By Julia Greer '25
In 1935, American neurologists John Fulton and Carlyle Jacobsen experimented on the frontal lobe of chimpanzees. They cut out sections of the chimpanzees’ brains and studied how it affected their behavior. Prior to the surgery, the chimps were out of control, throwing temper tantrums and becoming agitated when failing a task. Results differed, not long after their frontal lobes were removed, the chimps’ reactions spanned a range from docile to aggressive.. The frontal lobe is a section of the brain that helps with emotions, higher-level thinking, behavior, and needless to say, much more. At the time of the experiment, not much was known about the frontal lobe, and most knowledge came from few studies and records of brain injuries. One of the most famous records of brain injury is the case of Phineas Gage. Gage was a railroad worker that witnessed an accidental explosion in 1848. The force of the explosion sent an iron rod into his head, injuring his frontal lobe. Fortunately, Gage survived the explosion with his memory intact, but his personality was, let’s just say, different. Due to the frontal lobe’s responsibility for emotions, Gage, in this case, became more aggressive.
Fulton presented his research at the Second Annual International Neurological Conference in London, in late 1935. In the audience was António Egas Moniz. Inspired by Fulton’s work, Moniz, a Portuguese neurophysician, led a similar operation to Fulton and Jacobsen’s four months later. Previously, Moniz spent years studying brain imaging, and worked with depressed, anxious, and schizophrenic patients. With no data in hand, Moniz forwarded a theory that mental illnesses were caused by unstable connections between brain cells in the frontal cortex. He believed that he had to remove nerve fiber, which connects the frontal lobe to the thalamus. The thalamus is the part of the brain that receives and transmits sensory information. By removing this nerve fiber, he thought that all connections to the frontal lobe could be disconnected.
Moniz did not perform the procedure himself. Instead, he tasked his lab assistant to perform the lobotomy on a 60-year-old former prostitute with psychosis. His lab assistant drilled two holes into the patient’s frontal lobe and injected pure alcohol to break down the nerve fibers. The operation did make the woman lose symptoms of psychosis, but also, unfortunately, stopped her from displaying emotions. Moniz performed the lobotomy on approximately 20 more patients, experimenting with a leucotome (a wire-tipped ice pick like device), which allowed him to examine which nerve fibers to cut. He noticed that on previous patients, severing the nerve fibers completely was the only solution to getting the results he wanted: no symptoms of anxiety, depression, or schizophrenia. At first, the procedure was called leucotomy, “leuco-” meaning white matter or the nerve fibers, and “-tome” meaning knife.
Soon, Moniz’s work was introduced in the United States. Neurobiology professor at University of California, Berkeley, Walter Freeman was one of several supporters of lobotomy. He was also present during Fulton’s presentation on chimpanzees, and had done work similar to Moniz’s. Freeman and his assistant, Dr. James Watts, performed their first lobotomy on a housewife suffering from a mood disorder. Similarly to Moniz’s result, after the surgery the woman showed no symptoms of her disorder, but also showed no emotions. Later, more problems arose with her mental health. The colleagues renamed the procedure to the standardized lobotomy. In 1942, Freeman and Watts published a famous book on lobotomy, Psychosurgery: Intelligence, Emotion, and Social Behavior Following Prefrontal Lobotomy for Mental Disorders. After World War II, many soldiers returned to the U.S. with post-traumatic stress disorder (PTSD). The number of lobotomies grew from 100, before World War II, to a whopping 5,000 afterward. According to the Wall Street Journal, lobotomies were performed on WW II soldiers diagnosed with depression, anxiety, and/or schizophrenia, and occasionally those who identified as homosexual. Lobotomies were performed in hospitals as a final treatment if other attempts to cure mentally ill patients were deemed ineffective. However, the procedure left many patients in a state described as “overgrown children,” and common outcomes of the procedure were seizures, amnesia, motor function loss, and death.
Lobotomies soon became a solution to most mental disorders in psychiatric hospitals. As the procedure became popularized, more techniques were developed that were just as brutal, and as we now know, gave a very bad reputation to the field of psychiatry. For example, next came the transorbital lobotomy, in which a thinner version of the leucotome was pushed under the eyelid. Then, the surgeon would move the leucotome from side to side, severing the nerve fiber. Though lobotomies were first thought to be a medical success, criticism rapidly grew. In 1937, doctors noticed that patients often had uncontrollable eye movements after receiving a lobotomy. Moreover, psychologist Mary Francis Robinson determined that out of 90 lobotomy patients, most could not concentrate and had a lack of motivation. Lobotomy reached its controversial peak in 1949 when Moniz received the Nobel Prize in Medicine; he was considered the father of the procedure. Lobotomies lasted until 1952, when a French medicine company introduced chlorpromazine, which blocks dopamine receptors in the brain. Dopamine is most known for controlling behavior and emotions. With a chemical way for reducing symptoms of mental disorders, there was no need for lobotomy, so the use of the procedure decreased rapidly.
Now, lobotomies are known to be part of one of the darkest chapters in the history of medicine. They contributed to serious stigmas surrounding mental health, some of which still exist today. Today, mental disorders are mainly treated with medication that better targets the cells of interest and regulates the absorption of neurotransmitters such as serotonin. Thanks to modern medical advancements and better understanding in treatments, hopefully society won't have to go through another dark chapter of medical history.
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