Highly controversial even in its heyday, lobotomy was just one of many experiments within the realm of psychiatry in the quest to find a cure for mental illness. Due to new discoveries about the functions of different areas of the brain at the end of the 19th century, new ideas about surgical treatments for mental maladies became popular from the 1880s right through to the 1950s.
The idea that mental illness could be cured by operating on the frontal lobe was inspired by a study conducted on chimpanzees in 1935, which found that the removal of the prefrontal lobe caused a number of emotional changes in the primates. A neurologist from Lisbon, Egas Moniz, took the findings as inspiration to begin developing a similar treatment for his human patients. The procedure was picked up in the US by Walter Freeman and James Watts, who developed the standard surgical procedure which came to be known as lobotomy.
Destructive Surgery
Lobotomies were performed via two different methods. Moniz’s method involved cutting into the white matter of the prefrontal lobe using a whisk-like instrument. The instrument was moved back and forth, severing the nerve connections; the front of the brain would be effectively scrambled. In 1946, Freeman and Watts developed the trans-orbital lobotomy, where a pick was inserted through the eye socket to sever the nerve connections. Both techniques were extremely imprecise, and it was impossible to guarantee what the outcome of the procedure would be. Indeed, even neurosurgeons who promoted the use of lobotomies often reported at best a 50% ‘success’ rate.
The procedure essentially worked by destroying the part of the brain that manages executive function. The prefrontal cortex manages our ability to differentiate good and bad, predict expectations based on our actions, our ability to suppress urges that might have socially unacceptable consequences. It also plays an important role in decision making, and our ability to express ourselves as individuals.
In short, lobotomy destroyed a patient’s personality and their ability to regulate their behaviour through cognitive decision making. This made them docile and pliable; in some psychiatrists opinions, the perfect patient. Lobotomies were therefore typically performed on patients who were considered difficult to care for, and the procedure was disproportionately carried out on women.
A Famous Case
One of the most famous cases of lobotomy was the one performed on Rosemary Kennedy, the eldest sister of President John F Kennedy. Though details of her life are unclear, it is thought that she may have had some form of learning disability, and may have been suffering from depression. Fearing that her somewhat erratic behaviour would embarrass the family and harm her siblings’ political careers, her father arranged for her to have a lobotomy. In 1941, when Rosemary was 23 years old, Watts and Freeman performed a transcranial lobotomy, inserting an instrument through an incision in her skull. In a disturbing example of the inaccuracy of the procedure, Watts explained; ‘We made an estimate on how far to cut based on how she responded.’ When Rosemary began to become incoherent, they stopped.
As one could expect, the procedure was not a success. Rosemary was left with the mental capacity of a two year old. She could no longer walk or speak properly, and she became incontinent. Like so many other women who were subjected to lobotomies, Rosemary spent the rest of her life hidden from the rest of the world.
Lessons Learned
Today, we recognise that lobotomy was an indefensible violation of patient rights. In retrospect, the procedure offered no curative or therapeutic value, and served only to pacify people who were too difficult to care for. It was plain that lobotomies caused massive and irreparable damage, and even those in the psychiatric professions viewed it with growing unease. Thankfully, it was one of the first procedures to be dropped in favour of drugs at the advent of the 1950s, but it should still serve as a potent reminder of the dangers of unchecked medical hubris.
Sources and Further Reading
https://en.wikipedia.org/wiki/Rosemary_Kennedy
Shorter, E., A History of Psychiatry, (1997)