Medicine has been historically riddled with unethical practices targeting marginalized communities, and it is important to stay educated in these instances. In American medical history, lobotomies were one such practice. Lobotomies were a surgical procedure where the connections between the frontal lobe and the thalamus were severed. They were commonly used as a treatment for mental illness. Between 1949 and 1952, more than 50,000 of these lobotomies were done in the United States.
Although neurologist Dr. Walter Freeman was the one to popularize frontal lobotomies, Dr. John F. Fulton, an American physiologist, was the pioneer that discovered that psychosurgeries could be used to alter behavior. In 1935, Dr. Fulton presented his experiment where he severed the bilateral sections of the prefrontal cortex in two chimpanzees at the Second International Neurologic Congress in London. He reported that these animals became docile after surgery.
This congress was attended by three people who would significantly impact medicine from the 1930s to the 1950s. Two of these doctors were Portuguese neuroscientists Antonio Egas Moniz and Almeida Lima. They collaborated together to perform their first frontal lobotomy for mental illness in the 1935. That same year, Dr. Moniz would go on to present on a series of 20 patients and receive a Nobel Prize for showing that lobotomies could alleviate the symptoms of severe mental illnesses.
Dr. Walter Freeman also attended this same congress. Around the same time that Moniz was presenting his research, Dr. Freeman was working with Dr. James W. Watts to perform the first frontal lobotomy in the U.S. in 1936 on a woman named Alice Hamet. As a neurologist, Freeman was not licensed to practice surgery and needed Watts to do the procedure. Based on Moniz’s work, he modified the procedure to target specific frontal-thalamic tracts depending on the disorder. He would make his lobotomies more anterior for patients suffering from affective disorders and more posterior for schizophrenic patients with severe symptoms. Freeman and Watts also worked together to develop transorbital lobotomies.
When these procedures were performed for the first time, they were extremely invasive. They involved drilling two holes into the skull over the two sides of the lobe and inserting a long, thin, and sharp surgical tool to sever the connective tissue between the frontal lobes and the thalamus. However, Freeman wanted to be able to perform lobotomies himself. To do that, he had to develop a way to make the surgery “noninvasive”. He figured out that he could use a modified ice pick and hammer to slip into the eye socket to enter the frontal lobes and get the same result. Freeman claimed that this was a completely safe procedure.
Eventually, Watts and Freeman parted ways, and Freeman began independently performing lobotomies by 1948. The procedure now only took 10 minutes, and he began to travel across the country. He began to travel across the country to perform lobotomies at different state hospitals to spread the news of his procedure. He was often called more of a showman than doctor.
However, this period of popularity did not last. One reason for the end was the rise of chloropromazine, a pharmaceutical used to treat schizophrenia, bipolar disorder, and acute psychosis. Freeman’s reservoir of possible patients was reduced, and hospitals stopped inviting him to their wards. Additionally, his procedure was being scrutinized by his colleagues in the field. It became apparent to the general public that lobotomies did not cure anything. In fact, they often made the situation worse. Out of the 3500 patients Freeman treated, around 490 of them died and many did not realize the full effects of their lobotomy until years later. The public also began to realize that lobotomies were typically given to women who “had undesirable behavior” and to “rowdy” children at a disproportionate rate against their consent. It is important to understand the history of some of these medical practices so that we do not repeat it. We need to continually educate ourselves on our pasts, so that we may direct the future down a brighter path.
King Lab at Creighton University 