Psychosurgery, once considered one of the darkest chapters in psychiatry, is quietly resurfacing in specialized clinics. Once synonymous with crude lobotomies and devastating side effects, it’s now being revisited with far more precise tools and stricter safeguards.
For patients with treatment-resistant depression and obsessive-compulsive disorder (OCD), where antidepressants, psychotherapy, and even electroconvulsive therapy (ECT) have failed, some psychiatrists and neurosurgeons are exploring this option again. Here, we’ll look at what this treatment is, how it was once used, and why it’s being reconsidered today.
What psychosurgery is and what it was used for
Psychosurgery refers to surgical procedures on the brain intended to relieve severe and incapacitating mental disorders. The most infamous example is the frontal lobotomy, developed in the 1930s by Portuguese neurologist Egas Moniz. His idea was that severing certain brain connections could stop unhealthy thought patterns from looping endlessly.
By the 1940s and 1950s, thousands of lobotomies were being performed each year. The operations often left patients with blunted personalities, severe apathy, or permanent cognitive impairment. Despite Moniz winning the Nobel Prize in 1949, the lobotomy soon became a symbol of medical overreach, widely condemned after being portrayed in books and films like One Flew Over the Cuckoo’s Nest.
In the UK, similar operations were called leucotomies, with thousands carried out before psychotropic drugs like chlorpromazine offered safer alternatives. By the 1970s, mounting ethical concerns, patient advocacy, and new medications pushed psychosurgery into sharp decline. Regulations tightened, and by the 1980s, only a handful of procedures were done each year.
Why is this treatment resurfacing today
Modern psychosurgery looks nothing like its 20th-century past. Instead of crude cutting, today’s methods use stereotactic surgery: small bore-holes in the skull guide needles with millimeter precision to specific targets such as the anterior cingulate gyrus or internal capsule. Procedures like anterior cingulotomy and anterior capsulotomy aim to reduce symptoms without destroying large areas of brain tissue.
A major shift has also come with deep brain stimulation (DBS) and vagus nerve stimulation (VNS). These techniques don’t destroy brain tissue but instead use implanted electrodes to regulate abnormal activity. DBS is already widely used for Parkinson’s disease and is being studied for OCD and depression. Unlike lobotomies, these methods are reversible, adjustable, and performed under rigorous ethical oversight.
Still, controversy remains. Reported success rates for modern psychosurgery vary widely, from 25 to 70 percent, and the quality of data is limited. Small sample sizes, lack of placebo-controlled trials, and publication bias make it difficult to know how effective these surgeries truly are. The Royal College of Psychiatrists and other expert groups have called for stronger evidence before widespread adoption.
The history of lobotomies casts a long shadow, and it’s understandable that any resurgence of psychosurgery brings unease. The techniques being studied today are far more precise, regulated, and patient-centered than those of the past. With deep brain stimulation or targeted lesioning, the hope is to offer relief where all else has failed, without repeating the mistakes that made this one of psychiatry’s most infamous treatments.
