Finalist #2 in the Book Review Contest

[This is one of the finalists in the 2026 book review contest, written by an ACX reader who will remain anonymous until after voting is done. I'll be posting about one of these a week for several months. When you've read them all, I'll ask you to vote for a favorite, so remember which ones you liked]

I. SURGERY FOR THE SOUL

[content warning: this review is about lobotomies, and includes disturbing descriptions and pictures - SA]

Surgery for the soul required a sharp, eight-inch-long instrument—one time, an ice pick from the Uline Ice Company was used—and not much else. It did not require anesthesia or gloves, and the sharp instrument (either a leucotome or the sturdier orbitoclast) was not necessarily sterilized. It took less than ten minutes.

The first step was to shock the patient until they lost consciousness. This eliminated the need for anesthesia, since there would be at least a few minutes until the patient regained consciousness, and also made the procedure more flexible; it did not require a surgeon, and did not even have to be performed in a hospital.

The second step was to insert the sharp, eight-inch-long instrument into the brain. In most versions of the procedure, surgeons drilled holes into the skull and inserted the leucotome through those holes. Surgeons preferred an approach that allowed them to see where in the brain they were cutting. But the abbreviated procedure used a shortcut.

Just above and behind the eye is a thin plate of bone that forms the roof of the eye socket. With enough force, the leucotome can be driven through that bone and into the frontal lobes of the brain. The cracking sound produced when the instrument fractures the orbital roof has caused at least one experienced clinician to faint.

Once the instrument was inside, completing the surgery was simply a matter of rotating the tool left and right. The goal was to cut a large number of nerve fibers. Some thought that the procedure might work by severing fibers which maintained certain fixed distorted thought patterns; by destroying them, patients might be freed from the grip of their mental illness. But there wasn't agreement among practitioners regarding why the procedure might work.

This is the transorbital lobotomy. Around 50,000 people received lobotomies in the United States in the 1940s and early 1950s; approximately 10,000 used the transorbital method I just described, with the others using approaches surgeons would be more likely to approve of (e.g., using anesthesia, gloves, being able to see where you're cutting…).

It was billed as a cure for all sorts of mental illnesses, including schizophrenia, depression, and anxiety. And while some called it a method of last resort—a procedure which should only be used after every other conceivable method had failed—it was often used on people who did not have serious mental problems, and who had not tried less serious treatments.

https://www.astralcodexten.com/p/your-book-review-great-and-desperate