Buzz
To begin: No, a lobotomy is not something you should undergo (or perform) under any circumstances. It would be highly unlikely to find a surgeon willing to carry out this procedure, and whatever issues you may be facing could be much better addressed through other methods. In theory, however, a friend could carry out a lobotomy on you using basic tools—if there was ever a type of DIY brain surgery, this would be it. If you manage to survive the procedure, you likely wouldn't even regret it, simply because you wouldn't be left with much of 'you' to feel remorse.
What exactly is a lobotomy?
A lobotomy (or leukotomy) is a type of surgical intervention in which the prefrontal lobe of the brain is severed from the rest of the brain by cutting the nerve connections. Developed in the 1930s by the Portuguese neurologist António Egas Moniz, who was awarded the Nobel Prize in Medicine in 1949 for his work, the procedure was mainly used to treat conditions like major depressive disorder, obsessive-compulsive disorder, and sometimes schizophrenia. Approximately 50,000 lobotomies were performed in the United States, most between 1949 and 1952, although the practice continued into the late 1960s.
Regarding the theory of how surgery might help individuals with mental health disorders, I'll leave it to psychiatrist Richard L. Jenkins, who expressed the following in his 1954 paper titled "Effects of prefrontal lobotomy on patients with severe chronic schizophrenia", published in the American Journal of Psychiatry:
The theory suggests that the disruption of the schizophrenic process stems from a conflict that is beyond the patient’s ability to resolve…on the neurological front, this conflict is caused by a persistent, maladaptive resonance or 'eddy' of neural activity between the cortex and the diencephalon, obstructing the higher brain circuits.
"Morbid resonance?" An "eddy" that "blocks the higher circuits"? Sounds like genuine neuroscience, doesn’t it? Maybe we should start cutting into some brains!
The supposed advantages of a lobotomy
With sensational headlines like "Surgical Wizardry Restores Sanity to Fifty Raving Maniacs," the popular media of the 1940s and '50s portrayed the lobotomy as a miraculous treatment for mental disorders. In an outpatient procedure lasting about an hour, patients who had been confined to institutions for years were able to return home and lead normal, productive lives. Those plagued by anxiety became relaxed. Aggressive individuals turned docile. People who had been deeply depressed were smiling all day long.
However, the Saturday Evening Post and other publications conveniently overlooked one key detail in their rosy portrayal of lobotomy benefits: the procedure frequently erases the victim's sense of self and personality.
The numerous drawbacks of lobotomies
The prefrontal cortex is the area of the brain responsible for complex cognitive functions. It plays a crucial role in personality, decision-making, and regulating social behavior. Essentially, the prefrontal lobe is what defines our humanity, so when it is severed from the rest of the brain, the change is profound. Dr. Walter Freeman, a neurologist and pioneer in lobotomy, stated that the "personality of the patient is changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist." And indeed, a lobotomy achieves that (if the patient survives), but the life of a lobotomized individual is not one that most would wish for.
Freeman referred to the post-lobotomy condition as "surgically induced childhood," but that description falls short. After the procedure, patients became empty shells—passive, non-complaining, but unable to dress themselves, reluctant to get out of bed, and seemingly devoid of self-awareness or introspection. Freeman reported that about 25% of his patients remained in this state (essentially at the level of a "household pet," as he put it), though over time, some learned basic tasks or even regained simple math skills. A few relapsed, seeing their symptoms return. Others reportedly improved, with symptoms vanishing. Approximately 14% of patients died as a result of the procedure.
Although never widely embraced by the medical community, lobotomy gained popularity in mental institutions, and it's not hard to see why: it made people docile. In his 1950 book Psychosurgery, Freeman described a patient named Oretha, an institutionalized woman who required five attendants to administer her pre-lobotomy anesthesia. Afterwards, Freeman wrote, "We could playfully grab Oretha by the throat, twist her arm, tickle her ribs, and slap her behind without eliciting anything more than a wide grin or a hoarse chuckle." Yay?
Severely mentally ill individuals weren’t the only ones subjected to lobotomies. Freeman also performed the surgery on wives who no longer wanted to do housework, 12-year-old children who daydreamed excessively and stole candy, and many others. The most well-known case was that of Rosemary Kennedy.
At 23 years old, the often defiant sister of President John F. Kennedy was attending a convent school in Washington, D.C. After Rosemary was caught sneaking out at night, the nuns at the school grew concerned that she might be engaging in sexual activity. Her father, Joe Kennedy, decided to take Rosemary to Freeman, who performed her lobotomy in November 1941.
Whether the procedure was effective is a matter of perspective. Freeman initially hailed it as a success, noting that Rosemary no longer had the urge to sneak out at night. However, she also lost the ability to speak and walk. Over the years, Rosemary showed some signs of recovery, but she never regained clear speech and was never self-sufficient. In 1949, she was transferred to a special cottage at the St. Coletta School for Exceptional Children (formerly the "St. Coletta Institute for Backward Youth"), where she remained until her passing in 2005.
Enough with the history; let's move on to the brain surgery!
Step-by-step instructions for performing a lobotomy that you should absolutely never follow, and I shouldn’t have to warn you about this.
António Egas Moniz, the Nobel Prize winner (I can’t get over that), originally performed lobotomies by drilling holes into the skull and flooding specific parts of the brain with alcohol to destroy the tissue there—definitely not something you should attempt at home. Fortunately, Freeman, the P.T. Barnum of lobotomy, innovated the transorbital lobotomy, a simplified technique that didn’t even need an operating room. He rejected the formalities and cleanliness of operating rooms, performing lobotomies wherever he could. In fact, Freeman could complete a lobotomy in under 10 minutes. Fun fact: Freeman had no formal surgical training.
These steps are taken from Walter Freeman’s Psychosurgery, as recounted in Jack El-Hai’s excellent biography The Lobotomist. If you were to follow these instructions, you’d be committing multiple crimes, and someone would likely end up dead.
Necessary supplies
An icepick
A small hammer
An electroconvulsive therapy machine
The procedure
To carry out a lobotomy, Freeman would:
Sterilize his icepick. Most of the time. Sometimes he skipped this step.
Administer shocks of sufficiently high voltage to induce unconsciousness using an electroconvulsive therapy machine. Occasionally, Freeman would skip anesthesia altogether.
Slide the icepick under the victim’s upper eyelid, near the tear duct, keeping the shaft parallel to the nasal ridge and angled slightly away from the center of the head.
The tip of the icepick would rest against the thinnest part of the skull. Freeman would then lightly tap the hammer to break through the bone.
With that done, Freeman would easily push the icepick into the brain, advising a depth of 5cm. Any deeper and the “patient” would likely die.
Next, he would pull the icepick’s handle “as far laterally as the orbit’s rim will allow.” This was meant to sever the fibers at the base of the frontal lobe. Ideally.
Freeman described this step as “the ticklish part” because it brought him close to arteries. He would return the instrument to its original position and drive it another 7cm deep from the eyelid’s upper edge. Then he would move the icepick 15 to 20 degrees medially and about 30 degrees laterally. If done wrong, the person would die. If done correctly, they’d only maybe die.
Freeman would then twist the icepick out while applying pressure to the eyelid to prevent bleeding.
Sterilize the icepick again.
Repeat the process on the other eye. Freeman, being the showman he was, would sometimes perform both sides at once.
The lobotomy was now complete!
What happened to the lobotomy?
The lobotomy fell out of favor in psychiatric circles during the 1950s, partly because of its horror and lack of reliable success, but also because new psychoactive drugs could calm troublesome patients without the need for surgery. Why go through the effort of cutting into someone’s brain when thorazine could do the job? Despite the increasing doubts surrounding the procedure, Freeman carried on performing lobotomies until 1967, when the last institution to allow him said, “enough” after he killed a woman there.
However, the lobotomy hasn’t completely disappeared. A modernized, vastly improved version is still in use today. The temporal lobectomy is used to treat severe epilepsy that doesn’t respond to medication. While it’s a far cry from Freeman’s method of “just stick a needle in their brain and wiggle it around,” the basic principle is the same; now it’s more targeted and minimally invasive. It also yields much better results: Patients generally experience a reduction in epilepsy symptoms and retain their personalities intact.
