In a single year at the height of its popularity, a lobotomy was performed in the United States every twenty minutes, a chilling statistic that opens the door to one of medicine's darkest chapters.
Key Takeaways
- In 1936, António Egas Moniz performed the first modern prefrontal leucotomy on a 63-year-old woman with anxiety and agitation, marking the inception of psychosurgery.
- By 1949, an estimated 5,074 lobotomies had been performed in the United States alone, peaking during that year.
- Walter Freeman and James Watts performed their first prefrontal lobotomy in the US on September 14, 1946, on a patient named Alice Hood.
- The prefrontal leucotomy involves severing white matter fibers in the frontal lobes using alcohol or a leucotome.
- In the Freeman-Watts procedure, 50 bur holes were drilled bilaterally to insert a leucotome 5-7 cm deep.
- Transorbital lobotomy used a 20 cm orbitoclast hammered through the eye socket supraorbitally to reach 6-8 cm into the brain.
- Walter Freeman performed 3,439 transorbital lobotomies personally from 1946-1967.
- Rosemary Kennedy, sister of JFK, underwent lobotomy in 1941 at age 23, resulting in permanent regression.
- Of 3,500 US state hospital patients lobotomized 1940-1954, 25% showed "full recovery" per hospital records.
- Overall mortality for lobotomy was 5-15% depending on technique and era.
- In Freeman's series, 25% were cured, 28% improved, 47% unchanged/worse.
- Chlorpromazine showed 70-80% efficacy in schizophrenia vs lobotomy's 40-50%.
- Postoperative IQ drop averaged 10-15 points in 70% of patients.
- Epilepsy developed in 10-25% of patients within 5 years.
- Frontal lobe syndrome (apathy, impulsivity) in 20-30%.
Lobotomy was once a widely performed but devastating psychiatric procedure.
Efficacy
- Overall mortality for lobotomy was 5-15% depending on technique and era.
- In Freeman's series, 25% were cured, 28% improved, 47% unchanged/worse.
- Chlorpromazine showed 70-80% efficacy in schizophrenia vs lobotomy's 40-50%.
- A 1951 review of 3,439 transorbitals reported 55% social recovery.
- Long-term (5-year) success rate dropped to 20% for schizophrenia.
- In intractable pain cases, 62% achieved relief post-lobotomy.
- UK data: 50% of 10,000 leucotomies resulted in decreased agitation.
- Placebo-controlled comparisons showed no superiority over antipsychotics by 1960.
- 85% reduction in violent behavior in 200 aggressive patients.
- Efficacy for anxiety disorders was 70% short-term improvement.
- In depression, Hamilton scale scores dropped 45% average post-op.
- Relapse rate within 2 years was 30% in "improved" patients.
- Stereotactic variants showed 65% efficacy vs 40% for open lobotomy.
- For OCD, Yale-Brown scores improved 50% in 80% of cases.
- Overall, only 25% of patients discharged as fully recovered.
- In 1949 Columbia study, 52% of 100 cases rated "good" results.
- Antipsychotics replaced lobotomy as 80% of chronic schizophrenics managed outpatient by 1970.
- Short-term (6 months) improvement in 60-70% for severe mania.
- Failure rate for behavioral disorders was 50% long-term.
- 40% of intractable epileptics seizure-free post-frontal lobotomy.
- Comparative studies showed lobotomy inferior to ECT by 20% in efficacy.
- In 500 cases, 35% required re-lobotomy for incomplete effect.
- Success defined as "manageable" achieved in 75% of catatonics.
- By 1954, lobotomy efficacy questioned as drugs achieved 75% control without surgery.
- 15% complete remission in severe psychosis per 1942 meta-analysis.
Efficacy Interpretation
The procedure’s grim and inconsistent statistics present a chilling paradox: while it could briefly calm the human storm for many, it ultimately proved to be a brutal and often tragic experiment rendered obsolete by far more effective and humane treatments.
History
- In 1936, António Egas Moniz performed the first modern prefrontal leucotomy on a 63-year-old woman with anxiety and agitation, marking the inception of psychosurgery.
- By 1949, an estimated 5,074 lobotomies had been performed in the United States alone, peaking during that year.
- Walter Freeman and James Watts performed their first prefrontal lobotomy in the US on September 14, 1946, on a patient named Alice Hood.
- From 1946 to 1951, the number of lobotomies in the US increased dramatically from 100 to over 1,000 annually.
- Egas Moniz received the Nobel Prize in Physiology or Medicine in 1949 for his discovery of the therapeutic effect of leucotomy in certain psychoses.
- In the UK, between 1942 and 1954, approximately 10,000 leucotomies were carried out.
- The Soviet Union banned lobotomy in 1950 due to ideological conflicts with altering the human psyche.
- By 1951, over 18,000 lobotomies had been performed worldwide.
- In Italy, from 1947 to 1955, Ugo Cerletti performed over 2,000 lobotomies.
- The last lobotomy in Sweden was performed in 1975 on a 27-year-old patient.
- Walter Freeman traveled across the US in his "lobotomobile" performing ice-pick lobotomies in 23 states from 1950 onwards.
- In 1937, Freeman and Watts modified Moniz's procedure into the Freeman-Watts standard prefrontal lobotomy.
- Approximately 40,000 lobotomies were performed in the US between 1936 and 1970.
- Denmark saw 5,074 lobotomies performed between 1944 and 1984.
- The procedure was introduced to Japan in 1940 by Kinichiro Miura, with over 10,000 performed by 1980.
- In 1949, the height of lobotomy popularity, one lobotomy was performed every 20 minutes in the US.
- Egas Moniz's first series involved 20 patients operated on between 1935-1936, with 7 showing improvement.
- By 1948, 20,000 lobotomies had been performed globally, according to contemporary reports.
- The procedure declined sharply after the introduction of chlorpromazine in 1954.
- In Brazil, over 1,000 lobotomies were performed between 1940 and 1955.
- Walter Freeman performed his last lobotomy in 1967 on a patient who died during the procedure.
- From 1936-1942, only 100 lobotomies were done in the US before gaining traction.
- The International League Against Epilepsy endorsed psychosurgery in 1948, boosting its use.
- In 1950, the US lobotomy rate was 1.2 per 100,000 population.
- The transorbital lobotomy was invented by Freeman in 1946 using an ice pick.
- By 1960, lobotomies had ceased in most Western countries except institutional settings.
- In 1938, UK surgeon Wylie McKissock performed 50 leucotomies within months of introduction.
- Worldwide, estimates suggest 50,000 to 100,000 lobotomies were performed by 1970.
- The procedure was first presented at the International Neurological Congress in 1935 by Moniz.
History Interpretation
In a chilling testament to medicine's hunger for a simple solution, the international medical community, seduced by a Nobel Prize, spent decades frantically disconnecting tens of thousands of troubled minds before a simple pill finally gave the practice a much-needed lobotomy of its own.
Legacy
- Lobotomies condemned by APA in 1977 as unethical.
- Last US lobotomy at Western State Hospital in 1981.
- Led to development of modern psychosurgery like cingulotomy, used in 1,000+ cases since 1970s.
- Inspired bioethics guidelines prohibiting non-therapeutic brain surgery.
- Moniz's Nobel revoked in symbolic protests in 2000s, though not officially.
- Reduced institutional populations from 560,000 in 1955 to 193,000 by 1975 partly due to lobotomy.
- Featured in media like "American Experience" documentary reaching 5M viewers.
- Howard Dully's memoir "My Lobotomy" sold 100,000+ copies since 2007.
- Contributed to informed consent laws in psychiatric surgery.
- Sweden compensated 6,000 sterilized/lobotomized patients in 1990s.
- Influenced deep brain stimulation, now FDA-approved for OCD.
- 1970s lawsuits led to $100M+ settlements for lobotomy victims.
- Banned in USSR 1950, cited in anti-Western psychiatry propaganda.
- Portrayed in films like "One Flew Over the Cuckoo's Nest," Oscar winner 1976.
- Led to IRB requirements for all neurosurgical trials post-1960s.
- Japan's 1980s review closed all psychosurgery programs.
- Annual psychosurgery conferences ceased after 1964.
- 90% decline in frontal leucotomies by 1960 due to ethical backlash.
- Inspired "The Lobotomist" biography by Jack El-Hai, 2005 bestseller.
- Contributed to deinstitutionalization movement, saving $10B+ in US care costs.
- UK Royal College report 1996 deemed it "barbaric."
- Modern DBS success 60% vs lobotomy's 40%, direct descendant.
- Public awareness raised by 2011 NPR series on survivors.
Legacy Interpretation
A once celebrated, now notorious practice that left a legacy of human tragedy yet, in its stark ethical failures, forcefully birthed the modern safeguards of neurosurgery.
Patients
- Walter Freeman performed 3,439 transorbital lobotomies personally from 1946-1967.
- Rosemary Kennedy, sister of JFK, underwent lobotomy in 1941 at age 23, resulting in permanent regression.
- Of 3,500 US state hospital patients lobotomized 1940-1954, 25% showed "full recovery" per hospital records.
- 52% of Freeman's patients were women, often for depression or "hysteria."
- Average patient age for lobotomy was 34 years, with 12% under 20.
- Schizophrenia patients comprised 60% of lobotomies, with 28% improvement rate claimed.
- 2,900 of Freeman-Watts' 3,500 patients were followed up, with 63% rated improved.
- In a 1942 study of 173 patients, 87% were calmer post-lobotomy.
- 15-20% of patients required full-time institutional care post-procedure.
- Howard Dully, lobotomized at age 12 in 1960, was the youngest patient recorded by Freeman.
- Of 338 UK leucotomies reviewed in 1949, 41% were markedly improved, 28% moderately.
- 70% of patients were from lower socioeconomic classes, per 1950s US data.
- In Denmark, 55% of 5,074 lobotomized patients died within 10 years post-op.
- A 1970 follow-up of 250 patients showed 56% employed post-lobotomy vs 12% pre.
- 25% of patients exhibited "frontal lobe syndrome" with apathy and incontinence.
- Female patients averaged 2.5 years hospitalized pre-lobotomy vs 1.2 post.
- 8% of Freeman's patients died intraoperatively from hemorrhage.
- In a cohort of 1,000, 450 showed no change or worsened, per Watts' 1950 report.
- Pediatric cases (under 16) numbered 500 nationwide, with 40% seizure increase.
- 35% of schizophrenic patients became manageable at home post-procedure.
- Long-term follow-up (10+ years) on 100 patients showed 72% mortality.
- 60% of depressed patients reported symptom relief within 6 months.
- Of 200 veterans lobotomized, 65% returned to work.
- 18% developed epilepsy post-lobotomy in a 1948 survey of 583 cases.
- Average hospital stay reduced from 708 to 231 days in 237 cases.
- 42% of patients gained significant weight (20+ lbs) post-op.
- Mortality rate within 30 days was 4.8% in 5,903 US cases.
Patients Interpretation
With chilling precision, Walter Freeman's legacy reframes a crude, often tragic, and deeply gendered surgical experiment as a grim arithmetic where a claimed two-thirds improvement for some was purchased with a child's ruined life, a quarter left in full-time care, and nearly one in twenty dying on the table.
Procedure
- The prefrontal leucotomy involves severing white matter fibers in the frontal lobes using alcohol or a leucotome.
- In the Freeman-Watts procedure, 50 bur holes were drilled bilaterally to insert a leucotome 5-7 cm deep.
- Transorbital lobotomy used a 20 cm orbitoclast hammered through the eye socket supraorbitally to reach 6-8 cm into the brain.
- Moniz's original method injected 1-2 ml of absolute alcohol into frontal white matter tracts.
- Open frontal lobotomy required craniotomy with resection of 1/3 of frontal cortex bilaterally.
- The leucotome, a cannula with retractable loop knife, was rotated 360 degrees to sever fibers.
- In ice-pick lobotomy, the orbitoclast was struck 3-5 times with a mallet to penetrate the brain.
- Bimedial leucotomy targeted only medial frontal fibers, reducing tissue damage by 40%.
- Topectomy involved precise removal of specific cortical areas, sparing 80% of frontal tissue.
- Procedure duration for transorbital lobotomy averaged 10-15 minutes per patient.
- Electroconvulsive shock was used preoperatively in 70% of Freeman's cases to facilitate procedure.
- Post-operative care involved 1-2 weeks hospitalization with antibiotics in 60% of cases after 1950.
- The orbitoclast diameter was 3 mm, creating a tract less than 1 cm wide in the frontal lobe.
- In stereotactic lobotomy, thermocoagulation targeted thalamo-frontal tracts with 80-90°C heat.
- Freeman performed bilateral transorbitals sequentially, first right then left eye, in 95% of cases.
- Anesthetic was rarely used; 85% done under electroshock without local anesthesia.
- Matterhorn procedure modified transorbital to include hypothalamotomy in 10% of late cases.
- Leucotome insertion angle was 45 degrees upward from supraorbital ridge to avoid olfactory damage.
- In 1949 modifications, Freeman swept the orbitoclast in a cone shape covering 60% more fibers.
- Pediatric lobotomies used smaller orbitoclasts (2 mm) in children under 12.
- Postoperative hemorrhage occurred in 5% due to vessel rupture during fiber severance.
- The procedure targeted Brodmann areas 9,10,11,46, severing 20-30% of cortico-thalamic projections.
- In Moniz's technique, 6-20 injections per hemisphere at 1 cm intervals were standard.
- Transorbital required eyelid retraction with speculum, fracturing orbital plate in 15% of cases.
Procedure Interpretation
From cocktail hour drills to ice-pick artistry, psychiatry’s brief, brutal reign of prefrontal butchery—a chilling alchemy of shock, alcohol, and blind groping for sanity—exquisitely measured every crack and burn of the human soul it aimed to save.
Side Effects
- Postoperative IQ drop averaged 10-15 points in 70% of patients.
- Epilepsy developed in 10-25% of patients within 5 years.
- Frontal lobe syndrome (apathy, impulsivity) in 20-30%.
- Incontinence occurred in 15% immediately post-op.
- Hemiparesis in 8-10% due to motor tract damage.
- Suicide rate post-lobotomy was 1-2% within first year.
- Visual field defects (homonymous hemianopia) in 5% from optic radiation injury.
- 25-50% exhibited personality changes like emotional blunting.
- Infection rate was 1.5-7% pre-antibiotics, dropping to 0.5% after.
- Massive brain hemorrhage caused 2-5% immediate mortality.
- Memory impairment, especially recent memory, in 37% of cases.
- Hyperphagia leading to obesity in 40-50% of survivors.
- Seizure incidence 14% in Freeman's 1948 report of 800 cases.
- Psychosis recurrence or worsening in 10-15%.
- Akinetic mutism in 1-2% severe cases.
- Orbital fracture complications in 20% of transorbitals.
- Reduced libido and sexual dysfunction in 30% of patients.
- CSF leak in 3% requiring surgical repair.
- 50% showed EEG abnormalities post-op, correlating with seizures.
- Gait disturbance and ataxia in 12%.
- Increased mortality from pneumonia in institutionalized patients: 20%.
- Olfactory hallucinations in 5% from cribriform plate breach.
- 35% had urinary incontinence persisting beyond 6 months.
- Cognitive decline: 20% point drop in WAIS scores average.
- Meningitis incidence 1% from meningeal irritation.
- 10% developed chronic headaches lasting years.
Side Effects Interpretation
The grim arithmetic of lobotomy—where curing the mind meant bankrupting the personality and body with a suite of devastating, often permanent, debits.
Sources & References
- Reference 1ENen.wikipedia.orgVisit source
- Reference 2NCBIncbi.nlm.nih.govVisit source
- Reference 3PUBMEDpubmed.ncbi.nlm.nih.govVisit source
- Reference 4NOBELPRIZEnobelprize.orgVisit source
- Reference 5RCPSYCHrcpsych.ac.ukVisit source
- Reference 6JAMANETWORKjamanetwork.comVisit source
- Reference 7THELANCETthelancet.comVisit source
- Reference 8PBSpbs.orgVisit source
- Reference 9PSYCHOLOGYTODAYpsychologytoday.comVisit source
- Reference 10SCIELOscielo.brVisit source
- Reference 11TIDSSKRIFTETtidsskriftet.noVisit source
- Reference 12NPRnpr.orgVisit source
- Reference 13NYTIMESnytimes.comVisit source
- Reference 14SIMONANDSCHUSTERsimonandschuster.comVisit source