Lobotomy has a bad name, but it won its inventor a Nobel Prize. Does surgical intervention in the brain have a place in the medical armoury?
Brain surgery has a long history; ancient human skulls have been found with holes drilled in them (known as trepanning or trephining). In the late 19th century medics were experimenting with brain surgery to treat conditions such as schizophrenia. But it was a Portuguese doctor, António Egas Moniz, who really pushed the field forward with the development of the leucotomy in the 1930s.
At the time there was very little that could be done for patients with schizophrenia, depression or other serious mental health problems. Moniz’s approach was to inject alcohol into fibres joining the frontal lobes of the brain, to destroy the nerves and reduce unwanted brain activity. Moniz won the Nobel Prize in Physiology or Medicine in 1949 for this work.
The technique did in some cases work, though not always, and Moniz himself argued it should only be used as a last resort. (Despite the Nobel Prize, Moniz suffered for his science – he was shot by a former patient and ended up a paraplegic.) Lobotomy might have faded away had it not been for some enthusiastic supporters – particularly Walter Freeman in the USA.
Freeman promoted the ice pick lobotomy – rather than the special tools Moniz favoured, Freeman and his collaborating surgeons inserted a standard ice pick through the eye socket and jiggled it about under local anaesthetic. The whole operation took only a few minutes. Despite many medical misgivings, the lobotomy was wildly popular in the USA and elsewhere. It was also undoubtedly misused for political ends or by families embarrassed by mentally ill relatives.
By the 1950s, the fact that its success rate was low and its side-effects common and severe, often leaving patients in a zombie-like state, had led to its demise. The final nail in its coffin was the development of drugs, beginning with Thorazine, to treat mental disorders.
Brain surgery today
While lobotomies today are rare, surgical intervention in the brain is still carried out in the treatment of certain disorders (in a much more controlled way). As well as surgery for treating brain tumours, surgery can be highly successful in treating epilepsy, to prevent unwanted electrical activity spreading across the brain. Electroconvulsive therapy (ECT) is occasionally used for severe depression when a patient has not responded to other therapies.
Deep-brain stimulation is a successful treatment for Parkinson’s disease. Electrodes are inserted deep into the brain and electrical signals inhibit the nerve signals that cause the uncontrollable shaking seen in Parkinson’s.
Overall, though, surgeons are much less likely to dig into the brain these days. Partly this is because drugs can often do a similar job without the need for a scalpel, by altering brain chemistry. Even so, there are concerns that such drugs have excessive side-effects or are used too much – the rising use of Ritalin for attention deficit hyperactivity disorder (ADHD) being a case in point.
There is also the potential for drugs to be used to treat socially unacceptable behaviour. There have been calls, for example, for sex offenders to be treated with agents to curb their sexual behaviour. One lesson from the leucotomy episode is that we need to be wary that what seems initially to be a prudent medical technique does not become abused and misused.
Set of Watts–Freeman lobotomy instruments, c.1950.
Wellcome Library, London