In the 1940s Dr. Walter Freeman gained fame for perfecting the lobotomy, then hailed as a miracle cure for the severely mentally ill. But within a few years, lobotomy was labeled one of the most barbaric mistakes of modern medicine.
Prefrontal lobotomies were performed in the 1930s to 70s, but were especially prevalent in the late 1940s to early 50s. The procedure was popular in many countries, racking up a significant number of patients:
In the United States, approximately 40,000 people were lobotomized. In Great Britain, 17,000 lobotomies were performed, and the three Nordic countries of Finland, Norway, and Sweden had a combined figure of approximately 9,300 lobotomies. …In Denmark, there were 4,500 known lobotomies, mainly young women, as well as children with learning difficulties. In Japan, the majority of lobotomies were performed on children with behavior problems. The Soviet Union banned the practice in 1950 on moral grounds, and Japan and Germany soon followed suit.
Freeman believed that mental illnesses were caused by physical defects in the brain. In the spring of 1936 he came across a study conducted by Egas Moniz, a Portuguese neurologist, who took small corings from the brains of 20 patients with anxiety, depression and schizophrenia. Moniz claimed that the procedure eliminated symptoms in a third of them
Freeman built on the work of Moniz. He thought that disrupting the connections in the brain’s frontal lobes would bring patients relief from intense emotions and reset their personalities. Freeman didn’t have a license to perform surgery so he hired neurosurgeon James Watts. Later in 1936, Watts, under the direction of Freeman, performed their first lobotomy. He made incisions on the patient’s head, drilled holes through the skull, inserted a small spatula-like instrument into the brain and sliced through neural fibers connecting the frontal lobes to the thalamus.
After just a dozen operations, Freeman was ready to declare the lobotomy a success. He was confident in the procedure even if some patients relapsed (which prompted second, and sometimes third, operations). And even if there were some troubling side effects.
Edward Shorter, Medical Historian: Freeman’s definition of success is that the patients are no longer agitated. That doesn’t mean that you’re cured, that means they could be discharged from the asylum, but they were incapable of carrying on normal social life. They were usually demobilized and lacking in energy. And they were that on a permanent basis.
Eventually Freeman sought an easier, quicker way to lobotomize patients. By 1946 he devised a new method to access the brain using simple tools—an ice pick and hammer. (The first ice pick was actually taken from Freeman’s kitchen drawer. But modifications were made over time. The tip on earlier versions occasionally broke during the procedure.)
Andrew Scull, Professor of Sociology: Freeman would peel back each eyelid, insert his ice pick and with a hammer tap through the brain, wiggle it about, sever the frontal lobes, withdraw it. And when the patient came to, he or she would be given dark glasses to hide the black eyes they’d been given.
Freeman did the procedures himself, sometimes in his office. It took only a matter of minutes. He did not require an operating room and the equipment was portable, which made it convenient for travelling to mental asylums. (It was at this point that Freeman and Watts—who had grave concerns about the “ice pick” lobotomy being performed by those without formal surgical training—parted ways.)
Initially Freeman’s procedure was heralded in the press as a miracle cure and correspondingly there was a rise in patients receiving lobotomies. But after the advent of antipsychotic medications and the poor outcomes noted in the first clinical trials, the procedure was recognized as barbaric and Freeman himself downgraded in the public eye to a charlatan. The history of medical fads (lobotomy being only one of them) tells us that pioneering doctors, and the medical establishment that embraces them, can fail in their duty to “Do No Harm.” That people, even those possessing medical degrees, are imperfect and can champion poor science.
According to his son, Freeman felt justified in performing lobotomies because eliminating a patient’s intense suffering (and the associated high suicide rate) outweighed the loss of intellect and personality:
Walter Freeman III, son: …suffering the demons of mental illness. And he was trying to cure them of that, and the fact that they might turn into, let’s say, fat slobs afterwards was a small price to pay for the relief from this intense mental anguish. He pointed out repeatedly a very high rate of suicide of these individuals that they can’t stand this mental pain and he was helping them.
A significant number of post-op patients were reduced to a persistent vegetative state. And for others, the operation was fatal. A few patients were fortunate enough to have no noticeable side effects. For them, having a lobotomy appeared to bring great relief. But these patients were relatively rare.
But the patients with successful outcomes still had concerning side effects. They often lost their ambition and weren’t able to make judgments or function well socially. Most were significantly changed, never to be the same person again.
Adapted from: 4thWaveNow, (2017), retrieved from; https://4thwavenow.com/2017/02/10/lobotomy-the-rise-and-fall-of-a-miracle-cure/
2008 PBS documentary, “The Lobotomist,”, retrieved from; http://www.pbs.org/wgbh/americanexperience/films/lobotomist/