The orbital lobotomy was a surgery that gained popularity in the late 1940s as a way of treating the most dangerous mentally ill patients in asylums across the country, in fact it won a Nobel Prize for physiology in 1949. But within less than a decade, it was a scorned procedure that was banned in most places. How did it come about? Why was it banned? And how do we make sense of the thousands of lives that were ruined because of it?
TRANSCRIPT:
In November of 1941, a 23-year old woman was wheeled into an operating room. She had a history of mental disturbances and had become difficult for her family to manage. So they opted to undergo a promising new procedure that was shown to cure personality disorders. Once in the operating room, the doctors strapped her to a table. The surgeon grabbed an ice-pick shaped instrument, inserted it into the patient’s eye socket, and then…
That woman was Rosemary Kennedy. The younger sister of President John F. Kennedy. And the surgery was not a success.
Rosemary’s specific diagnosis isn’t entirely clear, because the family did everything they could to hide her condition but by all accounts she was mentally challenged. And as she entered her early 20s she became more irritable; difficult to control. And sometimes physically violent.
There are also rumors that she was sexually promiscuous and just in general behaving in ways that were embarrassing for one of the most powerful political families in the world.
The procedure was a prefrontal lobotomy, it was a surgery that’s about as terrifying as they come, but at the time was hailed as a giant leap forward in the treatment of mental illness. This was before all the psychiatric drugs we have now. In fact, it won the Nobel Prize for Medicine in 1949.
But within a decade of winning the highest acclaim in medicine, the procedure was considered barbaric and outlawed. Partly because of people like Rosemary Kennedy.
Because Rosemary’s condition didn’t improve after the lobotomy, she was permanently incapacitated, unable to walk, unable to speak, and incontinent for the rest of her life.
And she was FAR from the only one. Did I mention the lobotomy van? Yeah, there was a lobotomy van.
If you’re not really familiar with what a lobotomy is, it’s a procedure that’s as simple as it is brutal.
A patient is placed under sedation or general anesthesia and then a doctor takes an ice pick-like thing that they called an orbitoclast, inserts it into the corner of the patient’s eye, and then taps it with a mallet-like thing that they called a mallet.
Because why even bother trying to make it sound less brutal.
And by the way, you clicked on a video about lobotomies. This is going to be a bit gnarly. You’ve been warned.
By driving the ice pick into the brain with the mallet, the surgery was thought to cure severe mental illness.
And there were multiple types of lobotomies, which by the way were also called leucotomies. The one I just described is called a Trans-orbital lobotomy, because it goes through the orbit of the eye socket. There was also a transcranial lobotomy that went through the top or side of the head. But this obviously required drilling through skull.
And these used a syringe-like tool called a leucotome to pierce the brain and then it did its business with a wire loop or by injecting a sclerosing agent to harden the fibers.
But the goal of all of these was to disrupt the prefrontal cortex of the brain, so they are often called prefrontal lobotomies, or leucotomies.
Now I know all this sounds grotesque and insane but there was a reason why they were so popular for a while. It’s because the alternative was even worse.
There’s a stigma around mental illness. Always has been, and it’s still there today, but it used to be much, MUCH worse.
Because we really didn’t understand how the brain worked. I mean we barely knew how the body worked but especially the brain. People thought your emotions and personality came from your soul, so if you were messed up in that department, that was a soul thing, a spiritual thing. A religious thing.
So most people back then thought that mental illness was some kind of divine punishment or demonic possession, which came with some just swell treatments.
The first treatment is actually one of the first surgeries that we have evidence for, and that was trephination.
Trephination is quite simply drilling a hole into someone’s head, to, you know, let the demons out.
It’s thought they might have done this for mental health reasons, again, attributing it to a demonic possession – or maybe just for headaches.
But yeah we’ve found skulls with holes in them going back 7,000 years, and in a lot of these skulls, the hole had healed over, so they did survive this procedure.
In the late middle ages, bloodletting and purging were often used to treat mental illness, which should come as no surprise because they treated pretty much everything like that.
They were all about the four humours at that point, so they blamed everything on an imbalance in the humours, being blood, yellow bile, black bile, and phlegm.
This went all the way back to ancient Greek times but it was an English physician named Thomas Willis that made the connection between the humors and mental illness.
Which, while it sounds silly now, it was kinda groundbreaking at the time. To blame someone’s emotions and behavior on a physical issue and not “demon possession” was incredibly enlightened.
So all that draining of blood and forcing people to puke, that’s much, much more humane.
Hey, that’s foreshadowing!
In the 17th century, we start to see a proliferation of asylums for the mentally ill in an effort to kind-of take them out of society and sweep them under the rug but also it was justified as a place that would be best for them because isolation was a popular method of treatment at the time.
Another popular treatment was the Bath of Surprise, which was a common practice in many of these asylums.
This became a thing in the 1700s but it basically involved sedating patients by dunking them in ice-cold water with no warning.
Again, this was before any drugs that would calm a patient down but it turns out a little dunkarino in the old ice bath can kinda shock a person into calming down.
Which, I’m sure that the ice bath cult out there is pointing to that and saying, “yes, it shocks your central nervous system and you release dopamine, which calms the body…”
But I would just like to say in response that you are voluntarily subjecting yourself to something that they used to do to lunatics. Just saying.
The bath of surprise, by the way, eventually developed into hydrotherapy, which is where a patient is strapped to a tub for hours or days with continuous cold water piped into it.
As the 19th century and the Victorian age came around, institutionalized care was intensified, with asylums and mental hospitals springing up all across the United States and Europe, and at this point confinement became the prime directive.
These asylums were overcrowded and many of the patients were physically violent so they were mostly concerned with just protecting the staff.
This is where straight jackets came in, people were often chained to walls and put in cages, and I don’t mean jail cells I mean tiny, cramped cages like the size of a dog crate for hours, even days at a time.
They were subjected to wacky treatments like the rotating chair, which spun the patients around until they threw up, which again goes back to the purging that was based on the four humors so that was way behind the times.
They would sedate them with drugs, which was arguably ahead of its time, but these were very rudimentary and basically incapacitated them.
And the worst part of it all was that many of the people who found themselves in these asylums were committed for fairly mundane things like epilepsy and melancholy. “Willfulness” was considered committable, whatever that was.
Women were especially targeted. If you didn’t obey your husband or didn’t abide by the crushing Victorian social norms at the time, you could be labeled hysterical and sent off to the asylum.
It’s safe to say neurodiversity was not celebrated back then.
Not to mention that many of these people might have been just a little different when they went in but after six months or a year of that environment, they actually did develop mental illness – which only extended their stay and led to more overcrowding.
So yeah, none of this was working, and it’s a shame because it was instituted with the best of intentions. These asylums were supposed to provide exactly that – asylum. It was supposed to be a respite from the world that was causing them so much mental instability. But it usually just made things worse.
At the same time this was happening, though, brain science was progressing and our understanding of the brain was increasing, due in part to lucky accidents. Like one that happened in Vermont in 1848.
On September 13, 1848, a railroad worker named Phineas Gage was tamping down some explosive powder when the powder ignited and blew the tamping rod through the bottom of his cheek and out the top of his head. And somehow, he survived.
The Phineas Gage story has been told a million times, I’ve covered it on this channel before. It’s remarkable and gruesome and just wild that this guy survived a METER LONG IRON ROD going through his head… but he did.
He did not survive completely unscathed though.
Gage’s personality changed drastically. Before the accident, he was an amiable, well-balanced employee that got along with everybody. But afterwards he became difficult to deal with and easily irritable. He was impatient. He cursed at people a lot, which he never did before.
He also developed severe epilepsy, which he eventually died from 13 years later.
But it was this change in personality that got the attention of the psychiatric community.
This was the first time that damage to a specific part of the brain could be linked to personality issues, especially emotional regulation. And it started a whole field of study around figuring out which parts of the brain controlled what.
There was a motor cortex, there was a language and speech processing area, a visual processing area, long term memory, short term memory, and they figured out that the brain kind-of evolved from the back to the front.
It’s the back of the brain that controls the core functions of the body – breathing, circulation, digestion and whatnot. But it’s the front of the brain that handles the higher functioning stuff like decision making, judgement, and emotional regulation.
That’s why Phineas was able to survive the blast, it didn’t get to the base of the brain. If it had, he would have been toast. He was just lucky enough to have it pass through his prefrontal cortex.
Over the next century, more attention was paid to other “lucky accidents” that helped refine our understanding of the brain and its structures. That along with animal experiments and actual brain surgery, which was still in its infancy.
All of which came to a head at the Second International Congress of Neurology in 1935. A conference that would change the landscape of neurology and ultimately leave tens of thousands of people in a vegetative state.
It was held at the University College London on July 29-August 2nd, and while epilepsy was the main theme of the conference, it was a handful of presentations on the frontal lobes that stole the show.
There was the French neurosurgeon Clovis Vincent, with a paper titled “Modification of function observed after surgical intervention on the frontal lobes”
Neurologist Richard Brickner, from the New York Neurological Institute, talked about a surgery called a bilateral frontal lobectomy that was performed at Johns Hopkins University to remove a brain tumor.
And a Yale neurophysiologist named John Fulton presented a study called “The functions of the frontal lobes: a comparative study in monkeys, chimpanzees, and man”
The study reported on a couple of chimpanzees that received lobectomies and how they demonstrated a noticeable change in personality, specifically having fewer temper tantrums and “experimental neuroses”
Through all of this an idea began to form.
So, in the brain, the actual processing mostly occurs on the outside, the wrinkled surface, which is why it’s wrinkled, there’s more surface area to do more processing.
But inside the brain there are these bundles of fibers they call white matter that move the signals around to other areas of the brain. You can think of it as all the cables coming out the back of a rack of servers. Each server is a different brain module and the cables allow them to communicate with each other.
So these studies have shown that by removing parts of the frontal lobe, you can make an animal more complacent, of course that’s a major, risky surgery, so maybe instead of removing that frontal lobe altogether, all you have to do is cut some of those cables so it can’t communicate anymore.
This idea resonated strongly with another attendee of the conference, a Portuguese neurologist named Antonio Egas Moniz.
Mere months after attending the conference, Moniz and his assistant, Pedro Almeida Lima performed the first leucotomy, which involved going in through the skull with the leucotome tool to sever the white matter fibers connecting the prefrontal cortex.
Although in this first surgery, he also injected alcohol to destroy the frontal lobe completely. Because you know, why not?
He would refine the procedure over the years, though his work was cut short in 1939 when a schizophrenic patient shot him several times in his office. He survived, but he was paralyzed for the rest of his life. He eventually died in 1955.
The fact that he was gunned down by a patient only highlighted the fact or at least perception that some people with mental illness were dangerous, which only justified the surgery he pioneered even though it was permanent and resulted far more often than not in total mental incapacitation.
And nobody picked up this cause and ran with it more than a US doctor named Walter Freeman.
Freeman was also at the Second International Congress of Neurology and he met Moniz there – Moniz actually became a bit of a mentor for him.
Seriously that conference was like a focal point where all of this came together.
Walter Freeman modified Moniz’s procedure, calling his version a “lobotomy” which is why we call it that today. He did his first lobotomy in 1936 on a woman named Alice Hood Hammatt, a 63-year old housewife from Topeka, Kansas.
It… did not go well.
Hammatt suffered debilitating convulsions in the weeks following the surgery, and she died five years later – likely from complications.
Over the years, Freeman refined his procedure, always looking for a faster and less messy way to do it. And he found one. The aforementioned transorbital lobotomy. Enter the ice pick.
The layer of bone at the back of the eye socket is much thinner than at the top of the skull, which makes it easy to puncture with a sharp implement, it’s also closer to the white matter so you don’t have to go through as much brain tissue, all you had to do was wiggle it around once you’ve got it in there, and the nerves are severed. And it left no visible scars.
But its main claim to fame was that it was fast and could be performed in less than 10 minutes. You know, like an oil change.
It’s only brain surgery, why take your time with it?
He performed the first one in 1946 on a 29-year-old housewife named Sallie Ellen Ionesco.
And for a brief amount of time – and I mean a very brief amount of time – this surgery was extremely popular.
Again, keep in mind the alternatives – straight jackets, cramped cages, spinning chairs, overcrowded hospitals, injured staff members, and now there was this 10-minute surgery that left the patients totally docile, easy to manage, and maybe even happier?
There was a lot more drool though.
Because most of these patients were basically left in a vegetative state. Which again… if this was only reserved for the most violent, unmanageable patients who were suffering themselves from extreme mental illness… and given there were no better alternatives… I mean there is some gray area there.
The problem is, they went way, WAY further than that.
They started giving lobotomies out like freaking candy, it was touted as a permanent cure for virtually any mental condition – people were requesting lobotomies to fix their “malaise.”
And they got one!
It became so popular, and Freeman himself was so in demand, he took it on the road, visiting hospitals and mental institutions across the United States in a modified van that he called – and I’m not making this up – the Lobotomobile.
You know, like Batman. With his ice pick of justice.
Over two weeks in 1952, he performed 228 lobotomies in West Virginia for a state-sponsored lobotomy project called “Operation Ice Pick”
Freeman himself performed over 3500 lobotomies but something to keep in mind, he was just the face of the whole thing, there were hundreds of doctors performing this surgery. Between 1949 and 1952, over 50,000 lobotomies were performed in the US alone. And I can’t stress this enough, most of them were left in vegetative states or incapacitated in some way. And hundreds of people just straight-up died from the surgery.
And again, these were not all violent menaces to society, many of them were just on the spectrum or mentally challenged in some way. In fact, Dr. Freeman himself performed the lobotomy on Rosemary Kennedy.
After meeting her just once, he diagnosed her with “agitated depression” and performed the surgery on the same day. Rosemary’s mother never even gave permission to do the procedure.
Believe it or not, the lobotomy received the Nobel Prize for Physiology in 1949. It was awarded to Egas Moniz, and he was nominated by Walter Freeman.
And yet, by 1955, only 6 years later, the lobotomy was almost entirely discredited and banned in most places. So what happened?
To put it simply – science happened.
You know how I kept saying that given there were no better alternatives, the lobotomy made a kind of sense? Well suddenly there were much better alternatives.
The introduction of antipsychotic drugs like thorazine changed everything in the 1950s.
They worked better, were non-invasive, they weren’t permanent, they were cheap and best of all, they didn’t turn people into vegetables for the rest of their lives.
They just immediately made lobotomies look savage and brutal, and it fell out of favor very quickly.
Also the more of them that were performed, the more people got to see the actual results of the procedure, which were usually horrifying.
But Dr. Freeman, of course, would stand by his surgery to the bitter end. He continued advocating for lobotomies and doing them wherever he could for the next decade or so.
He performed his last lobotomy in 1967 on a woman named Helen Mortensen who, believe it or not, had already had 2 lobotomies – both of them by Freeman.
This third one would be her last though because she died of a brain hemorrhage after the surgery. This seemed to be the last straw for the medical community and Freeman was banned from operating after that. He died a few years later in 1972.
Some of Freeman’s patients are still alive today, like Howard Dully, who got a lobotomy from Freeman in 1960 when he was 12 years old. (react)
He told NPR in 2005:
“I’ll never know what I lost in those 10 minutes with Dr. Freeman and his ice pick. By some miracle it didn’t turn me into a zombie, crush my spirit or kill me. But it did affect me. Deeply. Walter Freeman’s operation was supposed to relieve suffering. In my case it did just the opposite. Ever since my lobotomy I’ve felt like a freak, ashamed.”
So yes, there were some people who survived it and weren’t turned into vegetables, but very few came out unscathed.
Thankfully lobotomies are a thing of the past and mental health has come a long way. And brain surgery has come an especially long way.
There are still surgeries where doctors sever white matter fibers to treat, say, extreme epileptic seizures. But these are done at the microsurgical level with extreme precision and they use robots and not ice picks.
And they take longer than 10 minutes.
Today medications and psychotherapy are the go-to course of treatment for most mental illnesses, though there are:
Brain stimulation therapies
- Deep brain stimulation
- Electroconvulsive therapy
- Repetitive transcranial magnetic stimulation
- Vagus nerve stimulation
We have never as a society been more aware and accepting of mental illness than we are today. In fact everybody seems to have something or be on some kind of spectrum it seems like.
That can all be a bit much and there are definitely uh… “trendy” mental illnesses which is a whole hornets nest I’m not going to poke here.
But bottom line, I would a million times over prefer that to people getting ice picks jabbed into their eyes for a mild depression.
The world is stressful and we’ve got a lot of problems but just for a minute, let’s be thankful for that.
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