A Procedure Gone Wrong: A Brief History of Lobotomies in the United States

Author: Esther Annorzie

July 9, 2025

Lobotomy Orbitoclast & Hammer Surgical Medical Tools [Image source: Etsy]

Early American communities saw mental illness as a moral failing. Family members became primary caretakers. Some individuals with mental illness experienced institutionalization in almshouses or jails. By 1890, all states had mental health hospitals. By the early 20^th century, American scientists and physicians recognized mental illness and their respective treatment options. 

During the early 20^th century, photos of patients in mental institutions living in horrific conditions spread throughout the country. Patients were often wardens of the state, senior citizens, isolated, and/or poor. The images sparked debate and public outcry. Americans noticed the similarities between mental institutions and concentration camps in Nazi Germany. Local and state governments struggled due to the excessive cost of treating patients in mental institutions. Mental institutions risked having to close operations entirely. 

During this time, scientists and researchers sought out alternative treatments for mental illness. Some researchers engaged in unethical experiments. For example, researchers exposed human subjects, including children, to torturous treatments such as electroshock therapies, severely affecting their personalities and behavior.^,, Initially, the treatments appeared to treat symptoms of mental illness. However, subjects tended to relapse over time. It became obvious that these experiments did not hold the cure to mental illness. 

During the 1940s, scientists began examining military men with damaged frontal lobes, observing their calmness, minimal anxiety, and limited depression.^, Through this discovery, a hypothesis formed around frontal lobes causing mental illness, thus removing the “bad parts” of frontal lobes may cure mental illness. In 1936, Portuguese neurologist Egas Moniz discovered the prefrontal leucotomy (later known as lobotomy), which he received a Nobel Prize in 1949. A lobotomy is a type of brain surgery performed to treat mental illness. Initially, lobotomies were mostly performed on patients with schizophrenia.  

Soon, lobotomies became a treatment option for people experiencing a variety of mental illnesses and behavioral problems. By the 1950s, lobotomies were performed more commonly. In total, approximately 50,000 people received lobotomies between 1949 and 1952. Initially, medical professionals across the world scoffed at the idea of slicing a patient’s brain to cure them of mental illness. But some medical professionals took up the challenge using Moniz’s discovery.

One such medical professional was Dr. Walter J. Freeman, a major figure credited for the widespread adoption of lobotomies in the United States. He was a physician trained in neurology and psychosurgery. Like most other neurologists of his time, Dr. Freeman believed that physical defects in the brain caused mental illness. He also believed that symptoms of mental illness stem from the thalamus sending messages to the frontal lobe. If those messages severed, then mental illness could be cured. In his mind, successful treatment involved patients’ ability to be “productive”. This included being employed and the ability to perform household tasks. The success of lobotomies arose from values of productivity, industry, and personal responsibility across the United States.

Freeman specialized in prefrontal lobotomies–a modified procedure based on Moniz’s original lobotomy procedure. Patients became unconscious, with their eyelids peeled back to insert eye picks. Then, a hammer would be used to sever patients’ frontal lobes. Sometimes, Freeman performed over a dozen lobotomies a day. When patients would relapse, Freeman would perform more lobotomies. He and his colleague, James Watts, eventually began to perform lobotomies on conscious patients. Over the course of his career, Dr. Freeman is estimated to have performed over 3,400 lobotomies. Additionally, he played a vital role in spreading awareness of lobotomies.

Freeman developed relationships with established writers of newspapers and magazines to promote his prefrontal lobotomy procedures. Press articles from the early 20^th century exposed public perception of lobotomies. According to qualitative and quantitative analyses performed by Gretchen J. Diefenbach and colleagues, biased and factitious reporting from 1935 through 1960 might have led to the rapid and widespread adoptions of lobotomies. During the early years (1935-1944), popular press articles favored lobotomies. Consequently, lobotomies rose in popularity. This is because lobotomies were performed before controlled studies about their long-term impacts were known.

Once studied, findings were troubling. However, some individuals had poor opinions of lobotomies such as members of the medical community. For example, in 1941, the American Medical Association (AMA) panel issued a warning regarding lobotomies. The AMA cited negative effects of lobotomies on personality such as lack of initiative, inappropriate social behavior, and apathy. Many articles sensationalized and misrepresented the procedure. The middle years (1945-1954) represented a period of increasing controversy when lobotomies began to be seen as somewhat problematic. News articles covered complications and deaths caused by lobotomies. The final years (1955-1960) highlighted the decline of lobotomy reporting in general. 

According to Freeman, over a quarter of patients undergoing lobotomy developed epilepsy. Other patients encountered bleeding, brain infection and abscess, dementia, intellectual impairment, incontinence, and obesity. Physicians questioned the ethics of lobotomies–especially considering that many lobotomies were performed when elected by one's family members. Patients and their families often took their doctor’s word as truth; informed consent did not exist. When Freeman’s patients would die, some families chose to stay connected to him, sometimes over the course of decades. Additionally, some sought his advice in areas outside of medical care such as marital relations, family disagreements, and sexual behavior–raising concerns about professional boundaries within his practice.

One of Freeman’s most famous patients was a member of the Kennedy family, Rosemary Kennedy. As a young adult, her outgoing personality concerned her parents. Worried that she would be an embarrassment to the family, Rosemary’s parents believed a lobotomy could help her conform to social standards. After Freeman performed the lobotomy, Rosemary’s personality changed entirely. She became disabled and could no longer walk nor talk. She needed full-time care until her death at age 86.

By 1954, the invention of drugs such as chlorpromazine offered safe alternatives to lobotomies. This caused lobotomies to lose favor among physicians and patients. Popular press no longer sensationalized the impact of lobotomies as they were no longer profitable. Today, lobotomies are rarely performed. Most people with mental health disorders engage in therapies, lifestyle changes, or medicine to treat their symptoms. In cases where these do not work, physicians study their brains using advanced technology such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) to determine if surgery is required.

At their inception, lobotomies presented a promising solution to addressing the symptoms of mental illness. However, the risks and consequences outweighed any positive effects. People placed their family members' conformity over the very real consequences of surgery. The medical community warned against lobotomies, but did not take appropriate action to sanction fellow physicians when poor outcomes arose. With lobotomies being under-studied during their inception, patients were put in high-risk, potentially life-threatening situations. Looking back at the history of lobotomies in the United States shows that new treatments should be studied for their risks before being widely administered, and the medical community should ensure that treatments are being properly administered.

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Glossary

• Abscess: A localized collection of pus in the body that forms in response to an infection. 

• Almshouse: A local public institution that provided housing and health care to socially disadvantaged people.

• American Medical Association: A national organization of American physicians with a mission to improve public health through the promotion of science and the art of medicine.

• Apathy: A lack of feeling or emotion.

• Chlorpromazine: A drug used to treat mental disorders and severe behavioral problems.

• Controversy: A state of prolonged public dispute or debate, usually concerning a matter of conflicting opinion or point of view.

• Dementia: A condition resulting in the loss of thinking, remembering, and reasoning that interferes with daily life and activities.

• Electroshock therapy: Also known as electroconvulsive therapy (ECT), a psychiatric treatment that causes a brief seizure by passing small electric currents through the brain.

• Epilepsy: A long-term brain condition that causes unprovoked, recurrent seizures.

• Factitious: An adjective that means not spontaneous or natural; artificial; contrived.

• Frontal Lobes: The most forward area of the brain that controls thinking, emotions, self-control, muscle control and movements, memory storage and other functions.

• Human Subject: A living individual who participates in research, experiments, or studies, often providing data, responses, or participates in interventions for scientific, medical, or social investigations.

• Impairment: Having a physical or mental condition that limits a person’s ability to perform daily activities.

• Incontinence: A condition where a person loses control over the release of urine from the bladder.

• Informed Consent: A document that explains diagnosis and treatment options including benefits and risks.

• Institutionalization: A process to influence a set of human interactions by developing or transforming rules and procedures.

• Lobotomy: A surgical procedure in which the nerve pathways in a lobe or lobes of the brain are severed from those in other areas.

• LSD: A drug that stands for Lysergic acid diethylamide. It causes symptoms of intense thoughts, emotions, sensory perception, and hallucinations.

• Nazi Germany: A period from 1933 to 1945 when Germany was controlled by the totalitarian dictator, Adolf Hitler.  

• Neurology: A branch of medicine focusing on the nervous system.

• Nobel Prize: An award administered by the Nobel Foundation and granted to individuals who have worked towards advancing humanity through intellectual achievements.

• Popular Press: Written material such as articles and magazines for the general public.

• Prefrontal leukotomy: A surgical procedure on the brain initially performed on patients with schizophrenia. Later known as “lobotomy”.

• Prefrontal lobotomy: A modified surgical procedure based on neurologist Egas Moniz’s lobotomy. Introduced to the United States by physician Walter Freeman and his colleague, James Watt.

• Psychosurgery: A type of brain surgery performed to treat psychiatric disorders.

• Quantitative Analysis: A systematic process to examine numerical data to understand behavior.

• Qualitative Analysis: A systematic process to examine non-numerical data to understand behavior.

• Relapse: A deterioration in health status after an improvement.

• Schizophrenia: A serious mental health condition that may cause hallucinations, delusions, and/or disorganized thinking and behavior.

• Sensationalization: Describing or showing something in a way that makes it seem more shocking than it actually is.

• Severed: A separation from the whole or divided into parts.

• Thalamus: A large mass of gray matter located in the middle of the brain. Responsible for motor and sensory information from the body to the brain.

• Transcranial magnetic stimulation (TMS): A noninvasive form of brain stimulation used to treat conditions such as depression and anxiety.

• Unethical: Actions or behaviors that are considered to be morally wrong.

• Warden of the state: A person who is under the guardianship of a legal authority.

  
  

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