The history of lobotomy

What almost was: how Janet Frame’s first literary prize prevented her undergoing this now banned procedure.

The history of lobotomy
Image courtesy of Claudia Hall.

Understanding of, and treatments for, mental health have come a long way since the invasive experimentation of the early 20thcentury. Where we look back on procedures like electroshock therapy and lobotomies with horror, physicians and psychiatrists of the time saw these as considered approaches to treating mental health.

"Prefrontal lobotomy ... has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier.” - Norbert Weiner, 1948
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António Egas Moniz (top) and Walter Freeman (bottom).

Leucotomy or lobotomy?

In 1935, Portuguese-born physician António Egas Moniz pioneered the leucotomy. This procedure involved drilling holes into the skull and feeding an instrument into the frontal lobe of the brain to disrupt the white matter. The procedure was performed with an instrument known as a leucotome; a needle-like tool with a retractable wire loop which was designed by Moniz and his assistant Almeida Lima. Earlier procedures had involved Moniz using ethyl alcohol to disrupt the brain’s neuronal tracts. By1937, nearly 40 patients had received a leucotomy. The treatment, and Moniz, were awarded and accoladed and Moniz received a Nobel Prize in Physiology or Medicine in 1949 for his contribution to psychosurgery and psychiatry.

American neurologist Walter Freeman reinvented the procedure in 1945, and the lobotomy was introduced to the world. The lobotomy was a quick procedure of approximately 10 minutes and could be performed as a pre-frontal lobotomy or transorbital lobotomy. The transorbital lobotomy was performed by hammering an implement through the eye socket and into the brain. Both versions of the lobotomy involved the ‘wriggling around’ of the implement in the brain. Transorbital lobotomies became the more popular as they did not require a sterile environment, anaesthesia, or surgical assistant. Transorbital lobotomies could be ‘taken on the road’ and Freeman continued to perform lobotomies on American patients until 1967.

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Timeline image courtesy of Claudia Hall.

Lobotomy in Aotearoa New Zealand

Between 1944 and 1950, ‘chronic and intractable’ patients were offered to Dunedin neurosurgeons as candidates for lobotomy. There were 65procedures performed during this time and surgeons D. Gilmour McLachlan and Murray A. Falconer were published in the New Zealand Medical Journal in1950 on the 65 procedures that had been performed.

Chronic emotional tension, violent or uncontrolled behaviour, or four years of illness were among several criteria for patients to be considered for lobotomy. Those who fulfilled the criteria were ‘prepared’ for the procedure using electroconvulsive therapy (given electric shocks until unconscious). The results of the procedures were downplayed by McLachlan and Falconer, with patients spending an average of six months in hospital following the procedure. Many were lethargic, apathetic, uncooperative, or inattentive. There was a loss of continence and many women had menstrual cycles disrupted for months. Several male patients experienced epileptic fits.

Janet Frame

Janet Frame is one of Aotearoa New Zealand’s most well-known and prolific authors. She was also someone with vast experience with the country’s mental health institutions in the 1940s and 1950s and spent over a decade in and out of psychiatric hospitals. Her official diagnosis (since disputed) was schizophrenia which was treated with insulin and electroconvulsive therapy. In 1951 she was scheduled for a lobotomy, for which her mother had given permission.

Her first publication, The Lagoon and Other Short Stories was awarded one of the most prestigious literary prizes in Aotearoa New Zealand in 1951: the Hubert Church Memorial Award. This unexpected award resulted in the cancellation of Frame’s lobotomy though she spent another four years in psychiatric care. She published her first full-length novel in 1957.

When she passed away in 2004, Frame was a lauded and internationally renowned author who had been appointed to the Order of New Zealand. Several of her novels and short stories recount a fictional perspective of her childhood and psychiatric hospitalisation, and her autobiography was adapted into the film An Angel at My Table in 1990.

The end of lobotomy

The barbarous act of hammering an implement into the brain to ‘wiggle about’ and disrupt the frontal lobe thankfully came to a worldwide end. The development and introduction of the first anti-depressants and anti-psychotics in the 1950s played an integral part. Coupled with better treatment was a shift in public opinion on the procedure and its outcomes. That Moniz was awarded a Nobel Prize for the leucotomy is almost met with disbelief that these procedures were ever lauded as appropriate treatment.

Our Health Journeys would like to thank Claudia Hall for her presentation on lobotomy as part of the Auckland Medical History Society’s annual programme on 6 July 2023. The text and visual components of this post is based on Claudia's research.