Gleb Pospelovo lobotomy — the most famous and darkest of psychosurgical operations
Oh, after treatment he will turn into a vegetable!.. — every psychiatrist has heard this or a similar phrase more than once, trying to persuade the patient and his relatives to be hospitalized. Everyone knows: in mental hospitals people are “zombified”, their brains are “burnt out”, they are “poisoned”, they are “turned into a plant” - in general, they are destroyed as individuals in all possible ways.
And before the hospital there was a patient - just a sight for sore eyes, aha!
In general, this way of thinking has a completely scientific name: social stigma. In fact: when a person is discharged from a mental hospital, he is often completely different from what his loved ones are used to. He was sociable - he became withdrawn, he was active, nimble - - he became inhibited and lethargic. And the media, books, cinema willingly show exactly how pests in white coats conduct their hellish experiments on people. I’ll tell you a “secret”: if anything turns our patients into “plants”, it’s not the treatment, but the disease. However, this was not always the case...
Remember the famous book (or its film adaptation) “One Flew Over the Cuckoo's Nest” and the fate of its main character, McMurphy? Let me remind you: McMurphy was lobotomized for violating hospital regulations. The cheerful, self-confident, lively rogue-simulator turns into a weak-minded, drooling wreck. The author of the novel, Ken Kesey, having worked as an orderly in a mental hospital, described the “frontal syndrome” or “frontal lobe syndrome” that developed in people after lobotomy surgery.
Bold idea
Brain lobotomy was developed in 1935 by Portuguese psychiatrist and neurosurgeon Egas Moniz. In 1935, at a conference, he heard a report on the consequences of damage to the prefrontal zone in chimpanzees. Although the focus of this report was on the learning difficulties associated with frontal lobe damage, Moniz was particularly interested in the fact that one monkey became calmer and more docile after surgery. He hypothesized that cutting nerve fibers in the frontal lobe could help in the treatment of mental disorders, in particular schizophrenia (the nature of which was still very vague). Moniz believed that the procedure was indicated for patients in serious condition or those whose aggressiveness made them socially dangerous. Moniz performed the first operation in 1936. He called it “leucotomy”: a loop was inserted into the brain using a guide, and with rotational movements the white matter of the neuronal connections connecting the frontal lobes with other parts of the brain was cut.
Prefrontal lobotomy, or leucotomy (from the Greek λοβός - lobe and τομή - incision), is a neurosurgical operation in which the white matter of the frontal lobes of the brain is dissected on one or both sides, separating the cortex of the frontal region from the underlying parts of the brain. The consequence of such an intervention is the elimination of the influence of the frontal lobes of the brain on the remaining structures of the central nervous system.
Moniz performed about a hundred such operations and observed patients. He liked the results, and in 1936 the Portuguese published the results of surgical treatment of his first twenty patients: seven of them recovered, seven showed improvement, and six did not experience any positive dynamics.
Egas Moniz was awarded the Nobel Prize in Physiology or Medicine in 1949 “for his discovery of the therapeutic effects of leucotomy in certain mental diseases.” After the Moniz Prize was awarded, leucotomy began to be used more widely.
So, Egas Moniz observed barely two dozen patients during his “lobotomy” practice; He never saw most of the others after the operation. Moniz has written several articles and books about lobotomy. Criticism followed: opponents argued that the changes after the operation most closely resemble the consequences of a brain injury and essentially represent personality degradation. Many believed that mutilation of the brain could not improve its function and damage could lead to the development of meningitis, epilepsy and brain abscesses. Despite this, Moniz's report (Prefrontal leucotomy. Surgical treatment of certain psychoses, Torino, 1937) led to the rapid adoption of the procedure on an experimental basis by individual clinicians in Brazil, Cuba, Italy, Romania and the USA.
In the land of great opportunities
American psychiatrist Walter Jay Freeman became the leading promoter of this operation. He developed a new technique that did not require drilling into the patient's skull, and called it "transorbital lobotomy." Freeman aimed the tapered end of a surgical instrument resembling an ice pick at the bone of the eye socket, using a surgical hammer to pierce the thin layer of bone and insert the instrument into the brain. After this, the fibers of the frontal lobes of the brain were cut by moving the handle of the knife. Freeman argued that the procedure would remove the emotional component from the patient's "mental illness." The first operations were carried out using a real ice pick. Subsequently, Freeman developed special tools for this purpose—the leukotome, and then the orbitoclast.
In the 1940s, lobotomy in the United States became widespread for purely economic reasons: the “cheap” method made it possible to “treat” many thousands of Americans held in closed psychiatric institutions, and could reduce the costs of these institutions by a million dollars a day! Leading newspapers wrote about the success of lobotomy, attracting public attention to it. It is worth noting that at that time there were no effective methods for treating mental disorders, and cases of patients returning from closed institutions to society were extremely rare.
In the early 1950s, about five thousand lobotomies were performed per year in the United States. Between 1936 and the late 1950s, 40,000–50,000 Americans underwent lobotomies. The indications were not only schizophrenia, but also severe obsessive-compulsive neurosis. Lobotomies were often performed by doctors who had no surgical training. Although not trained as a surgeon, Freeman nevertheless performed about 3,500 such operations, traveling around the country in his own van, which he called the “Lobomobile.”
Lobotomy was widely used not only in the USA, but also in other countries of the world—Great Britain, Finland, Norway, Sweden, Denmark, Japan, and the USSR. Tens of thousands of patients have undergone this operation in European countries.
The result is obvious
Already at the end of the 40s, psychiatrists “discerned” that the first studies of lobotomy were carried out without a solid methodology: they operated with incomparable techniques on patients with different diagnoses. Whether recovery occurred or not — this question was often decided on the basis of such a criterion as increasing the patient’s controllability. In the 1950s, more thorough studies revealed that, in addition to death, which was observed in 1.5-6% of those operated on, lobotomies can cause seizures, large weight gain, loss of coordination, partial paralysis, urinary incontinence and other problems. Standard tests of intelligence and memory generally did not show any significant impairment. The patients retained all types of sensitivity and motor activity; they had no impairments in recognition, practical skills or speech, but complex forms of mental activity disintegrated. More subtle changes such as decreased self-control, foresight, creativity, and spontaneous action were often reported; about selfishness and lack of concern for others. At the same time, criticism of one’s own behavior decreased significantly.
Patients could answer ordinary questions or perform usual actions, but performing any complex, meaningful and purposeful acts became impossible. They stopped experiencing their failures, experiencing hesitations, conflicts and, most often, were in a state of indifference or euphoria. People who previously had an energetic, restless or aggressive personality may have developed changes towards impulsiveness, rudeness, emotional breakdowns, primitive humor and unreasonable ambitions.
In the USSR, special methods for performing lobotomies were developed - much more accurate in a surgical sense and gentle on the patient. The surgical method was proposed only in cases of ineffectiveness of long-term treatment, which included insulin therapy and electric shock. All patients underwent a general clinical and neurological examination and were carefully studied by psychiatrists. After the operation, both gains in the emotional sphere, behavior and social adequacy, as well as possible losses, were recorded. The lobotomy method itself was recognized as fundamentally acceptable, but only in the hands of experienced neurosurgeons and in cases where the damage was considered irreversible.
With maintenance therapy with nootropics and drugs that correct mental disorders, a significant improvement in the condition was possible, which could last for several years, but the final result still remained unpredictable. As Freeman himself noted, after hundreds of operations he performed, about a quarter of the patients remained living with the intellectual capabilities of a pet, but “we are quite happy with these people...”.
Beginning of the End
The decline of the lobotomy began in the 1950s after the serious neurological complications of the operation became apparent. Subsequently, lobotomy was prohibited by law in many countries — data accumulated on the comparatively low effectiveness of the operation and its greater danger compared to neuroleptics, which became more and more sophisticated and were actively introduced into psychiatric practice.
In the early 70s, lobotomy gradually faded away, but in some countries they continued to operate until the end of the 80s. In France, 32 lobotomies were performed between 1980-1986, during the same period - 70 in Belgium and about 15 at Massachusetts General Hospital; about 15 operations were carried out annually in the UK.
In the USSR, lobotomy was officially banned in 1950. And there was not only an ideological background to this. In the foreground were reasons of a purely scientific nature: the absence of a strictly substantiated theory of lobotomy; lack of strictly developed clinical indications for surgery; severe neurological and mental consequences of the operation, in particular “frontal defect”.
"Lobotomy" with a bullet
More than 60 years have passed since lobotomy was banned in our country. But people continue to get head injuries and get sick with various ailments (Pick’s disease, for example), leading to completely distinct “frontal” symptoms. I will give a vivid observation of the consequences of “frontal syndrome” from my own practice.
Two soldiers at the training ground laughingly began pointing machine guns loaded with live ammunition at each other and shouting something like “Tra-ta-ta!..”. Suddenly the machine gun said its “word”... The result is one has a bullet in his head. Neurosurgeons somehow managed to revive and repair the guy; They inserted several plates into his skull and sent him to us — to resolve the issue of further treatment and disability.
In the conversation the patient made a strange impression. Formally, his mind was not damaged, his memory and stock of knowledge were at a normal level; He also behaved quite adequately — at first glance… One was struck by an unnatural calmness, even to the point of indifference; the guy talked indifferently about the injury, as if it didn’t happen to him; didn't make plans for the future. In the department he was absolutely passive, submissive; mostly — lying on the bed. They invited me to play chess or backgammon, asked the staff to help me — I agreed. Sometimes it seemed — order him to jump out the window — he would do so, and without hesitation.
And we received the answer to our questions a week later, when the patient was “caught up” with documents from neurosurgery, where his injury was treated. The surgeons described that the wound channel passed right through the guy’s frontal lobes. After this, all questions about the patient’s behavior were removed for us.
By the will of fate, I had the opportunity to meet this patient again, almost ten years after we met. This happened at a rehabilitation center where I worked part-time as a consultant. The guy has changed little in appearance. Sharpness and rudeness appeared in communication; mental abilities were completely intact. I didn’t notice the main thing: self-confidence and independence. The man had empty eyes... In life, he “floated with the flow”, completely indifferent to what was happening around him.
In conclusion, as before, I would like to wish: take care of yourself and your loved ones and remember that in most cases, even difficult and painful treatment is worth defeating a disease that deprives a person of his humanity.
01DecWhat is a lobotomy
Lobotomy is an operation performed on the human brain. As a result of a lobotomy, a small area of the brain is deliberately damaged, and in some cases completely removed. The second name of the operation is leucotomy. It comes from the Latin word “white”, as it is carried out on the part of the brain consisting of “white matter”.
Why is a lobotomy performed?
A lobotomy is performed to cure a patient of mental disorders. When a patient does not respond to other treatment, poses a threat to other people or himself, the doctor could decide to perform such an operation. The mechanism of action is based on the destruction of connections in the brain, as a result of which not only normal activity is disrupted, but also pathological activity - that which causes a disease or disorder. At the same time, the chances of a cure are far from one hundred percent, but side effects are almost inevitable.
Do they do lobotomies now?
No, lobotomy is prohibited throughout the civilized world. But it must be said that this happened not so long ago. Back in the seventies it was carried out in America, but in the USSR it was banned in 1950. Perhaps it would have been carried out now, but, fortunately, more effective drugs were introduced.
How is a lobotomy performed?
Since the purpose of a lobotomy is to damage the white matter of the brain, the principle of the operation comes down to two actions. The first step is to get inside the skull and get to the required area. As the least traumatic, it is worth mentioning the transorbital method. The instrument is inserted into the patient through the eye socket, and then penetrates the brain, piercing the thin part of the skull in this place. The device passes over the eyeball without injuring it. Methods involving trephination of the skull were also very common, by drilling it or even cutting through it in a certain area. The second stage is damage to the brain tissue itself. Sometimes an incision or puncture was simply made, but more often specific instruments were used to more severely injure the desired area.
What happens to a person after a lobotomy?
To begin with, it is worth talking about the side effects of this operation. Due to disruption of connections in the brain, serious negative consequences are almost always observed. Thinking, logic, memory are disrupted, a person degrades and loses his personality. Often patients completely lost contact with the outside world, turning into a “vegetable”, or even died. The reason for this is both the destructiveness of the operation itself and the unqualifiedness of the doctors who performed it. The condition of approximately a third of the patients improved, aggression passed, and schizophrenia receded. Some even regained their capacity and could once again be part of society. But the positive effect is mainly due to human degradation. An aggressive and uncontrollable patient became like a child with unformed thinking.
Previously, doctors used lobotomies to try to heal patients with poor mental health. Today this method seems ridiculous, and the word “lobotomy” itself is often used as a joke. It has long been clear that the technique does not work, but it is completely unclear how they even tried to treat anything in this way.
1. The creator of the lobotomy received a Nobel Prize
Nowadays, lobotomy is considered a clear failure of psychiatry, but in the past the procedure was performed on any occasion. The method was developed by the Portuguese doctor Egas Moniz, who was the first to perform an operation called prefrontal leucotomy. He inserted a loop into the brain and, using rotational movements, caused minor damage to parts of the brain. This is how Monis treated schizophrenia - he realized that patients after surgery were much easier to manage.
Later, another doctor named Walter Freeman “improved” the method - he began to operate through the upper wall of the orbit. It was clearly faster. We know this procedure today as transorbital lobotomy. In 1949, Moniz received the Nobel Prize for his discovery, and the untested procedure gained widespread confidence. Now it could be carried out legally. Soon, lobotomies were performed on thousands of patients around the world. Exclusively for medicinal purposes, of course. 
Relatives of some lobotomy victims petitioned the Nobel Committee to cancel the award because the procedure caused irreparable harm. The committee categorically refused to consider the requests and wrote a refutation, where it explained in detail how the committee’s decision was justified. Committee members believed that lobotomy was the best treatment for schizophrenia: it produces results, it is ahead of its time, after all, so why should the award for it be considered a mistake?
It should be noted that there were no precedents: the Nobel Committee has never canceled the award, and probably never will, because it is contrary to its policy. So Egas Moniz will remain in history as a brilliant doctor.
2. Many people thought lobotomy was a better alternative.
You may be wondering: How did the practice of piercing a person's eye with a tool that looks like a small ice pick become so popular? But the doctors had a good goal: to help people suffering from schizophrenia and other severe mental illnesses. The doctors who advocated lobotomy were not aware of all the risks of brain surgery. They couldn't see what they were doing, but the reason for the operation was justified: psychiatric hospitals were a terrible place for patients, and the procedure could help them lead something like a normal life.
The problem is that at that time there were no drugs that could calm a violent patient for a long time. A severely mentally ill person could cause great harm to himself or others, so sometimes drastic measures were required. Patients often had to be placed in straitjackets and placed in a private room with padded walls. In such conditions, violence was commonplace. Treatment was difficult and brutal, and without an effective treatment, schizophrenics and other patients had no hope of ever leaving the hospital.
Lobotomy seemed like a way out of a terrible situation for both patients and doctors. It’s a pity that in the end it became not a solution, but a dead end.
3. Patient monitoring
Moniz was the first to use lobotomy. Freeman made it popular. But at the same time, the pioneers of lobotomy did not approve of each other's methods. Moniz believed that the Freeman method (transorbital lobotomy) was not the most responsible way to do brain surgery. Freeman pierced the brains of patients for their own good with too much enthusiasm. But Moniz's method also had many disadvantages.
Moniz did not monitor the further fate of his patients. He didn't even have sufficient evidence to draw conclusions. Strange, isn't it? He performed brain surgery using a new technique that had never been tested anywhere before!
Moniz treated patients and monitored their behavior just a few days after breaking the connections in their heads. Many believe that the criteria for determining whether a patient was truly normal were biased: the doctor really wanted the result to be positive. Let's be clear: Moniz found improvement in most patients because that's what he wanted to find. Freeman, although he practiced perhaps a more barbaric method, worked with patients after surgery. He did not abandon them until his death.
4. Surgically induced childhood
Freeman coined a term for people who had recently undergone a lobotomy: surgically induced childhood. He believed that patients' lack of normal mental abilities, distraction, stupor, and other characteristic effects of lobotomy occurred because the patient regressed—reverted to a younger mental age. But at the same time, Freeman did not even imagine that damage could be caused to the individual. Most likely, he believed that the patient would eventually “grow up” once again: the re-adulting would happen quickly and ultimately lead to complete recovery. And he suggested treating the sick (even adults) in the same way as naughty children would be treated.
He even suggested that parents spank their adult daughter if she misbehaved, and later give her ice cream and a kiss. The regressive behavior patterns that often appeared in lobotomized patients disappeared over time in few, leaving the person mentally and emotionally paralyzed for the rest of their lives.
Many patients could not control urination. They really behaved like very naughty children: they instantly became excited by various stimuli, showed attention deficit disorder and uncontrollable outbursts of anger.
5. Informed consent
Nowadays, doctors must first inform the patient about what will be done, what the risks and possible complications are, and only then begin complex physical or mental treatment. The patient, being of sound mind, must understand the risk, make a decision and sign the documents.
But in the days of lobotomy, patients had no such rights, and informed consent was treated carelessly. In fact, the surgeons did whatever they wanted.
Freeman believed that a mentally ill patient could not give consent to a lobotomy, since he was not able to understand all its benefits. But the doctor did not give up so easily. If he could not obtain consent from the patient, he went to relatives in the hope that they would give consent. To make matters worse, if the patient had already agreed but changed his mind at the last minute, the doctor would still perform the operation, even if he had to “turn off” the patient.
In many cases, people had to agree to a lobotomy against their will: doctors or family members decided for them, who, perhaps, did not want to harm, but treated the treatment irresponsibly.
6 Lobotomy Destroyed People's Lives
Most often, a lobotomy either turned a person into a vegetable, or made him more obedient, passive and easily controlled, and often also less intelligent. Many doctors perceived this as “progress” because they did not know how to deal with difficult patients. If the lobotomy did not kill the patient, then doctors considered any irreparable brain damage to be side effects of the treatment.
Many people who asked for an appeal against Moniz's Nobel Prize complained that they or their relatives were not only not cured, but also irreparably damaged, which made them forever different from who they were. There was a case when one pregnant woman underwent a lobotomy because of headaches alone, and she never became the same: for the rest of her life she remained at the level of a small child, unable to eat or take care of herself. 
Another example: a boy named Howard Dulley was given a lobotomy at the request of his stepmother - she did not like that Howard was a difficult child. Freeman seriously recommended this method as a way to change personality. And the boy spent his life losing himself forever.
7. Surgical theater
It is believed that Freeman was too happy to be able to legally perform transorbital lobotomies on all patients indiscriminately. Not only did he not consider it necessary to properly inform the patient about the risks and the procedure, but he also boasted of his successes in front of excited people. Freeman often completed the procedure in ten minutes - somehow short for complex brain surgery, even if it were the most useful operation in the world. Unfortunately, the doctor himself did not think so.
He once performed 25 lobotomies in a day. It was he who first figured out the “humane” use of electric shock to perform operations while patients were unconscious. Worse, Freeman would sometimes lobotomize both sides of his brain just to show off. It is impossible to say exactly how many people he ruined their lives.
8. Chemical lobotomy
Today, a lobotomy is considered an absurd, barbaric procedure. But quite recently it was practiced everywhere, without even understanding what they were doing. I would like to believe that lobotomy disappeared forever because doctors finally realized what they were doing. But in reality, it was simply replaced by more effective treatment.
Of all the doctors, perhaps only Freeman adored lobotomy. Other doctors didn't like this procedure, but they resorted to it when they thought there was nothing else to do. But time passed, and the operation was replaced by psychotropic drugs. A medicine called aminazine appeared, which was initially called a “chemical lobotomy.”
People were afraid that chlorpromazine could also change personality forever. But the drug clearly did not turn patients into mindless children who cannot even control basic body functions. And soon lobotomy was abandoned forever as a medical practice.
If neurosurgeon Egas Moniz had been given the Nobel Prize in 1927 for the discovery of angiography, the world might not have known such a terrible operation - lobotomy. And so, thanks to his invention, many people were maimed, mainly women and children. The creator of the operation, Egas Moniz, observed only positive results in patients, which he published in medical journals.
With the help of a lobotomy they tried to treat mental illnesses, neuroses, and then simply “strange behavior” or attention deficit disorder. Moniz's followers refined the operation and performed it not just on an outpatient basis, but in front of a curious public. But first things first.
Hereditary aristocrat
António Caetano de Abreu Freyre – that was the scientist’s actual name – was a representative of a Portuguese aristocratic family. From a young age, interested in politics, he slandered the existing system, and in order not to incur royal wrath on his family, he took the pseudonym Egas Moniz.
Having received a higher medical education, he wavered throughout his life between political and medical activities. Without making a choice, he nevertheless achieved success in both areas. Thus, he held a parliamentary seat, was the Ambassador of Portugal to Spain and even the Minister of Foreign Affairs.
When the government changed, he returned to science and made the discovery for which he was nominated for the Nobel Prize twice - and never received it. This was the discovery of the method of radiocontrast angiography - a procedure that involves the introduction of a contrast agent into the vessels (Moniz guessed to use iodine as it, which is still used to this day), after which the vascular network of a certain organ is visible under fluoroscopy. The scientist also contributed to the development of a drug based on thorium dioxide – Thorotrast. It has been proposed to be used for both radiographic and radiographic studies.
Fatal scientific discovery
Without receiving a Nobel, 53-year-old Moniz continues to engage in science. In 1935, when he was already 61 years old, the scientist went to the next International Congress on Neurology. There he was interested in the report of two of his colleagues - Fulton and Jacobsen from Yale University. They conducted a series of experiments on monkeys, removing part of their frontal cortex. This kept the primates alive, but deprived them of their usual fussiness and anxiety.
The message interested Moniz keenly. He thought that interfering with the frontal lobes could help hopelessly mentally ill patients find peace and “normalcy.” In the same year, the scientist begins a series of experimental operations on patients with schizophrenia. He doesn't remove their frontal lobes—it's enough to sever the white matter that connects them. The operations were not carried out by Moniz himself, but by his assistant: at that time he was suffering from gout, and his hands could not make precise movements. Operations were performed through a hole in the temporal bone, where a metal loop was inserted, which destroyed the connections between the frontal lobes.
The intervention was called “leukotomy” because a dissection (“tomos”) of the white (“leukos”) substance was performed. This name was replaced by the word “lobotomy,” meaning the separation of the frontal lobes.
A year later, Moniz reported to the scientific community about the miraculous properties of the intervention. Thus, out of 20 mentally ill patients operated on:
- 7 recovered (became quiet and calm);
- 7 people began to behave better;
- 6 people had no dynamics.
The neurosurgeon observed them for a short time: when he saw the first signs of improvement, he documented them and, if possible, discharged them home.
Over the following years, Moniz's assistants, as well as his most famous followers, later called the "lobotomy kings", had so many seemingly successful operations that in 1949 Moniz was awarded the long-awaited Nobel Prize. However, he could not come to the award ceremony: at 74 years old, not everyone can do this.
Anatomical certificate
The human brain has 2 hemispheres - right and left. The basis of the hemispheres is gray matter, the cortex, consisting mainly of nerve cell bodies. The hemispheres are connected to each other using white matter, which consists mainly of processes of nerve cells covered with a “winding” - myelin, which gives these structures their white color.
The frontal lobe was originally known to be the primary motor area. The parts of the body for the movement of which it is responsible are located in a certain, already solved, sequence (it is slightly different on the right and left).
Tumors and hemorrhages in its central part lead to paralysis of half the body and, almost always, the opposite side of the face.
A little later it became known that the frontal lobes are responsible for:
- complex forms of behavior;
- thinking;
- ability to analyze;
- speech;
- will.
Those with lesions in the areas of the frontal lobes located in front of the motor cortex experienced severe personality disorders. Such patients are notorious for resuscitation doctors, neurologists, neurosurgeons, oncologists and phthisiatricians. They are called “frontal lobe syndrome,” and the diagnosis is “frontal lobe syndrome.”
It is characterized by loss of identity:
- the desire to do something, any intentions, plans, the will to live disappears;
- complex forms of behavior become inaccessible, only some stereotypes are preserved;
- speech becomes primitive;
- the ability to analyze disappears;
- the patient does not start a conversation, but can answer questions correctly. The speech lacks comparisons, metaphors, allegories - everything that makes it more beautiful;
- attempts to perform some actions (for example, cooking) that were previously brought to automaticity, even when receiving full instructions for the action, become impossible;
- actions are chaotic;
- memory is impaired;
- appetite increases due to the fact that the patient does not remember what he recently ate;
- memorization does not lead to effect;
- all interests disappear or change;
- If you point out to the patient his mistakes, he does not even try to correct them.
In common parlance, the complex of these symptoms is denoted by the phrase “became a vegetable.” All this happened after the operations of Moniz and his followers, but, of course, the violence and aggression of the patients disappeared. On the contrary, either a state of euphoria or emotional indifference appeared.
"Lobotomy Kings"
The discovery of lobotomy “went to the people”: other doctors became interested in it. The most famous were Watts and Freeman. The latter became especially skilled: back in 1945, he came up with a less traumatic method of surgical access - not by drilling a hole in the temporal bone, but by making a hole in the area of the inner wall of the orbit with a thin, sharp instrument (it looked like an ice pick). Another instrument, also invented by him, resembling a syringe - an osteoclast - was inserted into the resulting hole. It was needed to destroy the connections between the frontal lobes.
Freeman bought a van, equipped it with something like an operating table, and installed electricity there, since it was necessary to anesthetize with electric shock. In this van - the “lobomobile” - he traveled around the country, offering to all relatives of the mentally ill to heal them in a matter of minutes. The operations were carried out right there, and everyone could watch them. Lobotomies were offered to both disobedient children and women “to correct behavior.”
The popularity of the operation grew, and this is no wonder: almost immediately after the intervention the patient came to his senses, his behavior changed for the better. Signs of deterioration, return of previous disorders, epileptic seizures, intracerebral hemorrhages and infection of bones or brain tissue began much later. Every third patient became a “vegetable”, and every fifth patient died.
The most famous patient is President Kennedy's sister, Rosemary. Her operation was performed at the request of her father; The cause was mental retardation. The intervention left the girl a frail 2-year-old child who never got the opportunity to live a full life.
The end of triumph
In total, about 70 thousand operations were performed worldwide. More than half (40 thousand) are in the USA, 5 thousand operations per year; 2.5 times less - in the UK. About 400 interventions were performed in the USSR, using our own methods and according to strict indications, which included severe forms of mental illness, and not behavioral disorders or sexual orientation.
In 1950, lobotomy in the USSR was recognized as an “anti-scientific method.” Its popularity began to wane in other countries as mass reports appeared about the complications of this intervention. By the end of the 1970s, it was still being performed, but in isolated cases. The last lobotomy was performed in the late 80s.
Lobotomy is one of the darkest pages of psychosurgery, a terrible operation that was performed on patients suffering from mental disorders (mostly women). Even modern medicine doesn’t know much about mental health. The brain is a complex organ, and you can’t just poke around with a sharp piece of iron. Unfortunately, this is exactly what happened during a lobotomy - and the results of such surgical manipulations were very disastrous.
When we think of doctors, we think of someone we can trust. After all, they definitely understand this! Especially with something as complex as mental illness... And that's what makes the lobotomy story so tragic. All these patients clearly suffered (although not all of them were sick) and trusted the doctors - and the doctors deceived them. So here are some basic facts about the history of lobotomy.
Founder
In 1935, Portuguese psychiatrist and neurosurgeon Egas Moniz heard about an experiment: a chimpanzee's frontal lobes were removed and her behavior changed, she became obedient and calm. Moniz suggested that if the white matter of the frontal lobes of a person’s brain is dissected, eliminating the influence of the frontal lobes on other structures of the central nervous system, then schizophrenia and other mental disorders associated with aggressive behavior can be treated in this way. The first operation under his leadership was carried out in 1936 and was called “prefrontal leucotomy”: through a hole made in the skull, a loop was inserted into the brain, the rotation of which cut through the white matter of the frontal lobes. Moniz performed about 100 such operations and, after briefly observing the patients, published the results according to which a third of the patients recovered, a third showed improvement, and the rest showed no positive dynamics. Very soon he had followers in other countries. And in 1949, Egas Moniz was awarded the Nobel Prize in Physiology or Medicine “for his discovery of the therapeutic effects of leucotomy in certain mental diseases.” Who would argue with a Nobel laureate?
Propagandists
Many people became interested in Moniz's discovery, but the most famous promoter of lobotomy was the American psychiatrist Walter Jay Freeman. This picture shows him and his assistant, neurosurgeon James Watts. These two are the American lobotomy kings, who have personally performed thousands of operations. Freeman used electric shock as pain relief. In 1945, he came up with a new method - transorbital lobotomy, which could be performed without drilling the skull, using an instrument similar to an ice pick. Freeman aimed the tapered end of the knife at the bone of the eye socket, using a surgical hammer to pierce a thin layer of bone and insert the tool into the brain. After this, the fibers of the frontal lobes were cut by the movement of the knife handle, which caused irreversible damage to the brain and simply turned every fourth patient into a “vegetable.” By the way, the first operations were carried out using a real ice pick, and only then were new surgical instruments developed - the leukotome and the orbitoclast. Freeman successfully advertised his method of curing the mentally ill: he owned a special “lobomobile” - a van in which he traveled around the country offering miraculous healing, and performed operations right in front of the audience, in the spirit of a circus performance.
Lobotomies have even been performed on children.
So, you and I already have a rough idea of how a lobotomy was performed and what types of it existed. But why did doctors feel the need to delve into a patient's brain like this? Yes, because there were no other, more effective methods of treating mental disorders at that time, and doctors at that time knew much less about the diseases themselves. To the point that a restless, disobedient child, who would now be diagnosed with ADHD (attention deficit hyperactivity disorder), in those years could be sent for a lobotomy - “since nothing else helps.”
Surgical instruments
These are the instruments commonly used in lobotomies. They look like dentist's instruments - sharp, metallic and menacing-looking. Well, what else should things look like, with the help of which you first need to make a hole in the strongest bone of the skull, and then shred the brain a little? You can't do without a trepanation kit. Well, for transorbital lobotomy - special ice picks.
She changed people forever
If you break a leg or arm, the bone will take a long time to heal, but eventually the limb will work again and you will be the same as before. If you accidentally cut off half of your finger with a knife and manage to quickly get to the hospital, they can even sew your finger back on and everything will be fine. But if you break something in the brain, the chance that everything will return to normal is very, very small. After such a serious intervention as a lobotomy, the patient cannot remain the same person. The only difference is to what extent it can influence him - completely turn him into a zombie or partially change his behavior.
The side effects were horrific
After a lobotomy, a person began to behave differently. In the first few weeks, the patients' behavior showed a significant improvement, or rather change, from the condition for which they were treated. A person who was depressed might begin to show signs of joy. The patient with schizophrenia stopped showing its symptoms and began to behave normally. But then, most often, consequences occurred: a rollback to previous disorders or the development of new, even more serious disorders. Often after a lobotomy a person commits suicide.
By the end of the 1940s, sufficient experience had already been accumulated to identify the main side effects of lobotomy: unexpected and unacceptable changes in behavior, epileptic seizures in more than half of patients, brain infections, meningitis, osteomyelitis, cerebral hemorrhages, weight gain, loss of urinary control and defecation, death as a result of surgery with a probability of up to 20%.
John Kennedy's sister had a lobotomy
Rosemary Kennedy is the eldest of the sisters of John Kennedy, one of the most famous American presidents. The Kennedys were the perfect family and the children were perfect - everyone except Rosemary. She was born mentally retarded - this was the diagnosis made by doctors. The girl lagged behind other children in development and could not learn and socialize in the same way as them. I suffered from mood swings - sometimes frantic activity, sometimes depression. Her IQ was 75. By the age of twenty, her parents did not know what to do: Rosemary had become uncontrollable. They said that she had nymphomaniac tendencies and aggressive behavior. Doctors convinced the parents that they needed to try lobotomy - it just gained popularity as the newest way to cure such patients. It was in 1941, the operation was carried out by the “lobotomy kings” Freeman and Watts, as a result of the operation Rosemary remained a frail invalid for the rest of her life, with the development level of a 2-year-old child and the inability to care for herself independently. For the rest of her life - and she died of natural causes in 2005 - Rosemary Kennedy lived away from her family, in a separate house with a nurse.
The consequences of the lobotomy could no longer be corrected
The damage caused to the patient by a lobotomy was incomparably greater than the benefit - even if outwardly there was one. In the photo, the woman on the right looks calmer and happier, but does this mean that she really is? It seems that she has simply become more manageable. Depression, anxiety, schizophrenia are mental disorders that plague people every day, and many would wish for a quick surgery that would fix it all. But it is unlikely that you would want to perform an operation on yourself, as a result of which part of your personality will be irretrievably destroyed. Today, such patients are usually treated with medications and therapy, and if doctors see a negative effect, they stop the treatment and choose another one. Here at least there is a chance not to lose yourself completely.
Some statistics
The majority of lobotomy procedures were done in the United States (approximately 40,000 people). In the UK - 17,000, in the three Scandinavian countries - Finland, Norway and Sweden - approximately 9,300 lobotomies. In the early 1950s, about 5 thousand lobotomies were performed per year in the United States.
They tried to treat homosexuals with lobotomies
Homosexuality was considered a sexual perversion due to mental abnormalities. Yes, it was common practice to treat homosexual tendencies with electric shock, or resort to lobotomy if the electric shock failed. Or better yet, to both one and the other.
What are the frontal lobes of the brain responsible for?
The prefrontal cortex is responsible for many things that make us who we are. Brain development occurs gradually and the prefrontal cortex is the last to complete its formation - around the age of 20. It is responsible for self-control, coordination, emotional management, focus, organization, planning and most importantly, our personality. It’s terrible, but it is precisely this zone that is violated during a lobotomy.
Lobotomies were also performed for far-fetched reasons.
Sometimes people underwent this operation for some far-fetched and stupid reasons. One woman had surgery because she was “the meanest woman on the planet.” After the lobotomy, those around her noted her smiling and friendly nature. Well, she also began to bump into objects a little or drop bags in the middle of the road, but that’s okay. The main thing is with a smile on your face. Or here’s another case: a little girl had a lobotomy because she constantly tore and broke her toys. After the operation, she began to tear and break them even more often, but only because she did not understand anything.
Women are the main victims of lobotomies
The majority of patients undergoing this operation were women. Women were more powerless, more often suffered from depression, anxiety, hysteria, apathy, and they could easily be called crazy and sent to the hospital, and there - electric shock and lobotomy. The result may have suited their loved ones: the woman’s loss of individuality and the possibility of complete control over her. Women became dependent and obedient.
Lobotomy was quickly banned in the Soviet Union
The first lobotomy in the USSR was carried out in 1944, using its own method, close to the method of Egas Moniz. But in our country lobotomy was not as rampant as in America (about 400 operations were performed over the entire period). In 1949, very strict requirements were established for the selection of patients for whom such a procedure was indicated, and a list of clinics and neurosurgeons who had the right to perform it was compiled. And at the end of 1950, an order was issued prohibiting the use of prefrontal lobotomy at all. The resolution sounded like this: “Refrain from using prefrontal leucotomy for neuropsychiatric diseases, as a method contrary to the basic principles of surgical treatment of I. P. Pavlov.”
