Walter Freeman operating in Western State Hospital, 1949
One Flew Over the Cuckoo’s Nest etched the image of extreme psychosurgery into the minds of a generation when hero Randle McMurphy is lobotomised and left a shell of his former self – mute, motionless, “like one of those store dummies”. Lobotomies and other so-called ‘heroic’ invasive physical therapies developed during the early 20th century typified a radical new approach to the treatment of mental illness that broke from relegating patients to the asylum – but at what cost?
Watts and Freeman performing a lobotomy.
"We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch... We put an instrument inside... We made an estimate on how far to cut based on how she responded.” James Watts
These words describe the lobotomy that was carried out in 1941 on Rosemary Kennedy, sister of the then future US President. Said to have been intended to cure her mood swings, the procedure left Rosemary with urinary incontinence and the mental age of a child – staring blankly at walls for hours, her speech unintelligible.
In the theatre: Freeman operating.
Rosemary Kennedy was one of the most high profile early patients to undergo a lobotomy, but by no means was she an isolated case. By 1951, almost 20,000 individuals had been lobotomised in the United States. The lobotomy was not confined to the margins of medicine; despite acceptance of its often serious side-effects, for more than two decades it was a mainstream procedure.
Pioneered first by Swiss psychiatrist Gottlieb Burckhardt, and then by Portuguese neurologist Egas Moniz – who would later win a Nobel Prize for his work – lobotomies were brought to the US by American neurologist and psychiatrist Walter Freeman. In collaboration with his close friend, neurosurgeon James Watts, Freeman performed the first lobotomy in America in 1936.
Lobotomy pioneer: Walter Freeman.
Initially, the Freeman-Watts prefrontal lobotomy required drilling holes in the scalp, and surgery had to be performed in an operating theatre by trained neurosurgeons. Freeman wanted to change this – to make the surgery available to patients in mental hospitals without surgeons or anaesthesia. Sometime in 1945 he picked up an ice pick from his kitchen and began practicing new cutting techniques on grapefruits.
On January 17 1946, Walter Freeman performed the first transorbital or ‘ice-pick’ lobotomy in Washington, DC. First, the patient was rendered unconscious by electroshock. Then Freeman took a sharp ice instrument which he placed under the patient's eyelid against the top of the eye socket. A mallet was used to drive the instrument on into the frontal lobes of the brain and the sharp tip moved back and forth. The process was then repeated on the other side of the face.
Transorbital 'ice-pick' lobotomy.
In 2005, that first person to receive a transorbital lobotomy, Ellen Ionesco, maintained that Freeman was a “great man”. Ionesco’s daughter too has described how her mother “was absolutely violently suicidal beforehand. After the transorbital lobotomy there was nothing. It stopped immediately. It was just peace. I don't know how to explain it to you, it was like turning a coin over. That quick. So whatever he did, he did something right.”
Yet despite these and other endorsements, concerns about lobotomy grew. The surgery worked on the idea that by severing or coring out part of the frontal lobes, the nerve ‘circuits’ held responsible for mental illness would be broken. Yet there was a price. Lobotomies may have tempered the emotional extremes of certain personality disorders like severe depression, but when those feelings were cut away, so too were part of the patients – who were prone to being left in a vegetative state.
Howard Dully during his ice-pick lobotomy, 16 December 1960.
That’s not to say all patients were turned into a zombies. Howard Dully was subject to an ice-pick lobotomy at the hands of Walter Freeman when he was just 12. Submitted by his stepmother in 1960 on the grounds of schizophrenia – despite numerous diagnoses to the contrary – Dully revealed the truth about his past in 2005. “If you saw me you'd never know I'd had a lobotomy,” said Dully. “But I've always felt different – wondered if something's missing from my soul.”
The power of the lobotomy to change people’s personalities led the USSR to ban the procedure in 1950, with doctors stating that it was "contrary to the principles of humanity". Various other countries soon followed suit and by the early 1970s the practice had generally finished. Even so, through the early '80s, lobotomies continued to occur in certain US states and European countries – including the UK where 90 were performed.
Orbitoclast 'ice pick' instruments used in transorbital lobotomy.
Today, procedures known as cingulotomies and capsulotomies are conducted that involve minute lesions in parts of the frontal lobe, aiming to treat severe depression, severe anxiety and OCD. However, examples of such brain surgery are not only very different from traditional lobotomies but are decidedly less prevalent. Gone are the days when over 65,000 individuals were lobotomised in the US, Great Britain and Scandinavia alone.
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