The strange and curious history of lobotomy

A brain

It's 75 years since the first lobotomy was performed in the US, a procedure later described by one psychiatrist as "putting in a brain needle and stirring the works". So how did it come to be regarded as a miracle cure?

Deep in the archives of London's Wellcome Collection, that great treasure trove of medical curiosities, is a small white cardboard box.

Inside is a pair of medical devices. They are simple. Each consists of an 8cm steel spike, attached to a wooden handle.

"These two gruesome things are lobotomy instruments. Nothing sophisticated," says senior archivist Lesley Hall. "It's not rocket science is it?"

These spikes once represented the leading edge of psychiatric science. They were the operative tools in lobotomy, also known as leucotomy, an operation which was seen as a miracle cure for a range of mental illnesses.

For millennia, mankind had practised trepanning, drilling holes into skulls to release evil spirits.

Start Quote

Lesley Hall

These two gruesome things are lobotomy instruments”

End Quote Lesley Hall Wellcome Collection, London

The idea behind lobotomy was different. The Portuguese neurologist, Egas Moniz, believed that patients with obsessive behaviour were suffering from fixed circuits in the brain.

In 1935, in a Lisbon hospital, he believed he had found a solution. "I decided to sever the connecting fibres of the neurons in activity," he wrote in a monograph titled How I Came to Perform Frontal Leucotomy.

His original technique was adapted by others, but the basic idea remained the same.

Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain.

The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain.

Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in 1936, then spreading it across the globe.

One Flew Over The Cuckoo's Nest The hyperactive McMurphy, played by Jack Nicholson, is lobotomised in One Flew Over the Cuckoo's Nest

From the early 1940s, it began to be seen as a miracle cure here in the UK, where surgeons performed proportionately more lobotomies than even in the US.

Despite opposition from some doctors - especially psychoanalysts - it became a mainstream part of psychiatry with more than 1,000 operations a year in the UK at its peak. It was used to treat a range of illnesses, from schizophrenia to depression and compulsive disorders.

The reason for its popularity was simple - the alternative was worse.

"When I visited mental hospitals… you saw straitjackets, padded cells, and it was patently apparent that some of the patients were, I'm sorry to say, subjected to physical violence," recalls retired neurosurgeon Jason Brice.

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The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution.

"We hoped it would offer a way out," says Mr Brice. "We hoped it would help."

There were centres for lobotomy across the UK, in Dundee, North Wales and Bristol. But by far the most prolific lobotomist in the country, and indeed the world, was the neurosurgeon Sir Wylie McKissock, based at the Atkinson Morley hospital in Wimbledon.

"He was one of the great men of medicine of the 20th Century," says Terry Gould, who worked as McKissock's anaesthetist.

Walter Freeman and Egas Moniz Freeman (left) built on Moniz's discovery

He believes his former boss performed around 3,000 lobotomies, as part of his famously speedy approach to surgery. "It was a five-minute procedure. Very quickly done," says Dr Gould.

As well as operating at Atkinson Morley, McKissock would travel across the south of England at weekends, performing extra leucotomies at smaller hospitals.

"He was quite prepared to travel down to whatever the hospital was on a Saturday morning and do three or four leucotomies and then drive away again," says Mr Brice.

He says the operation could have dramatic benefits for some patients, including one who was terrified of fire. "Funnily enough she finished up after I had done the operation very much better, but she went and bought herself a fish and chip shop with grossly hot oil in it."

'I wish I'd never had it'

British housewife Eileen Davie suffered depression after the birth of her second son in 1948. Conventional treatment failed to help her, so her doctor recommended a leucotomy.

Speaking in a BBC documentary in 1976, her husband Sid, who signed the consent forms, said: "I got the impression that it was no more serious than having a tooth extracted."

The reality was very different. "She was irreversibly damaged," he said. Eileen became apathetic and listless. "I've cracked, haven't I?" as she put it. Several years later, she was told that the first operation had failed and she agreed to a second round of psychosurgery.

"I still felt that these were very eminent gentlemen and if were confident would be a success, it would be a success. They did it and it was a disaster," said Sid. Instead of curing her, she became more apathetic and had severe incontinence problems.

However, he had increasing doubts about lobotomy, especially for patients with schizophrenia.

Psychiatrist Dr John Pippard followed up several hundred of McKissock's patients. He found that around a third benefited, a third were unaffected and a third were worse off afterwards.

Although he himself had authorised lobotomies, he later turned against the practice.

"I got increasingly conservative about it because I don't think any of us were ever really happy about putting in a brain needle and stirring the works," he says. "Not a nice thought."

In 1949, Egas Moniz won the Nobel Prize for inventing lobotomy, and the operation peaked in popularity around the same time.

But from the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs.

What's the modern equivalent?

Jack El-Hai, author of The Lobomotist

"I'm not criticising chemotherapy because it's effective but compared to other treatments, in decades to come it will seem to be overly destructive and something that needed to be changed and will be changed.

"It's a very similar judgement, that the pluses outweigh the minuses."

Decades later, when working as a psychiatric nurse in a long-stay institution, Henry Marsh used to see former lobotomy patients.

"They had been lobectimised 30-40 years ago, they were chronic schizophrenics and they were often the ones were some of the most apathetic, slow, knocked-off patients," he says.

Mr Marsh, who is now one of Britain's most eminent neurosurgeons, says the operation was simply bad science. "It reflected very bad medicine, bad science, because it was clear the patients who were subjected to this procedure were never followed up properly.

"If you saw the patient after the operation they'd seem alright, they'd walk and talk and say thank you doctor," he observes. "The fact they were totally ruined as social human beings probably didn't count."

Here is a selection of your comments.

It's not that the lobotomy is a redundant science. Much like electroshock treatment, the theory behind it is for most of the part quite solid. The problem comes from trying to cut specific 'problem' connections in the early 20th Century is like trying to destroy a (invisible) needle in a haystack with a bazooka, the same is mostly true even with today's technology. Despite this, most early 20th Century lobotomists claimed around a 35% success rate. Apathy was often seen as a 'cured' result for patients who may have been incredibly violent and unruly.

Fraser, Australia

My mother suffered severe postnatal depression in the late 1960s and was hospitalised for several years. After unsuccessful treatment including ECT she underwent a leucotomy in the early 1970s. Whilst it improved her depression it did not cure it, and the side effects have been dramatic. She is a totally different person now, with very little drive and motivation. She has a very poor short term memory, and has put on a significant amount of weight. Was it worth it? I'm not sure.

Dr Julian Elford, Winchester, UK

One person said to have undergone this procedure was Rosemary Kennedy, sister of the late President. From a vivacious girl she became very much brain damaged and eventually became institutionalised. The remorse for this act created the awareness in the Kennedy family to start the Special Olympics movement.

Philip Grech, Attard, Malta

The lobotomy was a barbaric procedure (with very poor scientific support) which left severe and irreversible brain damage. As you indicate in passing, the procedure was applied to minor behavioural and affective disorders with devastating results. To say that the alternative was worse is like saying that lethal injection is good because electrocution is worse. The USSR banned lobotomy in 1950. Britain finally gave it up in the early 70s, after tens of thousands of permanently handicapped patients could no longer be swept under the carpet. Psychiatry in this country continues to substitute therapy for sedation, and the public remains indifferent.

R I Newnham, Sion, Switzerland

The 'modern equivalent' for me is not chemo (which saves people from an actual, life-threatening disease) but the current frenzy of weight-loss surgeries such as the gastric band and bypass. Like lobotomies these are being routinely misrepresented in the media as a 'miracle cure' and pushed onto those whose difference is seen as a threat to society by the surgeons who stand to benefit. Studies of the long-term complications remain in their infancy but early indications are that we're storing up a time-bomb of malnutrition, osteoporosis and endless revisions which if current take-up rates continue will eclipse the claimed costs of 'obesity' they were intended to reduce.

Rich, Leeds

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