Lobotomy back in spotlight decades after procedure’s end

The lobotomy, once a widely used method for treating mental illness, epilepsy and even chronic headaches, is generating fresh controversy 30 years after doctors stopped performing the procedure now viewed as barbaric.

A new book and a medical historian contend the crude brain surgery actually helped roughly 10 percent of the estimated 50,000 Americans who underwent the procedure between the mid-1930s and the 1970s. But relatives of lobotomy patients want the Nobel Prize given to its inventor revoked.

The lobotomy debate is discussed in an editorial in today’s New England Journal of Medicine.

Lobotomy was pioneered in 1936 by Portuguese neurologist Egas Moniz, who operated on people with severe psychiatric illnesses, particularly agitation and depression. Through holes drilled in the skull, Moniz cut through nerve fibers connecting the brain’s frontal lobe, which controls thinking, with other brain regions – believing that as new nerve connections formed the patient’s abnormal behavior would end.

Moniz, already widely respected for inventing an early brain-imaging method, gave sketchy reports that many patients benefited and was awarded the Nobel Prize for medicine in 1949.

Other doctors used a more primitive version than Moniz, punching an ice pick into the brain above the eye socket and blindly manipulating it to sever nerve fibers. By the late 1930s doctors were reporting many lobotomy patients were left childlike, apathetic and withdrawn. Use eventually waned with the advent of effective psychiatric drugs in the mid-1950s and the growing use of electroshock therapy.

Modern views of lobotomy have led to a call to pull Moniz’s Nobel prize. “How can anyone trust the Nobel Committee when they won’t admit to such a terrible mistake?” asks Christine Johnson, a Levittown, N.Y., medical librarian who started a campaign to have the prize revoked. Her grandmother became delusional in 1949, was lobotomized in 1954 after unsuccessful psychiatric and electroshock treatments, and spent the rest of her life in institutions.

Several years ago, a network of families of lobotomy patients started urging removal of an article on the Nobel Web site praising Moniz and saying he deserved the prize because there were no alternative psychiatric treatments at the time.

Meanwhile, journalist Jack El-Hai recently published “The Lobotomist,” about the chief U.S. proponent, neurosurgeon Walter Freeman, who did roughly 3,400 operations. He developed the icepick technique.

In the New England Journal editorial, Dr. Barron H. Lerner, a medical historian and associate professor at Columbia University College of Physicians and Surgeons, wrote that the procedure was a desperate effort to help many of the 400,000 patients confined to U.S. mental hospitals at mid-century.

He said a small number of patients became calmer and more manageable. “I think the numbers that were harmed were quite substantial,” Lerner said. “It was way overused, and it was used in inappropriate circumstances – retardation, anxiety, headaches.”