The Eclipse of Lobotomy: “Hecatombs of Mutilated Frontal Lobes”
Lobotomies Are No Longer Fashionable
The Eclipse of Lobotomy 1955-64
Shock therapies became popular at a time when mental health professionals were desperate because facilities were overcrowded and many conditions seemed incurable. These therapies appeared to help make unruly patients manageable and, more significantly, allowed the release of patients for whom there had been no hope. Lobotomy was among the most popular shock therapies.
When doctors first introduced lobotomies, there was much enthusiasm, which was evident in how the New York Times covered these new therapies.
Shortly after that, there was a growing awareness of lobotomy’s side effects in the medical community and the press. During this time, there were also dreams that lobotomies could cure all kinds of ailments, even if the operation reduced creativity, dulled some aspects of patient’s personalities, and, in some cases, left them in a vegetative state.
Chemical Lobotomies?
The introduction of pharmaceutical drugs to address mental illness changed the discourse around shock treatments. This “noninvasive alternative” to lobotomy, coupled with growing concerns about adverse side effects of shock treatments, would eventually result in a decline in the use of lobotomy (Diefenbach, 1999). In 1952, Chlorpromazine (Thorazine), a pill, was the first real alternative to lobotomy, and it was not nearly as messy. In 1955, Rusk reported that medical professionals who had been “exceedingly cautious” had become “enthusiastic” about two drugs that had been “predicated on the effect of lobotomy”(Rusk, 1955).
Another article described trials where patients on Thorazine or Resperin showed “significant improvement” (Weaver, 1955). These “breakthrough” drugs were described as “one of the most significant advances in the history of psychiatry,” because they “replaced lobotomy” (Weaver, 1955). They produced similar effects without the need for surgery (Preiffer, 1956). Interestingly, this demonstrates that lobotomy’s effects were not the main reason the operation was abandoned.
Dr Percival Bailey, director of the Illinois State Psychopathic Institute, staunchly opposed the use of “inadequate” shock treatments and psychotherapy during the 1956 APA annual meeting (Harrison, 1956). Harrison reported that during the meeting, there was a call to create a “foundation of pure science under the clinical and theoretical aspects of psychiatry” (Harrison, E2, 1956). There was an ongoing effort to focus on studies rather than specific cases. Bailey forcefully insisted that mental diseases would be solved through biochemistry (Harrison, 1956). Further, he lamented that
psychosurgery “swept across the country ´leaving hecatombs of mutilated frontal lobes behind it” (Bailey).
Despite these strong criticisms, there was still some positive reporting about lobotomy.
Were Lobotomies Still Acceptable?
Three years after the introduction of Thorazine, Egaz Moniz, the doctor who invented lobotomy, died. An obituary described him as the “first man to cure a mental disorder by a surgical operation” (NYT 20, 1955) This obituary claimed medical experts argued that this operation “justified itself” (NYT 20, 1955). Moniz was awarded the Nobel Prize in 1949 for his contributions to psychosurgery.
Despite the introduction of Thorazine and awareness about lobotomy’s side effects, other articles still discussed lobotomy and other shock therapies in a positive light. For example, In 1956, Harrisson, a reporter, wrote one describing the work of a psychoanalyst named Eugene Broady. Broady, who worked at Yale, thought lobotomies “regardless of clinical improvement” were useful because patients’ “repressive symptoms have been relaxed,” and this helped with psychotherapy (Harrison, E2 1956). Other reporters wrote positively about alternative methods to create brain lesions, which were “probably more precise” than lobotomies (Wiskari, 1959). Nevertheless, many more articles began to seriously question the use of lobotomy when less invasive alternatives existed.
The Old Mutilating Operation: the Dark Side of Lobotomies
The number of lobotomies that have been performed in the past decades allowed doctors to study their effects. The Times covered a British study that followed sixty schizophrenic patients for fifteen years and found lobotomy offered “no therapeutic advantage” (NYT 21, 1957). Others, like Stanley Lesse from the Neurological Institute of New York, argued that despite having no therapeutic value, about a third of those getting a lobotomy “resume[d] nearly normal life” (NYT 21, 1957). During these years, more articles began to portray lobotomies as dangerous. For example, these dangers were highlighted in an article that compared them to old operations (Slaughter, 1957). Another article by Harrison reported a British doctor who said that drugs had “abolished the need for the old and mutilating operation that has been so severely criticized” (Harrison, E4 1958).
Soon thereafter, interest in lobotomies continued to wane. In the next six years, lobotomies were only mentioned four times in the NYT. The first is in Fulton’s obituary, where his work on lobotomy is mentioned, yet no comment is made on its value or lack thereof (NYT 22, 1960). Two articles discussed newer treatments that sought to cure mental diseases by creating lesions in specific parts of the brain. The first, an “electrical lobotomy,” is about the use of implanted electrodes to reduce pain in cancer victims without causing “major physiological damage” (NYT 23, 1961). The second article discussed the use of an ultrasonic beam to target parts of the brain (Harrison, E5 1963).
These two articles continued to reflect the view that mental disease could be localized to a part of the brain. Secondly, they both state that lobotomies damage the brain. In one, Harrison reported that lobotomy was then “rarely used” because it has been charged with “creating ´vegetable-like’ patients with no hope of a normal life” (Harrison E5, 1963). The last mention of lobotomy in this period is in a lengthy article titled How the Machine Called the Brain Feels and Thinks. The author used lobotomies and the “significant personality changes” they produced as an example to substantiate the idea that the brain creates the mind (Wooldridge, 1964). The use of machines as a metaphor for the brain is interesting.
In the following decades, the Times published over six hundred articles using the word lobotomy. These articles coincided with renewed enthusiasm for modifying behavior through surgery. Plenty of them use lobotomy as a metaphor, but a few focus on medical history or review books. In fact, many new treatments that are significantly different from lobotomy are nevertheless given that moniker. Several of these treatments included brain surgery or the implantation of devices therein.
Why Did Lobotomies Stop?
Thorazine was seen as “miraculous,” making other shock treatments redundant (Pressman, 1986). Secondly, the decline in wounded soldiers, the apparent success of drugs, and the realization that earlier studies had been “misleadingly favorable” contributed to the eclipse of lobotomy (Kleining, 1985). Moreover, by the 1960s, a new wave of psychiatrists and neurologists who had not practiced in a world before drugs became doctors and thus more easily dismissed lobotomy (Pressman, 1986). Pressman argued that this shift had less to do with a realization by psychiatrists and neurologists that there were side effects but instead reflected that their “sensibilities had shifted” (Pressman, 1986).
During this period, some psychosurgery was still performed despite the decreasing popularity of such interventions. About five hundred such surgeries were performed by one hundred and forty-one physicians between 1971 and 1973 (Valenstein, 1977).
Lobotomy: A History in Three Periods
The Times' coverage of lobotomies accurately reflected the moods and opinions of medical specialists. Medical developments also affected the tone of the articles in this newspaper.
Our in-depth study of how the New York Times covered lobotomy suggests three periods:
Enthusiastic Endorsement (1935-44): articles are enthusiastic and rarely mention either disagreements or side effects.
Cutting Through The Problem: Early Enthusiasm for Lobotomy
Lobotomy in Practice (1945-1954): articles mention side effects, but primacy is given to patients becoming either productive or manageable. During this period, there was an eagerness to explore whether lobotomies can be used to treat other ailments.
A Gluttony For Lobotomy
The Eclipse of Lobotomy (1954-1964): There is a discussion about how to evaluate whether the operation is successful. The introduction of pharmaceutical drugs shapes this period. The Times started to publish articles that were enthusiastic about these rather and a few criticized the lack of specificity of the lobotomy.
Conclusions
Lobotomy, like other shock therapies, was introduced in an environment where mental hospitals were overcrowded, where patients had no hope of recovery, and where neurologists and psychiatrists were fighting for professional clout. This made lobotomies appear as technological solutions. It is easy to forget that those who advocated for shock therapies tried to bring the full force of science to cure mental illnesses (Pressman, 1986). Walter Freeman’s reputation and enthusiasm for lobotomy helped it become popular. He was a charismatic showman who carefully curated relationships with writers and reporters (Dully, 2007; Diefenbach, 1999). In fact, the very first article published on this issue resulted from Freeman inviting a reporter to witness a lobotomies” (Dully, 2007). Nevertheless, these operations became popular for a variety of reasons.
The press echoed the enthusiasm of mental health professionals who introduced these shock therapies. Contemporary articles tend to depict lobotomy with disdain and shock. While this is understandable, it is important to note that shock therapy enthusiasm was shared and that lobotomies were widely adopted. Those who proposed it, like Freeman, were well-respected and considered authorities in their fields. In 1942, an article in Time Magazine characterized lobotomy as a "drastic method of rescuing psychotic patients from complete insanity" (Singer, 1991). When James Watts died, the Times mentioned that lobotomies were popular and that disagreements and critics existed in the 1950s (Hilchey, 1994). Yet, this same newspaper hardly gave voice to those skeptics then. The Times and parts of the medical community probably fed into each other's enthusiasm, increasing the use of lobotomy.
The press had (has?) an important role when discussing possible medical treatments and interventions. For most of the 19th and 20th centuries, the press was the primary way in which the public could obtain important information. Thus, the press held and arguably holds great influence over public discourses. In this case, the enthusiasm of medical professionals and the press increased the number of people who were lobotomized.
Our investigation into how the press covered lobotomy makes clear that zealously adopting new therapies can cause great harm. This does not mean that all new therapies are harmful, but it suggests it would be wise to exercise caution before massively embracing them.
This week’s article has been adapted from a term project completed by Christian for a class on Narratives about Mental illnesses at HES.
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Fascinating stuff as ever, guys! I enjoyed reading this. I wonder whether there is mileage in expanding that point you made about the metaphor of the brain as a machine. If memory serves, the metaphor stretches at least as far back as Julien La Mettrie, who wrote 'Man a Machine' in the early days of the Enlightenment. I suspect for Moniz and people similar to him, it was barely a metaphor at all. They may well have thought of the brain as a literal machine, just one that was made of biological matter. In fact, the whole idea of lobotomies makes best sense in the context of mechanics. Perhaps we can even think of Thorazine as the oil in the gears.
I'd rather have a bottle in front of me than a frontal lobotomy.