09Chapter 7. The Nobel Prize for the Ice Pick: Lobotomy and Its Price

On January 17, 1946, in Washington, D.C., a woman named Sally Ellen Ionescu visited a psychiatrist’s office. She was suffering from severe depression. Her doctor, Walter Freeman, led her into a private room. He sat her down, connected the electroshock device, and administered the jolt. She lost consciousness.

She lay unconscious. A tool glinted in Freeman’s fingers. An ice pick. An ordinary ice pick from a standard set for breaking ice. How could such an instrument end up in a doctor’s hands? A mystery. But the answer already lurked in the surgeon’s deadly design. Freeman brought the tip to the patient’s face. The target—the eye socket. He inserted the ice pick from above, beneath the upper eyelid, into the tiny gap between the eyeball and the roof of the orbit. A moment of silence. Then—the strike. The mallet came down sharply on the handle. A crack. The thin bone plate above the eye was pierced. The tip of the tool plunged into the frontal lobe of the brain. Freeman clenched the handle. Moved it left to right. Up and down. Severing the connections between the frontal lobe and the rest of the brain, as though cleaving personhood from the mind. He withdrew the instrument. Blood drained from her face. But the operation wasn’t over. He repeated the procedure through the other eye socket.

The entire procedure took about ten minutes.

When Mrs. Ionesco came to, Freeman put her in a taxi and sent her home.

Twenty-five years. Two and a half thousand human brains. One ice pick. How is this even possible? Transorbital lobotomy. Colloquially known as “ice pick lobotomy.” The tool? The same one used to crack ice behind a bar. The entry point? The eye socket. Straight into the brain. His name was Walter Freeman. And here comes the first shock—he wasn’t a surgeon. He was an enthusiast. A van. Freeman drove cross-country in the most ordinary van. A hundred patients a week. But the real nightmare awaited in West Virginia: two hundred twenty-five people in just one twelve-day visit. Two hundred twenty-five. In twelve days. Stop. Think about it. He no longer needed an operating room. He no longer needed a neurosurgeon. What remained? Just an ice pick. A hammer. And an electroshock machine. That’s it. That’s the whole toolkit. A hammer. An ice pick. Electricity.

How many patients in the United States underwent lobotomy? Approximately fifty thousand. Of these, about ten thousand were subjected to Freeman’s method, performed with an ice pick. The rest underwent the earlier technique of prefrontal lobotomy, devised by another individual—the same person who received the Nobel Prize for it in 1949.

The Portuguese neurologist António Egas Moniz (1874–1955) was an academic in the fullest sense of the word. A member of parliament, Portugal’s Minister of Foreign Affairs at the 1918 Paris Peace Conference, a diplomat—but not just that. He was a brilliant neurologist, the pioneer of cerebral angiography—a method of X-ray visualization for blood vessels in the brain. A glimpse inside the skull, making the hidden visible. This breakthrough alone should have earned him a Nobel Prize nomination. If only he had received it for this achievement. But why didn’t he? What terrible secret lies behind this “if only”?

In 1935, at an international congress in London, Moniz heard a lecture by two American researchers, John Fulton and Carlyle Jacobsen. They had conducted experiments on chimpanzees. Specifically, they removed the frontal lobes of two chimpanzees named Becky and Lucy. Before the operation, when failing at a task, Becky would erupt into violent fits—rocking back and forth, screaming, and thrashing against the cage bars. After the operation, she remained calm in the face of any failure and no longer became angry.

Fulton and Jacobsen published a dry scientific observation. Just data. Just facts. And that was enough. In Lisbon, Egas Moniz bent over their report — and saw what the authors had not. Not an observation. A weapon. He went home. Found a neurosurgeon — Pedro Almeida Lima. And in November 1935, they entered the operating room. The patient — a middle-aged woman. Severe depression. A hopelessness that neither pills nor time could touch. Lima picked up a drill. Two holes in the skull. A leucotome slid inside — a narrow instrument with a retractable wire loop at its tip. Rotation. The loop burrowed into the white matter of the frontal lobe. Sawed it out. A small piece of brain — in exchange for hope. Or for emptiness. No one knew which yet.

Over the next two years, Moniz and Lima performed about twenty such operations, which they called leukotomy. Moniz published the results. By his assessment, seven patients showed “improvement”; seven showed “partial improvement”; and six showed “no change.

Twenty patients. Six months of observation. No control group whatsoever. The definition of “improvement” was so loose it could have applied to a corpse. A modest, methodologically flawed study. This was the foundation. The foundation upon which an entire industry would soon be built. In 1936, these shaky grounds caught attention across the Atlantic. In the U.S., a young psychiatrist named Walter Freeman (1895–1972) took up the cause. Armed with a scalpel of ambition and an ally—neurosurgeon James Watts—they adapted Moniz’s method, simplifying it slightly. Unnecessary details were discarded, leaving only the core. They named their brainchild the prefrontal lobotomy. It sounded almost harmless, like a dish in an upscale restaurant. But behind it loomed an avalanche.

By 1945, thousands of lobotomies had already been performed in the West. In 1946, Freeman devised his transorbital “ice pick” modification—aimed at making the procedure simple, quick, and eliminating the need for neurosurgical equipment.

In 1949, the Nobel Committee awarded Moniz the prize “for the discovery of the therapeutic value of leukotomy in certain psychoses.” That was the exact wording.

What happened to the patient during a prefrontal lobotomy? First, general anesthesia—or, in Freeman’s case, electroshock—was administered. Then, the surgeon would drill two holes into the skull. Through these holes, a leucotome—a tool with a metal loop—was inserted. The instrument reached the white matter of the frontal lobe—the nerve fibers connecting the frontal cortex to the rest of the brain. The loop would extend, rotate, and sever the fibers. The tool was then removed, concluding the procedure on one side. The same steps were repeated on the other side.

What happened to the patient afterward? This remains the most haunting question in the history of 20th-century psychiatry.

Surgically induced childhood.” That was the exact phrase—word for word—Freeman used in his papers to describe the outcome. His reasoning was mercilessly clear: after the operation, the patient regressed to a state of childhood emotional dependence. And this, he insisted, was a necessary stage of recovery. But what about the families? They would arrive and freeze in horror. Their mother. Their sister. After the lobotomy, she had become “inert,” “listless,” “passive,” “lost the will to live.” They would look at those living but hollowed-out bodies and no longer recognize their loved ones. Freeman knew what they were seeing. And he always had an answer ready: it would pass. This was merely a transitional state. Soon, she would be almost the way she was before.

For many patients, this condition never went away.

It didn’t work. Because the operation didn’t heal—it mutilated. Irreversibly. Forever. The frontal lobes. That’s what makes a person human. Planning. Initiative. The sense of time. Emotions. The ability to understand what comes next. Everything—it’s all there. In those lobes, connected to the rest of the brain by millions of nerve fibers. The surgeon inserts the instrument. Cuts. The fibers tear. The connections between the frontal lobes and the rest of the brain are destroyed. The person doesn’t become healthier. They become flat. Emotionally flat. Intellectually flat. Volitionally flat.

Freeman boasted that after a lobotomy he could turn patients into “a real household pet.” He wrote it just like that, without a trace of irony, in his papers. In his view, this was the clinical ideal.

And among those fifty thousand people operated on in the US were specific individuals whose names we know.

Rosemary Kennedy, the eldest daughter of Joseph and Rose Kennedy, and sister of the future president John F. Kennedy. In childhood, her development lagged behind that of her siblings. During adolescence, she experienced learning difficulties, mood swings, and possibly epileptic episodes. In her youth, she might have been diagnosed with mild intellectual disability accompanied by affective disorder—or perhaps not diagnosed at all. She was simply different. She simply didn’t fit into the Kennedy dynasty’s grand project.

Joseph Kennedy was worried. His political ambitions for his sons grew more insistent by the day. And Rosemary, at twenty-three—in 1941—had taken to slipping out of her convent school at night. Her father suspected she was meeting men. He worried: what if she got pregnant? What if there was a scandal?

He turned to Walter Freeman. Freeman proposed a lobotomy as the “solution.” Joseph Kennedy did not tell his wife about his decision. He told none of the other children. In November 1941, Rosemary, having arrived at George Washington University Hospital, was laid on the operating table. Freeman and Watts drilled holes in her skull.

During the procedure—to gauge how deep to cut—Freeman asked her questions. He had her recite the Lord’s Prayer, sing “God Bless America,” and count backward. “We assessed the depth of the incision based on her responses,” the medical records would later state. They cut and asked, cut and asked. When her answers became incoherent, they stopped.

It was too late.

After her surgery, Rosemary Kennedy couldn’t walk. She couldn’t speak clearly—only a few words. She couldn’t care for herself. She had no control over her bladder or bowels. Her intellectual and emotional functioning had regressed to that of a small child.

She was sent to St. Coletta’s Catholic boarding school in Wisconsin. Her mother did not visit her for twenty years. Her father never visited at all. Her brothers and sisters did not know where she was or what had happened to her until the early 1960s. Rosemary lived at the boarding school until her death in 2005—sixty-four years after the operation. She passed away at the age of 86. For nearly all those decades, she was effectively erased from the pages of Kennedy family history.

She was, perhaps, the most famous lobotomy patient of all. But she was just one of tens of thousands.

Walter Freeman performed lobotomies on anyone and everyone. Depression—lobotomy. Anxiety—lobotomy. Schizophrenia—lobotomy. Insomnia—lobotomy. Migraines—lobotomy. Homosexuality—lobotomy (yes, in several documented cases, the procedure was used to “treat” homosexual attraction). “Disobedience in teenagers”—in some instances, Freeman operated on twelve-year-old children.

One of them, Howard Dully, received a lobotomy from Freeman in 1960 at the age of twelve. His stepmother complained to the psychiatrist that the boy was “lazy,” “daydreaming,” and “disobedient.” The psychiatrist referred him to Freeman. Freeman diagnosed the boy with “childhood schizophrenia”—a diagnosis that does not exist in modern classifications—and performed a transorbital lobotomy. Dully survived. At great cost, he managed to build a life—he became a bus driver. In 2007, he told his story in the National Public Radio documentary My Lobotomy. It is one of the rare cases where a lobotomy survivor was able to speak publicly afterward.

Most couldn’t make it.

The statistics we have are incomplete—but shocking.

Between 1935 and 1960, an estimated one hundred thousand to two hundred thousand lobotomies were performed worldwide. Most of them in the United States, where the procedure was used most aggressively. But also in Britain, Scandinavia, Canada, Japan, France, Italy, Germany, and the Soviet Union.

The mortality rate for the procedure ranged between 2 and 6 percent. In other words, one in fifty to one in sixteen patients did not survive.

Of those who survived—according to various reports—around 40 percent showed “improvement.” And “improvement” was defined almost exclusively in behavioral terms: the patient became calmer, more manageable, less aggressive, less inclined to protest.

Around 40 percent showed no noticeable change.

Approximately 20 percent experience pronounced deterioration—severe cognitive and emotional impairments, a vegetative state, epileptic seizures, incontinence, and complete loss of independence.

But even the “improved” 40%—it wasn’t a cure. It was behavioral modification at the cost of destroying the person. These patients stopped feeling anxious, stopped feeling angry, stopped protesting. And they stopped creating. They stopped feeling joy. They stopped dreaming. They stopped loving. They became the very “domestic animals” Freeman wrote about.

1950. While Western neurosurgeons systematically turn living brains into compliant mush with their scalpels, the Soviet Union does the seemingly unthinkable: it officially bans lobotomy. One of the few countries on the planet brave enough to say “stop.” Beneath the dry decree of the Ministry of Health lies the signature of Minister Yefim Smirnov. But is it really that simple? Was this decision truly driven solely by humanism? Let’s dig deeper. The reason for the ban carries a whiff of the Cold War—an ideological stand against “bourgeois medicine.” The brutality of foreign scalpels became yet another proof of the rotting West. Yet the fact remains: while lobotomy reaches the peak of its monstrous fame in Western clinics, it is eradicated entirely in the USSR. Amid the grim history of Soviet psychiatry in the 20th century, a glimmer of light shines through.

But that doesn’t mean psychosurgery was never used in the Soviet Union. Isolated cases—particularly in the form of stereotactic operations—continued in the decades that followed. Still, lobotomy never became the mass phenomenon it did in the United States.

In the United States, lobotomy only began to fade after 1954, when the first antipsychotic — chlorpromazine, already in use in France for over two years — entered the American market. With the arrival of drugs that actually helped schizophrenic patients, it became clear: there was no need to slice into the brain with an ice pick. We have pills.

By 1967, Freeman had performed his last lobotomy. His patient, Helen Mortensen, d••• during the operation from an intracranial hemorrhage. It was the third d••• of Mortensen under Freeman’s care — she had already undergone lobotomy twice in previous years. This time, Freeman intended to perform a third operation on her. Perhaps he already understood that the method did not work as promised.

After this scandal, Freeman was banned from operating. He died in 1972, defending his practice to the very end and taking pride in the 3,500 lobotomies he had performed.

But the most terrifying part is not Freeman. What is terrifying is that the Nobel Committee awarded Moniz the prize in 1949, when the method was in its most active phase of use. It was not a gesture of recognition for pioneering work of the past. It was an active endorsement of current practice. It was a green light from the highest scientific authority in the world.

In 2011, Torsten Wiesel—himself a Nobel Prize laureate in medicine—publicly declared of the 1949 Nobel Prize: “It was a terrible mistake.

The committee, however, never officially revoked the prize. In Stockholm, Moniz’s portrait still hangs in the Medal Halls. His name remains on the list of laureates. And whenever the Nobel laureates are counted, his name is counted along with all the rest.

And so we arrive at the most bitter conclusion of this chapter. Psychiatry’s mistake, enshrined as a Nobel Prize, was never rectified by the very institution that made it. The Nobel Committee acknowledged its error through the voices of individual scientists—but never officially. Never institutionally.

This is an important lesson. Science makes mistakes. But it also has mechanisms for self-correction: randomized controlled trials, placebo, systematic reviews, meta-analyses. These mechanisms, slowly but inevitably, show what works and what does not. Lobotomy was eventually exposed by science. The ice pick left medicine. Freeman was expelled from the profession.

But the institutional bodies of science—academies, committees, editorial boards—often lag behind this process. They hesitate to admit their mistakes. They dislike revoking awards. They prefer to stay silent.

And here’s yet another facet of that very “silent audience” I mentioned in the preface. Society stays silent as sellers of esoteric nonsense deceive thousands right before its eyes. And scientific institutions remain silent too—too embarrassed to admit they once bestowed honors upon a catastrophe.

Today, in place of lobotomy, modern psychiatry uses several other approaches — neurosurgical and neuromodulatory. Deep brain stimulation (DBS) is used for severe forms of obsessive-compulsive disorder and treatment-resistant depression. Cingulotomy is performed extremely rarely, only in particularly severe cases when all other methods have failed. Stereotactic operations and transcranial magnetic stimulation are also performed.

All these methods are fundamentally different from what Freeman did. They are precise, reversible or semi-reversible. They are used only in exceptional cases. They require the patient’s informed consent, go through ethics committees, and are based on specific neurophysiological models.

But the legacy of fear that Freeman left behind — the legacy of transorbital lobotomy, the legacy of the “ice pick” — continues to weigh on all of modern neurosurgery for psychiatric disorders. Many patients who could genuinely be helped by DBS refuse it upon hearing the words “brain surgery.” And in that refusal, there is a certain justice. We are witnessing the echo of Freeman half a century after his d•••.

This, too, is a mistake he left in his wake. He didn’t just ruin the lives of the patients he operated on. He poisoned public trust in an entire branch of medicine for generations to come.

A Nobel Prize that helps give birth to a monster is a heavy burden to bear.

Several decades after Freeman’s d•••, his name in psychiatry textbooks became almost a curse word. In textbooks, Nobel laureate Moniz still remains an outstanding scientist. It is precisely in this gap — between the perception in textbooks and the real assessment — that one of the greatest unresolved problems of ethics in the history of science continues to exist.

Do we have a fair mechanism today to revoke Nobel Prizes for methods that have proven to be tragic mistakes?

Not yet. But this question confronts the scientific community, and it will continue to do so. And by the time we dare to raise such questions at the institutional level, we will have moved closer to a psychiatry that deserves to be called a science in the fullest sense of the word.

The Trail of a Formula. A Pinch of Truth: Damage to the frontal lobes alters behavior—Becky the chimpanzee stopped feeling anxious. Overgeneralization: “Therefore, severing frontal connections cures mental illness.” The Method: Lobotomy—just months after the report on two monkeys. The Industry: Up to a hundred thousand operations, Freeman’s assembly line, the Nobel Prize. The Victims: Lives lost and ruined, Rosemary Kennedy, Howard Dully—and trust in an entire branch of medicine shattered for generations to come.