A Trial and Error Approach to Mental Health

In the 1475 painting by Dutch Renaissance painter Hieronymus Bosch titled “Cutting the Stone,” he depicted the process of removing the stone from a patient’s brain. In the painting, 3 men are gathered around the patient in a field. One of the men is looking at the patient with a rather bored expression, as he seems more immediately focused on balancing the book he has on his head. Another man, dressed in the gown of a friar, is holding a metal jug while vividly explaining something to his team. The last man, who is wearing a tin funnel as a hat, is standing over the patient with his neck arched from concentration on his task, his scalpel plunged deep into his patient’s skull.

The patient sits amidst his medical team, glancing at the viewer from within a wince, his mouth agape as he grasps his chair with his left hand. What remains unclear to the viewer today, as they gaze upon this man’s face filled with anguish, is whether Bosch was for or against such an excavation activity.

Multiple other works of European art from the 15th and 16th centuries also depict this surgery being conducted on patients, but without much writing available to clarify the results of such surgeries, it is unclear whether anyone found this removal of the lunatic’s stone to yield any positive results.

The practice of curing mental illness by directly damaging the brain continued over the centuries, appearing again in 1888 when Swiss physician Gottlieb Burckhardt sliced into 6 brains in particular. Although he had no surgical experience, he did have good intentions, with his hope of treating 6 patients suffering from schizophrenia and psychotic hallucinations. So, he proceeded with his task, as no one made any immediate objections to his plans.

Like ancient physicians before him, Burckhardt used a trephine, which is a round cookie-cutter like bone saw on a stick, to drill holes near the patient’s temples. Where he veered away from old trephining practices of other surgeons was in his next move: cutting through the dura mater and scooping out his patients’ cerebral cortices. For this process, he frequently found a sharp spoon was most practical.

Noting the results of his efforts, Burckhardt found that some of his patients did become quieter with less hallucinatory activity—a definite plus. However, other patients, now lacking cerebral cortices after they were spooned out of their skulls, went on to kill themselves, die from their injuries, or continue to exist with severe neurological problems.

Although the term had not yet been invented, Burckhardt had conducted the first lobotomies on his patients, bringing forth the dawn of the field of psychosurgery. Unfortunately for Burckhardt, many of his contemporaries were outraged at what he had done to his patients, leading him to retire his spoon from actively scooping a patient’s brain ever again. However, other mental health entrepreneurs found scorn to be less of a deterrent and looked to new methods for scavenging through the mind.

In 1935, another psychosurgical cure was attempted by Egas Moniz, who invented the process of leucotomy, which means literally “cutting the white” in Greek. Moniz attempted his first leucotomy on a patient who was suffering from debilitating depression, hoping that perhaps the sadness could be removed from within her skull to cure her woes.

Moniz, unlike Burckhardt, employed an actual surgeon to do the task at hand: drilling a hole into the patient’s skull near the top of the brain. Following the drilling, they then poured ethanol into the patient’s skull to kill off parts of the frontal lobe.

In future efforts, Moniz advanced the handiwork of his hired hand by developing a metal rod he called a leucotome, which had a retractable wire loop at one end. Similar to a melon baller in shape, the leucotome gave surgeons firsthand experience as to the brain’s texture, with one enthusiastic surgeon explaining it felt like “what butter’s like when it’s been out of the refrigerator for a while.”

Enthusiasm for the leucotome prevailed, and Moniz was awarded the Nobel Prize for his efforts. Although the medical community’s clear excitement at the opportunity to feel their patient’s brains did result in substantial acclaim, many of his patients found the process less rewarding, with most of them returning back to the asylums from whence they came, still as mentally ill as they were before the melon baller graced the confines of their skull.


Kang L, Pedersen N. Quackery: A Brief History of the Worst Ways to Cure Everything. New York, NY: Workman Publishing; 2017.