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Lobotomy: Medical Advancement or Retrogression?

Biomedical Junior Year Experience: Medical Advancement Project

Helena Silva-Nichols

on 30 March 2015

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Transcript of Lobotomy: Medical Advancement or Retrogression?

destruction of the tissue in the frontal lobes of the brain, or severing of the connection between those lobes and the rest of the brain
Psychiatric Care: Pre-Psychosurgery Era
Despite significant progress in the study of mental illness, psychiatric care in the 1930's was extremely limited.

Treatment for mental disorders such as schizophrenia, bi-polar disorder, depression, obssesive-compulsive disorder, acute anxiety, anorexia nervosa, attention deficit disorder, uncontrollable rage or aggression, posttraumatic stress disorder and others included barbaric "shock therapies." Insulin induced comas, alternating high-pressure blasts of hot and cold water, and electroshock therapy were used to induce seizures believed to alleviate symptoms and cure mental illness.
The failure of these therapies resulted in overcrowded hospitals which were already understaffed and limited in resources due to underfunding caused by the Great Depression.
Lobotomizing WWII Veterans
The United States government lobotomized approximately 2,000 World War II veterans in the years following their return home. It was on July 26, 1943 that VA chief Frank Hines received a report recommending lobotomies for veterans with "intractable mental illnesses". The message stated that the procedure “may be done, in suitable cases, under local anesthesia. [It] does not demand a high degree of surgical skill.”
Recently investigated memos, letters and government reports of
1,930 patients
are suspected to be incomplete suggesting an even larger number of WWII veterans subjected to lobotomy.
Ethical Discussion
Lobotomy and Psychosurgery Today
Lobotomy and other psychosurgery procedures remain controversial issues. Psychosurgery is rarely practiced in western medicine which has transitioned from ablative surgical procedures to deep brain stimulation by electrode implantation for the neurosurgical treatment of mental illness. Opponents of this field of mental illness argue that no definitive knowledge exists identifying specific nervous areas with mental illness as originally postulated by Moniz.
Dr. Freeman modifies Fiamberti's transorbital lobotomy. In this procedure an orbitoclast (an ice pick-like instrument) is inserted above the eye ball and a hammer is used to perforate the orbital cavity to allow access to the prefrontal cortex. The instrument is then moved back and forth and removed. The entire process now takes as few as 4 minutes to complete allowing mass quantities of surgeries to take place.
Portuguese neurologist Egas Moniz postulates synaptic disorder as a cause of mental disorders (without basis on empirical data). Moniz, along with neurosurgeon Pedro Alameida Lima, perform the first frontal leucotomy (later known as lobotomy) on a human patient.
Conceptualization and Manifestation of the First Lobotomy
Antonio Caetano de Abreu Freire Egas Moniz 1874-1955
Neurologist Walter Freeman modifies Moniz's prefrontal leucotomy and coins his version lobotomy. Freeman employs neurosurgeon James Watts to aid him in performing the first prefrontal lobotomy in the United States on a 63-year-old female suffering from maniac and depressive symptoms of bi-polar disorder.
Lobotomy in the United States
"Production Line" Lobotomies
Italian psychosurgeon Amarro Fiamberti performs the world's first transorbital lobotomy by forcing a thin tube known as a leukotome through the bony orbit at the back of the eye socket and injects alcohol (formalin) into the frontal lobe.
First Transorbital Lobotomy
A Brief History of Psychosurgery
Advertisement for Dr. Freeman's transorbital lobotomy procedure
Portuguese neurologist Egas Moniz , founder of modern psychosurgery is awarded the 1949 Nobel Prize for Physiology or Medicine for the development of prefrontal leucotomy (lobotomy) as a radical therapy for certain psychoses, or mental disorders.
Nobel Prize in Physiology or Medicine
Often regarded as the greatest advancement in psychiatric care, Chlorpromazine (CPZ) (marketed, as chlorpromazine hydrochloride, in the United States as Thorazine and elsewhere as Largactil and Megaphen) drastically improves the prognosis of those struggling with mental illness around the world. The introduction of Thorazine pioneers the way for subsequent antipsychotic drug therapies essentially ending the era of mass psychosurgery in the 1950's.
Thorazine on the Scene
These conditions created a people desperate for a "quick-fix" to the troubling reality of
1 million

institutionalized mental patients
by 1940 and their staggering
80% yearly growth rate
Dr. Walter Freeman promised just that with the transorbital lobotomy.
As per records of the Veterans Association, lobotomies were preformed on soldiers diagnosed as depressives, psychotics, schizophrenics, and even on those identified as
. The drastic treatment of lobotomy for homosexuals along with other "socially unacceptable conditions" (such as an unruly housewife or rowdy 12-year old in the case of Howard Dully) exemplifies the inequality and oppression brought about by this so-called medical miracle.
From 1939 to 1951 more than 18,000 lobotomies were performed in the United States alone. In retrospect, the disastrous outcomes of such procedures are clearly defined
through empi
rical data. In fact, the premise upon which Dr. Egas Mon
iz beg
an lobotomizing humans was entirely unsound scientifically and medically.
Moniz ignored literature and his own results concerning the life-altering side effects of lobotomy (extreme apathy, significant loss in cognitive abilities, personality changes, and loss of initiative), began testing on humans without sufficient preliminary animal data, and falsified data setting forth an err
and dangerous premise for further developme
nt of the proced
ure by other physicians.

Additionally, Dr. Freeman performed lobotomies in an exceedingly irresponsible manner:
he operated on 19 minors disregarding their developing brains and autonomy (a procedure that had never before been tested in children)
he operated on hundreds of mentally ill patients with no regard for informed consent or their autonomy
he initiated a world-wide revolution of irreversible, life-changing procedures (most often entailing extremely negative outcomes) affecting countless individuals and their loved ones

Other ethical questions raised by the psychosurgery and specifically the commonplace practice of lobotomy of the 1940's and 50's are the following:
What aspects of our personalities make us human?
Is the destruction of brain tissue without complete understanding of ramifications medically and ethically sound?
Does apathy, retardation, loss of motivation and other negative side effects of lobotomy truely constitute success in mentally ill patients?
Lobotomy Timeline. (n.d.). Lobotomy Timeline. Retrieved September 7, 2014, from http://soundportraits.org/on-air/my_lobotomy/timeline.php

Walter Jackson Freeman II (American neurologist). (n.d.). Encyclopedia Britannica Online. Retrieved September 6, 2014, from http://www.britannica.com/EBchecked/topic/1524082/Walter-Jackson-Freeman-II

American Experience. (n.d.). . The Lobotomist. Retrieved September 8, 2014, from http://aolsvc.pbs.aol.com/wgbh/amex/lobotomist/program/index.html

Editors of Encyclopædia Britannica. (n.d.). lobotomy (surgery). Encyclopedia Britannica Online. Retrieved September 7, 2014, from http://www.britannica.com/EBchecked/topic/345502/lobotomy

Editors of Encyclopædia Britannica. (n.d.). Antonio Egas Moniz (Portuguese neurologist). Encyclopedia Britannica Online. Retrieved September 7, 2014, from http://www.britannica.com/EBchecked/topic/180095/Antonio-Egas-Moniz

The strange and curious history of lobotomy. (n.d.). BBC News. Retrieved September 5, 2014, from http://www.bbc.com/news/magazine-15629160

Moniz develops lobotomy for mental illness 1935. (n.d.). PBS. Retrieved September 5, 2014, from http://www.pbs.org/wgbh/aso/databank/entries/dh35lo.html

Lobotomy. (n.d.). Lobotomy. Retrieved September 7, 2014, from http://webspace.ship.edu/cgboer/lobotomy.html

Surgery of the Mind, Mood and Conscious State: An Idea in Evolution. (n.d.). World Neurosurgery. Retrieved September 6, 2014, from http://www.sciencedirect.com.ezproxy1.lib.asu.edu/science/article/pii/S1878875013009406

Roth, J. K. (2005). Lobotomy. Ethics (Rev. ed., pp. 863, 864, 854). Pasadena, Calif.: Salem Press.

Psychosurgery. (n.d.). Princeton University. Retrieved September 7, 2014, from

The Lobotomy Files: How one doctor steered the VA toward a lobotomy program.. (n.d.). WSJ.com. Retrieved September 8, 2014, from http://projects.wsj.com/lobotomyfiles/?ch=two

The ‘forgotten’ lobotomies on World War II vets. (n.d.). PBS. Retrieved September 7, 2014, from http://www.pbs.org/newshour/rundown/the-forgotten-lobotomies-on-world-war-ii-vets/
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