Because its effects are irreversible, psychosurgery—surgery that removes or destroys brain tissue—is the most drastic and least-used biomedical intervention for changing thoughts and behavior. In the 1930s, Portuguese physician Egas Moniz developed what would become the best-known psychosurgical operation: the lobotomy Moniz cut nerves connecting the frontal lobes with the emotion-controlling centers of the inner brain. His crude but easy and inexpensive procedure took only about 10 minutes. After shocking the patient into a coma, he (and later, other neurosurgeons) would hammer an instrument shaped like an ice pick through the top of each eye socket, driving it into the brain. He then wiggled the instrument to sever connections running up to the frontal lobes. Tens of thousands of severely disturbed people were given lobotomies between 1936 and 1954 (Valenstein, 1986).

Although the intention was simply to disconnect emotion from thought, the effect was often more drastic. A lobotomy usually decreased the person’s misery or tension. But it also produced a permanently listless, immature, uncreative personality. During the 1950s, after some 35,000 people had been lobotomized in the United States alone, calming drugs became available and psychosurgery became scorned—as in the saying sometimes attributed to W. C. Fields that “I’d rather have a bottle in front of me than a frontal lobotomy.”

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Today, lobotomies are history. More precise, microscale psychosurgery is sometimes used in extreme cases. For example, if a patient has uncontrollable seizures, surgeons can destroy the specific nerve clusters that cause or transmit the convulsions. MRI-guided precision surgery is also occasionally done to cut the circuits involved in severe obsessive-compulsive disorder (Carey, 2009, 2011; Sachdev & Sachdev, 1997). Because these procedures are irreversible, neurosurgeons perform them only as a last resort.