Our previous case study on Phineas Gage, the first documented case of traumatic brain injury, led the way to one of Psychiatry’s largest missteps: lobotomy. Gage’s radical injury severed many of the connections between his frontal lobe and other portions of his brain, effectively leading to significant changes in his personality and general sensibilities (O’Driscoll & Leach, 1998).
Building off of this discovery, a Swiss physician, Dr. Gottleib Burckhardt postulated that the severance of portions of the brain could be used to alter the behaviors of individuals with severe mental illness. In 1891, Burckhardt tested his theory on several schizophrenic patients and found that many of them became subdued after this aggressive form of psychosurgery. It was not until 1931 that physician-scientist, Antonio Moniz, began experimenting with psychosurgery as a treatment for severe mental illness. He developed a procedure that involved the insertion of leucetome (imagine a thin egg beater) into the brain and “scrambling” portions of the brain in an effort to modify behavior. Without any acknowledgement of the cruelty of the procedure, empirical evidence, good note keeping, or follow-up with patients, Moniz traveled around Europe showcasing his “magical treatment” (Gallea, 2017).
In the US in 1936, neurologist, George Freeman, and neurosurgeon, John Watts, performed a modified version of Moniz’s procedure, which he named the “lobotomy.” Subsequently, Freeman modified the technique to target transorbital portions of the frontal lobe. In this version he employed an ice pick-like tool to essentially sweep across the orbital portion of the frontal lobe (behind the eyes), destroying large portions of the nervous tissue. Watts saw this new technique as a bastardization of neurosurgery and parted ways with Freeman. Freeman continued to perform thousands of these procedures across the country (Caruso & Sheehan, 2017). Many of these procedures were performed without sterile environments or a neurosurgeon (Staudt et al., 2019).
Lobotomies showed a poor success rate, high mortality rate, and significant postoperative functional impairments. These procedures only became popular due to the overcrowding of psychiatric institutions and the charisma and showmanship of Dr. Freeman’s “demonstrations.” Over time, the procedure fell out of favor as the cruelty of it became popularized by books, movies (Caruso & Sheehan, 2017; Staudt et al., 2019). Generally speaking, psychosurgery was replaced by the pharmacological interventions seen today (Caruso & Sheehan, 2017).