The idea was that severing those connections and regrowing them could treat symptoms of the mental illness. At the time, it was practically the only effective treatment for severe depression, schizophrenia, suicidal tendencies and other mental disorders. Over the years, lobotomies were done on about 40, to 50, people in the United States in mental institutions and hospitals, El-Hai says.
About 10, of those procedures were transorbital or "ice pick" lobotomies, as Freeman himself referred to the procedure. Doctors used a long, ice pick-like device inserted above the eye through the thin layer of bone, penetrating into the brain's frontal lobe.
Freeman performed about 3, transorbital lobotomies himself, according to El-Hai; many others were done by psychiatrists trained by Freeman as he traveled across the country. While the older, far more invasive prefrontal lobotomy involved anesthesia, then drilling into the skull, the transorbital lobotomy was performed in 10 minutes without any major incisions. According to El-Hai, Freeman performed an all-time high of 24 lobotomies in one day in West Virginia.
According to estimates in Freeman's records, about a third of the lobotomies were considered successful. One of those was performed on Ann Krubsack, who is now in her 70s. Freeman helped me when the electric shock treatments, the medicine and the insulin shot treatments didn't work," she said. But the majority of patients did not do well -- some died, many were paralyzed and in the cases in which patients were well enough to leave the hospital after the procedure, many were left childlike and devoid of personality.
Mainly it meant getting out of the hospital, and these people who returned home from the hospital came home with severe disabilities from their lobotomies," El-Hai says.
Finally in , Thorazine, an antipsychotic medication, became available in the United States, and fewer lobotomies were performed as doctors opted for nonsurgical treatment. But Freeman disagreed with the new trend and continued to perform lobotomies after most of the medical community considered the procedure obsolete. In the s, there were no effective treatments for the severely mentally ill. Doctors had experimented with insulin shock therapy and Electro-Convulsive Therapy with limited success and asylums were filled with patients, including shell-shocked soldiers, who had no hope of a cure, or of going home.
It was against this background that Portuguese neurologist Egas Moniz developed the lobotomy - or leucotomy as he called it - in His procedure involved drilling a pair of holes into the skull and pushing a sharp instrument into the brain tissue. He then swept it from side to side to sever the connections between the frontal lobes and the rest of the brain. The idea was that you had these thoughts running round and round and by interrupting the circuit you would stop these distressing, obsessional thoughts," says the neurosurgeon and writer, Henry Marsh.
Moniz claimed that his first 20 patients had experienced a dramatic improvement - and a young American neurologist, Walter Freeman, was greatly impressed. With his operating partner, James Watts, he carried out the first lobotomy in the US in ; the following year, the New York Times referred to the operation as "the new 'surgery of the soul'". But to begin with it was complicated and time-consuming. While working at St Elizabeths Hospital in Washington DC, the largest mental hospital in the country, Freeman had been horrified by "the waste of manpower and woman power" he witnessed there.
He was keen to help patients get out of hospital, and set himself the goal of making lobotomy quicker and cheaper. In he devised the "transorbital lobotomy" in which steel instruments resembling ice picks were hammered into the brain through the fragile bones at the back of the eye sockets.
The operating time was drastically reduced, and patients did not need an anaesthetic - they were knocked out before the operation using a portable "Electro-Shock" machine. Freeman would drive across America during the long summer holidays to conduct his "ice-pick lobotomies" - sometimes taking his children along.
Initially described as a surgery of last resort for psychiatric patients for whom all other treatments had failed, Freeman began to promote lobotomy as a cure for everything from serious mental illness to post-natal depression, severe headaches, chronic pain, nervous indigestion, insomnia and behavioural difficulties. Many patients and their families were grateful to Freeman, who kept boxes filled with the letters of thanks and Christmas cards they sent him.
But in other cases the results were disastrous. She was left incontinent and unable to speak clearly after a lobotomy at the age of Over the course of his career, Freeman conducted lobotomies on 3, patients, including 19 children, the youngest just four years old. The reason for its popularity was simple - the alternative was worse. The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution.
But by far the most prolific lobotomist in the country, and indeed the world, was the neurosurgeon Sir Wylie McKissock, based at the Atkinson Morley hospital in Wimbledon. He believes his former boss performed around 3, lobotomies, as part of his famously speedy approach to surgery. Very quickly done," says Dr Gould. As well as operating at Atkinson Morley, McKissock would travel across the south of England at weekends, performing extra leucotomies at smaller hospitals.
He says the operation could have dramatic benefits for some patients, including one who was terrified of fire. However, he had increasing doubts about lobotomy, especially for patients with schizophrenia.
He found that around a third benefited, a third were unaffected and a third were worse off afterwards. Later that year, Moniz and his colleague Almeida Lima performed the first human lobotomy experiments, operating on 20 people. The doctors targeted the patients' frontal lobes because that brain region is associated with behavior and personality. Moniz reported the surgeries as a success in treating patients with conditions such as depression, schizophrenia, panic disorder and mania, according to an article published in in the Journal of Neurosurgery.
But the operations had severe side effects, including increased body temperature, vomiting, bladder and bowel incontinence and eye problems, as well as apathy, lethargy and abnormal sensations of hunger, among others. The medical community was initially critical of the procedure, but nevertheless, physicians started using it in countries around the world. Moniz's first lobotomy procedures involved cutting a hole in the skull and injecting ethanol into the brain to destroy the fibers that connected the frontal lobe to other parts of the brain.
Later, Moniz developed a surgical instrument called a leucotome, which contains a retractable loop of wire that, when rotated, cuts a circular lesion in brain tissue. Italian and American doctors were early adopters of the lobotomy.
American neurosurgeons Walter Freeman and James Watts were the first to perform the procedure in the United States in , making "nine cores in the white matter of each frontal lobe" of a year-old patient, according to a report in the journal The Lancet. They adapted Moniz's technique to create the "Freeman-Watts technique" or the "Freeman-Watts standard prefrontal lobotomy," in which a surgeon drilled holes in the patient's skull, then inserted and rotated a knife to destroy brain cells, targeting connections between part of the prefrontal lobes and a region in the thalamus, which is a grey-matter structure toward the center of the brain, The New York Times wrote in in Dr.
Watts' obituary. The Italian psychiatrist Amarro Fiamberti developed a procedure that involved accessing the frontal lobes through the eye sockets; that procedure would inspire Freeman to develop the transorbital lobotomy in , a method that would not require a traditional surgeon or operating room, researchers reported in in the journal Frontiers in Neuroscience.
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