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Lobotomy, also known as leukotomy or prefrontal leukotomy, is one of the most controversial neurosurgical procedures in the history of medicine, despite the fact that its invention was awarded with the Nobel Prize. The method, which was to treat patients with depression, schizophrenia and other mental disorders, led to a state of disability and even death for many of them.
What was the lobotomy procedure?
A procedure called a lobotomy, performed mainly in the 40s and 50s, consisted in inserting a tool into the skull of a sick person with a tool resembling a skewer for crushing ice. The doctor punched through the patient’s eye socket into the brain, breaking the nerve fibers between the frontal lobe of the brain and the diencephalon. This procedure was to prove helpful in the treatment of patients suffering from: schizophrenia, bipolar disorder, manic depression, anxiety, psychoses, hallucinations, excessive excitability and other mental disorders or behaviors considered abnormal. Homosexuals whose sexual orientation was considered a sexual disease were also directed to lobotomy.
Lobotomy – a historical outline
The history of lobotomy dates back to the 80s, when the pioneer of psychosurgery, Gottlieb Burckhardt, removed part of the cerebral cortex in six patients with symptoms of schizophrenia. Of those treated with this method, one died and one committed suicide. (1) Contribution to the development of lobotomy was made by a Portuguese neurologist, inventor of cerebral arteriography, and at the same time a politician and writer, António Egas Moniz. He described the achievements of Burckhardt and was considered the discoverer and popularizer of the procedure, proposing a prefrontal leukotomy procedure, which consists in injecting ethyl alcohol to destroy the nerve pathways connecting the frontal lobe with the rest of the brain. However, the procedure was not carried out by him, but by his colleague Pedro de Almeid Lima. (2) In 1949, Moniz was awarded the Nobel Prize in Medicine and Physiology.
However, two other scientists contributed to the popularization of lobotomy on a larger scale: Walter Freeman and James W. Watts. Freeman, following the descriptions of leukotomy in Moniz’s publications, performed the procedure for the first time in the USA. The operation took place in 1936 – from that moment it was performed more and more often. Different sources provide different data on the number of lobotomies performed.
An estimated 50.000 surgeries were performed in the United States alone, of which approximately 3.500-5.000 were the work of Freeman himself. (3) Over the years, countries began to ban lobotomy and Walter Freeman was stripped of his professional license. Pharmacological agents began to be used in the treatment of mental disorders in the 50s.
Lobotomy – side effects
At the time when lobotomy was popularized, patients did not have a large choice of therapeutic methods and were often doomed to exist in dark institutions for the mentally ill. Unfortunately, the lobotomy did not help them. Only in a very small percentage it caused improvement or maintenance of the previous condition. For the rest, it was associated with often catastrophic side effects, causing disturbances or even loss of personality, initiative, inhibitions, empathy and the ability to function independently. Its main effect turned out to be mental dullness. (4)
Currently, neurosurgery is used in very rare cases when all other treatments have failed in an individual patient. Practices include ablation and modulation procedures. Their essence is the chronic stimulation of specific structures of the brain without irreversible damage to the brain tissue. (5)