In 1935, the Portuguese neurosurgeon and psychiatrist António Egas Moniz performed a surgical intervention called leukotomy.

It consisted of making two holes in the front of the skull, and injecting alcohol directly into the frontal lobe of the brain through them. Years later, this practice was called lobotomy , and its popularity in the world of psychiatry led to Egas Moniz winning the Nobel Prize for Medicine in 1949. What had happened?

The birth of lobotomy

The etymology of the term leukotomy serves to give us an idea about the objective with which the lobotomies were performed; leuko means white, and tome means cut. Egas Moniz believed that certain mental disorders could be cured by causing some areas of the brain where the frontal lobe communicates with other areas of the brain to break down. That is, damaging parts of the white matter of the brain, so called because it is dominated by axons (the parts of the neuron that stretch out to communicate with distant nerve cells).

This neurosurgeon started from the idea that it was possible to considerably reduce the intensity and frequency of the symptoms of psychiatric disorders by causing all their psychological functions to decline. A part of the intellectual capacity and personality of each patient was sacrificed to try to bring him closer to healing.

Walter Freeman’s Lobotomy

Egas Moniz’s proposal may seem brutal today, but in its historical context it was well received in the field of non-Freudian psychiatry. In fact, in 1936, neurosurgeon Walter Freeman imported this type of intervention to the United States and, after giving it the name of lobotomy, he made it popular all over the world.

Freeman also made some changes to the procedure. After stunning patients with electroshock, instead of drilling two points in the skull and inserting spikes through them, he used ice-picklike instruments that he introduced into the eye socket between the eye and the part of the bone on which the eyebrow is located, and removed by trying to “sweep” parts of the frontal lobes of each brain hemisphere.

Since the wounds did not reach the deepest part of the brain, vital structures were not damaged and, in some cases, patients hardly noticed any changes during the first hours. In any case, the nervous system of these people was marked forever, and their way of behaving and experiencing life, too.

Why did lobotomy become popular?

It is hard to believe that the practice of lobotomies enjoyed a good reputation for a period, but the truth is that it did.

After making his method known, Freeman performed over 2,000 lobotomies during his career . The practice of lobotomy spread rapidly throughout the Western world, and it came to be considered one of the most useful tools that medicine could have.

People who voluntarily or involuntarily underwent lobotomy were not only patients with serious mental disorders such as schizophrenia or severe depression; on many occasions this operation was used to solve cases of behavioural problems, disobedient adolescents, etc. Freeman’s method may have been brutal, but a good part of society was willing to embrace that brutality.

The idea of ending deeply rooted behavioural problems with a few sessions was very tempting. In addition, if lobotomized people were more “calm”, one could end conflicts and relational problems simply by putting the focus on an individual who had to “change”.

The logic behind this good reception by a large part of the health institutions has to do with the hygienist mentality they held. At that time people with psychiatric disorders were crowded into overcrowded hospitals , and were often subjected to physical or psychological violence.

Lobotomy provided an opportunity to make these kinds of problems less obvious, easier to ignore. Patients were still sick, but after the operation they were less noticeable. The problem was solved in fiction and, in any case, the alternative to this practice was also terrible.

The emergence of psychopharmaceuticals and the end of the ice pick

The popularity of lobotomies began to plummet not because of a spontaneous awareness on the part of the population, but because of a rather less romantic event: the appearance of the first generations of psychoactive drugs for serious mental disorders in the mid-1950s.

Lobotomy promised an apparent quick solution to behavioural problems after a few sessions, a commercial exchange that, considering the many problems it could solve (in the family, at work, etc.), paid off. However, psychotropic drugs were not only much more effective , but also much easier to apply.

Similarly, when one of Freeman’s patients died from bleeding caused by the neurosurgeon, it became clear that the risks of lobotomy were high. In the 50s and 60s, many countries prohibited this kind of intervention , and the USSR even considered it “contrary to human rights”.

Anyway, the lobotomy had enjoyed such a good image that it still took a couple of decades to appear. The simplicity of the procedure (which could be performed in less than 10 minutes) continued to make it an attractive option for when there was no family or public monitoring.

Bibliographic references:

  • Cosgrove, G. Rees; Rauch, Scott L. (1995). “Psychosurgery” Neurosurg. Clin. N. Am.
  • Martínez, Luis Antonio (2009). Regressive reconstructive therapy. Books on the Web.