What Is a Lobotomy?
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Medically reviewed by Smita Patel, DO
A lobotomy is a surgical procedure that surgeons no longer perform, but that was thought to improve symptoms associated with conditions such as schizophrenia and other mental health disorders. The surgery involves accessing the brain to attempt to sever connections in the brain's pathways which were believed to impact thinking. Prior to lobotomy, therapies such as shock therapy, straitjackets, and sleep therapy were all employed as treatments for people with severe mental illnesses.
Lobotomy was an inexact and often ineffective procedure in helping reduce symptoms of various mental health conditions. The invention of antipsychotic medications meant lobotomy was no longer considered as treatment.
Why Would Someone Have a Lobotomy?
A lobotomy is a surgical procedure belonging to a field called "psychosurgery." From very early times (as early as the Stone Age or more than 2 million years ago), people have performed procedures to drill into the skull and access the brain to enact changes in a person's behavior. Fast-forward to the early 1900s, when psychosurgery started to experience a resurgence in the medical community.
Many of these early surgical procedures were at best barbaric and included removing portions of the brain in those suffering from severe schizophrenia with inconsistent and sometimes deadly results. Egas Moniz, a Portuguese neurologist, was thought to have invented lobotomy as a surgical approach in 1936. In the later 1930s, neurologist Walter Freeman and neurosurgeon James Watts began performing lobotomies in the United States.
A lobotomy was usually performed on a person who had severe psychosis—or seeing, hearing, or smelling things that were not there. However, there are case reports of patients who underwent lobotomy for the following medical conditions:
Gastrointestinal bleeding
Severe pain
However, a lobotomy was not scientifically proven to help these or other medical conditions.
How Was a Lobotomy Performed?
A lobotomy involves using surgical instruments to split the white fibers in the brain's frontal lobes. The frontal lobes (the part of your brain under your forehead) are responsible for brain functions that include language, motivation, personality, planning, and social behavior.
The initial surgical approach was performed in an operating room and involved drilling holes into the skull and using a surgical instrument called a leucotome to separate portions of the brain. This approach is known as a classic prefrontal lobotomy.
Dr. Freeman called his approach to lobotomy a "transorbital" lobotomy. He used a long, thin instrument that closely resembled an icepick to access the brain via the patient's eye socket. Using this approach, Dr. Freeman did not require an operating room, drill, or specialized sterile instruments.
Over time, the scientific community began to recognize there was little evidence to support the lobotomy's effectiveness. Unfortunately, more than tens of thousands of patients had already undergone the procedure to varying results.
What Are the Side Effects?
Lobotomy produced inconsistent results for those suffering from mental health disorders, such as schizophrenia and other conditions. Immediate post-surgical outcomes included:
Confusion
Itching
Numbness or tingling
Sensitivity to light and sound
Longer-term complications included:
Seizures (the most common side effect)
Chronic headaches
Death (estimated at about 5% of patients)
Relapse of previous symptoms
The true effects are difficult to know because reporting, evaluation, and record-keeping are not as standardized as they are now.
Modern-Day Treatments and Procedures
Medications to help reduce symptoms of mental health conditions have largely replaced invasive surgical approaches. Healthcare providers also have a deeper understanding of brain areas and their responsibilities.
Thorazine
The introduction of the medication Thorazine (chlorpromazine) in 1952 reduced the popularity of lobotomy. Thorazine is an anti-psychotic medication psychiatrists (medical doctors who treat mental health conditions) prescribe to treat schizophrenia and other disorders that cause you to experience psychosis. An estimated 2 million people were prescribed Thorazine in the first year the medication was available.
However, Thorazine can have significant side effects and interact with many other medications. For these reasons, the makers of Thorazine no longer sell the medication in the United States.
Antipsychotic medications
Healthcare providers prescribe antipsychotic medications to reduce hallucinations and depression and improve quality of life and social functioning. A number of antipsychotic medications are on the market today and include:
Abilify (aripiprazole)
Haldol (haloperidol)
Zyprexa (olanzapine)
Risperdal (risperidone)
Seroquel (quetiapine)
Geodon (ziprasidone)
Some people may need to try more than one medication and dosage to treat schizophrenia before finding one that improves their symptoms. Some medications are also available as long-acting injections.
Psychosocial Interventions
The American Psychiatric Association recommends people with schizophrenia receive treatment in a "coordinated specialty care program," which is an early interventional approach comprised of multiple components, including individual and family therapy, educational programming like social skills training, medication management, and case management to help a person find resources, such as housing and job placement.
All of these interventions, plus education on their condition, can help people living with schizophrenia enhance their overall quality of life and well-being.
Electroconvulsive Therapy (ECT)
Electroconvulsive therapy (ECT) is a treatment healthcare providers commonly use for major depression. However, they may prescribe the treatment for those with schizophrenia who do not respond to medications. An estimated 30% of those with schizophrenia have a poor response to antipsychotic medications.
The ECT procedure involves placing a person under general anesthesia and using small electric currents to stimulate the brain. The result is a brief seizure that can result in brain chemistry changes that may reduce schizophrenia symptoms. While some smaller studies have connected ECT with reducing cognitive symptoms in schizophrenia, larger clinical trials are not currently available.
A Quick Review
After 1955 surgeons rarely performed lobotomies due to the existence of medications that could improve mental health disorder symptoms without the need for invasive surgery. Psychosurgery techniques, including lobotomy, are no longer performed thanks to greater understanding of the brain and brain chemistry. Current treatments include antipsychotics and psychotherapy, which have more conclusive research as to their effectiveness.
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