"We went through the top of the head, I think she was awake,” Dr Walter Freeman recounted. “She had a mild tranquiliser. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch.”

Freeman was a neurologist and psychiatrist who, in November 1941, diagnosed 23-year-old Rose Marie Kennedy – President John F. Kennedy’s sister – with ‘agitated depression’.

Without her family’s knowledge, Rose Marie’s father consented to a prefrontal lobotomy, a procedure which rapidly diminished her mental capacity and left her partially paralysed, incoherent and incontinent.

Neurologist awarded with 1949 Nobel Prize for psychosurgery

Freeman has been credited as the father of lobotomy, after teaming up with neurosurgeon James Watts to perform the first lobotomy in America in September 1936.

Convinced that “that cutting certain nerves in the brain could eliminate excess emotion and stabilise a personality,”, he heavily propagandised the procedure and eventually called it the “Freeman-Watts Standard Procedure”, much to the reluctance of other American neurosurgeons who were suspicious and resistant against his work.

But the true origins of lobotomy did not stem from Freeman. The idea of a lobotomy – or “lobe cutting” – was actually conceived in 1890 by a German scientist, Friederich Golz, who reported that animals became tamer after their temporal lobes were removed. This finding inspired physician Gottlieb Burkhard to operate on six of his schizophrenic patients – he removed parts of their cortex and reported that they became calmer after the procedure, but his methods were criticised and rejected by medical authorities at the time.

The idea re-emerged in the 1930s, when a scientist from Yale University named Dr John Fulton observed that aggressive chimpanzees turned calm and manageable after their frontal and prefrontal cortex were damaged.

Leucotome. Photo credit: Nobelprize.org
Leucotome. Photo credit: Nobelprize.org

Based on Fulton’s ideas, Professor Antonio Egas Moniz from the University of Lisbon Medical School proposed to surgically cut the nerve fibers connecting the frontal and prefrontal cortex to the thalamus, to alleviate psychosis in psychiatric patients. Collaborating with fellow neurosurgeon Dr Almeida Lima, Moniz developed the leucotomy – trepanning two sides of the brain and inserting a special wire knife or “leucotome” to severe the brain fibres with several sideways movements – a procedure he claimed showed improvement in symptoms in agitated or depressive patients.

"Prefrontal leucotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder,” he said.

Moniz ended up being awarded the Nobel Prize in Medicine in 1949.

Lack of alternative therapies led to popularity of lobotomies

Freeman only began promoting lobotomy in America after reading Moniz’s reports. In January 1946, he performed the first documented transorbital “ice-pick” lobotomy. His innovation followed his dissatisfaction with the messiness and duration of the older techniques of lobotomy, which required surgical trepanning. Instead, he used an ice-pick and a hammer to penetrate the skin, bone and meninges through the tear duct in a single plunge, and moved the sharp tip back and forth.

The sight of the procedure was as ghastly as its description, and many seasoned neurosurgeons could not stand the sight of Freeman’s lobotomies.

Walter Freeman performing an ice-pick lobotomy. Photo credit: Medical Bag
Walter Freeman performing an ice-pick lobotomy. Photo credit: Medical Bag

But by 1949, the transorbital lobotomy had caught on. Psychiatric institutions were met with an alarming increase in admissions following World War II, but there were no alternative therapies available. Between 1939 and 1951, over 18,000 lobotomies were performed in the country, widely as a last-resort to treat severely mentally ill patients. Families who were eager to get rid of difficult relatives would also submit them to lobotomy.

Lobotomies were not performed under traditional anaesthesia. Instead, patients were shocked unconscious with a massive surge of electricity just before the ice-pick was plunged into their head.

Worse, most of these patients were incapable of informed consent – or were not given a choice in the matter at all.

"There were some very unpleasant results, very tragic results and some excellent results and a lot in between," said Dr Elliot Valenstein, who authored a book about the history of lobotomies.

"There was no other way of treating people who were seriously mentally ill," he says. "The drugs weren't introduced until the mid-1950s in the United States, and psychiatric institutions were overcrowded... (Patients and their families) were willing to try almost anything."

Development of antipsychotic drugs diminished need for lobotomy

It was only around 1950s when people began to heavily object lobotomies.

The lack of scientific evidence to back its benefit, countless reports of irreversible damage to the patients’ brains, as well as the appearance of novel antipsychotic drugs such as chlorpromazine in 1952, made lobotomy a less favoured choice for treatment of schizophrenia. As neurosurgeons began to abandon lobotomy for more humane approaches of treatment, the number of lobotomies dropped dramatically in the 1960s.

Fortunately, lobotomies are now rarely performed, if at all. Freeman himself performed his final ice-pick lobotomy in February 1967, after his patient, Helen Mortenson, died of a brain haemorrhage. Her death ended his career, but by then he had performed an astonishing 2,500 procedures across the country. MIMS

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