Day 6 of Our 31 Day Series How Medicine Got It Wrong

The Lack Luster Labors of Lobotomies

Lobotomy, also known as prefrontal leukotomy, is a neurosurgical procedure that involves the removal or disconnection of the prefrontal cortex of the brain, which was believed to be responsible for controlling emotional and behavioral impulses. The procedure was first introduced in the 1930s and gained popularity in the 1940s and 1950s as a treatment for various psychiatric disorders.

Walter Freeman and James Watts were two American neurologists who popularized the lobotomy procedure in the United States. Freeman, in particular, became known for his "ice-pick" lobotomy technique, which involved inserting a sharp instrument (often an ice pick) through the patient's eye socket and into the brain to sever connections in the prefrontal cortex. This method was often performed without anesthesia and sometimes in under 10 minutes.

Lobotomies were initially used to treat severe mental illnesses, such as schizophrenia and manic-depressive disorder, which were believed to be caused by overactivity in the prefrontal cortex. However, the procedure was also used to treat a wide range of other conditions, including anxiety, depression, and even homosexuality.

The patient population that was targeted for lobotomies was often made up of those who were deemed difficult or unmanageable by psychiatric institutions. This included patients who were agitated, violent, or suicidal, as well as those with intellectual disabilities or brain injuries.

While some patients did experience improvements in their symptoms after lobotomy, the outcomes were mixed, and the procedure was often criticized for its high mortality and complication rates. Estimates suggest that up to 10% of patients who underwent lobotomy died as a result of the procedure, while many others experienced severe side effects, such as seizures, paralysis, and personality changes.

One notable patient who underwent a lobotomy was Rosemary Kennedy, the sister of President John F. Kennedy. In 1941, when Rosemary was 23 years old, Freeman performed a lobotomy on her without the knowledge or consent of her family. The procedure left her severely disabled and unable to care for herself, and she spent the rest of her life in an institution.

It is estimated that over 40,000 lobotomies were performed in the United States before the procedure fell out of favor in the 1950s and 1960s. This was due in part to the introduction of new psychiatric medications, which offered a safer and more effective treatment option for many mental illnesses. The widespread use of lobotomy also led to public scrutiny and criticism of the procedure, and it eventually fell out of favor as a mainstream psychiatric treatment.

In summary, lobotomy was a controversial neurosurgical procedure that was popularized in the mid-20th century as a treatment for a wide range of psychiatric disorders. The procedure was associated with high mortality and complication rates, and its use declined in the 1950s and 1960s with the introduction of new psychiatric medications and public scrutiny of its use.

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References

1. "Lobotomy: Definition, History, and Overview" by Leonard L. Glass and Eric M. Plakun. In UpToDate, Waltham, MA: UpToDate Inc. (Accessed on February 15, 2023)

2. "The Lobotomy Files: A Forgotten Era of Psychosurgery" by Jack El-Hai. Mayo Clinic Proceedings, Volume 83, Issue 5, 2008, Pages 554-558.

3. "Ice Pick Lobotomy: A Case Study and Ethical Analysis" by Darryl K. Brown and Elizabeth A. Brown. Journal of Medical Ethics, Volume 31, Issue 12, 2005, Pages 727-729.

4. "Rosemary Kennedy and Her Lobotomy" by Michel Paradis. Dana Foundation Blog, June 25, 2018.

5. "The Lobotomy Era" by Tom Valeo. Psychology Today, November/December 1993.

6. Image: When Faces Made the Case for Lobotomy, NIH Record