The Ice Pick Lobotomy

Selected by Shane O’Mara

Would an ice pick driven through the eggshell thin bone above your eye into your brain cure your ‘maladies’, your ‘melancholy’, your ‘madness’? During the middle decades of the 20th century transorbital lobotomy, or ‘ice pick’ lobotomy, a radically invasive form of brain surgery, was used extensively for patients with psychiatric illnesses. It was a rapidly executed procedure, taking perhaps a few tens of minutes in total, requiring no more than a local anaesthetic, conducted for the purposes of ‘psychosurgery’.

This was the era before effective pharmacotherapies or psychotherapies for psychiatric illnesses; an era before there was an outline understanding of the psychological functions supported by the frontal lobes. We now know much about the frontal lobes: they support ‘executive functions’ within the brain such as planning, intending, imagining alternatives, initiating actions, directed remembering, and deferring gratification. In short, what makes us human.

In the unfortunate patient, the frontal lobes would be cut away from the rest of the brain by a simple and quick side-to-side motion, leaving the person with irreversible and enduring consequences. There were good intentions behind the procedure —curing the ‘incurable’ by radically intervening in the brain. However, transorbital lobotomy rendered many of its victims docile, mute and compliant. This therapeutic surgical strategy was a terrible but instructive failure of medical ethics, of patient treatment, and of neurological understanding of brain function and dysfunction. The legacy is what can go wrong. Medical ethics, safeguards and precautions have evolved so that similarly reckless experiments can never be conducted again.

About Shane O’Mara

Shane O’Mara is Professor of Experimental Brain Research at the School of Psychology in Trinity College Dublin, and the Director of the Trinity College Institute of Neuroscience. Shane’s research centres on examining how the brain makes memories. He explores what life would be like without memory, our enduring personal record of our hopes, experiences, desires, wishes, needs, loves and hatreds. He is particularly interested in how memories are encoded by neurons in the brain, and how this encoding is affected by psychiatric or other conditions. Shane is also interested in public policy applications and counterfactual interpretations of neuroscience, and has published over 100 papers in these areas.