Over the years, I’ve spent a lot of time investigating the history of lobotomy, and particularly the kinds of visual evidence doctors used to support this practice. It’s part of the book I’m finishing, Depth Perception, which is broadly about the ways doctors have used film and photography during the twentieth century. In one of my chapters, I write about the lobotomist Walter Freeman, who was a prolific photographer, describing what he thought his patient photographs showed, and how our understandings differ today.
I get a lot of questions about lobotomy from people who find me on the Web, and I know other people who specialize in the subject do, too. I thought it might be helpful for me to write down some of the answers to the most frequent questions I get about the practice of lobotomy in the United States.
I’m sorry to say that I can’t answer individual questions on this subject, but I do provide references to some excellent books on the subject below.
What is a lobotomy?
The term “lobotomy” (often used interchangeably with “psychosurgery” during the period in which it was practiced) refers to an operation that severs the connections to and from the prefrontal cortex, in the anterior part of the brain’s frontal lobe. Generally, it was performed in one of two ways. From 1936 to 1945, lobotomies were generally performed by drilling two holes in the skull, near the patient’s temples, inserting a long instrument called a leucotome, and severing the connections to and from the prefrontal cortex. From 1945 until 1967, lobotomies were generally performed by inserting a long, thin instrument into the back of a patient’s eyeball, puncturing the thin orbital plate above the eye and rotating the instrument so that it destroyed the connections to the brain’s frontal lobe. This second type of lobotomy is called the transorbital lobotomy.[1. Pressman, Jack David. Last Resort: Psychosurgery and the Limits of Medicine. Cambridge History of Medicine. Cambridge, U.K: Cambridge University Press, 1998.]
When was lobotomy practiced?
The first lobotomy was performed in Portugal in 1935. The last lobotomy appears to have been performed in 1967 in the United States. The high point for lobotomy was the late 1940s and early 1950s, following the introduction of the transorbital lobotomy and renewed attention to psychiatry following World War II.[2. Pressman 1998.]
Who got a lobotomy?
The medical historian Jack Pressman wrote, “The simple truth was that one could grow up in a socially powerful family, consult the most respected physicians in the nation, and enter the finest institutions money could buy — and still end up with a lobotomy.”[3. Pressman 1998, 4.] People often think of lobotomy as a treatment confined to impoverished medical institutions, but the procedure was at the forefront of medical science at the time, so its use was quite widespread.
What are the effects of a lobotomy?
People are often frustrated by my answer to this question, which is: It depends. There are no long-term, systematic follow-up studies of lobotomized people, so evidence is largely anecdotal or hypothetical. In addition, lobotomy could be performed in different ways, and not always precisely. However, in today’s terms, the frontal lobe is understood as the seat of the executive function, which controls cognitive management processes like impulse control, judgment, and self-reflection. Therefore, producing a lesion in the frontal lobe would likely have produced effects that we might understand as deficits: a lack of self-control, indifference to one’s surroundings, and an inability to reflect on one’s behavior.[3. See, for example, Stuss, Donald T. “Disturbance of Self-Awareness After Frontal System Damage.” In Awareness of Deficit After Brain Injury Clinical and Theoretical Issues, edited by George P Prigatano and Daniel L Schacter, 63–83. New York: Oxford University Press, 1991.]
Did lobotomy work?
Again, it depends, this time on your definition of “work.” During lobotomy’s heyday, mainstream psychiatry emphasized integration into family and work as the major indicators of mental health. To be psychiatrically healthy was not necessarily to demonstrate self-knowledge or insight; it was the ability to leave an institution, perform household tasks, and, ideally, return to the workplace. If a lobotomized patient could perform these functions, psychiatrists were likely to see his or her condition as improved.[4. Pressman 1998.]
Did people consent to lobotomies?
Today, we have laws that require informed consent before physicians perform a surgical procedure. But for most of the period lobotomy was practiced, those laws didn’t exist. Even the term “informed consent” didn’t exist until 1957. Freeman seems to have attempted to obtain cursory consent from patients or their families, but standards for consent were nothing like they are now. For more on the history of informed consent during this period, please see Ruth R Faden, Tom L Beauchamp, and Nancy M. P King, A History and Theory of Informed Consent (New York: Oxford University Press, 1986), especially pages 77 through 87.
How many lobotomies were performed?
We don’t really know. We think there were more than 20,000 performed in the United States, and tens of thousands more elsewhere.[4. Braslow, Joel T. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Medicine and Society 8. Berkeley: University of California Press, 1997.]
What was Walter Freeman’s motivation?
Walter Freeman, the world’s foremost proponent and practitioner of lobotomy, performed, by his own estimate, more than 2,500 of the operations. Walter Freeman was a strange character, brash and arrogant, but all of the evidence that I’ve read suggests that he truly believed that lobotomy was the best option for troubled patients. For more insight into Walter Freeman’s motivation, please see Mical Raz’s The Lobotomy Letters (2013) and Jack El-Hai’s The Lobotomist (2005).
I think that my relative may have been lobotomized. Where can I find his or her patient records?
This is a really tough one. If you suspect your relative may have been lobotomized by Walter Freeman, you can check with the archivists at the George Washington University Special Collections, who maintain the Walter Freeman/James Watts collection. Freeman maintained many patient records, and only descendants of lobotomized people may view them. If your relative was not lobotomized by Walter Freeman, you should start with the hospital where you suspect the operation took place and inquire about their policies for maintaining patient records.
Where can I find out more about lobotomy?
These are the best books on the subject, in my opinion:
Braslow, Joel T. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. Medicine and Society 8. Berkeley: University of California Press, 1997.
Dully, Howard, and Charles Fleming. My Lobotomy: A Memoir. New York: Crown Publishers, 2007.
El-Hai, Jack. The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness. Hoboken, N.J: J. Wiley, 2005.
Pressman, Jack David. Last Resort: Psychosurgery and the Limits of Medicine. Cambridge History of Medicine. Cambridge, U.K: Cambridge University Press, 1998.
Raz, Mical. The Lobotomy Letters: The Making of American Psychosurgery. Kindle file. Rochester, N.Y.: University of Rochester Press, 2013.