Nowadays it seems incredible, but there was a time when the lobotomy was celebrated as a miracle cure, described by doctors and the media as “easier than curing a toothache.”
In the UK alone, more than 20,000 lobotomies were performed between the early 1940s and the late 1970s.
While a minority of people experienced improvement in their symptoms after lobotomy, some were left groggy, unable to communicate, walk, or feed themselves.
Jack Nicholson como Randle McMurphy en “Atrapado sin salida” (One Flew Over The Cuckoo’s Nest).
Movie writers and directors have not been kind to the doctors who performed the lobotomies.
Movies and series like
Suddenly, last summer, One Flew Over the Cuckoo’s Nest (“Caught with no way out”) and Ratched (the Netflix series inspired by this latest movie) portray sadistic surgeons who prey on the vulnerable and leave dead-staring patients in their wake.
The truth, however, is much more complex.
Trying to help
Lobotomists were often
progressive reformers, driven by the desire to improve the lives of his patients.
In the 1940s, there were no effective treatments for the seriously mentally ill.
Doctors had experimented with insulin shock therapy and electroconvulsive therapy with limited success, and nursing homes were full of patients who
they had no hope to heal or to return home.
It was in this context that the Portuguese neurologist
Egas Moniz developed the lobotomy, or leukotomy, as he called it, in 1935.
His procedure consisted of drilling a pair of holes in the skull and pushing a sharp instrument into the brain tissue. He then swept it back and forth to cut the connections between the frontal lobes and the rest of the brain.
“It was based on this
terribly crude and simplistic view of the brain, which looked at it as a simple mechanism in which one could simply put things. The idea was that obsessive and distressing thoughts would go round and round and by interrupting the circuit you could stop those thoughts, “explains neurosurgeon and writer Henry Marsh.
“Actually, the brain is absolutely complicated and we don’t even begin to understand how everything is interconnected,” he says.
Moniz claimed that his first 20 patients had experienced dramatic improvement, and a young American neurologist,
Walter Freeman, he was very impressed.
With his collaborating partner, James Watts, he performed the first lobotomy in the United States in 1936 and the following year, the newspaper
The New York Times he referred to the operation as “the new ‘soul surgery'”.
But at first, the procedure was
complicated and it took a long time.
Walter Freeman demonstrating his transorbital lobotomy technique in 1949.
While working at St Elizabeths Hospital in Washington DC, the nation’s largest psychiatric hospital, Freeman had been appalled at “the loss of staff and women’s capabilities” he witnessed there.
He wanted to help patients get out of the hospital and set himself the goal of doing
make the lobotomy faster and cheaper.
With that in mind in 1946 he devised the “transorbital lobotomy” in which steel instruments that looked like ice spikes were hammered into the brain through the fragile bones at the back of the eye sockets.
was drastically reduced, and the patients did not need anesthesia, they were simply knocked out before the operation with a portable “electroshock” machine. “Lobotomies with ice pick”
Freeman would drive across the United States during long summer vacations to perform his “ice pick lobotomies,” sometimes taking his children with him.
And although it had initially been described as a last-resort surgery for psychiatric patients with whom all other treatments had failed, Freeman
started promoting lobotomy as a cure for everythingfrom severe mental illness to postpartum depression, severe headaches, chronic pain, nervous indigestion, insomnia, and behavioral difficulties.
Freeman’s colleague, Dr. James Shanklin, preparing a patient for transorbital lobotomy.
Many patients and their families were very grateful to Freeman, who kept boxes full of thank you letters and Christmas cards sent by them. But
in other cases the results were disastrous.
Freeman’s patients included Rosemary Kennedy, sister of the future President of the United States, John F. Kennedy, who was left incontinence and unable to speak clearly after a lobotomy at the age of 23.
Throughout his career, Freeman performed lobotomies on 3,500 patients, including
19 children, the youngest of only 4 years.
Freeman’s UK counterpart was the neurosurgeon Sir Wylie McKissock, who performed his own variation of the lobotomy on some 3,000 patients.
“This is not a time-consuming operation. A competent team in a well-organized psychiatric hospital can perform four such operations in
two or two and a half hours“he boasted.
“Actual bilateral prefrontal leukotomy can be performed by a properly trained neurosurgeon in six minutes and rarely takes more than 10,” he boasted.
Thanks in large part to McKissock,
more lobotomies per inhabitant in the UK than in the US Until the 1990s
As a medical student in the 1970s, Henry Marsh accepted a job as a nursing assistant in a psychiatric hospital, in what he describes as “the terminal ward where lost cases went to die.”
There he saw firsthand the
devastating effects lobotomy.
“It became painfully apparent that there was no adequate follow-up for these patients,” he says. “The patients who were the worst, the most apathetic, the ones who were broke, were the ones who had undergone a lobotomy.”
All had been operated on by McKissock and his assistants.
Later, after Marsh was trained as a neurosurgeon, a modification of the procedure, known as a limbic leukotomy, was still used.
Marsh describes it as “a kind of
microscopic version, much more refined, the kind of lobectomies that people had been doing many years before. “
He performed this operation himself on a dozen severe OCD patients as recently as 1990.
“They were all suicidal, all other treatments had failed, so I was not particularly distressed by that, although
I would have preferred not to“, dice.
“I did not see the patients afterwards, it was purely a technician. The psychiatrists involved assured me that the operations were a success,” he adds.
I ask him how he feels about these operations now. “I did not like doing them and I was quite glad to leave the practice shortly after becoming a consultant,” he confesses.
Freeman popularized “ice pick lobotomies.”
In the early 1960s, around 500 lobotomies were performed each year in the UK, up from 1,500 at its peak. By the mid-1970s, this number had dropped to around 100-150 per year, almost always involving smaller cuts and more precise targets.
The enactment of the Mental Health Act of 1983 introduced stricter controls and more supervision. Today,
psychosurgical operations are rarely performed. For worse
Howard Dully, who received a lobotomy from Walter Freeman at the age of 12, says he tries to avoid thinking differently.
what could have been his life if he hadn’t had it, for fear of anger overwhelming him.
“I have tried to rebuild my life. It took me a long time,” he explains. “I got into a lot of trouble when I was a young adult: drugs, alcohol and criminal activities, trying to steal and earn money and earn a living, so it hasn’t been easy.”
Diagram of a transorbital lobotomy.
Dully feels that the operation, performed because she had confronted her stepmother,
overshadowed all aspects of his life.
“You don’t go up to people and say, ‘Hi, I had a lobotomy,’ because if you do, they won’t be with you for long,” he says.
Sixty years later
can remember the operation in great detail.
“They raised their eye and went to the corner, beat it and shook it with this thing that looks like an egg beater,” he says.
it’s crazy. I mean, you are talking about a brain. Shouldn’t there be some precision involved? “As subtle as a headshot”
The lobotomy had its critics from the beginning and the opposition grew stronger as the poor results became apparent.
Walter Freeman, who initially claimed to have an 85% success rate, was found to have a 15% death rate. And when doctors investigated their patients’ long-term outcomes, they found that
only a third had experienced any improvement, while another third were significantly worse.
A former lobotomy advocate in the United States stated, “The lobotomy was really no more subtle than a gunshot to the head.”
The lobotomy earned Egas Moniz the Nobel Prize in Medicine.
Fifteen years ago, a group of doctors and lobotomy victims and their families campaigned for Egas Moniz to be stripped of the
Nobel Prize in Medicine which he won in 1949 for devising the lobotomy.
The Nobel Foundation, whose statute states that its awards cannot be withdrawn, refused.
Looking back, how should we view the people who carried out this controversial medical procedure?
“This business of dividing doctors into heroes and villains is wrong. We are all
a mix of bothWe are a product of our time, of our culture, of our training, “says Henry Marsh.
“The generation of surgeons that trained me had, I would not say divine powers, but enormous authority, no one questioned or questioned them, and I can think of some of the people who trained me who were, above all, decent people, and were corrupted by this power and turned a bit monsters as a result, “he concludes.
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