The rise and fall of lobotomies in Ontario

From the 1940s to the ’60s, more than 1,000 Ontarians — mostly women — underwent brain surgery to treat mental illness. But the “bubble of enthusiasm” burst
By Jamie Bradburn - Published on May 04, 2021
The first lobotomy in Ontario was performed in 1941 at Toronto General Hospital. (Airmaps Limited, Toronto Public Library)

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On July 23, 1941, a dubious surgical milestone was reached at Toronto General Hospital. The patient, a 58-year-old woman, had been diagnosed with paranoia and “involutional melancholia,” a condition that would today be regarded as a form of depression occurring in middle age. Her doctors later reported that “she continually described ‘little men’ who were hammering at her brain and slowly killing her and because of this she felt she would be better off dead.” Her condition had led her to pace anxiously around the psychiatric ward and to lose her appetite; her weight had dropped to 92 pounds.

Employing a surgical instrument called a leucotome that he had developed, neurosurgeon Kenneth McKenzie performed what he termed a “bilateral frontal lobe leucotomy” on the patient — the first lobotomy carried out in Ontario.

The surgery came at a time when it was thought lobotomies and related psychosurgeries could relieve several issues affecting the provincial mental-health system. Psychiatrists were frustrated that therapies ranging from water-based treatments to insulin-induced shock treatment had failed to improve the condition of their patients. The volume of patients requiring more intensive treatment programs had increased as the number of staff declined due to the Second World War. With resources stretched to their limits, staff struggled with the stress of dealing with patients, especially those they considered troublesome. They were therefore interested in the possibilities of an efficient method to discharge patients back into communities with minimal harm.

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Brain surgery as a means of treating mental illness seemed promising. The focus was on the frontal lobe, where it was believed abnormal pathways may have caused mental illness. First performed by Portuguese surgeon Egas Moniz in 1935, the lobotomy was quickly picked up and promoted by American physician Walter Freeman. After being impressed by initial results, Freeman toured North America over the next two decades promoting the virtues and advantages of lobotomies, even as his techniques grew more barbaric (he would, for example, insert an icepick-like instrument alongside the eye socket).

In 1938, McKenzie and fellow doctor Lorne Proctor visited Washington to observe the work of Freeman and his colleague James Watts. In their report to provincial officials, the doctors expressed reservations about the patient-selection process but said they had witnessed enough that they were prepared to encourage carefully selected trials in Ontario — the trials began three years later at the Toronto Psychiatric Hospital (a precursor to the Centre for Addiction and Mental Health).

Potential patients were chosen from the Ontario Hospitals, a system of mental facilities across the province. After arriving at TPH, they were examined and tested for their suitability for the procedure. In the early years, those chosen were mostly diagnosed with involutional melancholia or schizophrenia. Up to three weeks of mental and physical testing was performed at TPH, followed by review by neurosurgeons and psychiatrists. If surgery was approved, patients were transferred to Toronto General Hospital the morning prior to surgery. After surgery, the patient would return to TPH to recover.

The first lobotomy was regarded as a success. After surgery, it was recorded, the patient’s delusions vanished, her anxiety diminished, and her weight increased — and she was able to assist with the care of convalescent residents of a boarding house. She died two and a half years later from breast cancer.

Between 1941 and 1944, 27 patients were lobotomized. All survived the process. Assessing the results in an article published by the Canadian Medical Association in 1946, McKenzie and Proctor said that the only significant complication they had observed was an increased sex drive in 25 per cent of the patients; that disappeared within 18 months. Only four cases were regarded as total failures, though those deemed successes were not without issues. For example, a 23-year-old male schizophrenic endured two short relapses, could not hold a job for more than a few months, wandered from home, and spent his money “foolishly.”

In the TPH’s 1942 report to the Rockefeller Foundation, it was noted that “this neurological procedure resulted in the discharge or the improvement of all cases in this group of patients, who previous to this treatment were considered to be chronically mentally ill with little hope of improving under routine hospital care.”

Any consideration of expanding the program for a better statistical study was set aside when the Rockefeller Foundation ended its general funding for TPH in 1944. This, combined with wartime pressures, resulted in a lack of beds and fewer available nursing staff.

The suspension of all lobotomies upset the procedure’s most enthusiastic supporters. “It is a matter of considerable regret to us that with good prospect of relief of psychic pain and even social or clinical recovery that some patients must continue in hospital because this treatment is not made available to them,” lamented G.H. Stevenson, the superintendent of the Ontario Hospital in London.

After the war, positive press about lobotomies from the United States, which exaggerated its benefits, led to public pressure on the province to revive the program — and it did so in April 1948. In a memo sent to Ontario Hospital superintendents, TPH director Aldwyn Stokes warned that “on account of widespread and uncritical lay publications, that great pressure is being exerted by relatives and interested persons to have this operation performed indiscriminately without regard to a proper medical judgement. Unless the tendency to an indiscriminate application for supposed automatic benefit is resisted both the project and the method are likely to fall into disrepute.”

Such pressure was evident during a March 1949 meeting of the Mental Patients’ Welfare Association in Toronto. During a discussion of lobotomies, the lead speaker declared the procedure a miracle and said that the province was being short-sighted for not promoting a surgery that would benefit the majority of mental patients. They also observed that it was equally short-sighted not to provide families with full information on recovery and rehabilitation.

Initially, the new program authorized one patient transfer per week to TPH for testing, but demand soon overwhelmed the program’s capacity — by early 1950, the wait-list was closed for nearly a year. Stokes had some reservations about expanding an operation that still wasn’t considered a standard procedure, but the number of surgeries increased after federal funding was provided in late 1949. TPH took on a research role, while the actual surgeries began to roll out to the Ontario Hospitals, starting in London in 1951.

The age range of patients now stretched from 14 to 78; the majority were women. Success was largely measured according to how quickly patients could exit the system, re-enter communities, and find work. Rehabilitation periods varied, with six months the generally agreed-upon standard. London’s Westminster Hospital for war veterans offered nearly a year of support; patients, for example, could participate in dances and sporting activities, wear their own clothes, and make visits within the community. Some officials, such as Stevenson, gushed to the press about the “literally amazing results,” such as an overall reduction in other illnesses. Provincial officials realized that increasing the number of lobotomies helped relieve overcrowding and took care of troublesome-to-violent patients.

In a 1954 study of 116 patients, Abraham Miller noted that 91 per cent experienced “personality defects.” These included a limited capacity for new learning and a reduced ability to cope with changes in their lives. “Even those patients who were functioning extremely well in terms of relationship with people, regular work, and social activities,” Miller observed, “did so as long as conditions were stable and supportive relationships constant.” Miller, like other observers, was not fully convinced that these changes were due to surgery or any worsening of existing mental conditions. He also found that at least 12 per cent of the patients studied had developed epilepsy.

Not often mentioned were the devastating effects that often became evident after lobotomized patients returned home. Among those operated on during this period was Lilly Robertson, who had been in and out of the Ontario Hospital in St. Thomas. Her son, news anchor Lloyd Robertson, later compared her post-surgery condition to a line in Sylvia Plath’s novel The Bell Jar that described a lobotomized character as being in a state of “perpetual marble calm.”

“That’s exactly how I remember my mother later in her life, with her large eyes staring out from behind big glasses, and I knew she was not capable of making any kind of real connection to her son,” Robertson recalled in his autobiography The Kind of Life It’s Been. “The operation hadn’t taken away the paranoia but had drained her of any dimension of emotional response.

The decline of lobotomies began with the introduction of behaviour-modifying drugs, such as chlorpromazine, in the mid-1950s and accelerated as it became clear they did more long-term harm than good. McKenzie himself developed reservations. In a paper he co-wrote that was published shortly before his death in 1964, he concluded that the prefrontal leucotomy “did not lead to any significant or predictable rate of remission which would not have been expected in any event without the operation.” The Canadian Medical Association Journal criticized the low number of carefully measured and statistically quantified studies and stated that “as soon as even elementary attention is paid to such measures, the bubble of enthusiasm is apt to subside quite rapidly.” When Miller revisited the subject in 1967, he concluded that, while lobotomies had limited value as a treatment method, “perhaps it has found its proper place as a therapeutic method capable still of relieving unremitting and severe mental distress in a patient unresponsive to all other modes of treatment.”

By the end of the 1960s — and after between 1,000 and 1,800 operations had been conducted — the provincial lobotomy program had wound done. Amendments to the Mental Health Act in 1978 outlawed psychosurgeries such as lobotomies for involuntary or incompetent patients in Ontario, although some forms are occasional undertaken today to treat conditions such as obsessive-compulsive disorder. 

In the conclusion of his essay on the history of lobotomies in Ontario, writer Geoffrey Reaume observes that the professionals who performed these surgeries had a lot to answer for ethically and legally: “They had the training, experience, and authority in their field to assess, better than anyone else, the irreversible risks and potentially damaging impact on patients that this operation entailed, without feeling pushed into it by relatives, the media, or the wider public. Since many doctors wanted to be seen to be actually ‘doing something’ about treating people who were mentally disturbed, their own critical judgement became impaired. Their patients paid a very high price indeed.”

Sources: Essays in Honour of Michael Bliss: Figuring the Social (Toronto: University of Toronto Press, 2008); Ontario’s Leucotomy Program: The Roles of Patient, Physician, and Profession by Brianne Collins (master’s thesis, University of Calgary, 2012); The Kind of Life It’s Been by Lloyd Robertson (Toronto: HarperCollins, 2012); TPH: History and Memories of the Toronto Psychiatric Hospital, 1925-1966, Edward Shorter, editor (Toronto: Wall & Emerson, 1996); the November 1946, December 5, 1964, and April 15, 1967, editions of the Canadian Medical Association Journal; the March 25, 1949, edition of the Globe and Mail; and the August 26, 1952, edition of the Toronto Daily Star.

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