Many articles were written when the first case of a lobotomy was performed. After hearing about it being a "cure" to mental illness, many people rushed to try to get the surgery for their loved ones. It was seen as a scapegoat for "irrational behavior" and the perfect "fix" for "madness." It was publicized in magazines, radios, television, and more.

Media Portrayal of Lobotomies in 1935-1960

Lobotomies rose to fame on account for the few number of solutions to mental illness and the high number of patients there were. It was a very quick solution for doctors and had very few evidence to support it, but also very few evidence to debunk it at the time. 

How Lobotomies Gained Popularity

The Lobotomy procedure was created by the Portuguese Neurologist, Egas Moniz. He concluded that by splitting the fibers of the brain by the separate lobes, there will be a reduction in irrational behavior from the patient. He later went on to win a Nobel Peace Prize for his work, even though there was lack of evidence to support his surgery. His idea steamed from research of a decrease in neurosis in chimpanzees when splitting the frontal cortex from the rest of the brain.

The Invention of the Lobotomy

Oftentimes, lobotomies were performed on people experiencing neurosis and it was used for treating  Schizophrenia patients and patients of depression with suicidal ideations. After the surgery, it was reported that they were much calmer and relaxed. This was also true for when lobotomies were used to treat chronic pain. The patients felt "indifferent" to the pain after the surgery was performed. Many reported a loss of creativity and a change in personality. There might have been a decrease in symptoms, but also a decrease in other important aspects that made the patient and  individual. 

Lobotomy Results

Many different tools were used to complete this surgery. The Leukotome (pictured) was used for the more classical procedure. Other methods included using a needle 3-6 times a day and inserting it to disturb the white matter. Another method was using Iridium in the brain for a fast and "effective" procedure. 

Surgical Techniques for Lobotomy

Dr. Freeman originally used an icepick to separate the cortex and would use a stirring motion to do so. It was a very fast procedure and would take roughly 10 minutes when given anesthesia. His first procedure using the icepick was on his own wife. She was left with no suicidal tendencies but also as a thoughtless person. 

Dr. Freeman's Original Lobotomy Procedure

A woman named Sarah Simpson was found guilty of attempted murder after trying to kill a school teacher with the delusion that she was “trying to persecute her.” She was declared “not sound of mind” and was sent to a mental hospital. She then received a lobotomy from Dr. Angelucci in 1952. She was then considered “of sound mind” and was brought back into society because of this procedure. 

Case Study of Lobotomy

Researchers studied 133 patients who had lobotomies done and followed them over the years to see how they were doing after the procedure. These patients received the lobotomy between the years of 1948-1952 and were followed up with in 1962-1963. The patients got a lobotomy for the following reasons. 17 had passed away, leaving only 116 to follow up on. 

Studies on Patients with Lobotomies

- Bimedial lobotomy: medial half of the frontothalamus radiations is cut.
- Transorbital lobotomy: frontothalamic fibres are cut by a leukotome that is put supra-orbitally in frontal lobes.
- Cortical undercutting of orbital-medial regions of frontal lobes.
- Ultrasonic lobotomy- ultra-sonic waves destroy fibres of the thalamofrontal radiation.
- Topectomy- ablation of selected parts of frontal lobe cortex
- Cingulectomy- anterior part of the cingulate gyrus is removed by subpial suction.
- Thalamotomy- frontothalamic connections are cut at the level of the thalamus by electrocoagulation using stereotaxic techniques.


Types of Lobotomies

It is the surgical separation of the parts of the frontal lobes from the rest of the brain. Even though there was no scientific evidence behind this treatment, few recoveries made it seem like this was helping patients with schizophrenia. 
An image of the same is attached below: 

Miami University of Ohio

Earlier, there were no treatments to help people who are suffering from schizophrenia. Add to this the neglected institutions where patients were not cared for, people were desperate for treatment and they resorted to a procedure called lobotomy.
Other treatments are: 
- Psychosurgery 
- Drug called Chlorpromazine

Currently, there are additional therapies used for treatment of schizophrenia.

In 2020, The American Psychiatric Association released a clinical practice guideline with pharmacotherapy and psychosocial intervention recommendations.

Pharmacotherapy recommendations:
- Antipsychotic medication (2nd generation agents)
- Clozapine for treatment-resistant patients OR patients with persistent suicidal thoughts/attempts OR consistent hostility and aggressive tendencies)

Psychosocial Intervention recommendations
- A specially coordinated care program created for patients who undergo their first episode of psychosis
- Cognitive-behavioral therapy

Treatment of Schizophrenia 

Breedlove, S. & Watson, N. (2017). Behavioral neuroscience, eighth edition. Oxford University Press.

Behavioral Neuroscience 8th Edition

Lobotomy: Earliest Treatment of Schizophrenia 

Also known as the neurosurgery for mental disorders, psychosurgery is the surgical modification of the brain to treat psychiatric disorder. It involves much smaller lesions and is rarely performed (last resort). It can be used for many other disorders also such as severe epilepsy. 

Treatment of Schizophrenia : Psychosurgery 

 An antipsychotic drug, one of the class of phenothiazines, this drug proved to be a actual treatment of schizophrenia as it was found that chlorpromazine reduces the positive symptoms of schizophrenia such as the hallucinations, delusions and disordered thinking. Also known as Thorazine, it revolutionized psychiatry and helped many patients. 

Treatment of Schizophrenia: Chlorpromazine

1st-generation antipsychotics, also known as neuroleptics and conventional antipsychotics, were a 1950s breakthrough. They were made as dopamine antagonists and they seemed to reduce positive symptoms like delusions and hallucinations. These drugs were about 60%-70% effective for people with schizophrenia in reducing their symptoms. The two most popular 1st-generation antipsychotics are Chlorpromazine and Fluphenazine.

Treatment of Schizophrenia using 1st-Generation Antipsychotics

2nd-generation antipsychotics, also known as atypical antipsychotics, are different from 1st-generation in that they are not primarily dopamine antagonists and they dont just reduce positive symptoms, but also negative symptoms like apathy and alogia. They are not found to be more effective or be better tolerated than 1st generation in treatment as it depends on the patient and what works for them.

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