Psychosurgery

by

Jesper Vaczy Kragh

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0047

Introduction

Though experiments with surgery for mental disorders were reported in the late nineteenth century, the beginning of psychosurgery is usually dated to 11 November 1935. On that day, a depressed sixty-three-year-old woman was admitted to the Santa Marta Hospital in Lisbon, Portugal, to undergo a surgical procedure devised by Professor of Neurology Egas Moniz and carried out the next day by his assistant, Almeida Lima. The operation was the first time in history that deep incisions were made in the white matter of the brain of a psychiatric patient. Moniz called the treatment “leucotomy,” after the Greek words for white (leukos) and cut (tomia). Moniz’s claims of cures and improvements in up to 70 percent of patients indicated a success rate unparalleled in 1930s psychiatry, and other doctors began to express an interest in trying it out, none more enthusiastically than the American neurologist Walter Freeman. Together with surgeon James Watts, Freeman performed his first leucotomy in 1936. The American duo also developed their own technique and named the procedure “frontal lobotomy,” after the Greek words for lobe (lobos) and cut (tomia). In 1945, Freeman introduced a new method, transorbital lobotomy, using an ice pick, which was hammered through the thin part of the skull at the eye socket, further into the brain, and wiggled from side to side in order to cut nerve pathways in the frontal lobes. Other physicians around the world also tested and refined the procedure developed by Moniz. Their different techniques were grouped under the heading “psychosurgery,” which Moniz had coined as an umbrella term for leucotomy, frontal lobotomy, transorbital lobotomy, and new variations on the same theme. Despite earlier experiences with brain surgery for mental disorders, Moniz was seen as the inventor. In 1949, the Nobel Committee awarded Moniz the Prize for Medicine and Physiology for inventing psychosurgery. After this, the treatment became even more popular in many countries. Lobotomy was often considered to be a last resort for patients who had spent many years in hospital after all other treatments had failed. Many psychiatrists expressed high hopes of discharge or noticeable improvements in otherwise potentially fatal conditions, especially in patients with schizophrenia, but, at the same time, they were aware of the serious side effects of psychosurgery. However, psychosurgery was also used to control difficult patients with a diagnosis such a psychopathy who had only short-term stays in the hospitals. Evaluations of the effects of lobotomy varied, and some doctors of the time refused to use the treatment. A decline occurred in many countries in the 1950s, especially after the introduction of psychopharmacology in psychiatry (chlorpromazine, etc.), but also as a result of new medical, social, and cultural ideas. During the 1970s, heated debates about psychosurgery surfaced. The unclarified theoretical basis for lobotomy and the extensive adverse effects often provoked alarm or consternation in many countries. Critical historical works on lobotomy were published in the 1980s. This literature has subsequently been supplemented by studies on the cultural, social, and medical aspects of psychosurgery. In recent years, an interest in deep brain stimulation among psychiatrists and neurosurgeons has generated new attention to historical and ethical issues of psychosurgery. However, psychosurgery remains one of the most controversial chapters in the history of medicine.

General Overviews

The historiography of psychosurgery is covered in detail in Collins and Stam 2014. Most books in English concern the American aspect of the history of psychosurgery and, in particular, the role of Walter Freeman. The early works on the history of psychosurgery, published during the discussions of the 1970s and 1980s, are characterized by a critical version of this history. The first well-researched and well-written account is the monograph Valenstein 1986, primarily on psychosurgery in the United States and Portugal. A shorter version is available in Valenstein 1997. Studies of the European history of psychosurgery in German- and French-speaking countries are Hill 1992, Meier 2015, and Lévêque and Cabut 2017. As Kragh 2021 demonstrates, lobotomy had a breakthrough in the Nordic countries during the 1940s. Review articles in neurosurgical journals like Neumaier, et al. 2017 and Lichterman, et al. 2022 offer overviews of the development of psychosurgical techniques from early lobotomy to stereotactic procedures and deep brain stimulation (DBS). An excellent book on the history of DBS is Fangerau, et al. 2011.

• Collins, Brianne M., and Henderikus J. Stam. “A Transnational Perspective on Psychosurgery: Beyond Portugal and the United States.” Journal of the History of the Neurosciences 23.4 (2014): 335–354.

  DOI: 10.1080/0964704x.2013.862123

  An excellent historiographical survey on the transnational history of lobotomy, spanning not only scholarly work on the topic, but also contemporary sources on 20th-century psychosurgery. A good starting point for scholars and students searching for information on the history of psychosurgery.

• Fangerau, Heiner, Jörg M. Fegert, and Thorsten Trapp, eds. Implanted Minds: The Neuroethics of Intracerebral Stem Cell Transplantations and Deep Brain Stimulation. Bielefeld, Germany: Transcript Verlag, 2011.

  This edited collection is a fine introduction to the history of deep brain stimulation and the ethical concerns that this psychosurgery technique gives rise to. Contributions from scholars from a range of different disciplines.

• Hill, Jürgen. Der Frontale Griff in das Gehirn und die Entwicklung der Psychochirurgie. Münster, Germany: Lit. Verlag, 1992.

  This book in German outlines the global history of psychosurgery. It contains short chapters on the development of psychosurgery in various countries and a useful list of references to 20th-century articles on psychosurgery. However, lobotomy in German-speaking countries is Hill’s primary focus. An academic publication based on analysis of printed sources of the time.

• Kragh, Jesper Vaczy. Lobotomy Nation: The History of Psychosurgery and Psychiatry in Denmark. Cham, Switzerland: Palgrave Macmillan, 2021.

  DOI: 10.1007/978-3-030-65306-4

  A history of psychosurgery and other somatic treatments in Denmark from 1922 to 1983. The events in Denmark are situated within the context of the international history of psychosurgery. The introduction covers the historiography of psychosurgery and the major works on the topic.

• Lévêque, Marc, and Sandrine Cabut. La chirurgie de l’âme: De la lobotomie à la stimulation cérébrale profonde, soigner ou contrôler notre cerveau. Paris: Jean-Claude Lattès, 2017.

  This book in French, written by neurosurgeon Marc Lévêque and science journalist Sandrine Cabut, is a readable account on the international history of psychosurgery, from Egas Moniz to recent experiments with deep brain stimulation.

• Lichterman, Boleslav L., Michael Schulder, Baobin Liu, Xinyu Yang, and Takaomi Taira. “A Comparative History of Psychosurgery.” Progress in Brain Research 270.1 (2022): 1–31.

  DOI: 10.1016/bs.pbr.2021.12.003

  Neurosurgeon Lichterman and coworkers provide a trajectory of psychosurgery in Russia, China, Japan and the United States. Interesting review of source materials, showing that psychosurgery was taken up again in Russia and China in the 1980s. In the 2000s, psychosurgery has been used to treat drug addiction in hundreds of patients in these two countries.

• Meier, Marietta. Spannungsherde: Psychochirurgie nach dem Zweiten Weltkrieg. Göttingen, Germany: Wallstein, 2015.

  Meier’s book in German is a well-researched history of psychosurgery in Switzerland and, to a lesser extent, other German- and French-speaking European countries, including studies of 300 patient records of lobotomy patients in Switzerland. More than 1,200 psychosurgical operations were performed in Switzerland during the period 1946 to 1971. An excellent German-language introduction to the field.

• Neumaier, Felix, Maria Paterno, Serdar Alpdogan, et al. “Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery.” World Neurosurgery 97 (2017): 603–634.

  DOI: 10.1016/j.wneu.2016.10.008

  A neurosurgery survey of the various procedures used in the period 1935 to 2013, from lobotomy to deep brain stimulation. Identifies three generations of surgical procedures. A good introduction to the surgical techniques with many references to lobotomy articles of the time.

• Valenstein, Elliot S. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York: Basic Books, 1986.

  A seminal work on the history of somatic treatments, particularly psychosurgery, in psychiatry. Useful accounts on the history of lobotomy in Portugal and the United States, but also information about developments in other countries. A well-written, critical introduction to the field.

• Valenstein, Elliot S. “History of Psychosurgery.” In A History of Neurosurgery: In Its Scientific and Professional Contexts. Edited by Samuel H. Greenblatt, T. Forcht Dagi, and Mel H. Epstein, 499–516. Park Ridge, IL: American Association of Neurological Surgeons, 1997.

  A chapter on the history of psychosurgery by the author of Valenstein 1986. Valenstein estimates that between 60,000 and 80,000 people all over the world underwent a lobotomy during the period 1935 to 1956. A fine introduction to the important events in the history of psychosurgery.