top of page
Search

The History of the Lobotomy for Psychiatric Treatment and the Story of Dr. Walter Freeman’s “Lobotomobile”

  • Writer: FibonacciMD
    FibonacciMD
  • 10 hours ago
  • 6 min read

Updated: 1 hour ago

Explore the tragic history of the psychiatric lobotomy and its legacy in modern medicine.


Dr. Walter Freeman about to perform a transorbital lobotomy
Dr. Walter Freeman about to perform a transorbital lobotomy

For a brief period in the mid-20th century, severing nerve connections in the frontal lobe was considered a breakthrough treatment for schizophrenia, depression, and violent behavior.  Psychosurgery, or more specifically, frontal lobotomy, was performed on tens of thousands of patients.  Proponents believed that the procedure allowed severely depressed or violent psychotic patients to leave crowded asylums.  Critics argued that the procedure was unethical, pointing out that it frequently left patients apathetic and emotionally blunted, carried a significant mortality rate, and left some patients in a vegetative state.

 

History

In prehistoric times, trephination, the practice of drilling holes into the skull, was thought to have been performed by shamans or healers to treat conditions such as epilepsy, headaches, or other cerebral illnesses by allowing the demons supposedly causing them to escape.


The first relatively modern psychosurgical procedure prior to the lobotomy was performed in 1888 by Swiss psychiatrist Dr. Gottlieb Burckhardt.  He resected portions of the temporal and parietal lobes in six patients displaying severe psychiatric symptoms and aggressive behavior.  His work was not well received by his colleagues at the time, and he stopped performing the procedure.


At a 1935 scientific conference, Dr. John F. Fulton of Yale, with his colleague Dr. Carlyle Jacobsen, presented an experiment involving bilateral frontal cortex resections on chimpanzees. The surgery caused the animals to become less aggressive leaving them “devoid of emotional expression” and incapable of the “frustrational behavior” typically seen in the species. 


Dr. António Egas Moniz, a professor of neurology at the University of Lisbon, and his colleague, neurosurgeon Dr. Almeida Lima, attended that conference, and later became the leading proponents of psychosurgery.  (Moniz is also known as the “father of cerebral angiography.”)


Severe mental illness in the late 19th and early 20th centuries had no effective treatments, leaving patients confined to psychiatric hospitals for long periods of time.  The use of straitjackets and isolation in cells with padded walls was common, and the number of institutionalized psychiatric patients continued to increase dramatically.  In 1937, the U.S. had “more than 450,000 patients institutionalized in 477 asylums, with nearly one-half of them hospitalized for five years or longer.” 


Austrian neurologist Sigmund Freud developed psychoanalysis near the end of the 19th century, but talk therapy offered limited benefit to patients with severe psychotic disorders.  During the 1930s, physicians also experimented with insulin shock therapy and, later, electroconvulsive therapy (ECT).  Although ECT proved effective for some psychiatric disorders, particularly severe depression, it failed to help many patients with chronic psychosis.  In this desperate therapeutic environment, physicians had few effective options for treating severe psychosis, and psychosurgery appeared to offer a promising solution.


In 1935, Moniz and Lima started performing frontal leucotomies (later called lobotomies), which destroyed the white matter connections between the prefrontal cortex and the thalamus.  Initially, they used alcohol injections but soon turned to surgical procedures, ultimately presenting results on 20 psychiatric patients. They reported that their patients were calmer, easier to manage, and less emotionally reactive after surgery.  In 1949, Moniz was awarded the Nobel Prize in Physiology or Medicine “for the discovery of the therapeutic value of leucotomy in certain psychoses.” (In 2005, some relatives of lobotomy patients petitioned the Nobel Committee to revoke the prize, although the request was denied.) 


In the United States, neurosurgeon Dr. James W. Watts and neurologist Dr. Walter Freeman started performing frontal lobotomies using burr holes on the sides of the skull to access the brain.  In 1942, they published a report on 200 patients who had undergone the procedure, and noted that 63% improved, 23% were unchanged, and 14% either deteriorated or died from the surgery.  Many patients were considered improved because they became calmer and less aggressive, although these changes often came at the cost of initiative, personality, and emotional responsiveness, as well as a significant risk of death.  One of their most famous failures was Rosemary Kennedy, John F. Kennedy’s sister. She was lobotomized in 1941 at the age of 23, in an attempt to treat an intellectual disability combined with mood swings and rebellious behavior.  Following the procedure, she lost much of her ability to walk and speak and required lifelong care.


Dr. Walter Freeman – “Ice Pick” Surgery and the “Lobotomobile“

Freeman later developed the transorbital leucotomy (transorbital frontal lobotomy), where he accessed the brain through the top of the eye socket.  He initially used an ordinary ice pick and later an instrument he invented, called the orbitoclast, to destroy the connections between the frontal lobe and the thalamus.

ice pick lobotomy

This did not require opening the skull as a traditional frontal lobotomy did.  He frequently administered electroconvulsive therapy to his patients prior to the procedure to induce unconsciousness, rather than as a psychiatric treatment.  Freeman’s lack of sterile technique (he frequently did not wear surgical gloves or masks) and the crude nature of the surgery eventually alienated Watts, while also drawing criticism from other neurosurgeons.  As a significant percentage of his patients either showed no change, got worse, or died, the medical community became disenchanted with the procedure.  Freeman, however, was undeterred and remained an enthusiastic advocate of the procedure.  He drove his customized van around the country performing the procedure in hospitals and occasionally even in hotel rooms.  The van was later dubbed the “lobotomobile“ by critics and the press.

Dr. Walter Freeman in his van, later known as the Lobotomobile
Dr. Walter Freeman in his van, later known as the “Lobotomobile”

Freeman bragged he could finish the procedure in less than 10 minutes.  He performed over 3,500 lobotomies in his career, sometimes up to 25 in a day, with some sources attributing approximately 490 patient deaths from his surgeries.  While some desperate families expressed gratitude at the time, Freeman ultimately left many people permanently incapacitated or dead.

ice pick lobotomy headlines

Frontal and prefrontal lobotomies became widely used procedures, and between 1936 and 1956, an estimated 60,000 lobotomies were performed in the U.S. and Europe.  The procedure gained popularity because it offered overcrowded psychiatric hospitals a way to reduce violent or disruptive behavior at a time when few effective treatments existed.


The End of the Lobotomy

In 1952, the first successful antipsychotic medication, chlorpromazine, was released in Europe and was available two years later in the U.S., marking the beginning of an era of effective pharmacologic treatment that would ultimately replace lobotomies.  Additional antipsychotic drugs followed in subsequent years.  However, Freeman continued to perform transorbital frontal lobotomies until he was finally banned from operating in 1967, following the death of what turned out to be his last patient.


Summary 

In an era when little could be done for severe mental illness, lobotomy appeared to many physicians to be a miraculous solution.  However, it often produced devastating consequences, including profound personality changes, cognitive impairment, and death.  One of the controversies surrounding lobotomy was that “improvement” was measured by patient compliance and calmness rather than preservation of personality, independence, or quality of life.  Fortunately, the development of effective psychiatric medications provided safer alternatives and brought this controversial chapter in medical history to an end.


If you liked this article, you may also find these other FibonacciMedicine history of medicine articles interesting:

References 

bottom of page