Frequently asked questions about lobotomy

Image from the manuscript for Walter Freeman and James Watts' second edition of Psychosurgery (1950).
Image from the manuscript for Walter Freeman and James Watts’ second edition of Psychosurgery (1950).

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.]

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Flesh made light: investigating X-ray films

Still from Barbara Hammer's film, Sanctus, which shows an X-ray image of a head and torso in profile
Still from Barbara Hammer’s Sanctus, courtesy of the Medical Film Symposium

I’m flying back from a trip to the George Eastman House (in Rochester, New York), where I did a couple days of archival research. I thought I’d write a bit about what I was doing there and what I found, in the hope that capturing the experience here will help me organize my thoughts about it later.

I was interested in a physician-filmmaker named James Sibley Watson, Jr., who made a number of striking cinefluorographic (X-ray) films. I’ve been hoping that Watson will be the basis of a fourth chapter of my book, Depth Perception, which is about medical filmmaking. Each chapter focuses on a different aspect of what, together, we think constitutes a body: mind, anatomy, disease, and, with the addition of this fourth chapter, skin. My argument is that it’s surprisingly difficult to make a medicalized body cohere on film. It takes tons of editing tricks, special effects, and dedicated equipment. In fact, it’s so difficult, I argue, that we should pause to consider whether the medicalized body exists at all.

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