INTRODUCTION Once, severing the connections within the brain irreversibly to alleviate the pain of the human mind was considered one of the promising treatments of modern medicine. Starting in the 1930s, lobotomy rose to prominence in hospitals, newspapers, scientific meetings, and even the Nobel podium by the 1940s. However, the question of what is meant by "recovery" stood at the darkest point of this history. On the morning of September 14, 1936, Alice Hood Hammatt was preparing for surgery in Washington. According to Freeman's records, Hammatt had wanted to cancel the surgery at the last moment. At the center of her objection was the shaving of her hair; the doctors convinced her by promising to preserve her curls as much as possible. The next morning, when the anesthetist entered the room, Hammatt's anxiety rose again. She was asking what would be done, wanting the man to be removed, and struggling in her bed. A few minutes later, she lost consciousness. Walter Freeman and neurosurgeon James Watts were about to perform the first prefrontal lobotomy in the United States. The two doctors made incisions in the scalp, created holes on the right and left sides of the skull, and advanced an instrument called leucotome into the frontal regions of the brain. A wire loop extending from the tip of the instrument was rotated to make circular cuts in the white matter. The operation, which lasted about an hour, ended after a total of twelve separate cuts in Hammatt's brain. In the first hours, the patient appeared calm. However, six days later, disorientation and stuttering began; she struggled to speak and write. Freeman recorded these as signs indicating loss of function in the frontal lobe. Her condition partially improved in the following days, and Freeman declared that the agitation and depression the patient had experienced before the surgery had eased. From today's perspective, the image is disturbing: a physically intact brain has been entered, and the nerve connections have been irreversibly severed in order to reduce mental pain. However, the dark history of lobotomy is not just the story of a few "mad doctors" who plunged knives into people's brains. The truly disturbing aspect is that it has turned into a medical treatment that was published in scientific journals, practiced in hospitals, discussed by physicians, and ultimately honored with the Nobel Prize. Cutting the Pain Inside the Brain The world of psychiatry in which lobotomy was born was very different from today. The possibilities of psychotherapy against severe depression, schizophrenia, and similar serious mental disorders were limited; rather harsh methods such as insulin shock, convulsive treatments, and later electroshock were used. Especially in severe cases, the question before doctors was simple yet frightening: What would be done with patients who did not respond to other treatments and had the potential to harm themselves or others? The International Neurology Congress held in London in 1935 became one of the turning points in the history of this question. John Fulton and Carlyle Jacobsen from Yale reported that there was no significant loss of intelligence in two chimpanzees whose frontal lobes had been surgically damaged, whereas the animals' experimental anxieties had significantly decreased. It is reported that the Portuguese neurologist António Egas Moniz asked whether the same result could be achieved in humans. Fulton was not receptive to this idea. Upon returning to Portugal, Moniz began working with neurosurgeon Almeida Lima on psychiatric patients. Moniz's method initially relied on injecting alcohol into the connections in the brain's prefrontal region. Then, the leucotome was developed. By rotating the ring at the end of the tool, small core-shaped cuts were made within the white matter, thereby severing some connections between the prefrontal cortex and other areas of the brain. Moniz and Lima reported that after the surgeries, their patients became calmer and more manageable, but their emotional responses were also blunted. The details of Moniz's method are described in Freeman and Watts's 1942 book Psychosurgery ; the same source also mentions complications such as fever, headache, vomiting, drowsiness, and temporary incontinence following the operations. Here lay the idea that would determine the future of lobotomy: Instead of eliminating the thought believed to cause the illness, the emotional response created by that thought could be reduced. Freeman was greatly influenced by this idea. According to Jack El-Hai, the accuracy of Moniz's theory was not as important to him as the results. Moniz had reported positive outcomes in his first patients diagnosed with agitated depression, and for Freeman, this made the method worth trying in America. Freeman and Watts ordered a leucotome, practiced using the tool on brains taken from cadavers, and eventually chose Alice Hammatt as the first suitable patient. Permission for the operation was sought from Hammatt and her husband; the family also gave approval for the surgery after consulting psychiatrist Karl Menninger. This detail is important. Telling the history of lobotomy simply as "people were operated on without their knowledge" simplifies the truth. Some patients or their families consciously accepted the operation. However, the informed consent standards of the time were not the same as today's, and the options presented to the patient were sometimes extremely severe. In another case reported by El-Hai, in 1941, a woman suffering from severe paranoia was given a choice between being committed to a mental hospital or undergoing lobotomy by Freeman. The woman chose the surgery. Therefore, it was not only the technique of the surgery that was dark. The extent to which the patient could truly make a free choice would also become part of the discussion. 1940s: From Experiment to Mainstream To understand the rise of lobotomy, one must understand the mental hospitals of the time. Psychiatric institutions were facing a serious capacity problem. People with mental illness were being confined to institutions for long periods, and hospitals were struggling to respond to the increasing number of patients both financially and in terms of staff. Miguel Faria's historical examination emphasizes that frontal lobotomy developed not only as a search for treatment in the 1930s but also under the pressure of overcrowded psychiatric institutions and reached its peak in the 1940s. Freeman and Watts initially defended lobotomy as a last resort in this environment. In their 1942 work, they wrote that they selected only severe cases with significant functional loss for the surgery. They believed that the intense emotional burden accompanying obsessive thoughts had "faded" before their complete disappearance. However, in the same section, they also acknowledged that in some patients, the mechanisms that normally inhibit behavior could disappear, leading to aggressive or socially problematic behaviors after the surgery. By 1942, they already had hundreds of cases on hand. When Freeman and Watts' Psychosurgery was published, a series of 200 illnesses was reported. According to their criteria, the results showed a 63% improvement in patients, 23% with no change, and 14% with deterioration or death as a result of the surgery. That same year, the Journal of the American Medical Association published a positive editorial regarding the foundations and applications of the method. The meaning of the word "success" should be carefully considered by today's reader. For Freeman, being able to send a patient home was an important outcome in itself. As reported in Jenell Johnson's study, one of Freeman's aims with transorbital lobotomy was to discharge as many patients as possible from the hospital with a procedure that was as simple as possible. Being able to return to their family was interpreted as both a social and economic success. Considering the costs of large state psychiatric institutions, each discharged patient also represented a cost reduced from the public budget. Therefore, one of the most fundamental issues in the history of lobotomy emerges: Did a patient's becoming quieter, more manageable, or being discharged really mean they had improved? Even Freeman and Watts' own observations showed that the answer was not always yes. Records cited by El-Hai indicated that patients who exhibited the most indifference, insensitivity, and repetitive behaviors after surgery were sometimes the ones who lost the most signs of anxiety and depression. Freeman believed that marked mental dullness and unresponsiveness were indicators of better recovery in some depressed and agitated patients. In other words, there was a disturbing relationship between the success of the operation and the damage it caused: The way a person experiences pain was also being altered to reduce that pain. Freeman and Watts operated on patients while they were awake under local anesthesia to determine how much tissue they needed to cut in some procedures. The patient answered questions, performed mathematical operations, or stated where they were; the doctors were trying to understand how much disorientation occurred from the given answers. According to El-Hai, this method was applied to 66 patients. Some patients were able to notice the instruments and sounds in the operating room while their skulls were being opened. The aim was not to cause pain to the patient. Freeman and Watts were trying to use the patient's mental state as a kind of measuring tool during the operation to cut the right amount of nerve connections. However, this practice also reveals how experimental the development of lobotomy was: Doctors were altering the functions of the brain and trying to understand the limit of sufficient but not excessive damage by talking to the patient during the operation. “Icebreaker” and the Transformation of Lobotomy into a Spectacle Freeman had a major problem with the classic prefrontal lobotomy. Drilling into the skull required an operating room, a neurosurgeon, anesthesia, and a serious health infrastructure. However, the state hospitals he believed needed treatment the most were precisely lacking in these. According to El-Hai, Freeman eventually began to move away from the idea that lobotomy should only be a "last resort" and believed that a simpler, faster, and cheaper method could reach many more people. The solution was in the eye socket. The origin of the transorbital approach did not belong to Freeman; the Italian surgeon Amarro Fiamberti had developed a similar method in 1937. However, it was Freeman who made the method famous and widespread in America. He began his own transorbital operations in 1946. A short-term loss of consciousness was induced in the patient through electroshock, and instead of opening the top of the skull, access was gained through the lower eyelid, passing through the thin bony layer of the eye socket. In his first operation, Freeman did not even use a specially made surgical instrument: According to Jack El-Hai and Jenell Johnson, he used a ice pick from his kitchen. Freeman later had a special transorbital leucotome made for this purpose, but the term "ice-pick lobotomy" had already become established in history. The appeal of the method was its speed. While classical surgery could take hours and require a long recovery period, Freeman could complete the transorbital method in minutes. The instrument was advanced under the upper eyelid, passing through the thin bone separating the eye socket from the frontal lobe with a hammer blow, and then the instrument was moved side to side to cut the nerve fibers. Freeman's own accounts even mention the sound that could be heard when the bone broke. Since electroshock devices were already common in state hospitals, the method became even more portable as it did not require additional classical anesthesia options. The line wa