What Is Lobotomy

Overview

A lobotomy is a surgical procedure that was created in 1936 by Egas Moniz. It involves making a lesion, usually in the frontal lobe; however, there are also different types.¹ The aim of this procedure is to help treat psychological disorders.¹ Lobotomy is one of the most controversial medical procedures, and since its development, many alternative medicines have been put forward instead.¹ This includes various types of antipsychotic medication and talking therapies.¹ 

There are two main types of lobotomy. There is a prefrontal lobotomy and a transorbital lobotomy. The main difference between these is the location of the incisions, but the procedure is mostly the same.² The procedure is most often associated with cutting and the use of needle-like instruments; however, the first lobotomies used alcohol injections into the frontal lobe.³ 

The theory behind the lobotomy is quite simple. Moniz hypothesised that patients' mental illnesses were caused by abnormal neural connections in the frontal lobe. Therefore, cutting these areas would remove the illness.³ Moniz’s work in psychosurgery earned him a Nobel prize. Although Moniz’s contributions were praised initially, controversy and criticisms shortly followed. People began to speculate whether the treatment's success outweighed the negative impact it had on the patient’s life afterwards.³

Types of lobotomy

There are two main types of lobotomy. There is a prefrontal lobotomy and a transorbital lobotomy. 

• Prefrontal lobotomy

The prefrontal lobotomy was the first lobotomy to be introduced as a medical procedure to treat psychological disorders. The prefrontal lobotomy started with various incisions to reach the frontal lobe.² The first lobotomy then used alcohol injections to destroy any unwanted, abnormal connections in the frontal lobe that were believed to be causing the mental illness.³ The lobotomy then progressed and began to use cutting or sectioning methods to remove the unwanted connections.²

• Transorbital lobotomy (icepick lobotomy)

The transorbital lobotomy was introduced in 1945 by Walter Freeman, who aimed to adapt the traditional prefrontal lobotomy into a less controversial procedure. The transorbital procedure involves an icepick-like instrument being forced into the frontal lobe via the eye socket. The pick was used to destroy any abnormal connections in the frontal lobe that were thought to be the cause of mental illness. 

The theory behind both lobotomies is the same. However, their methodology and location differ. This procedure was a lot quicker than the traditional lobotomy and would only take approximately 10 minutes. Due to its supposedly less invasive nature, this surgery was used on patients with less severe psychological disorders. Similarly, patients were left with significant changes to their personality and life.

The theory behind the lobotomy 

The lobotomy was first developed in 1936 as a treatment for mental illness.⁴ The main aim of a frontal lobe lobotomy is to change certain behaviours. However, another pressing issue was the driving force behind the development of the lobotomy. Around the time of its introduction as a medical procedure, mental institutions were suffering from severe overcrowding and needed a solution to reduce the number of patients.⁴ At this time, there were limited treatment options, so new inventions were vital. The theory behind lobotomy has been around for a while in the form of various psychosurgeries. This includes trephinations performed by shamans.⁴

So, you might be wondering how cutting the brain helps with mental illness. Well, Moniz hypothesised that patients with mental illnesses have abnormal neural connections in the brain, particularly in the frontal lobe. Therefore, cutting these connections would get rid of mental illness.³

Treatable psychological disorders with a lobotomy

Below is a list that shows what mental illness could have been treated with a lobotomy.

• Depression
• Anxiety
• Bipolar
• Obsessive-compulsive disorder (OCD)
• Schizophrenia

The first patient

Moniz performed the first psychosurgery on a 63-year-old woman. This patient was experiencing severe anxiety, depression, insomnia and hallucinations.³ Although lobotomies are mostly associated with cutting and needle-like instruments, the first lobotomies actually used alcohol injections into the frontal lobe. Following the procedure, a psychologist analysed the patient's behaviour to see how effective the procedure was. The evaluation reported that the patient's symptoms decreased significantly. Moniz was awarded a Nobel prize in 1949 for his work in psychosurgery.³

Lobotomy procedure

Before

Before performing a lobotomy, local anaesthetic is injected into the area. For both a prefrontal and transorbital lobotomy, the patient's scalp is shaved and sanitised. The area that is going to be cut is then marked out.²

During

Following this, an incision is made through the skin and muscle. Burr holes are then made in this opening. This incision is further opened, exposing the cortex. A sharp knife is then used to cut the cortex and subcortical regions. The neurologist performing this procedure will make sure to reach each of the marked-out areas before making the lesions into the frontal lobe and sectioning them. After the incisions are made, iodised oil is placed on the incisions.²  

After

Normally, there is no need for any further operations unless complications or missed areas are identified. Patients are able to stand and walk after the operation quite quickly. Usually, patients will have mild adverse effects after the operation, including a headache, possible fever, and disrupted blood pressure and heartbeat. After a few days, functioning returns to a more typical state. Personality changes are often noticed or reported after this procedure.²

Controversy and criticisms

The lobotomy has been one of the most controversial medical procedures in history. Shortly after its development, there was lots of criticism regarding the procedure and its necessity. During the same time, other forms of psychological treatments were developed and were viewed more positively due to their less invasive nature.¹ Despite all the controversy and criticism, lobotomy has found its place in modern medicine as a suitable treatment for some illnesses. This procedure has been refined over the years, but the basic principle is still the same.¹

The controversy began shortly after its invention. People began to speculate whether the procedure's effects were worth the negative consequences. Patients experienced significant changes to their personality and daily life following the procedure. Sometimes, they were even referred to as “drooling zombies”.³ Furthermore, Moniz was also questioned about his follow-up techniques and lack of adequate reporting regarding his methodology and results.⁴ Due to all of these contributing factors, other treatment options were searched for in order to replace the lobotomy. This resulted in the decline in the number of lobotomies performed and, ultimately, its replacement.³

Decline and replacement

Thousands of prefrontal and transorbital lobotomies were performed between the 1930’s and the 1960’s. However, due to the severe criticisms the procedure received, the popularity and number of lobotomies declined. The two main reasons for the decline in lobotomies were the negative impact on patients following the procedure and the poor documentation of the procedure's methodology and any follow-ups.⁵

A similar trend was observed amongst transorbital lobotomies, too. Over a few decades, Freeman performed over 3500 lobotomies. However, towards the end of the 1950s, there was a decline in the number of surgeries. This is mostly down to the introduction of new, less intense treatments such as antipsychotic or antidepressant medication. Before the lobotomy could be replaced, alternative treatments needed to be put into place. The next treatment developed after the lobotomy was different types of antipsychotic medications. From this point onwards, antipsychotic medications would become the most readily available treatment for mental illness and also the most popular. This is most likely because these types of medication are easy and non-invasive, especially in comparison to a lobotomy. However, there are still some neurosurgeries that are performed in modern medicine; they are just not very common due to the negative stigma associated with them, despite their refinement.⁵

Summary

The lobotomy is a neurosurgical procedure that first took place in 1936 by Egas Moniz. The procedure consists of preparing and cutting open an area of the brain. The two main types of lobotomy are the prefrontal lobotomy and the transorbital lobotomy. Moniz’s theory behind this surgery suggested that mental illness is caused by abnormal neuronal connections and networks within the frontal lobe. Moniz was initially praised for his contributions to psychological disorders and even received a Nobel prize. However, this was shortly followed by controversy and criticism surrounding the procedure. The two main issues were the lack of documentation and any follow-up checks, as well as criticisms about the effectiveness of the procedure. Although the procedure produced positive results in terms of reducing the psychological symptoms that were being initially treated, patients were often left with arguably the worst symptoms. Patients were reported to have significant personality changes and were sometimes even referred to as drooling zombies due to the condition they were left in. Due to all these reasons, it probably doesn't surprise you that the popularity of lobotomies significantly declined after this controversy. Despite this, neurosurgeries did find a place in modern-day medicine; they just aren't as common. Neurosurgeries are an option for certain psychological disorders; however, due to their stigma and invasive nature, alternative routes are normally pursued first. This includes medication, such as antipsychotic medications, or other therapies, such as talking therapies.