It was only in 1936 that the first prefrontal lobotomy on record was performed in America, by psychiatrist Walter Freeman. This was [EDIT: "improved" by Freeman in 1946 to produce] the famous "ice-pick" lobotomy that you will most likely see in films such as Shutter Island (or a personal favorite of mine, despite its strange relationship with history and a NSFW particularly hammy performance by David Caruso, Session 9). [EDIT: And how could I forget One Flew Over the Cuckoo's Nest?] But yes, lobotomies were quite common in the U.S. throughout the 1940s and 1950s. Just under 19,000 were performed in the U.S. alone, according to historian Gerald Grob.

Freeman actually travelled the U.S. performing a twisted "one-man medicine show" (Shorter, A History of Psychiatry). Nevertheless, lobotomies declined in practice after their "peak year" in 1949. They were banned in countries such as Germany and Japan, but not America. If historian Edward Shorter is to be believed, it was actually the advent of psychopharmacology which led to the decline of lobotomies in the 1950s, and not public outcry.

The final nail in the coffin of the asylum (and I'm moving a little past lobotomies here) was the movement toward deinstitutionalisation. And this actually goes towards answering your second question about major obstacles in the treatment of the mentally ill. Throughout the middle portion of the twentieth century, asylums came under increasing criticism for their segregation and alleged maltreatment of psychiatric patients. This meant that many developed something of a fear of the asylum, which would have discouraged them from either committing themselves or relatives. The writings of several theorists such as Thomas Szasz and Michel Foucault also popularized the so-called "anti-psychiatry" movement, which culminated in a wide-spread state divestment from specialized psychiatric hospitals (asylums). Throughout the 1970s, countries such as Canada, the United States, England, and more, shuttered their psychiatric facilities and moved towards a model of community care.

EDIT: Just wanted to add this excellent BBC documentary about the asylum, which addresses deinstitutionalisation as well.

Didn't JFK's sister have a lobotomy? Might just be rumor I heard.

On a semi related note, I like to think of Inception as the sequel to Shutter Island, stuck in his head trying to forgive himself.

EDIT: I came from r/all and didn't realise what sub I was in, sorry. I am not a historian (obviously).

Hey guys - I'm a legit lobotomy historian! I did my master's thesis on invasive psychiatric treatments prior to the advent of pharmaceutical treatments). The discussion of lobotomies was the bulk of my paper - and I included the case history of a woman who had psychosurgery in the 1990's (yes it is still practiced!) - but I discussed a wide array of invasive, "barbaric" treatments as well.

The tl:dr of my thesis is that, in the context of treatment options at the time, and the grievous treatment and mediocre-at-best outcomes for psychiatric patients, invasive psychiatric treatments were not barbaric as we perceive them to be. Doctors weren't monsters. They were desperate.

I can't speak to Shutter Island - if I saw it I don't remember it - but I can tell you all about lobotomies!! I was on vacation when this popped up as a question, so I am going to give you a run down on the history of psychosurgery as if no one has yet answered your question, and then I'll go back and respond to other comments. I'll answer your question and then get into the nitty gritty.

Primary answer: lobotomies had fallen out of favor by the 1950's. They were very uncommon at that point.

I have to break this into multiple posts, so everything gets included. You can just follow along in the replies.

Were lobotomies painful for the patient? It's hard for me to even wrap my mind around it. :/

For more information on lobotomies, I cannot recommend more highly Jenell Johnson's recent book, American Lobotomy: A Rhetorical History. It's a riveting read and I could not put it down when I started. In it she explores the changing and sometimes contradictory attitudes held toward lobotomies in the United States from the 1930s to more recently. Surprisingly, Johnson does not talk about Shutter Island, though she does talk about One Flew Over the Cuckoo's Nest and a few other popular books/movies on lobotomy. I suspect the absence of Shutter Island in her book was owing to needing to draw the line somewhere in her analysis (also, I haven't seen Shutter Island, so perhaps the presence of lobotomies is a small one in it anyways).

It is easy to recoil in horror at the idea of rampant lobotomies today, but they were seem as quite beneficial in their day. When lobotomies were first proposed as a therapy, they were considered a wonder operation. The physician who developed the procedure was awarded the Nobel Prize in Medicine for 1949. Why would they be seen that way? Because the therapeutic options for patients before lobotomies were pretty hopeless. You might have some mental health practitioners who thought that psychotherapy techniques might work, and sometimes they do, but for the very severely disabled they do very little. There were a whole host of other "therapies" that were proposed — i.e., trying to teach the patients to do menial labor ("occupational therapy"), giving them lots of baths ("hydrotherapy"), and later shock therapy (both electrical and insulin-based) — and none of them did much obvious good a lot of the time. There was one mental health director in California who thought that surgical sterilization of men would improve their dispositions (and because things were not very much overseen, he was allowed to sterilize a lot of people for this reason) — a quack position, but hard to distinguish from other fairly quack positions.

Then lobotomies come around. They at least produced some change. Sometimes positive. Sometimes negative. But they had an effect.

(I often joke with my students that if you find someone trying to sell you a treatment that has no warnings about negative effects, it probably has no positive effects either. Anything biochemically active usually can make things go wrong. If it claims that literally nothing can go wrong, then it probably does nothing at all.)

So suddenly this new tool showed up for the mental health practitioner — something that gave them promise that these completely "far gone" patients might be able to change in some way, and maybe that change will be for the positive.

Of course, it often was for the very negative. As became evident within a decade. But it's a nice point in the history of medicine that just because something seems like it is hurting people more than it is helping them, it can persist for a long time — we still have debates over a lot of treatments that are going on today, and there are complicated extra-medical reasons that doctors and societies sometimes prefer to do things the unpleasant way (anesthesia was initially resisted in part based on somewhat "moral" reasons — that it was part of being a human being to have to be tough regarding surgeries and to experience extreme pain; we often see arguments of this sort regarding "natural" childbirth today).

Once a new tool for enacting change showed up, lobotomies quickly fell out of favor. The first major antipsychotic drug — thorazine — began being used in the early 1950s. Lobotomy declined at the same time. We might pause and note that thorazine, and many other drugs, can have extremely terrible effects as well. This is not a statement against psychiatry (I am no Scientologist!), but a general statement about the fact that the tools of the psychiatrist have traditionally been very limited, and they have grasped at anything that looked like it might do something to help their patients, and that many of those things they grasped for, in retrospect (and sometimes at the time), had pretty terrible side-effects.

To take a brief "presentist" view — I think a view of the history here can easily lead one to take a "humble" view of our understanding of the human brain and our ability to chemically or surgically enact positive change with it. It is a very complicated organ and we understand it only in glances at the moment. I am sympathetic to those physicians in the past (and their modern counterparts) who wanted to help their patients and found themselves willing to try very extreme measures, since the less extreme ones seemed to do nothing. I am also sympathetic to people who are distrustful of new "wonder therapies" given the rather dismal track records of many of them.

A great history of changing therapeutic methods in California mental hospitals is Joel Braslow's Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. I found his work very useful when I did my own research into the history of compulsory sterilization programs, which was sometimes (as noted) used as a "therapy" and not as a means for eugenics.

Does anyone know where I can find statistical breakdowns? I.E. How many lobotomies were done on Women vs. Men? Etc.