Prefrontal and transorbital lobotomy

Domain XVI · Historical, discredited & harmful · Egas Moniz, Walter Freeman, James Watts · 1935 · Lisbon

What it is

Lobotomy is listed here for history and safety. It caused deaths, seizures and lasting changes of personality and is not a treatment. The guide describes what patients and families went through, never how the operation was performed, and covers the psychotherapist's own work: historical literacy,…

Format

• Session number and length follow the client's needs and the setting.
• Recognition and assessment. Goal: identify how the history reaches this client (family member operated on, fear of treatment, interest, records, compensation). Format: ordinary individual or family sessions. Move on when the client's question and the impact on them are clear.

Who practises it, and how they are trained or regulated

• Regulation and redress, 1970s onward. The US National Commission for the Protection of Human Subjects reported on psychosurgery in 1977 with safeguards for institutionalised people and those unable to consent. In England and Wales, section 57 of the Mental Health Act 1983 requires both consent and an independent second opinion for any surgical operation for destroying brain tissue or its functioning. Norway's last…
• Version followed: the history of prefrontal leucotomy (Egas Moniz, Lisbon, from 1935) and of prefrontal and transorbital lobotomy in the United States (Walter Freeman and James Watts from 1936; Freeman's transorbital operation from 1946), as stated by the Nobel Prize organisation's historical article (Jansson 1998), PBS American Experience, the Minnesota Governor's Council on Developmental Disabilities, the e-WV…

Evidence status, as the guide reports it

• Ban and decline, 1950-1960s. The Soviet Union banned lobotomy in 1950, after debates among psychiatrists that became politicised in 1947-1949 and a Party intervention in 1949-1950 linked to the campaign against Western influence. Chlorpromazine (1952) made lobotomy largely obsolete for…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• premature closure after a single record is found. Working: the client feels able to return without shame.
• confidentiality limits, which should be explained early. Working: the concern is with the body able to act.
• over-generalising one region's findings. Working: the client gains context without losing the specific person.
• presentism or, conversely, excusing harm as "of its time". Working: the team names current practices to examine.
• the context being heard as excusing harm; let the client hold both. Working: guilt becomes grief or proportionate anger.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.