Following Egas Moniz's original leucotomy, American neurologist Walter Freeman developed and toured the country performing a crude 'transorbital' version — driving an ice-pick-like instrument through the eye socket in minutes, often in outpatient settings without a surgeon present. Antipsychotic drugs, lawsuits and mounting evidence of permanent harm ended the practice almost entirely by the 1970s.
The lobotomist no longer exists as a living trade. Here is what erased it, and which profession took on the work.
1793–1899
Moral treatment and the birth of the asylum reform movement
Pinel's unchaining of patients at the Bicêtre, and a parallel reform led by Quaker tea merchant William Tuke at England's York Retreat from 1796, argued that routine, useful work and humane surroundings healed more effectively than restraint. The idea spread internationally — reformer Dorothea Dix alone persuaded American state legislatures to fund more than thirty new asylums between the 1840s and 1880s — but many of the resulting institutions grew overcrowded and custodial again within a generation.
What else was happening then
1899
Kraepelin splits psychosis into two diseases
The sixth edition of Emil Kraepelin's textbook, based on years of tracking patient outcomes in Heidelberg, distinguishes dementia praecox — which worsened over time — from manic-depressive insanity, which came in recoverable episodes; the split remains recognizable in diagnosis today as schizophrenia and bipolar disorder.
1900
Freud publishes The Interpretation of Dreams
Sigmund Freud's book, dated 1900 on its title page though released in Vienna in late 1899, argues dreams reveal unconscious wishes and lays the theoretical groundwork for psychoanalysis, which would dominate much psychiatric theory in Europe and North America for the next half-century.
1935
The first leucotomy is performed in Lisbon
Neurologist António Egas Moniz designs, and surgeon Almeida Lima carries out, the first prefrontal leucotomy — cutting connections in the frontal lobe to treat severe mental illness. The procedure, later popularized in a cruder outpatient form as the lobotomy, wins Moniz a Nobel Prize in 1949 and, decades later, widespread condemnation.
1952
Chlorpromazine calms psychosis in Paris
Psychiatrists Jean Delay and Pierre Deniker trial chlorpromazine, a compound developed for surgical anesthesia, on psychiatric patients at Sainte-Anne Hospital in Paris and find it reliably calms psychotic symptoms without simply sedating patients into unconsciousness — the discovery that launches modern psychopharmacology and, within two decades, empties much of Europe and North America's asylum wards.
Where that work lives now
Diagnoses and treats mental illness through medication and therapy, one of medicine's only specialties with legal authority to detain a patient in crisis.
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