The issue has resurfaced following the release of a new book that contends the crude brain surgery only helped about 10 percent of the estimated 50,000 Americans who received lobotomies from the mid-1930s to the 1970s.
In an editorial in Thursday's New England Journal of Medicine, Dr. Barron H. Lerner, a medical historian and associate professor at Columbia University College of Physicians and Surgeons, wrote that the procedure was a desperate effort to help mental patients and that only a small number of patients became calmer and more manageable.
"I think the numbers that were harmed were quite substantial," Lerner said in an interview. "It was way overused, and it was used in inappropriate circumstances — retardation, anxiety, headaches."
Relatives of patients who underwent the procedure agree. They are pushing the Nobel Foundation to posthumously strip the prize given to the lobotomy's pioneer, Portuguese neurologist Egas Moniz.
"How can anyone trust the Nobel Committee when they won't admit to such a terrible mistake?" asks Christine Johnson, a Levittown, N.Y., medical librarian who started a campaign to have the prize revoked.
Moniz developed the lobotomy procedure in 1936 as a way to treat people with severe psychiatric illnesses, particularly agitation and depression. Through holes drilled in the skull, he cut through nerve fibers connecting the brain's frontal lobe, which controls thinking, with other brain regions — believing that as new nerve connections formed the patient's abnormal behavior would end.
Moniz, already widely respected for inventing an early brain-imaging method, gave sketchy reports that many patients benefited and was awarded the Nobel Prize for medicine in 1949. He died in 1955.
Rosemary Kennedy, former President Kennedy's mildly retarded sister, had a lobotomy in the 1940s at age 23. She remained in an institution until she died in January.
Other doctors used a more primitive version than Moniz, punching an ice pick into the brain above the eye socket and blindly manipulating it to sever nerve fibers.
By the late 1930s doctors were reporting many lobotomy patients were left childlike, apathetic and withdrawn — not unlike the depiction in the novel and movie "One Flew Over the Cuckoo's Nest." Use eventually waned with the advent of effective psychiatric drugs in the mid-1950s and the growing use of electroshock therapy.
Modern views of the lobotomy have led to a call to pull Moniz's Nobel prize.
Johnson's grandmother, Beulah Jones, became delusional in 1949, was lobotomized in 1954 after unsuccessful psychiatric and electroshock treatments, and spent the rest of her life in institutions.
One member of Johnson's campaign, retired nurse Carol Noell Duncanson of Marietta, Ga., said her mother, Anna Ruth Channels, was lobotomized while pregnant to end chronic headaches in 1949. Channels, described as a brilliant and vivacious woman, was sent home incapacitated, Duncanson said.
"The woman could not feed herself, she could not toilet, she could not speak and she was combative," Duncanson said.
Channels eventually relearned those things but remained childlike and unable to care for her daughters, who spent years in foster care. Her husband abandoned her and she lived the rest of her life in a small West Virginia town with her mother, who was resentful and ashamed of her, and an abusive brother, Duncanson said.
"She never had a life after her lobotomy. She had nothing," the daughter said.
Johnson, whose grandmother died in 1989, started the Web site psychosurgery.org several years ago to build a support network among families of lobotomy patients. Then she and group members began urging removal of an article on the Nobel Web site praising Moniz and saying he deserved the prize because there were no alternative psychiatric treatments at the time.
The Nobel Foundation refused to remove or change the article. Now Johnson is asking Nobel laureates to support her campaign to strip Moniz's Nobel.
"There's no possibility to revoke it," said foundation executive director Michael Sohlman, who could not recall a Medicine Prize ever being challenged. "It's a nonstarter."
The Nobel charter has no provision for appeal of a prize awarded, he said, and the foundation ignores such criticisms, as it did when Palestinian leader Yasser Arafat's Peace Prize was challenged.
Meanwhile, journalist Jack El-Hai recently published "The Lobotomist," about the chief U.S. proponent, neurosurgeon Walter Freeman, who did roughly 3,400 operations. He developed the ice pick technique.
El-Hai began his research eight years ago after meeting a relative of a man committed to a mental hospital for epilepsy around 1930 and later lobotomized. As he got into his research about Freeman, El-Hai wondered, "What led this undeniably gifted and compassionate doctor to champion a brain-mutilating procedure and why he stayed with it so long, past the point of reason?"
El-Hai said patients no longer felt strong emotions and their behavior changed immediately, which was Freeman's goal. But he concluded Freeman was driven to be a showman.