A Brief History of the Frontal Lobotomy

Update: I am pretty flattered right now, the subject of my term paper, Howard Dully himself, commented on my paper. He has a website over here, and has a book due out in September called My Lobotomy. Glance at my paper for a synopsis, it's a great story.

I have a history of publishing my term papers on my blogs. I know its not education related, but just in case you are interested. It should be noted as I did my research, that I noticed a simularity between the history of lobotomies and education. Bonus points if you accurately predict my grade (out of 100).

Rory D. Hester
Psy 201
March 26, 2007

Frontal lobotomies have achieved a unique place in the culture of the United States. The procedure is lampooned in cartoons, mentioned in popular music (Hanzlick), and the term used frequently in common conversation, often as part of a derogatory remark… i.e. “Did you have a lobotomy or what?” My stereotype image of a neurosurgeon is still that of a mad scientist hacking away parts of people’s brains, even though it has been over 40 years since Walter Freeman performed his last lobotomy. This paper will attempt to give a brief history of frontal lobotomies, including its effects on several patients, and take a look at its influence on future neurological surgeries.

The history of the frontal lobotomy can be traced back to a German scientist, Friederich Golz, who performed experiments that involved the removal of the neocortex of dogs in 1890 to calm them down (Sabattini). This inspired at least one physician to experiment with a similar procedure on six schizophrenic patients, but the procedure was criticized by medical authorities.

In 1935, Carlyle Jacobsen and Dr. John Fulton performed similar experiments on chimpanzees, which got the attention of a Portuguese neuropsychiatrist, Dr. Antônio Egas Moniz, at the University of Lisbon Medical School. Moniz, started experimenting with a procedure called a leucotomy, which involved cutting the nerves that connected the prefrontal and the frontal cortex to the thalamus. His results were mixed however and he strongly advocated that the procedure should only be used on completely hopeless patients.

Moniz’s work inspired a young ambitious neurologist, Walter Freeman, to take up where he had left off. Eventually he developed and perfected a procedure called the "ice-pick lobotomy". This procedure was so quick and easy, that it was able to be done on an outpatient basis. Frontal lobotomies could now be performed on a wide scale basis, and public opinion supported it. Over 18,000 frontal lobotomies were performed in this country, with tens of thousands performed overseas between 1939 and 1951.

Unlike other physicians in the past, Freeman was able to convince both the press and his colleges that the new procedure would revolutionize the treatment of mentally ill patients. A study of popular press articles on frontal lobotomies showed the positive effects of lobotomies were mentioned more than possible negative consequences until the mid 1950’s (Diefenbach). They also noted that Freeman’s enthusiasm for the procedure predated studies on the long term effects of the operation. This surely contributed to the sheer volume of procedures performed.

While today, we look back at this period with a sense of embarrassment, it should be remembered that at the time the procedure was accepted by much of the medical establishment. According to a review of the scientific journals of the day, “The neurosurgeons who performed the operations, and the scientists who justified it, all came from the highest ranks” (Pressman 4). The culmination of neurosurgeons seeking legitimization, the simplicity of the procedure, and a large number of state psychiatric hospitals all created the perfect conditions for a culture of “lobotomy” to take over the psychiatric field. Not only did lobotomies have the potential to cure people they were also “aesthetically pleasing and financially rewarding” (Pressman, 194).

In the 1950’s though, the climate began to change. A large scale study, called the Columbia-Greystone project, failed to provide evidence of positive benefits of the procedure. Then in the 1950’s a new class of drugs began to be developed that enabled psychiatrists to manage many of the symptoms that lobotomies had been used to cure (Vertosick). A national debate began to take place about the morality of damaging healthy tissue of vulnerable patients. Lobotomy started to loose its luster, and gradually faded out from the mainstream of neurosurgery, but not before it was performed on a young boy named Howard Dully.

In 1960, Rodney and Lou Dully, Howard’s stepmother, went to see Walter Freedman about their 12 year old son. According to Dr. Freedman’s notes, Lou Dully was at her wits end with Howard, even though other doctors had told her that he was a normal 12 year old boy. With Freedman’s encouragement, Howard’s parents agreed to have him lobotomized in December of 1960. Howard had no memory of the operation, and after he was told of the operation “he took it without a quiver. He sits quietly, grinning most of the time and offering nothing” (My Lobotomy). Apparently though, the operation was not successful enough for his parents and shortly thereafter he was shipped off into mental institution.

Even though you would never notice anything peculiar about Howard Dully, except of course for his size, he always felt that something was missing inside of him. After an exhaustive two year investigation of his procedure, he was finally able to confront his father about the operation. He was also able to meet some other victims of lobotomies, and come to terms with the procedure. As he notes in the All Things Considered story, "I know my lobotomy didn't touch my soul. For the first time I feel no shame. I am, at last, at peace." He was one of the lucky ones though, the procedure did much more damage to many people, including Rose Marie Kennedy, a relative of President John F. Kennedy, who after having the operation at the age of 23 for mood swings and mile mental retardation, was reduced to an infantile state according to her biography at the John F. Kennedy Presidential Library and Museum.

In February 1967, Walter Freeman performed his last lobotomy on Helen Mortenson. She died of a brain hemorrhage, and ended the chapter of Freeman’s lobotomies on demand, though the procedures still has effects on medical ethics and modern neuroscience. A new generation of neurosurgeons is wrestling with the same issues. Today, Harvard Medical School and the Massachusetts General Hospital, perform a procedure called a cingulotomy, which consists of burning dime size holes in the frontal cortex of patients (Eskandar). Even the perception of neurosurgery is that of extreme precision, but the reality is that the brain is an extremely complex organ, and operating on it is similar to repairing a watch with a monkey wrench.

While I support the need for scientists to conduct research and experiments with brain surgery, history tells us that we must be careful. The history of brain research and psychiatry has been riddled with fads, including Freud’s psychotherapy, electroshock therapy, and lobotomies. We have to be careful, that our curiosity about the way the mind works does not blind us into leaping on a large scale onto the next medical fad. The popularity of the Freeman’s lobotomy would be harder to duplicate into days world. The general public is more skeptical of scientists, and the media is much quicker to investigate potential problems with procedures. Though we shake our heads today at what Freeman did in the past, in fifty years, I can’t help but get the feeling that doctors will consider some of our methods almost as crazy. Medicine is best served by the scientific method, but we must remember that unlike other scientific fields, fellow human beings are the guinea pigs.

References

Biography of Rosemary Kennedy. Retrieved March 22, 2007 from John F. Kennedy Presidential Library website:
http://www.jfklibrary.org/Historical+Resources/Biographies+and+Profiles/Biographies/Biography+of+Rosemary+Kennedy.htm

Boeree, C. (2001). A Brief History of the Lobotomy. Retrieved March 22, 2007 from Shippenburg University, George Boeree’s web site: http://webspace.ship.edu/cgboer/lobotomy.html

Diefenbach, G., Diefenbach D., Baumeister, A., West, M. (1999). Portrayal of Lobotomy in the Popular Press: 1935-1960*. Retrieved March 25, 2007 from University of North Carolina at Asheville. Department of Psychology website: http://facstaff.unca.edu/ddiefenb/lobotomy.html

Eskandar, E., Cosgrove, G. (2001). Psychiatric Neurosurgery Overview. Retrieved March 22, 2007 from Harvard University, Massachusetts General Hospital, Department of Neurosurgery website: http://neurosurgery.mgh.harvard.edu/Functional/Psychosurgery2001.htm

Hanzlick, R. (1983). I’d rather have a bottle in front of me (Than a frontal lobotomy). Lyrics retrieved March 22, 2007 from http://everything2.com/index.pl?node=frontal%20lobotomy

Pressman, J. (1998). Last Resort, Psychosurgery and the Limits of Medicine [Electronic version]. Cambridge University Press. New York.

My Lobotomy: Howard Dully’s Journey. (2005). Retrieved March 19, 2007 from National Public Radio website: http://www.npr.org/templates/story/story.php?storyId=5014080

Sabbatini, R. (1997). The History of Psychosurgery [Electronic version]. Brain and Mind. Retrieved March 22, 2007 from http://www.cerebromente.org.br/n02/historia/lobotomy.htm

Whitaker, R. (2002). Mad In America, Bad Science, Bad Medicine, and the Mistreatment of the Mentally Ill [Electronic Version]. Perseus Publishing. Cambridge, Ma.

Vertosick, F. (1997). Lobotomy's back - controversial procedure is making a comeback [electronic version]. Discover Magazine. Retrieved March, 23 2007 from http://discovermagazine.com/1997/oct/lobotomysback1240