Panic attacks, melancholia, depression, mood swings. These were just a few mental illnesses and side effects thereof that lobotomies aimed to cure in the mid 1930s when lobotomies were first practiced. Legally and medically sound, the early version of a lobotomy consisted of severing the connection of the frontal lobe with the other parts of the brain. Doctors would either inject a chemical into the brain that would dissolve or permanently damage the tissue and nerves or sever them manually. Despite the realization that lobotomies caused more harm than good, they were still legal and performed in many countries up until the mid-1980s.[1] In today’s society and according to modern medical standards, they are banned in almost all countries. However, the legacy of lobotomies lives on and its successors are being used, studied and regulated in modern medicinal practices.
A similar, although far more researched and legal, procedure called a ‘cingulotomy’ is performed today and doctors are using it to treat a host of issues such as chronic pain and Obsessive Compulsive Disorder (OCD). Similar to its predecessor the ‘lobotomy’, the ‘cingulotomy’ is a form of neurosurgery that severs the connection of tissue and synapses in the brain. While medical professionals will first recommend things such as therapy and medication before resorting to an invasive procedure, a ‘cingulotomy’ can be used for treatment resistant illnesses by targeting areas associated with certain pain and mental illnesses .[2]
Procedures that target the brain, spinal cord or column, and the nervous system fall under the category of ‘Neurosurgery’[3], an area of medicine whose regulations vary in many countries, especially in regards to neurosurgery for psychiatric disorders (NPD). Countries across Asia, Europe, and the Americas haveOh i laws, rules and regulations that govern NPD, all with their own pros and cons.[4] The definition of ‘neurosurgery’ and what it can be used for, differs from country to country and all jurisdictions will have their own restrictions and exceptions. For example, Ireland defines neurosurgery as “any surgical operation that destroys brain tissue or the functioning of brain tissue” [5] and it posits that it can be used for ameliorating a mental disorder.[6] In Saskatchewan, Canada, however, neurosurgery is defined as “[a]ny procedure that by direct access to the brain removes, destroys or interrupts the normal connections of the brain for the primary purpose of treating a mental disorder or involves the implantation of electrodes.” [7] Although similar, these two definitions show how jurisdictions define neurosurgery in different degrees of specificity.
The language used in law to define neurosurgery and its purposes is also an important factor when looking at the development of the field of neurology and procedures to treat mental and chronic illnesses. When definitions are too limited, it can impede the development of research and technology in the field of neurology and specifically NPD. On the other hand, when definitions are too broad and a purpose for neurosurgery is not clearly defined, this could lead to a misuse of treatments for things that are either unrelated to the field of neurology or for medical matters that do not require treatment as invasive as neurosurgery.[8] While some jurisdictions address this by updating their laws, rules and regulations, others have instead regulated the matter of neurosurgery under the general rules of medicine.
Regardless of how a country has chosen to regulate the field of neurology and NPD, it is important to remember that this is still an ever changing field and medical practice that will require updated laws and regulations to ensure it can continue to develop in a safe and effective manner. The lobotomy may not be legal anymore, but its successors are, and the brain will continue to be studied and operated on as humans try to unlock what goes on inside the mind. In order to do so safely and successfully, the field of neurology will require the creation and maintenance of proper definitions, laws and regulations.
[1] Emma Dibdin, ‘The Controversial History of the Lobotomy’ (PsychCentral, 6 May 2022) <https://psychcentral.com/blog/the-surprising-history-of-the-lobotomy> accessed 26 February 2025
[2] ‘Cingulotomy’ (Columbia University) <https://www.neurosurgery.columbia.edu/patient-care/treatments/cingulotomy> accessed 26 February 2025
[3] ‘What is Neurosurgery’ (Oregon Health & Science University) <https://www.ohsu.edu/school-of-medicine/neurosurgery/what-neurosurgery> accessed 26 February 2025
[4] Jennifer A Chandler and others, ‘International Legal Approaches to Neurosurgery for Psychiatric Disorders’ (2021) 14 Frontiers in Human Neuroscience <https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2020.588458/full> accessed 26 February
[5] Mental Health Act 2001, s 58 (IRE)
[6] Jennifer A Chandler and others, ‘International Legal Approaches to Neurosurgery for Psychiatric Disorders’ (2021) 14 Frontiers in Human Neuroscience <https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2020.588458/full> accessed 26 February
[7] Mental Health Services Act c. M-13.1, s 2(aa) (CAN)
[8] Jennifer A Chandler and others, ‘International Legal Approaches to Neurosurgery for Psychiatric Disorders’ (2021) 14 Frontiers in Human Neuroscience <https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2020.588458/full> accessed 26 February
