Throughout human history, disciplines such as medicine, psychology, psychiatry and biology have had dark episodes.

From eugenics, to concentration camp doctors, to the defence that racial differences explain differences in intelligence, there are many cases in which science was wrong and damaged a whole society. The principle of “primum non nocere” (“first do no harm”) has not always been respected, although there may have been good intentions behind it.

This is the case with lobotomy, a practice used to improve the lives of patients with mental disorders and to free them from the bad life they led in the asylums of the mid-20th century. However, this practice proved to be very harmful, giving rise to a set of negative effects that could not be said for sure if they meant an improvement or not in the quality of life of those intervened. In this article we will review the effects of lobotomy on the lives of patients undergoing surgery , in addition to a brief history of this technique.

Brief history of lobotomy

Lobotomy has been a technique that, from the beginning, has been a huge controversy in the field of psychiatry. Its roots go back to the primitive trepanations of ancient cultures . This type of intervention consisted of opening holes in the skull and “expelling” the bad spirits that were located in the head. According to their beliefs, these cultures maintained that these entities were responsible for mental disorders.

However, lobotomy itself is much more modern, and was developed during the 20th century. The Portuguese António Egas Moniz was the one who laid the foundations of this technique through his first leukotomies , with the aim of treating and curing psychotic disorders. This intervention consisted of cutting the connections of the frontal lobe with the rest of the brain, arguing that this would reduce the problematic symptomatology. He won the Nobel Prize for Medicine in 1949 for being responsible for this technique.

Later, Walter Freeman, a doctor with notions of surgery and neurosurgery, modified this technique from his contact with Moniz’s leukotomy, and thus created the lobotomy. Reformulating the postulates of the Portuguese scientist, Freeman maintained that behind the mental disorders there was an interaction between the thalamus and the prefrontal cortex, and that it was necessary to destroy the connections between both structures.

To perform his technique, Freeman reached a point where he needed only about ten minutes, and as a surgical instrument, an ice pick was sufficient. Here, the word “ice pick” is not a metaphor; Mr. Walter Freeman used tools taken from his own kitchen (according to one of his sons) in order to use them on the brain of his patients.

The intervention was quite simple. First, I took the aforementioned kitchen instrument and inserted it under the upper eyelid to reach the frontal lobe and, with a hammer, I tapped to “punch” (never better) the aforementioned connections. A particularity of this operation, unthinkable today, is that it was a blind operation. What does this mean? It means that Mr. Lobotomist did not know exactly where he was going .

In short, a lobotomy consisted of sticking an ice pick into the patients’ brains for about ten minutes and trying their luck. During the process, the patient was awake, and questions were asked. When what the patient was saying made no sense, it meant that it was a good time to stop.

It should be said that at that time little was known about the great importance of the frontal lobe , a region which is in charge of executive functions: concentration, planning, working memory, reasoning, decision making…

Effects of cerebral lobotomy

Although the aim of this surgery was to improve the patients’ condition and reduce their symptoms, the fact is that both in the short and long term the patients showed signs of worsening . In fact, even the defenders of this technique and expert lobotomists recognised that after the intervention the patients showed changes in their personality and intelligence.

Walter Freeman himself coined the expression “surgically induced childhood” to refer to the post-operative state manifested by lobotomized patients. In essence, after the lobotomy, many patients seemed to behave like children . However, Freeman seemed to be convinced that this was only a temporary phase. According to this physician, after a period of “maturation” the patients would behave like adults without disorder or with some improvement.

But in practice this did not happen. It was only a matter of time before the lobotomy technique was shown to be clearly counterproductive and clearly detrimental to the health and autonomy of the patients.

The first symptoms manifested by lobotomised people were usually stupor, confusional state and urinary problems such as incontinence , with a clear loss of sphincter control. Along with this, there were alterations in eating behaviour, with an increase in appetite to such an extent that a lot of weight was gained after the operation.

Personality was an aspect that was very affected . There was less spontaneity, less self-care and less self-control. The capacity to take initiative was reduced and there was less inhibition in the face of pleasant stimuli. Inertia was another of the most common effects in people who were lobotomized.

As mentioned above, the frontal lobe was involved, which is in charge of executive functions. Therefore, it was normal to see that capacities such as planning, working memory, attention and others were also diminished . There was also an effect on social cognition, with some being unable to put themselves in the place of others because of this.

The “remedy” calmed the patients, causing their activation to decrease, but not because the disorder had magically disappeared, but rather because they had been turned into zombies. To make matters worse, many patients began to suffer convulsions after being operated on , supporting the famous saying that “the cure is worse than the disease”.

However, the most clearly serious effect was death. According to some sources, one in three patients did not survive this type of intervention , despite its short duration. There were also multiple cases of lobotomized persons who ended up committing suicide because of it.

Bibliographic references:

  • Cosgrove, G. Rees; Rauch, Scott L. (1995). “Psychosurgery. Neurosurgery Clinics of North America.
  • Cooper, Rachel (2014). On deciding to have a lobotomy: either lobotomies were justified or decisions under risk should not always seek to maximise expected utility. Medicine, Health Care and Philosophy. 17(1):143 – 154.