In the U.S., lobotomies are no longer used as surgery to treat psychiatric problems. Some other types of psychosurgery are still performed when other treatments have failed.

Few medical procedures in history have garnered as much controversy as the lobotomy. Tens of thousands of lobotomies were performed in the United States in the mid-1900s, often leading to devastating outcomes.

A lobotomy, also called a leucotomy, is a type of psychosurgery that was used to treat mental health conditions such as mood disorders and schizophrenia. Psychosurgeries are procedures that involve the physical removal or alteration of part of the brain.

Lobotomies involved separating tissue in an area called the prefrontal cortex in one of two primary ways:

  • Frontal lobotomy. A surgeon drilled a hole into each side of the skull and cut through brain tissue with an instrument resembling an ice pick called a leucotome.
  • Transorbital lobotomy. A surgeon inserted a leucotome through the eye socket and drove it through a thin layer of bone with a mallet to access the brain.

These procedures are no longer performed in the United States. Read on to learn more about why lobotomies were traditionally performed and why psychosurgery is used today.

Lobotomies are no longer performed in the United States. They began to fall out of favor in the 1950s and 1960s with the development of antipsychotic medications. The last recorded lobotomy in the United States was performed by Dr. Walter Freeman in 1967 and ended in the death of the person on whom it was performed.

In Europe, the Soviet Union banned lobotomies in 1950, a year after inventor Dr. Egas Moniz won the Nobel Prize for medicine. They persisted into the 1970s in the rest of Europe and into the 1980s in Scandinavia.

Some other types of psychosurgeries are still used today, such as:

  • cingulotomy
  • anterior capsulotomy
  • subcaudate tractotomy
  • limbic leucotomy
  • corpus callosotomy

With advancements in medications, psychosurgeries are rarely performed. Surgery is usually only used when all other treatment options have failed. Surgical techniques still in use today include:

Cingulotomy

Cingulotomy is the most commonly performed psychosurgery in North America. It’s a type of surgery that involves altering tissue in the anterior cingulate region associated with feeling chronic pain. It’s sometimes used to manage symptoms of:

Anterior capsulotomy

An anterior capsulotomy is a potential treatment for severe OCD that doesn’t respond to psychotherapy and medications. It involves altering the part of the brain that carries information from the thalamus and brainstem to the prefrontal region.

In a 2019 review, researchers found that of 512 people who received treatment from 1961 to 2018, 73 percent responded to the surgery and 24 percent saw their symptoms resolve.

Subcaudate tractotomy

A subcaudate tractotomy may be used to treat delusions and hallucinations in people with severe schizophrenia with aggressive symptoms. It involves cutting connections between the limbic system and a part of the prefrontal lobe called the orbitofrontal cortex.

Limbic leucotomy

Limbic leucotomy is a combination of the subcaudate tractotomy and cingulotomy. It’s been performed since the 1970s to treat mood disorders and OCD.

Corpus callosotomy

Corpus callosotomy involves severing the corpus callosum, a bundle of nerves that connect your left and right brain hemispheres. In a 2017 study, researchers found that corpus callosotomy is a potentially effective treatment for generalized epilepsy in people with drug-resistant epilepsy.

Lobotomies were considered experimental even at the height of their popularity. Although some people did see improvements in their conditions, many other people experienced life-alternating side effects, or even died.

One of the highest-profile cases of a failed lobotomy was that of Rosemary Kennedy, younger sister of John F. Kennedy. After undergoing a lobotomy in 1941 to treat seizures and extreme shifts in mood, she lost her ability to walk or talk. Her personality was permanently altered, and she was left with physical disability.

Risks of psychosurgeries include the risk of death and:

António Egas Moniz and his colleague Almeida Lima are credited with the development of the lobotomy in 1935. They promoted their frontal lobotomy procedure across Europe, despite keeping poor patient records and lacking evidence of effectiveness. The procedure quickly gained popularity, despite thousands of people experiencing severe side effects and outcomes, such as seizures, infections, and death.

American neurologist Walter Freeman and surgeon James Watts championed the procedure in America. Influenced by an Italian colleague, Freeman eventually switched to the transorbital method, in which an icepick-like instrument was inserted through the eye socket to reach the brain. He passionately spread the surgery across North America, despite haphazardly performing surgeries without proper sterilization.

Tens of thousands of lobotomies were performed in the United States between the 1930s and 1960s, often without informed consent. Eventually, lack of evidence supporting the procedure finally caught up with it, and it was largely abandoned once the medication chlorpromazine was developed.

Despite a risk of severe side effects and outcomes, lobotomies were once used to treat many mental health conditions, including schizophrenia, depression, and bipolar disorder. Nowadays, treatment for mental health conditions largely consists of medication and psychotherapy.

Antipsychotics and other medications

Antipsychotics are often the initial treatment for acute schizophrenic episodes. They block the effects of the neurotransmitter dopamine on your brain to reduce feelings of anxiety or aggression as well as hallucinations and delusional thoughts.

Many other types of medications are also used to treat mental health conditions, including:

Psychotherapy

Psychotherapy, also called talk therapy, is a common type of mental health treatment. It may be administered alone or in combination with medication. There are many types of psychotherapy used to treat mental health conditions. They include:

Hospitalization

Some people with severe mental health conditions may need to be admitted to a medical facility. Laws vary by state, but in most states, a person can be held in facility involuntarily if they pose a danger to themselves or others.

Lobotomies were surgeries that involved altering a part of the brain called the prefrontal cortex. Sometimes these surgeries were performed without consent and without proper sterilization, despite a lack of evidence for their effectiveness.

Lobotomies are no longer performed and have largely been replaced by medications. Some other types of psychosurgeries are performed in very rare circumstances to treat conditions such as severe depression or OCD that doesn’t respond to other treatments. These surgeries are considered last resorts.