Scientific Roots in Lisbon: When the Brain Was Seen as 'A Cable That Could Be Cut'
In the early 1930s, in a small laboratory at Santa Marta Hospital in Lisbon, Portuguese neurologist António Egas Moniz was examining brain angiograms of schizophrenia patients. He was not looking for physical lesions—because none were found—but for a radical hypothesis: that psychotic symptoms might stem from 'too rigid neural circuits' in the prefrontal cortex. Moniz, known for his contributions to neuro-radiology, argued that if these circuits were severed, emotions and impulses would 'calm down.' In 1935, together with surgeon José Lima, Moniz performed the first leucotomy on a 63-year-old woman with severe depression. Using a ring-shaped instrument (leucotome), they made small holes in the skull and rotated the tool to destroy white matter in the frontal lobe. The result? The patient became more 'calm,' but also lost spontaneity, empathy, and the ability to make complex decisions. Moniz announced success—and the medical world, which was running out of therapeutic options, listened.
Rapid Spread Under the Shadow of Colonial Institutions
Within less than five years, Moniz's technique spread to the United States, Britain, and—through colonial hospital networks—into Malaya and Java. At Tanjung Rambutan Hospital (established in 1919 in Perak), archival records from 1948–1955 show at least 27 lobotomy procedures were performed on 'manic-depressive' and 'chronic psychotic' patients, mostly young men aged 20–35. At Magelang Mental Hospital (Dutch East Indies), documents from the Dutch Colonial Ministry mention the use of 'prefrontal leucotomy' as 'the last resort for patients unresponsive to hydrotherapy and isolation.' Surprisingly, there were no signed family consent records; most procedures were approved by colonial medical officers based solely on 'professional judgment.' The colonial social context also played a role—patients were often categorized as 'unproductive' or 'disruptive to order,' and lobotomy was seen as an efficient way to 'restore social function' without requiring long-term care.
Freeman and the 'Ice Pick': When Neurosurgery Became a Mass Spectacle
In the United States, Walter Freeman—a psychiatrist without formal surgical training—turned lobotomy into a 'mass' procedure. In 1945, he introduced transorbital lobotomy: using only an 'ice pick' inserted through the eyelid and gently tapped into the brain, Freeman could perform the operation in under ten minutes—without full anesthesia or a sterile operating room. He performed over 3,500 procedures, often in front of medical students and journalists. In Malaysia, a modified version—known as 'controlled lobotomy'—was carried out at Kuala Lumpur Hospital in the early 1950s, but with strict oversight by British neurosurgeons. However, the 1953 Public Health Records of Malaya noted concerns: 'some cases showed progressive cognitive decline and loss of social initiative after six months.'
Fall and Late Acknowledgment: When Science Admitted Its Mistakes
The decline of lobotomy began not due to ethical protests, but due to the emergence of chlorpromazine in 1952—a first antipsychotic drug that proved effective without damaging brain structure. Gradually, the medical community began questioning the value of a procedure that left many patients in a 'functional vegetative' state: able to walk and eat, but losing emotional drive, guilt, or desire to learn. In the 1970s, the Malaysian Medical Council issued official guidelines banning lobotomy except in 'extreme cases and with written ethical approval.' However, there was no official recognition of the victims—no compensation, no reconciliation, and no central archive storing their names. Only in 2019 did the National Archives of Malaysia open some files from Tanjung Rambutan Hospital—including clinical notes stating 'Patient X, 28 years old, after lobotomy: no longer recognizes siblings, but can sing folk songs without error.'
An Unhidden Legacy: Why This Story Must Be Remembered
Lobotomy is not just a dark chapter in medical history—it is a sharp mirror showing how institutional power, social pressure, and lack of neuroscience understanding can sacrifice humans in the name of 'well-being.' In Nusantara, this story is rarely discussed because its records are scattered in colonial archives, unpublished health documents, and family oral memories that are reluctant to be opened. But now, with increased access to digital archives and interdisciplinary studies between medical history and disability studies, this narrative is beginning to emerge—not to blame, but to remind: every medical breakthrough must be balanced by principles of autonomy, justice, and scientific humility. As written by medical historian Dr. Lim Siew Cheng in a 2021 study on colonial psychiatry, 'The most dangerous thing is not the absence of knowledge—but blind belief that knowledge is sufficient.'
An Endless Epilogue: Names Lost in Medical Records
The names of lobotomy patients in Malaya—like many around the world—are never recorded in medical textbooks. They were not subjects of further study, not interviewed, and not given space in the narrative of 'progress.' Yet their traces remain: in nurses' notes mentioning 'Mr. A, no longer angry, but has never smiled since August 1951'; in letters from families requesting 'do not send our child to Tanjung Rambutan again'; in death records listing 'pneumonia' as the main cause—despite the patient having lost swallowing reflexes two years earlier. History is not just about great figures and political decisions. It is also about quiet moments when the knife entered the brain—and about voices that were never heard.
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*Rujukan: [Lobotomy — Wikipedia](https://en.wikipedia.org/wiki/Lobotomy)*