What Is a Prefrontal Lobotomy?

Lobotomy is a neurosurgical procedure invented in 1935 by a Portuguese neurologist named Moniz. Moniz won the Nobel Prize in 1949 for his achievement. It was believed that lobotomy was successful in the treatment of various psychological diseases like depression, bipolar disorders, mania, schizophrenia, etc. It was even used for the treatment of homosexuality.

Freeman, an American neurologist was amazed by Moniz's discovery. He together with a college and a neurologist named Watts brought lobotomy into the US and made it globally popular. Freeman performed about 3500 to 5000 lobotomies by himself. Also, he made some changes with the help of Watts in Moniz procedure making it even easier to perform the surgery. This does not require anaesthesia anymore and the whole procedure is performed within 10 minutes. He even treated about 20 patients who were under the age of 18.

Lobotomy was used as a treatment procedure until the mid 1950s. Today, the procedure is illegal all over the world, even though some countries still don’t have a law that bans it. Freeman performed his last lobotomy in 1957. But, why is lobotomy banned now? The first reason is, it did not bring any improvement in the patient's condition and on the other hand, it even made their condition worse. Second, medical treatment became more successful in the treatment of depression, schizophrenia and other conditions. Antidepressants and antipsychotics became widely available and successful resulting in the beginning of a new era in psychiatry.

The prefrontal lobotomy, also called the transorbital lobotomy, is a shift from the original lobotomy procedure that involved inserting a leucotome through the eye rather than the skull. The procedure was devised by Walter Freeman, an American neuropsychiatrist in 1946 to make the lobotomy procedure more accessible to patients who had no access to an operating room.

How was prefrontal lobotomy done?

At first, the upper eyelid is lifted to expose the top of the eye just where the gap of the eye socket is located. Only a thin layer of bone is present at this point, separating the eye socket from the brain matter. An orbitoclast, similar to the leucotome used in a typical lobotomy is then placed here and a mallet is used to hammer it into the brain.

The orbitoclast would be 5cm deep into the brain when it would be turned 40 degrees toward the nose, returned to the original angle and hammered 2 centimetres further. Another twist would be made towards the nose to make the orbitoclast return to its original angle before withdrawing it finally from the eye. This is only half of the procedure because the entire process would be repeated on the other eye in the opposite direction.

How was prefrontal lobotomy different?

The original procedure invented by Egas Moniz in 1935 involved drilling a hole into the skull where a leucotome would be inserted. The leucotome is a hollow instrument about 2cm in diameter and 11cm in length and had a retractable wire which would be pushed to form a loop at the end. Before the invention of leucotome, a sharp metal instrument similar in shape to an ice-pick was used.

After the leucotome is inserted into the space between the prefrontal cortex and the rest of the brain, it would be wiggled from side-to-side, then removed and ethanol is injected into the space created. The ethanol is supposed to destroy the fibres permanently which connected the frontal lobes to the rest of the brain creating a barrier.

The prefrontal lobotomy has the same effect, except the fact that its entry point is different. The only similarity between the prefrontal lobotomy and the original procedure is that the patient had to be unconscious or under anaesthesia. However, Walter Freeman suggested that his procedure could be done after an electroconvulsive shock if anaesthesia was not available. This is the reason why prefrontal lobotomy began to increase in popularity across the world.

How popular was prefrontal lobotomy?

This procedure was introduced in 1946 around the time when lobotomies were under heavy criticism. But this did not stop Walter Freeman from performing such operations. Many described him as a showman because he would travel around the world and perform almost 10 such operations in a day.

The prefrontal lobotomy was also popular because it did not require an operation room, causing Freeman’s assistant to accuse him of turning it into an office procedure. The simplicity of the procedure allowed many psychiatrists to perform the procedure in their clinics and it was impossible to tell just how many of these operations were performed. However, it is estimated that Walter Freeman alone performed between 3,500 to 5,000 lobotomies, many of them being prefrontal lobotomies.

The frontal lobe and its function

The cerebrum, the largest part of the brain is divided into for lobes, one of which is the frontal lobe. Each lobe has different functions. The cerebrum is also divided into two hemispheres, the right and the left. The right hemisphere helps you think creatively, while the left hemisphere helps you think logically. Hence an individual possesses a left-sided frontal lobe and the right-sided frontal lobe.

The frontal lobe is located in the frontal and upper area of the cortex. Its main function is to carry out higher mental processes such as planning, making decisions, thinking, etc. The frontal lobe is also a part of the brain where the personality is determined. This part of the brain is also important in fluency and meaningful speaking.

The frontal lobe is connected to other parts of the brain including the hypothalamus. They are linked to the memory centres throughout the brain apart from the sensory centres.

The prefrontal cortex which is located within the frontal lobes helps in social interaction. They are responsible for empathic behaviour too.

Damage to any part of the prefrontal cortex can affect the sexual activity and sexual interest as well.

It is worthwhile to know that the left side of the frontal lobe controls the right side of the body and vice versa. It is also the most common part of the brain that gets damaged during a head injury.