Brain Lobotomy: A Historical and Moral Dilemma with No Alternative?

Pioneered in 1936 by Portuguese neurologist and politician Egas Moniz, lobotomy was a definitive lesional surgery on the brain, which consisted of splitting the white fibers in the frontal lobes. Sixteen years later, the first antipsychotic medication appeared at Sainte-Anne Mental Hospital in Paris, drastically reducing the number of surgical lobotomies in France and worldwide. Lobotomy has been one of the most criticized medical procedures in history, with thousands of patients lobotomized around the world and causing serious consequences to their personalities and intellectual function.

In the 1940s, the French language was widely used as an alternative language in medical studies, the reason we decided to focus a francophone review on this subject. We conducted the first francophone review of the reported data for the period from 1935 to 1985. Moreover, for a clearer understanding of the background of the time, we also studied the social historical environment.

A total of 1340 cases of lobotomized patients were identified through a review of 29 studies. The indications had varied and were not limited to mental illness. Lobotomy was also performed in some rare cases on patients with peptic ulcers or ulcerative colitis to stop gastrointestinal hemorrhage. The lobotomy techniques were numerous, varying from classic lobotomy to the transorbital injection of radioactive iridium 194.

We have discussed the psychiatric, societal, and media contexts that led to the emergence of lobotomy. Our aim was to highlight this period in the history of medicine and place the medical practice into perspective.