What part of the brain is removed in a lobotomy?

In this post we are going to answer the question ‘’What part of the brain is removed in a lobotomy?’’ We will teach you what lobotomy is when it appeared and what this rare brain surgery consists of.

What part of the brain is removed in a lobotomy?

During a lobotomy, parts of the prefrontal cortex are damaged or removed.

It happened one summer afternoon in 1848, during the construction work of a new railway line in the North American state of Vermont.

To level the ground, the drillers dipped gunpowder into the bottom of a hole drilled in the rock, placed the detonator, added sand to plug it, and smashed the mixture with an iron bar.

In one of these operations, the foreman, Phineas Gage, forgets to put the sand, in such a way that, when the gunpowder explodes, the bar shoots out and goes through his head from bottom to top.

To everyone’s surprise, the 25-year-old not only does not die on the spot, but he will also recover miraculously, although he will undergo a radical personality change. “Gage was no longer Gage,” in the words of his doctor.

Such is his character that they end up kicking him out of all jobs for lack of discipline. The seizures of epilepsy, a sequel to the wound, became more and more frequent until his death in 1860.

Gage’s accidental “lobotomy” has gone down in the history of neurology as the first case to document the effects caused by injury to the frontal lobes of the brain, which is the part involved in surgical lobotomies.

Brain specialization

Although trepanations were already practised in prehistoric times, in modern times, the first surgeries on a physically healthy brain in order to remedy the symptoms of a mental disorder or disease – a practice is known as psychotherapy – did not occur until the last quarter of the 19th century. By then, scientists had already provided evidence of brain specialization.

Paul Broca, for example, had identified the brain areas that control language functions, located in the left frontal lobe.

The observation of these early works led the Swiss psychiatrist Gottlieb Burckhardt to think that perhaps he could alleviate the psychic disorders of his patients at the Maison de Santé de Préfargier by lightening their brain mass.

The first candidate was a 51-year-old woman suffering from hallucinations, who, in 1889, Burckhardt removed a small piece of cerebral cortex of about five grams by a surgical procedure called topectomy.

The intervention was repeated four more times over the next fourteen months, and although the hallucinations did not stop, the woman’s violent behavior gradually diminished. Between 1889 and 1891, Burckhardt practiced the technique with five more patients, obtaining uneven results.

When he presented his report the following year, the medical community jumped on him, calling injury to a physically intact brain a real aberration. Such was the rejection that it would be necessary to wait almost half a century before someone dared to repeat a psychosurgery.

The first leukotomies

In July 1935, the Second International Congress of Neurology took place in London, in which John F. Fulton and Carlyle Jacobsen, physiologists from Yale University, presented the results of experiments in which the frontal lobes had been removed at a chimpanzee named Becky.

Before the operation, Becky, who already had a strong temper, would erupt in anger when she made mistakes in performing tasks that were rewarded with food. But, unexpectedly, she stopped getting angry, and even became docile, after her intervention.

The presentation was attended, separately, by Neurology professors António Egas Moniz, from the University of Lisbon, and Walter Freeman, from George Washington.

At 61, the first of them was known both for his political and diplomatic career – he had been Minister of Foreign Affairs of Portugal – and for having discovered cerebral angiography, a pioneering technique based on X-rays that allowed visualizing the arteries of the brain and for which he was nominated twice for the Nobel Prize.

After the congress, Moniz returns to Lisbon ready to put into practice the surgical method on the frontal lobes in humans.

In November of the same 1935 he ventured with a 63-year-old patient who presented hallucinations and violent anxiety attacks, among other psychopathologies.

Actually, who operates is her disciple and friend Pedro Almeida Lima, since Moniz had deformed hands due to the gout disease. Almeida drills two small holes in the front of the skull and then injects pure alcohol into the brain.

Neurologists believed that by destroying certain brain connections, obsessive thoughts and delusions would also be eliminated. So it was.

In March 1936 they had already operated on about twenty patients, introducing a modification in the technique, which they baptized with the name of leucotomy.

Moniz himself designed the leukotome, a steel instrument in the shape of a hollow stylet that sliced ​​small pieces of white matter, similar to the device with which the core of an apple is extracted.

The ice pick technique

Let us remember the other figure present at the London congress, Dr. Freeman. When, at 28, he becomes the youngest laboratory director in the history of St. Elizabeths Psychiatric Hospital in Washington.

Walter Freeman is obsessed with identifying some physical difference between the brains of psychotic individuals and those of healthy individuals, disparities that give you some clue about the disease and its cure. In 1936 he read the works of Moniz and a world opened up before him.

In September of that same year, Freeman, assisted by surgeon James W. Watts – he lacked a license to operate – performed what would be the first intervention to treat a psychiatric disorder in the United States.

The patient, a 63-year-old woman diagnosed with agitated depression, underwent a prefrontal leukotomy following the Moniz procedure.

Encouraged by the favorable results, Freeman and Watts repeat over and over again the lobotomies – a term that they coined – and introduce some variables, such as, for example, the use of a flat spatula to perform the cuts or local anesthesia.

Aware of the controversy that the technique would arouse among the scientific community, the American neurologist invests great efforts in winning over the press.

Sensational headlines such as “Surgery of the Soul” or “Miracle of Surgery” soon appear, creating an aura of rigor that is actually nonexistent. And ignoring, even, the serious consequences that the lobotomy generated in some patients.

And it is that, as his fame grew, he began to practice lobotomies on his own, not as a last resort, but en masse, directly using an ice pick as an instrument. Upon arriving at a hospital in his brand new “lobotomobile”, the staff already had the patients lined up.

Freeman inserted the metal awl under the eyelid to pierce the eye socket with a light hammer blow. With each hammer blow, the awl gently entered the patient’s frontal lobe, severing and destroying it. Hopefully, not all of them survived.

Why was the lobotomy popular?

It is hard to believe that the practice of lobotomies enjoyed a good reputation for a period, but the truth is that it did.

After publicizing his method, Freeman performed more than 2,000 lobotomies in his career. The practice of lobotomy spread rapidly throughout all Western countries, and it came to be considered one of the most useful tools that medicine could count on.

The people who underwent the lobotomy voluntarily or involuntarily were not only patients with serious mental disorders such as schizophrenia or severe depression; on many occasions this operation was used to solve cases of behavior problems, disobedient adolescents, etc.

Freeman’s method may have been brutal, but a good part of society was willing to embrace that brutality.

The idea of ​​ending deeply rooted behavioral problems with just a few sessions was very tempting. Furthermore, if lobotomized people were more “calm”, conflicts and relational problems could be put to an end, simply by focusing on an individual who had to “change.

The logic behind this good reception from a large part of the health institutions has to do with the hygienic mentality they held. At that time, people with psychiatric disorders were herded into crowded hospitals, and were often subjected to physical or psychological violence.

The lobotomy provided the opportunity to make these kinds of problems less obvious, easier to ignore. The patients were still sick, but after the operation it was less noticeable that they were there.

The problem was solved in fiction and, in any case, the alternative to this practice was also terrible.

Chlorpromazine appears

The appearance of psychotropic drugs and the end of the ice pick

The popularity of lobotomies began to plummet not due to a spontaneous awareness on the part of the population, but because of a much less romantic event: the appearance of the first generations of psychotropic drugs for serious mental disorders, in the middle of the years fifty.

The lobotomy promised an apparent quick solution to behavioral problems from a few sessions, a commercial exchange that, taking into account the many problems it could solve (in the family, at work, etc.), paid off. However, psychotropic drugs were not only much more effective, but also much easier to apply.

Similarly, when one of Freeman’s patients died from bleeding from the neurosurgeon, it became clear that the risks of lobotomy were high. In the 1950s and 1960s, many countries prohibited this kind of intervention, and the USSR came to consider it “contrary to human rights.”

In any case, the lobotomy had enjoyed such a good image that it still took a couple of decades to appear. 

The simplicity of the procedure (which could be carried out in less than 10 minutes) continued to make this measure an attractive option for when there was no surveillance from family members or public entities.

FAQS: What part of the brain is removed in a lobotomy?

What part of the brain is removed during a lobotomy?

A leukotomy is a surgery that involves cutting the connections to and from the prefrontal lobe of the brain.

What does lobotomy do to a person?

The first symptoms manifested by lobotomized people were, normally, stupor, confusional state and urinary problems such as incontinence, with a clear loss of sphincter control. 

Along with this, there were alterations in eating behavior, manifesting an increase in appetite to such an extent that a lot of weight was gained after the operation.

Are lobotomies illegal?

The psychiatric community categorizes lobotomy as a “barbaric practice”, even being declared illegal in several countries.

Did a lobotomy ever work?

Around a third of the lobotomies were considered effective, according to estimates in Freeman’s records.

What replaced lobotomy?

The drugs replaced the lobotomy.

In this post we answered the question ‘’What part of the brain is removed in a lobotomy?’’ We teached you what lobotomy is when it appeared and what this rare brain surgery consists of.

If you have any questions or comments please let us know!

References

Cosgrove, G. Rees; Rauch, Scott L. (1995). “Psychosurgery” Neurosurg. Clin. N. Am.

Faria, M. (2013). Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1 – From trephination to lobotomy. Surgical Neurology International, 4(1), 49. https://doi.org/10.4103/2152-7806.110146

Terrier, L.-M., Lévêque, M., & Amelot, A. (2019). Brain Lobotomy: A Historical and Moral Dilemma with No Alternative? World Neurosurgery, 132, 211–218. https://doi.org/10.1016/j.wneu.2019.08.254

‌