It was the most brutal, barbaric and infamous medical procedure of all time: an icepick hammered through the eye socket into the brain and "wriggled around", often leaving the patient in a vegetative state.
The first lobotomy was performed by a Portuguese neurologist who drilled holes into the human skull. But it wasn't until an American psychiatrist adapted the procedure — using an icepick and hammer — that the very word lobotomy became widely known and widely feared.
Writer Dorothy Parker once quipped, "I'd rather have a bottle in front of me than a frontal lobotomy."
But, still, the popularity of lobotomies spread like wildfire, with thousands of people being subjected to the 10-minute procedure.
One of the biggest tragedies was that people were kept in the dark about the horrific consequences. Before-and-after photos were publicly circulated, showing a "manic-looking" person followed by a photo of the same person looking calm, or even smiling.
Few people realised that, in the "after picture", the patient was often more zombie than human.
Years later, the icepick lobotomy was known as the medical procedure that "turned lunatics into idiots".
It was 84 years ago this month that one of the biggest disasters in modern medicine began; a frightening example of what happens when a "revolutionary new treatment" is put into practice before it has been extensively tested. We'll also take a look at one of the youngest patients — aged 12 years old — as well as the most famous patient; the tragedy of US President John F Kennedy's sister Rosemary.
THE STIGMA OF MENTAL ILLNESS
At the time lobotomies were most popular, from the mid-1930s to 1950s, mental illness was a dreadful stigma for families. But unless you sent your relative to a mental institution, there were few other options. Anti-psychotic drugs, such as clozapine, were not introduced clinically until the 1970s.
Janet Sternburg wrote the book White Matter: A Memoir of Family and Medicine, after learning that two of her aunts had frontal lobotomies. One suffered from depression while the other was schizophrenic.
Sternburg wrote, "There was no real alternative to locking psychotic patients up; there were no anti-psychotic drugs yet. Mental illness was a stigma that made families try to hide the existence of their mentally ill members and made potential spouses hesitant to marry into a tainted family.
"There was a eugenics movement with the philosophy that some people didn't deserve to live. That attitude probably made it more acceptable to experiment on patients."
DRILLING HOLES INTO THE SKULL
Portuguese neurologist Antonia Moniz performed the first lobotomy in 1935, drilling holes into a patient's skull, pouring alcohol into the frontal cortex to sever the nerves, before coring sections of the brain with hollow needles.
This procedure, which he called a "leucotomy", was supposed to cure a variety of mental health issues, particularly depression and schizophrenia, for patients who were believed to be beyond help.
Today, we know that his method was barbaric and the fact that he wasn't a doctor should have sent shudders down the spines of anybody in contact with him.
Yet, in 1949, Moniz received a Nobel Prize for his work. There have been widespread calls for his prize to be revoked but nothing has been done about it yet.
The theory that mental health could be improved by psychosurgery first came from Swiss neurologist Gottlieb Burckhardt, who claimed he had a 50 per cent success rate when he operated on schizophrenics.
Even though his colleagues criticised his work, Burckhardt claimed that, following the operation, the patients appeared to calm down. This "calmness" was more likely due to the patients being in a "zombie-like" or vegetative state, unable to speak or think for themselves.
But the horrifying procedure was about to get a whole lot worse.
AN ICE-PICK IN THE BRAIN
US neuropsychiatrist Walter Freeman was intrigued with Moniz's work and decided to experiment for himself. Freeman believed that mental illness was caused by overactive emotions, and if the brain was cut up, he'd be effectively cutting away those emotions.
After practising for a few weeks on cadavers, Freeman performed the first frontal lobotomy in the US, on 63-year-old Alice Hood Hammatt, a housewife from Kansas who was believed to be suffering from anxiety and depression.
Assisted by Dr James Watt, Freeman drilled holes in Hammatt's skull over the left and right frontal lobes. They then inserted a leucotome (a narrow shaft) through the hole on the left side into the exposed part of the brain.
An hour later, Freeman declared the operation was a success, even though Hammatt suffered a convulsion in the weeks following the surgery. (Hammatt died five years after her surgery, although she managed to spend the last years of her life away from mental institutions).
This so-called success led Freeman to come up with a new plan. He wanted to devise a lobotomy that was faster and less messy than drilling holes into a person's skull. So he went back to experimenting on cadavers, searching for an easy way to access the brain. He used a tool he'd found in his kitchen — an ice pick.
Freeman realised he could easily reach the brain by using the icepick, which was into the brain through the eye sockets; he named this radically invasive form of brain surgery a "transorbital lobotomy" but it became more commonly known as the "icepick lobotomy".
The barbaric procedure was responsible for at least 490 deaths and left thousands of people in a vegetative state.
Sadly, in many cases, that was believed to be an improvement in the lives of many mentally ill people as they were now easier for mental institutions or family members to take care of.
Here's how the "icepick" lobotomy worked:
First, the patient was rendered unconscious by electroshock or simply given a local anaesthetic (depending on their mental health).
Then the icepick-like instrument was inserted above the patient's eyeball. Using a hammer, the icepick was hammered into the eggshell thin bone above the eye, where the instrument was wriggled back and forth to sever the connections to the prefrontal cortex in the frontal lobes of the brain.
It's difficult to believe that an icepick can be hammered into the most complex part of the human body — the brain — while the instrument was moved from side to side (by a man who was not a surgeon).
The operation was over in around 10 minutes and in at least a third of all cases, rendered the patients compliant, docile and mute with childlike behaviour.
According to Freeman, the patient woke up without "any anxiety or apprehension".
THE YOUNGEST PATIENT WAS 12 YEARS OLD
Twelve-year-old Howard Dully was forced to have a lobotomy because, as his stepmother insisted, he was "defiant, daydreamed and even objected to going to bed". (In other words, he was a typical 12-year-old).
He was taken to several doctors who all concluded that Howard was "just normal". But his stepmother took him to Freeman who suggested the boy undergo a lobotomy.
Freeman wrote in his diary about Howard in 1968 November: "I explained to Mrs Dully that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs Dully said it was up to her husband, that I would have to talk with him and make it stick."
December: "Mr and Mrs Dully have apparently decided to have Howard operated on. I suggested they not tell Howard anything about it."
January 4, 1961, following the 12-year-old's lobotomy: "I told Howard what I'd done to him … and he took it without a quiver. He sits quietly, grinning most of the time and offering nothing."
Howard told America's National Public Radio in 2005, when he was 56, that he's always felt different and wondered if there was something missing from his soul.
"I have no memory of the operation, and never had the courage to ask my family about it."
THE TRAGIC STORY OF ROSEMARY KENNEDY
The most famous person to undergo a lobotomy was Rosemary Kennedy, the sister of future US president John F Kennedy.
According to medical historian Dr Lindsey Fitzharris, Rosemary was said to be a rebellious child who experienced the occasional mood swings. In November 1941, her father took her to see Freeman who was, by then, famous.
"Freeman diagnosed 23-year-old Rosemary with 'agitated depression' and suggested she undergo a lobotomy to correct her erratic behaviour. Freeman performed the operation right then and there on Rosemary, without her mother's knowledge," Dr Fitzharris said.
"Shortly afterwards, it became clear that something had gone terribly wrong. Rosemary could no longer speak, and her mental capacity was equivalent to that of a toddler.
"Her father institutionalised her, telling people that his daughter was mentally retarded rather than admitting that her condition was due to a failed brain operation.
"It was only after his death decades later that the truth behind her condition was revealed. Rosemary never did recover her ability to speak coherently and remained in care until her death in 2005 at the age of 86. She was the first of her siblings to die of natural causes."
Rosemary's mother Rose Kennedy was said to be absolutely devastated and saw her daughter's lobotomy as the first of the family's many tragedies.
Interesting note: 80 per cent of the lobotomies performed in the US in the early years were carried out on women.
LOBOTOMIES ON THE ROAD
Freeman's icepick lobotomies were in such high demand he took the "show" on to the road, taking his icepick and hammer on tour. He visited hundreds of hospital and mental institutions.
"He performed icepick lobotomies for all kinds of conditions, including headaches. His van was later known as 'the lobotomobile'. Many of his patients had to relearn how to eat and use the bathroom. Some never recovered," Dr Fitzharris said.
"And, of course, there were fatalities. In 1951, one of his patients died when Freeman suddenly stopped to pose for a photo during the procedure. The surgical instrument slipped and went too far into the patient's brain. Many others fell victim to a similar fate at the good doctor's hands."
THE END OF THE GHASTLY PROCEDURE
Eventually, the horrors of the lobotomy came under attack from the medical community.
By the 1970s, several countries had banned the procedure altogether, including Russia which banned lobotomies as being "inhumane".
Between 1936 and 1951 it's believed up to 50,000 lobotomies had been performed around the world.
Why were lobotomies so popular? It's because the alternative — being locked up in a mental institution — was considered to be worse.
Psychiatrist Dr John Pippard followed up on hundreds of lobotomy patients in the UK and turned against the practice, even though he had authorised several himself.
"I got increasingly conservative about it because I don't think any of us were ever really happy about putting in a brain needle and stirring the works," Dr Pippard told the BBC.
Freeman eventually retired his "lobotomobile" and opened a private practice in California; but, contrary to popular belief, he never lost his licence to practice medicine.
Today, surgical lobotomies are no longer performed. (The rise of drugs like thorazine make it easier to lobotomise patients chemically).
The story of Anita Welsh is one that quite typically sums up the horrors of a lobotomy. Welsh was lobotomised by Freeman in 1953, due to post-natal depression. Her daughter Rebecca told NPR that her mother spent most of her life in mental institutions. She is convinced that Freeman's lobotomy destroyed her mother's life.
"I personally think that something in Dr Freeman wanted to be able to conquer people and take away who they were," Ms Welsh said.