What is a lobotomy? Risks, history and why it’s rare now

Few medical procedures in history have generated as much controversy as lobotomy. Tens of thousands of lobotomies were performed in the United States in the mid-1900s, often resulting in devastating results.

A lobotomy, also called a leucotomy, is a type of psychosurgery used to treat mental health issues such as mood disorders and schizophrenia. Psychosurgeries are procedures that involve the physical removal or modification of part of the brain.

Lobotomies involved the separation of tissue in an area called the prefrontal cortex in one of two main ways:

  • Frontal lobotomy. A surgeon drilled a hole on either side of the skull and cut through the brain tissue with an ice-pick-like instrument called a leucotome.
  • Transorbital lobotomy. A surgeon inserted a leucotome into the eye socket and drove it through a thin layer of bone with a mallet to access the brain.

These procedures are no longer performed in the United States, but some other types of psychosurgery are still performed when other treatments have failed. Read on to learn more about why lobotomies were traditionally performed and why psychosurgery is used today.

The lobotomies are not anymore made in the United States. They began to fall out of favor in the 1950s and 1960s with the development of antipsychotic drugs. The last recorded lobotomy in the United States was performed by Dr. Walter Freeman in 1967 and ended in the death of the person on whom it was performed.

In Europe, the Soviet Union banned lobotomies in 1950, a year after the inventor, Dr. Egas Moniz, won the Nobel Prize in Medicine. They persisted into the 1970s in the rest of Europe and in the 1980s in Scandinavia.

Some other types of psychosurgery are still used today, such as:

  • cingulotomy
  • anterior capsulotomy
  • subcaudal tractotomy
  • limbic leucotomy
  • body callosotomy

With advances in medication, psychosurgery is rarely performed. Surgery is usually only used when all other treatment options have failed. Surgical techniques still used today include:

Cingulotomy

The cingulotomy is the most of the time practiced psychosurgery in North America. It is a type of surgery that involves modifying the tissues of the anterior cingulate region associated with the sensation of chronic pain. It is sometimes used to manage the symptoms of:

Anterior capsulotomy

An anterior capsulotomy is a potential treatment for severe OCD that is unresponsive to psychotherapy and medication. It involves modifying the part of the brain that carries information from the thalamus and brainstem to the prefrontal region.

In a 2019 review, researchers found that of 512 people who received treatment from 1961 to 2018, 73% responded to surgery and 24% saw their symptoms disappear.

Subcaudal tractotomy

A subcaudate tractotomy can be used to treat delusions and hallucinations in people with severe schizophrenia with aggressive symptoms. It involves cutting the connections between the limbic system and a part of the prefrontal lobe called the orbitofrontal cortex.

Limbic leucotomy

Limbal leukotomy is a combination of subcaudate tractotomy and cingulotomy. It has been practiced since the 1970s to treat mood disorders and OCD.

Corpus callosotomy

A corpus callosum callosotomy involves cutting the corpus callosum, a bundle of nerves that connects the left and right cerebral hemispheres. In a study 2017researchers have found that body callosotomy is a potentially effective treatment for generalized epilepsy in people with drug-resistant epilepsy.

Lobotomies were considered experimental even at the height of their popularity. Although some people saw an improvement in their condition, many other people experienced life-altering side effects or even death.

One of the most publicized cases of failed lobotomy was that of Rosemary Kennedy, the younger sister of John F. Kennedy. After undergoing a lobotomy in 1941 to treat seizures and extreme mood swings, she lost her ability to walk or speak. Her personality was permanently altered and she was left with a physical disability.

The risks of psychosurgery include the risk of death and:

António Egas Moniz and his colleague Almeida Lima are credited with developing the lobotomy in 1935. They promoted their frontal lobotomy procedure across Europe, despite poor patient record keeping and lack of evidence of effectiveness. The procedure quickly grew in popularity, despite thousands of people suffering side effects and serious results, such as seizures, infections, and death.

American neurologist Walter Freeman and surgeon James Watts championed the procedure in America. Influenced by an Italian colleague, Freeman eventually switched to the transorbital method, in which an ice-pick-like instrument was inserted into the eye socket to reach the brain. He passionately spread surgery across North America, despite random surgeries being performed without proper sterilization.

Tens of thousands of lobotomies were performed in the United States between the 1930s and 1960s, often without informed consent. Eventually, the lack of supporting evidence for the procedure eventually caught up with it, and it was largely abandoned once the drug chlorpromazine was developed.

Despite a risk of side effects and serious outcomes, lobotomies were once used to treat many mental health conditions, including schizophrenia, depression, and bipolar disorder. Today, the treatment of mental health disorders consists largely of medication and psychotherapy.

Antipsychotics and other drugs

Antipsychotics are often the initial treatment for acute schizophrenic episodes. They block the effects of the neurotransmitter dopamine on your brain to reduce feelings of anxiety or aggression as well as hallucinations and delusional thoughts.

Many other types of medications are also used to treat mental health issues, including:

Psychotherapy

Psychotherapy, also called talk therapy, is a common type of mental health treatment. It can be given alone or in combination with medications. There are many types of psychotherapy used to treat mental health issues. They include:

Hospitalization

Some people with severe mental disorders may need to be admitted to a medical facility. Laws vary by state, but in most states a person can be involuntarily detained in a facility if they pose a danger to themselves or others.

Lobotomies were surgeries that involved modifying a part of the brain called the prefrontal cortex. Sometimes these surgeries have been performed without consent and without proper sterilization, despite the lack of evidence of their effectiveness.

Lobotomies are no longer performed and have largely been replaced by medication. Some other types of psychosurgery are done in very rare circumstances to treat conditions such as severe depression or OCD that do not respond to other treatments. These surgeries are considered a last resort.

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