First, take an ice pick from your kitchen...then shove it just under your upper eyelid...

In 1935, Portuguese physician and neurologist António Egas Moniz pioneered a surgery he called prefrontal leucotomy. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later changed technique, using a surgical instrument called a leucotome that cut brain tissue by rotating a retractable wire loop (a quite different cutting instrument also used for lobotomies shares the same name). Moniz was given the Nobel Prize for medicine in 1949 for this work.

The American neurologist and psychiatrist Walter Freeman was intrigued by Moniz's work, and with the help of his close friend, a neurosurgeon named James W. Watts, he performed the first prefrontal leucotomy in the U.S. in 1936. Freeman and Watts gradually refined the surgical technique, and created the Freeman-Watts procedure (the "precision method," the standard prefrontal lobotomy).

The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed that this surgery would be unavailable to the patients who needed it most: those that lived in state mental hospitals with no operating rooms, no surgeons, no anesthesia, and very little money. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in mental asylums, which housed roughly 600,000 American inpatients at the time.

Inspired by the work of Italian psychiatrist Amarro Fiamberti, Freeman decided to access the frontal lobes through the eye sockets, instead of through drilled holes in the scalp. In 1945, he took an icepick from his own kitchen and began to test the new surgical technique on cadavers. The technique was called "transorbital lobotomy," and it involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A hammer or mallet was then used to drive the leucotome through the thin layer of bone and into the brain. The leucotome was then moved from side to side, to sever the nerve fibers connecting the frontal lobes to the thalamus.

In selected patients, the butt of the leucotome was pulled upward, sending the tip farther back into the brain, producing a "deep frontal cut," a more radical form of lobotomy. The leucotome was then withdrawn, and the procedure was repeated on the other side. Walter Freeman first performed a transorbital lobotomy on a live patient in 1946. This new form of psychosurgery was intended for use in state mental hospitals that often did not have the facilities for anesthesia, so Freeman suggested using electroconvulsive therapy to render the patient unconscious.

Notable cases

Rosemary Kennedy, the sister of President John F. Kennedy, was given a lobotomy when her father complained to doctors about the 23-year-old's moodiness. Dr. Walter Freeman personally performed the procedure. Rather than any improvement, however, the lobotomy reduced Rosemary to an infantile mentality including incontinence. Her verbal skills were reduced to unintelligible babble. Her father hid the nature of Rosemary's affliction for years and described it as the result of mental retardation. Rosemary's sister Eunice Kennedy Shriver founded the Special Olympics in her honor in 1968.

Here is Rosemary's story - "the first of the Kennedy family tragedies."

In 1941, when Rosemary was 23, her father was told by her doctors that a cutting edge procedure would help calm her "mood swings that the family found difficult to handle at home". Joseph Kennedy gave permission for the procedure to be performed by Dr. Walter Freeman, the director of the laboratories at St. Elizabeths Hospital in Washington, D.C., together with his partner, James W. Watts, MD, from the University of Virginia. Watts performed his neurosurgical training at the Massachusetts General Hospital, and later he became the Chief of Neurosurgery at the George Washington University Hospital. Highly regarded, Dr. Watts later became the 91st president of the Medical Society of the District of Columbia. The procedure in question was a lobotomy.

At the time only 65 previous lobotomies had been performed. Dr. Watts, who performed the surgery while Dr. Freeman supervised/observed, described the procedure:

We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside," he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards. ... "We made an estimate on how far to cut based on how she responded." ... When she began to become incoherent, they stopped.

—James W. Watts

Instead of producing the hoped-for result, however, the lobotomy reduced Rosemary to an infantile mentality that left her incontinent and staring blankly at walls for hours. Her verbal skills were reduced to unintelligible babble. Her mother, Mrs. Rose Kennedy, remarked that although the lobotomy stopped her daughter's violent behavior, it left her completely incapacitated. "Rose was devastated; she considered it the first of the Kennedy family tragedies."

Freeman went on to perform more than 3,000 lobotomies before his license to practice medicine was revoked (because of the death of a patient). Such lobotomy treatments are now discredited by the mental health and medical communities, and the procedure is no longer used.

Can anyone tell what the F_ _ _ is wrong with our medical system? They only stopped doing lobotomies when thorazine came on the market...they called it a "chemical" lobotomy. Has anything really changed?