1946, The year Walter Freeman went from driving ice picks into ice cubes to
utilizing them to impale human eyes. Once regarded as a breakthrough in mental health
care, lobotomies have cast a darkness across medical history. When lobotomies were
first developed, doctors believed they could be used as a cure for severe mental illness.
However, after they were used widely across the nation, many patients were left with
lifelong injuries. After World War II psychiatric hospitals experienced overcrowding due
to the shortage of employees and the growing demand for mental treatment. In
response to overcrowding, doctors were desperate to get patients out of asylums, it was
around this time when Walter Freeman introduced his simplified version of the prefrontal
lobotomy, the Transorbital Lobotomy. The surgery involved driving an ice pick through
the eye and into the frontal lobe of the brain to destroy tissue. Freeman’s lobotomy did
not require an operating room or a professional neurosurgeon, making it an extremely
risky procedure, this also made it easier to perform, causing it to spread quickly around
the world. In this essay, I aim to analyze the moral ramifications of lobotomies and look
at the flaws that let this procedure remain unchecked.

Before we discuss Walter Freeman’s Orbitoclast we must first set the scene and
address the historical context which allowed for something like this to unfold. In the
mid-20th century, the study of psychology and neurology was still in its developmental
stages and there was little knowledge about mental illness and its origins. People
dealing with mental illness were often ostracized from society and sent away to
psychiatric institutions, sometimes for the rest of their lives. The general stigma around
mental illness was based on fear, and society saw these people as violent or
unpredictable. Authors Jo C. Phelan, Bruce G. Link, Ann Stueve, and Bernice A.
Pescosolido (2000), analyzed multiple surveys and studies on the public perception of
mental illness, concluding that society had a narrow view of mental illness and often
rejected people dealing with these issues. Nunally found in 1961 (cited by Jo C. et al.,
2000) that “people were more likely to apply a broad range of negative adjectives such
as “dangerous,” “dirty,” “cold,” “worthless,” “bad,” “weak,” and “ignorant” to a person
labeled as “insane” or “neurotic” than to an “average” person”. It is evident that society
was not accepting of the mentally ill and had little respect for them which would explain
the lack of value for their safety as patients and why they were treated the way they
were.

In many ancient cultures when there was no knowledge of psychology mental
illness was often thought to be caused by evil spirits and demons. The mentally ill were
feared and believed by many to be possessed. One of the oldest known treatments for
mental health was discovered In medieval Europe and dates back to 5000 BCE. The
medieval lobotomy, also known as Trephening Involves making a hole in the top of the
head using stone tools to release demons from the patient’s head (Charka). Sometimes
priests would attempt exorcism or torture the “spirit” which was really the person,
sometimes this would result in execution. Many religions also believed that mental
illness was a god-given punishment “The Hebrews as well as the ancient Persians
believed that illnesses were inflicted by God as a punishment, a punishment for your or
your ancestor’s sins.” (Charka). Some of these beliefs are still thought to be true by
some today and although we have come far from ancient times we still deal with
powerful stigmas that play a role in the way mental health is viewed today.
Psychosurgery was first done in 1890 by Gottlieb Burckhardt, a Swiss
psychiatrist who performed the surgery on 6 patients with schizophrenia. Burckhardt
went about the surgery by removing parts of the patient’s brain and observing their
behavior after. Despite one of the patients dying and others experiencing seizures,
Burckhardt reported that the subjects were calmer after the surgery (Stone). When
Burckhardt reported his findings his idea was rejected and he was shunned by the
medical community, his attempt at psychosurgery was seen as inhumane and had no
research to support it. In 1930 Burckhartds’s idea was revisited by Antonio Egas Moniz
a Portuguese neurologist who would work with his colleague Almeida Lima to create the
leucotomy. Moniz’s leucotomy would go down in history as the first lobotomy as it began
to gain popularity in Europe (West). The leucotomy was done by making a hole in the
head and using a metal loop-shaped wire to remove the cores of the brain from the
frontal lobe. The first lobotomies had severe side effects but continued to be done.

The lobotomy would first be performed in the U.S. in 1936 by American
neurologist Walter Freeman and neurosurgeon James Watts. 10 years later in 1946
Walter Freeman modified the European leucotomy making the surgery less invasive and
more simple. This modification of the original lobotomy was known as the Transorbital
Lobotomy, It used the Orbitoclast which was modeled after an ice pick and would be
hammered through the eye into the frontal lobe to separate tissue. This new method of
doing lobotomies made them much easier and they didn’t require a sterile setting or
even a proper surgeon. Due to the unsafe and unprofessional work conditions, James
Watts stopped working with Walter Freeman in 1947 (Torkildsen). Freeman traveled the
States performing lobotomies on thousands of people as young as 12 years old with no
certified training as a surgeon, he would teach other non-professionals to perform the
surgery making it even more accessible. In just the year 1949 a total of more than 5,000
lobotomies had been done and by the time Freeman died in 1972, he had performed
3,439 lobotomies alone (Torkildsen). The impact Walter Freeman had on the medical
world as one man is unfathomable, His methods of popularizing lobotomies and
advertising them led to the destruction of thousands of lives. “an estimated three out of
every 10 people died from Freeman’s transorbital lobotomies. Many more came out of
the procedure with permanent brain damage that left them physically and/or cognitively
impaired.” (Pressman)