In response, doctors refined their techniques. They replaced the lobotomy with more specialized approaches: the cingulotomy, the anterior capsulotomy, and the subcaudate tractotomy. Studies of these procedures found evidence of benefit for at least one fourth of patients suffering from problems such as OCD and depression. Even with the risk of side effects, those in the field still say the procedures were by and large successful. They were typically carried out on patients with schizophrenia, severe depression or Obsessive Compulsive Disorder OCD - but also, in some cases, on people with learning difficulties or problems controlling aggression.
While a minority of people saw an improvement in their symptoms after lobotomy, some were left stupefied, unable to communicate, walk or feed themselves.
But it took years for the medical profession to realise that the negative effects outweighed the benefits - and to see that drugs developed in the s were effective and much safer. Writers and film directors have not been kind to the doctors who carried out lobotomies. From One Flew Over the Cuckoo's Nest and the Netflix spin-off series, Ratched, to Suddenly Last Summer, they portray sadistic surgeons preying on the vulnerable and leaving dead-eyed patients in their wake.
The truth is more complex. Lobotomists were often progressive reformers, driven by a desire to improve the lives of their patients. In the s, there were no effective treatments for the severely mentally ill. Doctors had experimented with insulin shock therapy and Electro-Convulsive Therapy with limited success and asylums were filled with patients, including shell-shocked soldiers, who had no hope of a cure, or of going home.
It was against this background that Portuguese neurologist Egas Moniz developed the lobotomy - or leucotomy as he called it - in His procedure involved drilling a pair of holes into the skull and pushing a sharp instrument into the brain tissue. He then swept it from side to side to sever the connections between the frontal lobes and the rest of the brain.
The idea was that you had these thoughts running round and round and by interrupting the circuit you would stop these distressing, obsessional thoughts," says the neurosurgeon and writer, Henry Marsh. Moniz claimed that his first 20 patients had experienced a dramatic improvement - and a young American neurologist, Walter Freeman, was greatly impressed. With his operating partner, James Watts, he carried out the first lobotomy in the US in ; the following year, the New York Times referred to the operation as "the new 'surgery of the soul'".
But to begin with it was complicated and time-consuming. While working at St Elizabeths Hospital in Washington DC, the largest mental hospital in the country, Freeman had been horrified by "the waste of manpower and woman power" he witnessed there. He was keen to help patients get out of hospital, and set himself the goal of making lobotomy quicker and cheaper.
In he devised the "transorbital lobotomy" in which steel instruments resembling ice picks were hammered into the brain through the fragile bones at the back of the eye sockets. The idea behind lobotomy was different. The Portuguese neurologist, Egas Moniz, believed that patients with obsessive behaviour were suffering from fixed circuits in the brain.
In , in a Lisbon hospital, he believed he had found a solution. His original technique was adapted by others, but the basic idea remained the same. Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain. The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain. Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in , then spreading it across the globe.
From the early s, it began to be seen as a miracle cure here in the UK, where surgeons performed proportionately more lobotomies than even in the US.
Although Freeman found this procedure great, he wanted to develop a procedure that would be faster, more effective, and require fewer resources and specialized tools. But Freeman wanted lobotomies to be a more streamlined process. So, in —10 years after performing his first lobotomy in the U. Once the ice pick was inside, he literally wiggled it around, severing the nerves connecting the prefrontal cortex to the thalamus.
Though his first transorbital lobotomy was done with an ice pick, Freeman later made his own instrument based on the ice picks design—the orbitoclast. While the prefrontal lobotomy took over an hour, Freeman's transorbital lobotomy could be done in 10 minutes or less. Because it didn't require anesthesia—patients were knocked out before the operation using ECT—it could be performed outside of the hospital. Shortly after doing his first ice pick lobotomy, Freeman began traveling the country performing lobotomies on all who were willing.
Though lobotomies were initially only used to treat severe mental health condition, Freeman began promoting the lobotomy as a cure for everything from serious mental illness to nervous indigestion. About 50, people received lobotomies in the United States, most of them between and Freeman himself is said to have performed about 3, patients, including 19 children.
The youngest was just 4 years old. In many instances, lobotomies had negative effects on a patient's personality, initiative, inhibitions, empathy, and ability to function on their own. Here are a few people who underwent lobotomies and the impact the operation had on their lives. Freeman and Watts performed the first lobotomy in the U. Six days after the operation, Hammatt experienced transient language difficulties, disorientation, and agitation.
Nevertheless, Freeman considered the outcome a success. Probably the most notable person to have undergone a lobotomy is Rosemary Kennedy, sister of U. President John F.
As a child and young adult, Kennedy has mild developmental delays that impaired her performance in school. As Rosemary got older, she reportedly began to experience violent seizures and temper tantrums, lashing out at those around her. Seeking a treatment to ease her outbursts and fearing that Rosemary's behavior would create a bad reputation for herself and for the whole family, Rosemary's father arranged a lobotomy for Rosemary when she was 23 years old.
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