A LOBOTOMY PRIMER

The term “lobotomy” has crept into everyday parlance to refer to someone who is out of it, a lump on a log. A lobotomy does change a person’s personality, that is what it is designed to do, but the effects vary considerably from individual to individual. This was part of the problem with its introduction. Neurosurgeons were, in effect, experimenting when they performed the procedure and experimenting no less on human beings. My mother was one of them. The other problem was that the procedure soon turned from being a last-resort intervention into being the first-resort. My mother saw Walter Freeman, the major proponent of lobotomies in the United States, on a Friday and was given a lobotomy the following Monday.

So what is a lobotomy and how did the extensive use of it come about? The answer to the latter is a cautionary tale for today.

A lobotomy is a surgical procedure that cuts the neural connections between the frontal lobes and the rest of the brain. As I explain in my memoir Examined Lives, there are various types of “lobotomies.” Although lobotomies were performed by doctors in many countries, we are most familiar in the United States with those performed by the doctor who lobotomized my mother and who pioneered what is known as the transorbital lobotomy, or as it was more popularly known as the “ice pick” method. According to Freeman’s own description in an article entitled “Transorbital Lobotomy” in the American Journal of Psychiatry (108, No. 11: 824), he would first give a series of electric shocks every two minutes to knock the patient out. He would then cover the patient’s nose and mouth with a towel, and aim the ice pick device he used, called a leucotome, under the upper eyelid. A hammer was used to drive the leucotome through the orbital bone so he could swish it back and forth to make the cuts. He did this without any imaging of the inside of the skull. He literally could not see what he was doing.

Ice Pick Instruments

As I said earlier a lobotomy was designed to change a patient’s personality. In supposed return for relief from mental anguish, the patient lost other aspects of his or her personality and cognitive functions. All the evidence points to it being mainly “her.” In the case of my mother she lost what my aunt called her “sparkle.” It was not until researching Examined Lives that I discovered a mother I had never known—vivacious, competent and so full of life.

The idea of doing a lobotomy arose out of research on chimpanzees that was reported by two Yale University professors at a major neurological conference held in London in 1935. The Portuguese neurologist Egas Moniz, who later received the Nobel Prize in Medicine or Physiology for his work, was impressed by the research and devised the first type of lobotomy for humans, using it on 20 severely mentally ill patients. It must be remembered that this was a time when there were no drugs to treat mental illness and there was no oversight of medical research. Although Moniz’s results were certainly not uniformly successful, he was excited enough by them to almost immediately publish a monograph without waiting for further follow-up of the patients. As the monograph circulated, there was world-wide interest in the procedure, including interest by Walter Freeman, a fellow neurologist.

It is Freeman who is responsible for the dramatic increase in the 1940’s of lobotomies in the United States. He was hardly the only doctor who performed them. But he was the main crusader. It was not only his development of the transorbital lobotomy, which he envisioned as a quick, inexpensive means of bringing relief that a psychiatrist could perform in his/her office rather than in a hospital setting, but his showmanship that propelled the lobotomy craze. Although there was criticism from the start within the medical community, Freeman muted it by his graphic means of captivating the public media. He not only was friendly and engaging with reporters; he went on tours, mainly to state mental institutions, performing multiple lobotomies a day for an audience without the benefit of mask or surgical gloves. Eventually, however, the tide turned against him. Criticisms began to appear in the press and there were fewer and fewer places that allowed him to do the procedure.

MOHAI,Seattle Post-Intelligencer Collection. 1956.5,25616

The rapid expansion of the use of lobotomies not only for the most severely mentally ill patients but even for conditions such as ulcerative colitis is a lesson for today when we witness the opiate epidemic and other misuses of medical discoveries for conditions they were not designed to treat. The losers in the end are not only the patients but their families.

For me, the circumstances leading up to my mother’s lobotomy and its aftermath described in Examined Lives had a major impact on my life, leading years later to three major depressions. My mother’s lobotomy had not solved her issues; she in fact became psychotic and had to be institutionalized. She found there, ironically, the right people to help her later leave the institution and lead a productive life. But in the course of it I lost my mother. My parents divorced with my father’s having custody and I saw her rarely. It was in writing Examined Lives that I rediscovered her.

If you are interested in more information on Walter Freeman and lobotomies, you might want to look at the YouTube of the PBS documentary “The Lobotomist” (2008).

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