Are Lobotomies Still Performed Today? | Modern Reality

Classic lobotomy is almost never used now; modern brain procedures for severe illness are rare, tightly regulated, and far more targeted.

The word “lobotomy” still shows up in movies, jokes, and scary stories. In real clinics, it means something specific: a broad, irreversible cut that damaged frontal-lobe wiring on purpose. That procedure built a grim legacy in the mid-1900s, then collapsed under its own results—high harm, uneven benefit, and better options arriving fast.

So what happens in 2026 when someone asks if lobotomies still happen? The honest answer depends on what they mean by “lobotomy.” The historic operation—Freeman-style “ice pick” work and similar broad cuts—has been abandoned in mainstream care. A different category still exists: limited, carefully targeted procedures done in a few places for a small set of treatment-resistant conditions, with layers of consent, review, and follow-up.

Are Lobotomies Still Performed Today? What the term means now

For the procedure most people picture, the answer is no. The classic operation severed large bundles of connections near the front of the brain. Modern practice does not treat that as an acceptable routine option. Even sources that describe lobotomy historically note that it is rarely performed now, and that any present-day surgical work in this area is narrower and tied to strict selection and oversight. Britannica’s lobotomy overview explains that the old technique fell out of favor and that only limited surgical approaches are used in resistant cases.

That “rare” part matters. Some hospitals still offer certain lesion procedures, and some centers offer implanted stimulation systems. These are not “lobotomies” in the classic sense, even if the public lumps them together. They target small, defined regions using imaging and stereotactic methods, and they are generally reserved for people who have tried many standard treatments without relief.

What a lobotomy actually did

A lobotomy, also called a leucotomy, was meant to change symptoms by disrupting connections between the frontal lobes and deeper brain structures. Early versions involved opening the skull and cutting white-matter tracts. Later, the transorbital approach went through the eye socket with a thin instrument.

The goal was blunt: reduce distressing symptoms by damping circuits tied to fear, obsession, agitation, or mood. Many patients became quieter. Some families reported less distress. Many patients also lost drive, initiative, emotional range, and parts of their personality. Some developed seizures or severe disability. Death occurred as well. That mix—occasional improvement paired with irreversible harm—made the procedure hard to defend once alternatives improved.

Why medicine moved away from lobotomy

Three forces pushed lobotomy out of routine use.

• Better treatments arrived. Medication options and structured therapies expanded, and inpatient care changed.
• Results were hard to predict. Two people with similar symptoms could have completely different outcomes, with no way to “undo” damage.
• Ethics and consent tightened. Past practice included weak consent, social pressure, and institutional incentives that would not meet current standards.

Even the Nobel history around the procedure reads as a cautionary tale. NobelPrize.org’s facts page on Egas Moniz notes the procedure’s rise, its later recognition of harms, and its rapid decline once medications expanded.

What replaced lobotomy: targeted lesion procedures and stimulation

Modern neurosurgery that tries to relieve severe, treatment-resistant symptoms tends to fall into two buckets.

Targeted lesion procedures

Instead of broad cuts across frontal-lobe wiring, surgeons create a small lesion in a defined target. Common targets include parts of the cingulate region or internal capsule. Tools can include radiofrequency, focused beams, or other methods guided by imaging. The idea is to change a circuit with minimal collateral damage.

These operations are rare and usually offered only after many other treatments have failed. They also come with long screening and follow-up. A narrative review in BJPsych Advances describes modern lesion procedures used under strict rules in the UK, including use for severe depressive disorder and obsessive–compulsive disorder when other treatments have not worked. BJPsych Advances review on ablative neurosurgery outlines current practice and constraints.

Implanted stimulation systems

Stimulation is different: instead of destroying tissue, clinicians implant electrodes and deliver controlled pulses. The best-known use is in movement disorders, though certain severe psychiatric conditions have been studied as well.

In the United States, the FDA has granted a Humanitarian Device Exemption for a deep brain stimulation system as an adjunct to medication for chronic, severe, treatment-resistant obsessive-compulsive disorder in adults who have failed multiple medication trials. FDA’s Humanitarian Device Exemption listing (H050003) spells out the indication and limits.

How to tell “lobotomy” from modern practice

People often use “lobotomy” as shorthand for any brain procedure tied to mental illness. That blur causes confusion. A few checks can clarify what is actually being offered.

• Target size. A classic lobotomy disrupted wide swaths of frontal connections. Modern lesion work targets tiny, mapped coordinates.
• Reversibility. A lesion is permanent. Stimulation can often be adjusted, paused, or removed, though surgery is still a major step.
• Oversight. Legitimate centers use multi-disciplinary review, detailed consent, and long follow-up.
• Indications. Current procedures are limited to narrow, well-defined cases after extensive prior treatment.

If a clinic markets “lobotomy” as a casual fix, that’s a red flag. Modern teams use specific names for specific procedures and put consent and risk detail front and center.

What risks are still on the table

Even today’s targeted options carry real risk. Brain surgery can cause bleeding, infection, seizures, stroke, or lasting cognitive and emotional changes. Implanted systems add device risks: lead movement, hardware failure, battery replacements, and stimulation side effects. A careful team treats these as known hazards, not rare surprises.

When modern neurosurgery enters the conversation

In most cases, it enters late. A patient may have tried multiple medications at adequate doses, structured psychotherapy, inpatient or intensive programs, and other evidence-based options. Clinicians then ask whether there is a reasonable chance that a procedure could reduce symptoms enough to restore function, with risks the person is willing to accept.

This is also where diagnosis precision matters. “Treatment-resistant” is not a vibe; it’s a documented history of trials, adherence, and outcome tracking. Centers often ask for medical records across years, not weeks.

Table: Lobotomy vs modern brain procedures

Procedure type	What gets changed	How it is viewed today
Classic lobotomy (frontal leucotomy)	Broad disruption of frontal connections	Historic, widely rejected; almost never used
Transorbital lobotomy	Broad disruption via eye-socket route	Historic, viewed as unsafe and unethical
Anterior cingulotomy	Small lesion in cingulate region	Rare; used in limited, refractory cases
Anterior capsulotomy	Small lesion in internal capsule	Rare; used in limited, refractory cases
Limbic leukotomy	Combined small lesions in defined targets	Rare; specialist-center option
Subcaudate tractotomy	Small lesion in subcaudate tracts	Rare; performed in few locations
Deep brain stimulation for severe OCD	Implanted electrodes deliver pulses	Limited indication; device-based, adjustable
Other functional neurosurgery (case-by-case)	Target depends on condition and protocol	Research or tightly selected clinical use

Consent and safeguards: what “strict” really means

Modern practice tries to prevent the failures that haunted the lobotomy era: rushed decisions, vague consent, and pressure on vulnerable people. Safeguards vary by country and center, yet the pattern repeats.

Independent review

Before a procedure is offered, a team that includes psychiatry, neurosurgery, nursing, and ethics review the case. The point is to test whether the person has truly exhausted standard options and whether the proposed target matches the symptom profile.

Documented capacity and voluntary agreement

Consent is not a signature on a clipboard. It’s an ongoing process, with time to ask questions, bring family, and review written materials. Many programs also require a cooling-off period so a person can decide without time pressure.

Long follow-up

Outcomes are tracked for months and years. Teams look at symptom scales, function, medication changes, and adverse events. Device programs adjust settings gradually and log responses.

Why people still ask about lobotomy

The question keeps coming up for a few reasons.

• Language drift. People use “lobotomy” as a catch-all term for brain interventions.
• Film and book memory. Stories keep the old images alive.
• Real modern procedures exist. When someone hears about DBS or lesion procedures, it sounds close enough to spark the question.

If your interest is academic, the topic is a window into how medicine learns: early optimism, poor measurement, then tighter science and ethics. If your interest is personal, it’s also a reminder that modern care is built around choice, documentation, and narrow indications.

Questions to ask a specialist center

If you or a loved one is being evaluated for a modern brain procedure, clear questions can keep the process grounded.

• What exact procedure is proposed, and what target is planned?
• What treatments have to be tried first, and what counts as an adequate trial?
• What benefits are realistic in this center’s own outcomes?
• What are the most common adverse events here, not just in papers?
• What follow-up schedule is required over the next year?
• What life changes might follow, like driving limits or work restrictions?

A trustworthy team expects blunt questions. If you feel rushed, or if answers stay vague, that mismatch is information.

Table: Practical guardrails and trade-offs

Topic	What to look for	Why it matters
Diagnosis and severity	Clear criteria, documented impairment, long history	Avoids procedures for cases that may respond to standard care
Prior treatment record	Multiple trials with dates, doses, adherence, outcomes	Confirms “treatment-resistant” is real, not assumed
Procedure naming	Specific terms like cingulotomy, capsulotomy, DBS	“Lobotomy” talk can signal sloppy framing
Consent process	Time to decide, written info, repeat discussions	Reduces coercion and misunderstanding
Center experience	Team credentials, case volume, published outcomes	Skill and follow-up systems vary by site
Reversibility	Stimulation adjustable; lesion permanent	Trade-offs differ, even if both are rare options
Long-term monitoring	Scheduled reviews, symptom scales, device checks	Captures benefit and catches harms early

Where this leaves the question

In day-to-day medicine, no. The classic procedure is a historical warning sign, not a modern tool. What remains is a small set of carefully targeted neurosurgical options, used rarely for people with severe, persistent illness that has resisted extensive prior care. The safest way to think about it: “lobotomy” is mostly a label from history, while modern practice uses defined targets, imaging, and strict safeguards.