Lobotomies: Past and Present

Psychosurgery has early roots in our history, beginning with trephination—the process of opening the skull in an effort to release evil spirits that cause psychological illness (Selling, 1940). In the 1930s, a Portuguese neurologist by the name of António de Egas Moniz developed a psychosurgery procedure that, when performed by other physicians and psychiatrists, resulted in irreversible brain damage in thousands of patients. Dr. Moniz could be considered the “father” of the lobotomy. Then the United States was introduced to a revised procedure by Walter Freeman—the transorbital or "ice pick" lobotomy (Cooper, 2014; Freeman, 1950). This procedure became a popular treatment method prior to the introduction of psychotropic medications. Freeman (1950) described the procedure as “a sharp-pointed instrument [being] driven through the orbital plate by way of the conjunctival sac and moved about” (p. 270). In other words, an ice pick was driven through the eye socket and moved in a circular motion to sever nerves and gray matter from the brain in an effort to relieve a patient of the distress associated with psychological symptoms. Adults with a variety of psychological symptoms (e.g., depression, anxiety, schizophrenia), as well as children with psychological and behavioral symptoms (e.g., aggression, unruliness, insubordination) were deemed appropriate candidates for transorbital lobotomy in the 1940s through 1960s (Gostin, 1980). Potential side effects ranged from intellectual and emotional impairment to behavioral shifts and changes in personality, including a flat and withdrawn affect. Even “vegetable like states” were noted, among other physical side effects, such as incontinence and seizures (Gostin, 1980). However, because these procedures did not always result in immediate, noticeable deficits, in many cases patients walked away with relief from their psychological ailments, which in turn resulted in a continued use of the procedure. Howard Dully was one of Dr. Freeman’s patients who received a transorbital lobotomy when he was 12 years old. Dully wrote a memoir describing the impact of the lobotomy on his childhood and adulthood. Lobotomies are still performed, but only in rare cases of severe depression and schizophrenia, in which patients are unresponsive to all other forms of treatments.




After reading the article written by Dr. Walter Freeman in 1950, and the contemporary NPR article, consider the questions below. (An additional video clip of Howard Dully can also be viewed.) Then submit your responses.

Question 1


Question 2

According to the NPR article, in what year did Dr. Freeman perform the first transorbital, “ice-pick” lobotomy?

Question 3

According to the NPR article and the video clip, which of the following did not occur with Howard Dully’s transorbital lobotomy?

Question 4

Answers will vary. One possibility: Individuals who suffer from mental illness are willing to try extreme measures for symptom relief, even with the possibility of negative side effects.

Question 5

Answers will vary. One possibility: An extensive operation, indicating a large quantity of frontal lobe disconnection, reduced the patient to a state of helplessness. Freeman would describe this patient after surgery as lazy, rude, boisterous, restless, and inane. Freeman would also describe the patient as relatively unteachable, having lost those social skills that are necessary for living outside an institution.

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