Lobotomy is a neurosurgical procedure that involves altering the brain. Specifically, in the most common form of lobotomy practiced in the mid-20th century, surgeons targeted the frontal lobe, the area at the front of the brain responsible for higher-level functions like planning, decision-making, and personality. The standard lobotomy procedure, prevalent in the 1940s and 1950s, entailed creating holes in the skull to access the brain tissue, severing connections between the frontal lobe and another brain structure called the thalamus.
This procedure was pioneered by Portuguese neurologist Egas Moniz, who was even awarded the Nobel Prize in 1949 for his discovery of the therapeutic value of leucotomy in certain psychoses. Lobotomies were performed on tens of thousands of individuals, primarily to treat conditions like schizophrenia, mood disorders, and obsessive-compulsive disorder (OCD), particularly when other treatments were ineffective.
The Purpose of a Lobotomy
In the era before modern psychiatric medications and therapies, lobotomy emerged as a radical intervention for individuals suffering from severe mental illnesses that did not respond to available treatments. During the 1940s and 1950s, options for psychiatric care were limited, often consisting of insulin coma therapy and electroconvulsive therapy (ECT). Mental institutions were often overcrowded with patients experiencing significant distress.
Lobotomy was introduced as a method to alleviate the suffering of these patients. The primary goal of the surgery was to disrupt the nerve pathways connecting the frontal lobe to the thalamus, known as the thalamo-frontal radiation. Various techniques were developed to achieve this, including the use of surgical instruments like brain cannulae and leukotomes, as well as methods involving chemical injections, electrocoagulation, and even ultrasonic waves to destroy brain tissue.
By today’s medical standards, these surgical methods are considered crude and risky. However, during their time, lobotomies were seen as a potential solution for desperate situations. A significant study conducted in the United States revealed that approximately 44% of patients who underwent lobotomy were discharged from hospital care following the procedure. Similar outcomes were reported in studies from Canada (45%) and England and Wales (46%), suggesting a perceived improvement in patient conditions that allowed for release from institutional settings.
Conditions Lobotomy Aimed to Treat
Lobotomies in the 1940s and 1950s were primarily intended for individuals who had endured mental disorders for extended periods and had not found relief through other means. The conditions treated with lobotomy included a spectrum of severe psychiatric illnesses:
- Obsessive-compulsive disorder (OCD)
- Severe depression
- Psychosis
- Schizophrenia
- Bipolar disorder (Manic depressive psychosis)
- Chronic neurosis
- Psychopathic personality
The fundamental principle behind lobotomy was the belief that disrupting the connections between the frontal cortex and other brain regions, particularly the thalamus, would diminish the flow of abnormal and overwhelming stimuli to the frontal lobe. It was hypothesized that these excessive stimuli contributed to impulsive and violent behaviors associated with mental illness. By performing a lobotomy, the aim was to induce a state of calmness and docility in patients, making it possible for them to return home and live with their families, albeit with significant alterations to their personality and cognitive functions.
Alt text for the image: Diagram illustrating the frontal lobe of the brain, the target area in a lobotomy procedure.
