The Lobotomy Isn’t Dead, It Just Got Precise

Say "lobotomy" and most people picture a patient on a gurney, a dimly lit operating room at the end of a long, empty hallway, and a doctor holding something resembling an ice pick. Surgeons still operate on the brain to treat psychiatric illness, but things are a little different today. It isn't the lobotomy of the 1940s, but it isn't entirely unrelated either. So, are lobotomies still performed today? Sort of.

What a Lobotomy Actually Was

In late 1935, Portuguese neurologists began destroying connections between the frontal lobes and deeper brain structures in patients with severe mental illness. The 1949 Nobel Prize was awarded to one of them for this work. Walter Freeman, an American neurologist, later popularized a faster "transorbital" version that reached the brain through the eye socket, and tens of thousands of lobotomies were eventually performed.

The context matters. Asylums were overcrowded, effective treatments were scarce, and lobotomy looked like hope. It was used for schizophrenia, severe depression, OCD, and even "psychopathic personality." It was also applied unevenly. One recent historical review notes that the informal selection criteria included being female and being non-compliant.

Did It Work?

The best answer is "sort of," and mostly in the short term. In one of the early reports on 20 patients, roughly a third were described as greatly improved, a third moderately improved, and a third unchanged. But follow-up lasted only weeks. Some patients did become calmer and went home. Others became apathetic, disinhibited, or developed seizures, and some died.

By the 1960s, classic lobotomy had been largely abandoned for two main reasons: One, chlorpromazine, the first widely used antipsychotic, arrived in the U.S. in 1955. Two, the mounting ethical backlash from professionals and the general public finally reached a tipping point.

Then Versus Now

Today's descendants fall under the name psychiatric neurosurgery, and they're reserved for a very small group: people with severe OCD, for example, who haven't responded to medication and exposure therapy. The differences from the 1940s are substantial. Instead of cutting blindly, surgeons use MRI guidance to place tiny, precise lesions with focused radiation or laser heat, or they implant electrodes for deep brain stimulation (DBS), which can be adjusted. The FDA approved DBS for severe OCD in 2009 under a special pathway for rare conditions, which means it was judged to have probable benefit, not proven effectiveness.

And the results? A meta-analysis of 38 studies found that around 57 percent of patients with refractory OCD responded to either ablative surgery or DBS, with no clear difference between the two. That's meaningful for people who've run out of options, but it also means roughly four in ten didn't respond.

The studies are small, too. One recent report examined 10 patients treated with laser capsulotomy, and another study looked at six patients treated between 2017 and 2025. Researchers also note that cognitive side effects appear subtle but are not yet well studied.

Conclusion

Psychosurgery didn't vanish. It narrowed, and in doing so it traded the confidence of the 1940s for caution. The real lesson of the lobotomy era isn't that brain surgery for mental illness is inherently monstrous. It's what happens when a treatment spreads faster than the evidence for it. The open question today is how we weigh last-resort options for people who have exhausted everything else, and how we make sure the evidence keeps up.

© Kevin Bennett, Ph.D., 2026

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