What Is Lobotomy?

Medically Reviewed by Jabeen Begum, MD on November 11, 2022
4 min read

Lobotomy is a surgical procedure performed on the brain. The brain has several lobes, each with different functions. The frontal lobe was the part of the brain targeted in the standard lobotomy operations practiced in the 1940s and 1950s. This surgery consisted of making holes in the skull, removing some brain tissue, and severing the connections between the frontal lobe and the thalamus. 

The procedure was pioneered by the Portuguese scientist Egas Moniz. Tens of thousands of lobotomies were carried out in some countries to treat schizophrenia, affective disturbance, and obsessive-compulsive disorders (OCD). Moniz was awarded the Nobel Prize in 1949.

A lobotomy is a surgical procedure to provide relief to people with mental illnesses unresponsive to standard treatment. This method was pioneered during the 1940s and 1950s, when treatments for psychiatric disorders were few, chiefly insulin coma and electroconvulsive therapy (ECT). Psychiatric wards and mental asylums were full of suffering men and women. 

A lobotomy was used to treat these patients. The operation aimed to sever the nerve fibers between the frontal lobe of the brain and the thalamus, the thalamo-frontal radiation. Many methods were used, including brain cannulae, leukotomes, chemical injection, electrocoagulation, and destructive ultrasonic waves.

By today's standards, these surgeries were primitive and dangerous. But a large study in the U.S. found that 44% of patients were released from hospitals after the surgery. Similar good results were reported by studies in Canada (45%) and England and Wales (46%).

During the 1940s and 1950s, lobotomies were performed to treat patients suffering from mental disorders for many years. Some conditions treated by lobotomy included:

A lobotomy disrupts the connections between the frontal cortex and the rest of the brain, particularly the thalamus. Doctors believed that doing so would reduce abnormal stimuli reaching the frontal area. Such stimuli were thought to cause impulsive and violent behavior. A lobotomy would make the patient calm and docile so that they could be sent home to live with their family.

Lobotomies were pioneered in the 1930s, a time when mental asylums were packed with men and women. Effective treatments were few, and many patients spent years locked up in crowded asylums. Though a lobotomy seems repulsive today, it was seen as a ray of hope then. It restored normal functioning to a portion of people who underwent it. Many of them were able to rejoin their families.

The surgery involved removing a part of the frontal lobe of the patient's brain through a hole or holes made in the skull. Many people with depression and schizophrenia benefited. One of the pioneers was Dr. Walter Freeman, who started the procedure in the U.S. in partnership with a qualified neurosurgeon. Later, he started doing the procedure himself and performed thousands of lobotomies, including 19 on children. He used and taught a transorbital approach, carried out through the eye socket using an instrument he designed himself.

Dr. Freedman himself reported that over a quarter of patients undergoing lobotomy developed epilepsy. Many people had other severe adverse effects, becoming apathetic or displaying inappropriate social behavior. 

Lobotomy was also used to reverse aggressive tendencies in some people. Many doctors opposed such surgery, believing it was unethical to attempt to change a human's personality. There was also public resentment over the severe side effects and reckless use of lobotomy. With the introduction of medications like chlorpromazine and haloperidol in the 1950s, classical lobotomy was almost abandoned by the 1960s.

Operations on the brain are always risky. It's an exceedingly delicate organ and is easily damaged, often irreversibly. Several immediate and long-term side effects are known after lobotomy:

  • Bleeding after the operation
  • Brain infection and abscess
  • Dementia
  • Epilepsy
  • Intellectual impairment
  • Disinhibition and inappropriate social behavior
  • Epilepsy
  • Apathy
  • Incontinence
  • Obesity
  • Dementia
  • Mortality (2%)

Surgery to treat psychiatric disorders is still being done but it is vastly different from a classical lobotomy. Now, doctors can precisely map the malfunctioning parts of the brain by imaging techniques like computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalograms (EEG), and other sophisticated methods. The current techniques are called stereotactic neurosurgery. They're used to treat:

  • Intractable pain
  • Epilepsy
  • Movement disorders (Huntington's chorea, Parkinson's disease, dystonia)
  • Mental health disorders (schizophrenia, OCD, depression)

Brain surgery to treat psychological disorders is considered only after medicines given for a long time have not worked. The procedure is done by an expert neurosurgeon, often using tools like a microscope, gamma knife, and robotic surgery. The benefits are far more predictable, and there is significantly less damage.

Many medicines are now available for mental health disorders. The vast majority of people with these problems do well with medicines, counseling, therapy, and other regular treatment. But a small proportion of people are not helped by these therapies and need surgery. In carefully selected patients, brain surgery is an option when nothing else is working. Their brain is meticulously studied by advanced imaging and other methods. The surgery is performed by qualified neurosurgeons.

Operations on the posterior hypothalamus reduce aggressive and restless behavior.

Stereotactic amygdalotomies relieve psychomotor epilepsy and aggressive behavioral disorders.

Cingulotomy (surgery on the cingulate lobe of the brain) relieves OCD and depression.

Other procedures like limbic leucotomy and anterior capsulotomy precisely target specific areas of the brain.

Deep brain stimulation is successful in the treatment of dystonia, epilepsy, essential tremor, and Parkinson's disease. It is being tried for OCD and depression but is considered an experimental therapy.

Lobotomy as a procedure has come a long way from the 1940s. Doctors have access to better imaging technology, and surgical techniques have been refined. The placement of surgical lesions is much more precise, and such surgery is considered for very few patients. Advances in brain surgery hold out hope for people with mental disorders not helped by medical treatment.