It’s easy to think of lobotomies as some ancient, medieval torture method. We picture flickering lights in a Victorian asylum and a doctor who looks like a movie villain. But honestly? The reality is much weirder—and way more recent. When we ask what do lobotomies do, we’re really asking how a simple surgical tool could supposedly "fix" a human soul by physically shredding the brain’s wiring.
They were remarkably common. Between the late 1930s and the early 1950s, tens of thousands of people in the United States alone underwent the procedure. It wasn’t just for "violent" patients either; it was used for anxiety, depression, and even what doctors back then called "difficult" behavior in children.
So, What Do Lobotomies Do to the Brain?
Basically, a lobotomy is the intentional destruction of the connections between the prefrontal cortex and the rest of the brain. The prefrontal cortex is the part of you that plans, dreams, worries, and feels complex emotions. It’s the "executive" in your head. By severing these neural pathways, doctors weren't "curing" a disease in the way an antibiotic kills a germ. Instead, they were essentially short-circuiting the brain's ability to process intense emotion.
Think of it like cutting the fiber optic cables to a high-speed computer. The computer still turns on. The fans still spin. But it can’t really do anything complex anymore.
The most famous version, the transorbital lobotomy, was popularized by Dr. Walter Freeman. He didn’t even use a traditional operating room most of the time. He used a tool modeled after an ice pick from his kitchen, tapped it through the thin bone of the eye socket with a mallet, and swished it back and forth.
What happens next? The patient often became "docile." That was the medical term used back then. To a harried hospital staff in an overcrowded 1940s psychiatric ward, a patient who sits quietly in a chair and stares at a wall is a "success." But for the person inside that body, the cost was everything that made them them.
The Two Faces of "Success"
The results were all over the place. There was no "standard" outcome, which is part of what makes the history so terrifying.
Some people, like Rosemary Kennedy (sister to JFK), were left almost entirely incapacitated. Before the surgery, she was described as high-spirited and occasionally prone to mood swings. After the procedure, she lost the ability to speak clearly and spent the rest of her life in an institution. It was a disaster.
Then there were others who seemed "better" on the surface. Howard Dully, who was lobotomized at age 12 because his stepmother found him "defiant," survived and eventually wrote a memoir about it. He described living much of his life in a bit of a fog, struggling with focus and emotional depth, but he functioned.
What did the procedure actually achieve?
- It reduced "agitation" by physically removing the capacity for it.
- It often caused "apathy," where the patient had no drive or initiative.
- It frequently resulted in a "blunted affect," meaning no more highs or lows. Just a flat line.
- In many cases, it caused incontinence or seizures that lasted a lifetime.
The Rise of the "Ice Pick" Doctor
Walter Freeman was a showman. He drove around in a van he called the "Lobotomobile." Seriously. He’d perform these surgeries in front of audiences, sometimes doing two at once, one with each hand. He wasn't a surgeon; he was a neurologist.
His logic was that the "affective" (emotional) component of mental illness was localized in the frontal lobes. If you broke the connection, the "morbid thoughts" couldn't reach the rest of the brain. He genuinely believed he was helping people. He thought he was emptying out the "snake pits" of the state asylums.
📖 Related: The Real Definition of Crazy: Why We Use It Wrong and What Science Actually Says
But he ignored the data. He didn't do long-term follow-ups. He just saw the immediate "calming" effect and moved on to the next town.
Why Did We Ever Think This Was a Good Idea?
You have to remember what hospitals were like in 1945. They were overcrowded. They were loud. There were no effective antipsychotic drugs. Thorazine hadn't been invented yet. If you had a family member with severe schizophrenia or uncontrollable mania, your options were basically "lock them in a room" or "try this new surgery that the guy in the Lobotomobile says works."
Desperation drives bad science.
The Portuguese neurologist Egas Moniz actually won a Nobel Prize in 1949 for developing the leucotomy (the precursor to the lobotomy). It was considered cutting-edge science. It’s a stark reminder that the medical "consensus" can be catastrophically wrong when it prioritizes convenience over human rights.
The Long Shadow of the Frontal Lobe
When we look at what do lobotomies do from a modern neurobiological perspective, we see a cautionary tale about brain plasticity and localization. We now know the brain is far more integrated than Freeman ever imagined. You can't just snip one wire and expect the rest of the machine to work the same way.
The prefrontal cortex is involved in:
💡 You might also like: What is in a Prenatal Vitamin: What Most People Get Wrong
- Working memory: Holding information in your head for short periods.
- Personality expression: Your unique quirks and responses.
- Decision making: Weighing the future consequences of current actions.
- Moderating social behavior: Knowing what is appropriate to say or do.
When those connections go, so does the "future self." Lobotomy patients often lived entirely in the present moment, not because they were "mindful," but because they literally couldn't conceptualize the future or their own goals anymore.
How the Era Finally Ended
It wasn't a sudden ban that stopped the lobotomy. It was chemistry.
In the mid-1950s, the drug chlorpromazine (Thorazine) hit the market. It was marketed as a "chemical lobotomy" because it could calm psychotic patients without the need for an ice pick. Suddenly, surgery looked barbaric and unnecessary. By the 1960s, the practice had mostly died out in the West, though Freeman kept doing them until 1967, when a patient died of a brain hemorrhage after her third lobotomy. He was finally banned from operating.
Today, we use deep brain stimulation (DBS) or very precise, laser-guided "lesioning" for extreme cases of OCD or depression that don't respond to anything else. But these are worlds away from the blind "swishing" of the 1940s. They are targeted, measured, and involve informed consent—something Rosemary Kennedy and Howard Dully never had.
Actionable Insights: Lessons from the Lobotomy Era
Understanding this dark chapter of medical history isn't just about being a history buff. It’s about how we evaluate health treatments today.
- Question "Instant Cures": If a medical intervention promises to solve a complex mental health issue with a single, dramatic physical change, be skeptical. Mental health is almost always a "slow medicine" field involving therapy, lifestyle, and carefully managed medication.
- The Importance of Longitudinal Data: One reason the lobotomy lasted so long was the lack of follow-up. Always look for long-term studies (5-10 years) when considering new or invasive medical treatments.
- Bioethics Matter: The lobotomy flourished because "difficult" people were seen as problems to be managed rather than humans with rights. Ensure any treatment you or a loved one receives respects the "whole person," not just the elimination of symptoms.
- Brain Health is Holistic: Your prefrontal cortex needs more than just "not being damaged." It needs sleep, low inflammation, and cognitive challenges to thrive. Protecting those neural pathways is far easier than trying to repair them once they are gone.
The lobotomy didn't "fix" anything. It just silenced the parts of the human experience that were inconvenient to others. By understanding what do lobotomies do, we can better appreciate the complexity of our own brains and the absolute necessity of protecting our mental autonomy.