Caroline Webb

1 Caroline Webb Inequity and the Body THE FEMALE VICTIMS OF LOBOTOMY: A HISTORY OF MISOGYNY IN MENTAL HEALTH I. Introduction and Background The practice of lobotomy, a surgical procedure that involves the cutting and or scraping away of a portion of the brain, was largely performed within the United States during the mid20th century as a means of treating mental illness (March & Gelso, 2020). Approximately fifty thousand lobotomies were performed in the United States from 1936 to 1972, with the majority being performed during the late 1940s through the early 1950s being coined the “lobotomy boom” (March & Gelso, 2020). The procedure was invented by Portuguese neurologist Egas Moniz and his colleague Almeida Lima in 1935 and was introduced to the United States shortly after. (Tondreau, 1985). The lobotomy was initially believed to be a promising treatment for a wide variety of mental illnesses, such as schizophrenia and depression, with the potential to alleviate symptoms and improve the patient’s quality of life (March & Gelso, 2020). However, as the procedure significantly became popularized, it was clear that the procedure was not as effective as originally believed; there were significant risks causing serious side effects, including change in personality, loss of motor function, and even death (Bernstein et. al, 1975). 2 The procedure continued to be performed for several decades due to a variety of factors, including the lack of effective alternatives and the influence of powerful advocates such as Walter Freeman, a prominent American psychiatrist who championed the procedure (Caruso & Sheehan, 2017). Freeman was known for his showmanship and performed over 3,000 lobotomies in his lifetime, often using an ice pick instead of a surgical instrument (Caruso & Sheehan, 2017). He believed the procedure could cure a range of mental illnesses and made grandiose claims about its success rate (Caruso & Sheehan, 2017). Freeman’s influence directly contributed to the widespread use of lobotomy and the perpetuation of harmful gender stereotypes. Furthermore, it is important to note the role that the media played in promoting the use of lobotomy during this time period. Popular magazines and newspapers portrayed lobotomy as a miracle cure, emphasizing its potential to cure mental illness and improve patient’ lives. These media outlets often failed to mention the risks and side effects of the procedure, contributing to the widespread acceptance of lobotomy as a viable treatment option (Diefenbach, et al., 2010). This raises questions about the responsibility of the media in promoting medical procedures and the potential consequences of sensationalizing medical treatments without providing accurate information to the public. Despite the severe risks associated with the surgical procedure, it was disproportionately performed on women during the 1940s-1950s in the United States (Tone, 2018). According to a study, women received lobotomies at a rate of approximately two to three times that of men during this time period (Tone, 2018). This raises questions about why women were more likely to undergo this procedure, and whether they were intentionally being targeted for lobotomy as a means of control. 3 “ By 1942, 75% of lobotomies Freeman and Watts had performed were on women. It wasn’t just Freeman and Watts. A comprehensive survey of US psychiatric facilities between 1949 and 1951 found that most patients lobotomized by doctors were women.” (Tone, 2018) This paper aims to explore the history of lobotomy, with a specific focus on the disproportionate rates of lobotomy among women in the United States. By examining the social and cultural factors that contributed to this trend, as well as the impact of lobotomy on patients’ families, this paper will argue that lobotomies were often used as a means of controlling women’s behavior and enforcing gender roles. Through an analysis of primary and secondary sources, this paper sheds light on the ways in which the lobotomy was used as a tool of social control and the lasting impact it had on the lives of women and their families. II. History of the Lobotomy The inventor of the lobotomy was Portuguese neurologist Egas Moniz, whose real name was Antonio Caetano de Aubreu Freire, who developed the procedure in the late 1930s (Tondreau, 1985). Moniz was born into a prominent yet poor family and received his medical degree from the University of Lisbon in 1911 (Tan, 2014). He went on to become a professor of neurology at the same university and was known for his work in cerebral angiography, which involved injecting dye into the bloodstream to visualize the brain’s blood vessels (Tondreau, 1985). Moniz’s original intent with the lobotomy was to treat severe mental illnesses, such as schizophrenia and manic depression, which at the time were considered incurable (Tan, 2014). 4 Moniz believed that patients became mentally ill due to the presence of abnormal neural connections originating from the frontal lobes (Tan, 2014). The procedure consisted of drilling holes, known as trephination or burr holing, into the patient’s skull and severing the connections and white matter between the prefrontal cortex and the rest of the brain using a specialized tool called a leucotome (Tan, 2014). Lobotomies were most commonly performed on patients who were deemed mentally ill or “insane”, often in overcrowded and underfunded mental health institutions (Bernstein et. al, 1975). For uncooperative or violent patients, the procedure was often modified resulting in a more invasive version known as the transorbital lobotomy, in which a leucotome was inserted through the eye sockets (Faria, 2013). The United States as a whole had a complicated relationship with lobotomies, with some praising the procedure as a miracle cure and others condemning it as a barbaric practice ((March & Gelso, 2020). While the medical industry viewed as a breakthrough in treating mental illness, non-medical personnel such as journalists and the public were often skeptical and critical of the procedure (March & Gelso, 2020). Ultimately, lobotomies fell out of favor in the 1950s and 1960s due to concerns about their efficacy and safety, and the procedure is no longer performed as a mainstream treatment for mental illness (March & Gelso, 2020). The success rate of lobotomies varied widely depending on the specific procedure and the individual patient, with some patients experiencing temporary relief of their symptoms and others suffering severe and permanent side effects (March & Gelso, 2020). The last lobotomy in the United States was performed in 1967, and the procedure in now considered a relic of a bygone era in the history of psychiatry (March & Gelso, 2020). 5 III. Women’s Health and Lobotomies During the 1940s and 1950s, lobotomies were performed more frequently on women than men. According to statistics, women received lobotomies at a rate of two to three times that of men (Caruso & Sheehan, 2017). Doctors were unsure of the reasons for this gender disparity, with a doctors claiming that while they were aware of the disparity, they merely thought of it as coincidence, or just how the cards played out (Seedat, 2010). Gender disparities in medical treatment were evident not only in lobotomies, but also in routine medical care. For example, it was found that women were less likely than men to receive recommended treatments for heart disease (Xhyheri & Bugiardini, 2010). This disparity was attributed to factors such as differences in symptoms presentation, physician biases, and sociocultural factors. Regarding the actual lobotomy procedure, there is no evidence to suggest that it was performed differently on women than on men. However, research has shown that different parts of the brain may be affected depending on the patient’s sex. For example, a study found that women who underwent lobotomies had more extensive damage to the frontal cortex than men, while men had more damage to the temporal lobe (Raskin, et al., 2006). It is also unclear whether there were post-procedure symptoms that exclusively impacted women. In terms of the population of women who received lobotomies, there were also disparities based on socioeconomics, race, and sexuality. For example, women from lower socioeconomic backgrounds were more likely to receive lobotomies than women from higher socioeconomic backgrounds (Bidell & Stepleman, 2017). Additionally, African American women and LGBTQ+ women were more likely to receive lobotomies due to societal prejudices and discrimination (Bidell & Stepleman, 2017). 6 It is unclear how women who received lobotomies felt about the procedure, as opinions likely varied depending on the individual. However, some sources suggest that women felt manipulative pressures from their families or caretakers to receive the procedure. For example, one study found that 11% of patients who underwent lobotomies were committed involuntarily (Faria, 2013). Additionally, some women may have believed that their symptoms were resolved, while others may have experienced long-term negative effects. It has been reported that 25-50% of patients who underwent lobotomies were hospitalized again within five years (Faria, 2013). IV. Familial Impact of the Lobotomy It is important to consider the impact of societal and cultural expectations on the decision to undergo a lobotomy. Women were expected to conform to a certain standard of behavior and appearance, and those who did not were often seen as abnormal or undesirable. This many have led some women to seek out the procedure as a way to fit in with societal expectations or to please their husbands or families. However, this expectation of conformity may have also contributed to a lack of agency for women in deciding whether to undergo the procedure. As feminist scholar Andrea Dworkin has previously stated, “No woman could have been Nietzsche or Rimbaud without ending up in a whorehouse or lobotomized” (Dworkin, 1983). While her statement may seem hyperbolic, it speaks to the idea that women were often seen as needing to be “fixed” or “tamed” through intervention. During the peak of lobotomy procedures in the mid-20th century, there was a notable different in the percentage of married women versus unmarried women who received the procedure. Approximately 30% of women who received a lobotomy were married, compared to 7 only 15% of men who were married (Bernstein et. al, 1975). This disparity raises the question of why married women were more likely to undergo the procedure. While there is no clear and definitive answer, some sources suggest that husbands may have played a role in pushing and urging their wives toward the procedure. In his book, “The Lobotomist”, Jack El-Hai suggests that Dr. Walter Freeman commonly favored husbands’ inputs on the procedure and their description of their wives’ symptoms, rather than the patient herself (El-Hai, 2007). This suggests that husbands may have seen the procedure as a way to make their wives more docile and easier to control. However, it is unclear how the wives themselves felt about the procedure. While some reports suggest that patients do become more docile post-procedure, it is unknown whether this was seen as a positive change by the wives, or if they even had a say in the matter (Bernstein et. al, 1975). Furthermore, it is unclear how other members of the patient’s family viewed the procedure, including children and family members. However, there were some complaints from patients’ family members blaming the lobotomy for their loved ones’ behavior (El-Hai, 2007). Additionally, it is important to consider the impact of familial beliefs on the decision to undergo a lobotomy. Studies have shown that personal beliefs and attitudes can be passed down from parent to child, raising the question of whether the “idealized lobotomized women” standard was perpetuated in this way and how it may still impact modern times (Chen et. al, 2021). Family members may have also felt a societal pressure to conform to this ideal, further influencing their attitudes towards the procedure. Thus, the impact of lobotomies on patients’ families was likely far-reaching, and further research is necessary to understand its full extent. The practice of lobotomies in mid-20th century American was a complex and controversial issue. The decision to undergo a lobotomy was often influenced by familial beliefs 8 and attitudes, which raises important questions about the role of societal expectations in the decision-making process. Given the lasting impact of lobotomies on patients and their families, it is crucial to continue studying this period in medical history and understand its implications for modern medical practices. V. Conclusion Throughout this paper, we have explored the disturbing history of lobotomies, particularly in their disproportionately negative impact on women. We have delved into the reasons why women were more likely to receive lobotomies than men, the differences in treatment between male and female patients, and the impact of lobotomies on women’s families and society as a whole. Our findings suggest that lobotomies were often used as a way to control women’s behavior and emotions, rather than as a legitimate medical treatment. Women from certain socioeconomic backgrounds, races, and sexualities were particularly vulnerable to receiving lobotomies, indicating that systemic biases were at play. The fact that many doctors at the time could not explain why more women were receiving lobotomies than men is concerning, as it suggests that the decision to perform this procedure was often arbitrary and not based on sound medical reasoning. Additionally, we have seen the impact of lobotomies went far beyond the patients themselves. Husbands often saw their wives as more docile and easier to control after the procedure, while children and other family members were left to grapple with the aftermath. The 9 fact that lobotomies were often forced upon women against their will raises questions about the ethics of medical treatment and the importance of informed consent. While the practice of lobotomies has largely ended, the legacy of this dark period in medical history continues to affect women to this day. It is important to continue to shed light on the injustices done to women in the past in order to prevent similar injustices from occurring in the future. This paper is just one small step towards a deeper understanding of the ways in which women have been mistreated by the medical system. Moving forward, it is important to examine how these findings can be applied to other areas of women’s health and well-being. For example, we can use the lesson learned from the history of lobotomies to inform how we approach treatments for mental health issues in women today. By acknowledging the ways in which gender biases have influenced medical treatment in the past, we can work towards creating a more equitable and just future for all. In conclusion, the history of lobotomy demonstrates the ways in which gender biases and social norms can influence medical practices and the treatment of patients. By focusing on the disproportionate impact of lobotomies on women, this paper has highlighted the dangers of allowed systemic biases go unchecked in the medical field. Furthermore, the fact that lobotomies were performed on a large scale for several decades in the United States, with many patients being forced to receive the procedure against their will, underscores the need for more robust regulations and ethical standards in medical research and practice. It is crucial that we continue to study the history of lobotomy and other medical procedures to gain a better understanding of how gender, race, and class impact medical treatment. This knowledge can then be used to develop more equitable and just healthcare policies and practices that prioritize patients’ well-being and autonomy. 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