor) that Freeman would carry the icepick instruments in a leather doctor’s bag. And he drove a station wagon, nicknamed the “Loboto-Mobile.”

  32. Thanks for listening, BTW my book “My Lobotomy” will be out September 4th 2007 and it goes a lot deeper than the 22 minutes that was allowed for the radio documentary.

  33. I was researching lobotomies for a project I am working on and came across this interesting article. My grandmother received a frontal lobotomy in about the mid-1950′s in England. She would have been in her 50′s at the time. She had been suffering from anxiety and some depression (her husband had been killed by a drunk driver a couple of years prior). Lobotomies were already quite controversial by that time, and my mother and her sister (who were only in their early 20s at the time) were under considerable pressure to authorize the procedure, which they did. After the lobotomy my grandmother’s anxiety had subsided but her personality had flat-lined. Apparently she had no emotional reactions at all, she had no interest in anything, and she spoke in an extremely monotone voice. Her attention span was also very short after the procedure. I don’t know if that’s typical. She died a few years after the lobotomy, from another cause. I know my mother felt tremendous guilt later about the decision she had made; I’m not sure if she ever came to terms with it.

  34. luke: “The psychiatrists of Freeman’s era did what they could with the crude tools at their disposal, and it wasn’t very much.”

    It was not that Freeman did “the best that was possible at that time” to help these people. He “cured” children for their bad behaviour, people with simple headaches, communists for their ideas, etc. That man was obsessed with what he did.

    He was obsessed of creating mindless machines, of destroying people’s will and personality, and nobody stopped him. He was not an inch better than Mengele.

    Anything less than a war crimes tribunal for that sicko would have been intolerable. People get the chair for far less, he instead had a licence to kill off thousands of people!

    Which doctor would inflict physical damage on his patient? Without consent, without a court order, without anything?

    Didn’t they swar the hippocratic oath, “To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.”, and “ever to do deliberate harm to anyone for anyone else’s interest” to name just a few parts?

    It is unbelievable there are still some who defend him “oh, but he just wanted to help, and it was the best method of his time”. This is just sick. Everyone who conducted this type of “operation” still alive today should be brought to court.

  35. I’m disturbed by unanimous condemnation of prefrontal lobotomy. I don’t think it’s fair. I’d guess that nearly everyone who has written in has never dealt with wildly psychotic manic or delirious persons. In the days that psychosurgery was performed there were no effective alternative treatments, no means of controlling dangerous injurious behaviors except restraints and torture such as immersion and these worked only temporarily and required prolonged hospital confinement. Many lobotomized persons were able to be discharged home. “Desperate Cures” is an apt description and Moniz and Freeman were not Joseph Mengeles. Freeman was certainly guilty of self aggrandizement and performing his procedures sloppily and too widely. The American media helped to popularize a procedure that reduced most to a state of docility and inertia. Lobotomies may have had limited efficacy at one time but are now simply outmoded. Medicine marches on.

  36. truly fascinating ^_^ i love a good rally show of clinical work! my goodness what great informalities you have given me! i find it so very lovely!

  37. I don’t know this just seems unreal. I feel so sorry for the patients. No one should ever stick a knife in the brain without knowing exactly what things are, where they are, and what they do. I wonder what the patients thought of this procedure. Freeman should have never been awarded.

  38. He doesn’t react to either love or punishment. He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it says ‘I don’t know.’

    It actually sounds like the boy may have been autistic, possibly Asperger’s. Of course at the time there’s no way he would have been diagnosed as such, as although it had been named, autism was not commonly diagnosed, and Asperger’s was definitely not a diagnosis to be considered at the time.

  39. The modern practice that springs to mind is the treatment of children who are said to have ADHD. I have heard the supposed symptoms of ADHD described as “childhood”. There may be medical condition for some of them, but I’d bet that there are a whole lot for whom it is just convenient to the adults to keep them drugged.

  40. Well I think that lobotomy were terrible . But to say that anti-depesent and neuroleptic drugs are just as bad is wrong . There are people out there that need them to function , I am one of them. I was just in the hospital becuase of sever axaity (sorry about spelling) and oppsesive,compulsive,disorder also bi polar . If it was not for my meds I would still be there they have helped me greatly . They do have side effect I do not like . But it better then how I was feeling .And I tell my doctor what I do not like and we are slowly getting me on the right drugs that will help me with the least side effects.

    What I do not like about these meds is how people treat you once they find out you are on them and how they think you do not have to be on them that theres nothing really wrong with you . Anyways I am glad I am in today day and age becuase if I was back then they would have locked me away and gave me a lobotomy . O by the way they still do eltro shock treatment on people that have really bad mental disorders some of the people I take to while I was in the hospital told me they had it . But now they hook a think up to your toe and shock you that way . But they still loose some of ther memories which I think is sad

  41. I’d see the equivalent 21st Century barbaric practice as that of conversion therapy, you know, changing gay to straight.

    I’ve seen a number of people come out of that process as more fucked up messes than they were when they went in. And yes, they were still gay.

  42. Do you see that set of keys on Freeman’s belt as he operates? What’s up with that? Did he have a job as a janitor? The guy was an enthusiastic monster, destroying lives with manic abandon. Frankly, he was mad, and should have been lobotomized. If merely imprisoned, he would certainly have operated on fellow inmates. Unfortunately, the history of psychiatry is rife with pseudo-scientific figures who seemed attracted to the field mainly for the power over others, a deep desire to control and destroy lives, the ego gratification of having their ridiculous theories taken seriously, and of course, the governmnent checks.

  43. Anyone wanting to know of the MANY damaged people, from lobotomies, use of “anti-psychotics”, and other forms of mental health “treatment”, should read Robert Whitaker’s excellent book, “Mad In America”. There is also news that he is working on a new book on the subject.

    People diagnosed as “mentally ill” are ROUTINELY treated as though they are no longer people. If you don’t take your drugs, you can be confined and forced to take them, regardless of whatever provable damage the drugs are doing to you. Ditto for electric shock, euphemistically called “electro-convulsive therapy”. Ask Ray Sandford what he thinks of ECT, the State of Minnesota has forced him to have ECT every couple of months for several years, and his doctors will not even state how long this must continue.

  44. Earlier today I was chatting with an anesthesiologist acquaintance of mine about his son, and a mentee of mine, who will be starting medical school together this Fall. I mused externally that perhaps I should have gotten an M.D. to compliment my Ph.D. and neuroscientific training. The thought continued to hang heavy on my mildly regretful mind throughout the day. “I am a creative fellow,” I complimented myself. “Perhaps I could have come up with some clever surgical techniques!” Powerful, indeed, is the temptation to intervene in very direct ways, especially to stop human suffering or to affect the human condition. Ah, but after reading this blog by Mo, some peace has been granted. By a career choice, my tendencies toward putting exploration into practice were checked and the great Hippocratic injunction to do no harm was decisively satisfied.

    (As a minor note, I found the comment in support of the ACLU in Post #15 to be bizarre, to say the least. Personally, I’d throw my hopes in with the conservatives and their legal organizations. I trust more their capacites to apprehend and defend human dignity and freedom.)

  45. Thanks for a great summary. Beside US, lobotomy has been common treatment in scandinavia. Sweden has a lobotomy frequence 2.5 times the US. Interresting to note, the same pattern occur ; a strong, charismatic person is advcating the treatment, himself preforming and evaluating (not always correct i might add) thus building a carieer.

    The lobotomy will always remain in a gray zone of history – partly because ambition, presige and poor jugement of singular individuals as much as the treatment itself.

  46. Wow, glad I found your blog. I am no scientist, but I have been fascinated by the brain since as far back as I can remember. I read the autobiography by Howard Dully, “My Lobotomy” along with what I consider a great companion read on Freeman, “The Lobotomist.” From what I read, Freeman was definitely a maverick, and his ambitions to promote his methods were very misleading. He used a chimp during a medical symposium to show how well the leucotomy worked. What he did not disclose however, was that the chimp died soon after.

    Initially perhaps Freeman wanted to help the very mentally ill, and others were treated for chronic pain that left them unable to function. However, like many ambitious and ego driven people, he became less selective on who he chose for the procedure. Howard Dully was such a case, and at the tender age of 13 it is unimaginable. “The Lobotomist” was written in a fairly objective manner in my opinion. I believe an earlier post said he was seen in a positive light- unless compared to another book, I disagree with that opinion. It was all very disturbing to me, and I am not in any way an adversary to psychiatric medicine and practice. Freeman did carry around a custom made “ice pick” leucotome with an inscription…perhaps his name or initials, I can’t remember exactly. He also was not well taken by the psychiatric community, ie the surgical community. He was not a surgeon, and had no business performing surgeries. He was also all about quantity, and not keen on sterilization—note the above photo—no gloves, no scrubs, mask, etc. It is unbelievable!

    Howard Dully, you are brave to tell your story. I have tons of respect for you, and I thoroughly enjoyed your book. I am sorry your father allowed himself to be manipulated by Lou. It sounded like you did have family who were fighting for you, and I hope you have found some happiness in finding the truth you longed for. Again, you have done a great justice in sharing your experiences, and shedding light on a little known dirty secret many never knew about. Bravo and thank you!

    In regards to the followers of this experiment, I believe Milgram did a fine job on showing how easily humans are persuaded into doing what they are told because an authority says it is okay. Social group think. Thanks for the great history!

  47. I would like to relate several experiences I have had with doctors regarding treatment for mild psychological disorders.

    1) I was prescribed Chlorpromazine by a general practitioner for anxiety. It felt like wet concrete had been poured into my brain and then solidified, leaving me unable to think.

    2) I was hospitalised for schizophrenia, based on lies told by a neighbour of mine, though I had earlier seen a psychiatrist about hearing voices. I found the psychiatrists to be a bunch of authoritarian assholes who used hospitalisation as a form of punishment/social control.

    3) I have been on 3 different drugs for voices, all quite new and based on current theory and practice – none of them work. After I decided to go off the drugs the female voice I used to speak to (quite happily) told me she was bored with me and has since refused to talk.

    4) They also tried a fourth drug but I refuded to take it because it made me feel retarded and gave me a voracious appetite. I was a voluntary patient at that stage so they didn’t mind my refusal, but had I been in hospital it would have been mandatory.

    5) The vast majority of people I met in hospital had little if any psychiatric disability, but doctors in my country (Australia) repeatedly write into newspapers claiming a chronic shortage of beds to treat the seriously mentally ill. Psychiatry, from my experience, is an industry. As in many industries its practitioners are mainly interested in maximising their income by exaggerating the prevalence and seriousness of “mental illness”. They are also mainly authoritarian bastards who routinely invent symptoms (in my case, a supposed “lack of affect”), chronically overestimate the seriousness of “illness” in the patients, and are more than happy to step all over their human rights.

  48. Your article, as usual, is well-written, though I have one small objection. Calling medication a form of lobotomy is counterproductive and frankly just wrong. I’ve experienced life without medications and with it, and life substantially improved with the meds. I wouldn’t call medication a lobotomy any more than I would call some other medication that treats an illness like diabetes a “lobotomy”. If the symptoms are bad enough, the medication is a good thing. I would even hedge a bet that Jon, your poster of 11-22-09, has not yet found a sufficient combo to work for him. He implies that hearing voices isn’t a bad thing, and that he shouldn’t be medicated because of them. But his escalating crossover into the world of delusions will eventually cause himself and/or others harm. That’s why he needs meds.

  49. Science is in the wrong hands. Other methods have emerged since. many all in the name of mind control and torture not just inside the lab but in torture centers disclosed or undisclosed and more horrific attack taking place in the privacy of once home. microwave attacks and various form of electroshock.

    In third world countries and respectable so called democracy. The cases will surface gradually. The politics of fear is a powerful forms of repression and oppression, for now. if they can kill a million they can kill one. Adam

  50. Article is interesting, but author doesn’t know what he/she is talking about with regards to anti-psychotics.

    Any scientist worth his/her salt doesn’t make judgments off anecdotes. This is how anti-vaccine woo gets started.

  51. A very interesting article.

    I would like to point out to the other commenters that the Citizens Commission on Human Rights is a known affiliate of the Church of Scientology and as such, should not be considered a reliable source.

  52. “He doesn’t react to either love or punishment. He objects to going to to bed but then sleeps well. He does a good deal of daydreaming and when asked about it says ‘I don’t know.’ He turns the room’s lights on when there is broad daylight outside.”
    That only describes what, about 50% of teenage males? Talk about an evil stepmother…

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