Lobotomy
Lobotomy is a surgical procedure historically employed to treat severe psychiatric conditions, primarily initiated by early 20th-century physicians who believed that disrupted neural connections in the brain were responsible for emotional and cognitive disturbances. The procedure typically involved severing connections in the frontal lobes, with notable early contributors including Gottlieb Burckhardt and António Egas Moniz, the latter of whom received a Nobel Prize for his work on prefrontal leukotomy. As techniques evolved, Walter Jackson Freeman introduced the transorbital lobotomy, which allowed for quicker and less invasive procedures using a metal instrument inserted through the eye socket.
Despite some initial reports of patient improvement following lobotomies, subsequent evaluations revealed mixed results, and many patients experienced significant adverse effects on their emotions and cognition. By the mid-1950s, the advent of effective antipsychotic medications, such as chlorpromazine, led to a decline in the use of lobotomies, shifting treatment approaches in mental health care. Today, lobotomy is considered a controversial and largely outdated practice, reflective of an era when options for managing severe mental illness were limited.
Lobotomy
- DATE: 1935 forward
- TYPE OF PSYCHOLOGY: Psychopathology
Lobotomy describes several different surgical procedures that all result in the deliberate destruction of brain tissue located just behind the forehead. The procedure was primarily performed on individuals suffering from severe mental disturbances such as schizophrenia or chronic depression.
Introduction
The surgical procedure referred to as a lobotomy was initially proposed by physicians who believed that severe emotional and cognitive disturbances were caused by aberrant neural connections in the brain. It was hypothesized that destruction of this abnormal brain tissue could lead to clinical improvements for major psychiatric disturbances. The lobotomy was used, in part, because there were relatively few treatment alternatives to improve the condition of people who suffered from severe psychiatric conditions such as schizophrenia.
Gottlieb Burckhardt, in 1890, is credited as being one of the first surgeons to perform a psychosurgery procedure on mental patients to address symptoms such as agitation and hallucinations. Others, such as Ludvig Puusepp, in 1910, began to operate more specifically on the frontal lobes of the brain to help a group of patients suffering from manic-depression psychosis. The results of the surgeries were mixed, and Puusepp, like Burckhardt, concluded that the dangerous procedure was not worth the risks to patients.
Years later, in 1935, Portuguese physician and neurologist António Egas Moniz, working with surgeon Pedro Almeida Lima, revived the psychosurgery debate by performing a prefrontal leukotomy. This type of lobotomy involved drilling holes on each side of the top of the head, near the frontal areas, and then inserting a leukotome, a needle that contains a small circular wire that can be deployed. Once the leukotome was in position, the wire was released and the instrument was twisted to cut the white matter of the brain, which contains primarily nerve connections from the frontal lobes to other areas of the brain. In 1949, Egas Moniz became the first physician from Portugal to be awarded the Nobel Prize for Physiology or Medicine for his work on the development of the lobotomy.
Movement Away from Prefrontal Leukotomy
One year after Egas Moniz and Lima’s initial prefrontal leukotomy, American physician Walter Jackson Freeman II and surgeon James Watts began to modify the medical procedures. Freeman and Watts did away with the leukotome and started to drill holes on each side of the head, near the temples. A blunt spatula was then inserted and waved toward the top and back and toward the bottom of the head, effectively severing the neural connections between the frontal lobes and the thalamus. This procedure came to be known as the Freeman-Watts standard lobotomy. This procedure was believed to be more precise in its ability to selectively destroy connections between the frontal cortex and the thalamus and to produce better clinical results. However, Freeman still did not like the fact it was a time-consuming surgery that involved drilling into the cranium and required an operating room.
In 1946, Freeman began to popularize a new version of the lobotomy called the transorbital procedure. Although this procedure had its beginnings in Italy in the late 1930s, Freeman altered the way that brain tissue would be destroyed. Freeman’s procedure involved taking a sharp metal instrument (he first used an ice pick; later specialized tools known as orbitoclasts would be developed) and placing it under the patient’s eyelid. A mallet would then be used to tap the instrument until it broke through the thin bone behind the eye socket. The instrument was then inserted a couple of inches into the head and moved back and forth. Freeman perfected this procedure to the point that he could train another physician to complete it in ten minutes, without the use of a surgical room. This simple transorbital procedure made it possible for lobotomies to be performed on a far larger number of patients. Although Freeman himself performed about thirty-five hundred lobotomies during his career, it is believed that tens of thousands of lobotomies were performed worldwide.
Treatment Effectiveness
Of Egas Moniz’s first twenty patients, fourteen were reported to have recovered or to have substantially improved. The remaining six were believed to have shown some improvement in that they had had more severe symptoms (hallucinations and delusions) before the surgery. Egas Moniz was criticized, however, because he followed his patients for only a few days after the surgery. One follow-up study that was conducted twelve years later revealed that the results were not as positive as initially reported.
Freeman reported that patients, with the exception of those who were suffering from chronic schizophrenia and a limited number of other types of psychosis, generally benefited from the procedure. Follow-up studies have found that it is difficult to determine who will benefit from a lobotomy and what kinds of detrimental effects the procedure will have on emotions and cognition. Also, proselytizers of the procedure overstated the positive outcomes. By the mid-1950s, the introduction of antipsychotic medication such as chlorpromazine (Thorazine) had begun to transform the lives of residential psychiatric patients to the point that lobotomies became seldom used.
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