What Is a Lobotomy and Why Is It Rare Now?
An Outdated Type of Brain Surgery
Medically reviewed by Nicholas R. Metrus, MD
A lobotomy is a type of brain surgery that involves the removal or cutting of a portion of the brain, usually for the purpose of treating a mental health condition. This medical procedure was never a common type of treatment, and it was primarily used between the 1940s and the 1960s.
Lobotomies were sometimes safe and effective for treating psychiatric disorders but often caused substantial adverse effects, including significant changes in personality and loss of independence.
Lobotomy is no longer used in the United States to treat mental health conditions. Many safe and effective therapies can treat mental health disorders, including medication, psychotherapy, and minimally invasive surgical interventions, such as the use of electrical stimulation to help alleviate symptoms of mental health conditions.
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What Is a Lobotomy Exactly?
"Lobotomy" is defined as the removal of one or more of the lobes of the brain, but the term has been used to describe transection (cutting) regions of the brain for the treatment of psychiatric conditions such as schizophrenia or major depressive disorder.
When lobotomy was used to treat psychiatric disorders, the procedure involved the removal or transection of part of the frontal lobe of the brain, which is the part of the brain that controls personality and behavior.
Lobotomy is a major brain surgery that requires access to the brain tissue through either a burr hole (a hole that is drilled into the skull) or craniotomy, which is cutting or lifting away part of the skull to obtain access to the brain tissue. A lobotomy is a high-risk surgical procedure that can be life-threatening.
When these procedures were done, people who survived a lobotomy could potentially experience fewer psychiatric symptoms, such as delusions (irrational beliefs that are not true) as a result of the surgery. But side effects included significant personality changes and diminished ability to control their behavior and actions.
Related: Frontal Lobe Damage: Symptoms, Causes, and Treatments
Are Lobotomies Still Performed Today?
According to historians, lobotomy was pioneered in 1936 by Portuguese neurologist António Egas Moniz. The practice spread to other parts of Europe, as well as the United States. At the time, it was considered a breakthrough that could help people with severe psychotic disorders.
As effective antipsychotic medications emerged and the dangers of lobotomy raised ethical concerns, the procedure became less common. Lobotomy, as it existed, is not accepted as a treatment in the United States today.
Many neurosurgical procedures involve the removal or resection of brain tissue, but these are done very differently than psychiatric lobotomy. For example, resection of tumors and cancer from the brain is a lifesaving surgery.
Some types of brain surgery to treat epilepsy or movement disorders involve the removal or resection of brain tissue to stop seizures or movement disorder symptoms from occurring.
Related: Frontal Lobotomy and Medical Ethics
Why Were Lobotomies Performed?
Lobotomy was performed to reduce symptoms of mental health conditions, primarily schizophrenia and major depressive disorder. The procedure decreases some of the nerve communication in the frontal lobe of the brain, which can prevent the behaviors that result from these mental health disorders.
According to the medical documents, some people who survived a lobotomy experienced an improvement in psychiatric symptoms. However, these people did not experience a healthy quality of life or maintain independent self-care. Medical records also indicate that these procedures were dangerous and that many people did not survive.
What Lobotomies Do to People?
Lobotomy changes the way people function, often leading to diminished awareness and interactions. People who underwent lobotomy were found to have reduced cognitive (thinking, problem-solving, and reasoning) abilities, as well as impaired emotional responses.
As with any type of brain surgery, there is a risk of edema (brain swelling), infection, bleeding, unintentional damage to the brain, disability, or death.
Today, lobotomy is not considered an ethical intervention. However, decades ago, it was seen as a potential solution for people with severe mental illness.
It even was considered to be a medical advancement and a more humane treatment than earlier ways of coping with mental illness—which had included approaches such as placing people in isolation.
Can a Person Survive After Lobotomy?
The answer to whether a person can survive a lobotomy is maybe. In the past, some people survived after lobotomy, but many died due to complications.
Brain surgery often relies on monitoring that can help pinpoint areas of the brain that need to be removed or transected. This type of monitoring can help locate areas of the brain that are involved in crucial functions, such as language and mobility, to reduce the risk of adverse effects.
Medical Treatments Preferred Over Lobotomies Today
Psychiatric care for mental health conditions has improved substantially over the past 100 years. Advances in psychiatric treatments have yielded many treatment alternatives that are far safer and more effective than lobotomy. Psychosurgeries are rarely used today.
Common treatments for psychiatric disorders include:
Antipsychotics and other medications: Medications that can help treat psychiatric disorders include first- and second-generation antipsychotics, atypical antipsychotics, antidepressant medications, and antianxiety medications.
Psychotherapy: Psychotherapy involves talking with a professional who is trained in diagnosing mental health disorders and providing techniques for managing mood, gaining insight into behaviors, learning how to control responses, and coping with symptoms such as delusions and hallucinations.
Hospitalization: In some situations, mental health symptoms can be harmful and dangerous to a person's health. A period of hospitalization with medical supervision and medication can help in stabilization and creating a long-term treatment plan.
Psychosurgeries Used Today
With advancements in psychotropic medications, psychosurgeries are rarely performed. Surgery can be an option in very specific situations, and usually only after less invasive therapies have not been sufficiently effective.
Psychosurgical procedures include:
Anterior cingulotomy: This procedure targets a small area in the brain that controls sensation. It may be used as a therapeutic option for chronic pain that is medication-resistant.
Ventral capsulotomy: This procedure is used to make a small cut in an area of the brain that controls sensory processing. It can be used as a therapy for treatment-resistant obsessive-compulsive disorder (OCD).
Subcaudate tractotomy: This procedure involves cutting a small area near the back of the frontal lobe as a therapy for treatment-resistant mood disorders.
Limbic leucotomy: This procedure targets an area of the brain that controls emotions. It is used to treat medication-resistant depression and obsessive-compulsive disorder.
Corpus callosotomy: During a corpus callosotomy, the surgeon cuts the corpus callosum, which physically connects the two hemispheres of the brain. This procedure stops communication between the left and right sides of the brain. It is used as an intervention for some types of treatment-resistant epilepsy.
Deep brain stimulation: This therapeutic intervention involves the placement of a device that sends electrical impulses to a region of the brain to control symptoms of depression.
These procedures require extensive presurgical testing to help pinpoint the location and to avoid adverse effects.
Learn More: The Anatomy of the Brain
Summary
Lobotomy is an outdated procedure that was used in the past for the treatment of psychiatric conditions. While lobotomy is no longer considered safe, the initial introduction of this surgery followed medical protocols of the time.
With advancements and pharmaceutical management and other forms of treatment, lobotomy is no longer used in the United States to manage psychiatric disorders. It is dangerous and can cause substantial impairment of an individual’s personality and ability to take care of themselves.
Other medical treatments can help reduce the symptoms of psychiatric disorders. These include medication, cognitive behavioral therapy, counseling, and surgically implanted devices to control symptoms. Psychiatric care nowadays relies on diagnostic criteria and treatment protocols.
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