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A Frankenstinean Cure: Lobotomies and Mental Illness

The surgical procedure of a lobotomy is a gruesome one with a violent past. Many of us have heard of the procedure, but few know exactly what it means. A lobotomy is defined as the severing of neural pathways between lobes of the brain, which was used in previous medical practices as a way to ‘calm’ patients. Of course, many ethical dilemmas arose in protest to the permanent damage that this procedure caused on the brain, and it was deemed unethical in 1950.

The history of the lobotomy began with a man named Gottlieb Burkhardt, who was inspired by the experiments on dogs by a man called Friederich Golz. Friederich’s experiments involved the surgical removal of the temporal lobe of dogs, and he found through these experiments that those dogs had become ‘calmer’. Desperate to achieve similar results in the patients that he supervised at a Switzerland insane asylum, Gottlieb Burkhardt surgically removed parts of the cortex in schizophrenic patients. Six patients were operated on. Discouraged by the negative effects of the surgery and under fire for ethical violations, this type of surgery was rarely performed afterward.

However, the form of the surgery that we expect when we discuss lobotomies was first discovered by Carlyle Jacobsen’s experiments on chimpanzees. Through damaging the brains of chimpanzees, he observed a similar result that Gottlieb Burkhardt and Friederich Golz demonstrated in their experiments. This concept was again used as a surgical procedure on humans by John Fulton, who severed the neural pathways instead of removing parts of the brain. (Sabbatini, Renato M.E. “The History of Lobotomy.” Sabbatini, R.M.E.: The History of Lobotomy, www.cerebromente.org.br/n02/historia/lobotomy.htm.)

In spite of all of these experiments, the lobotomy was not used for a large amount of patients until a more precise method was developed by a man called Antonio Moniz by using a specialized knife for the procedure. By disconnecting the link between the frontal lobes and the thalamus, the lobotomy was beginning to be used by doctors as a last attempt for treatment. Used for severe violence and/or depression, the lobotomy was hailed as a cure for many of the mental illnesses that could not be cured at the time. In fact, his results were so effective that Moniz was awarded the Nobel prize for his discovery.

The journey of the lobotomy continues with two surgeons named Watts and Walter Freeman. Together, they developed a procedure which they called ‘trans-orbital leucotomy’. (Sabbatini, Renato M.E. “The History of Psychosurgery.” Sabbatini, R.M.E.: The History of Psychosurgery (Brain & Mind Magazine, 1(2), June/August 1997, www.cerebromente.org.br/n02/historia/psicocirg_i.htm.)

Commonly referred to as an ‘ice pick lobotomy’, this surgical procedure was performed by using an icepick-like instrument and a hammer to drive the pick into the top of the eye socket and accessing the brain through this hole. The ‘ice pick’ was then twirled to sever the neural fibers, inserted through the other eye socket and performed again. While incredibly gruesome and violent, this procedure was very quick. (Freeman, Shanna. “How Lobotomies Work.” HowStuffWorks Science, HowStuffWorks, 27 Oct. 2008, science.howstuffworks.com/life/inside-the-mind/human-brain/lobotomy1.htm.)

Fortunately, the practice of a lobotomy soon fell out of fashion in the middle of the 1950’s with the introduction of promising medicines in the form of antidepressants and antipsychotics. With it’s grizzly history, it is understandable that modern doctors are very hesitant to perform lobotomies or similar surgeries on their patients. (The Editors of Encyclopædia Britannica. “Lobotomy.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 29 Oct. 2014, www.britannica.com/topic/lobotomy.)

Because of the introduction of the psychological drugs mentioned above, these types of surgeries are rarely performed as anything but a last resort. The lobotomies that were performed in the 1900s were used as a treatment for aggressive behavior. Unfortunately, while the surgery did assist in alleviating some of this behavior, the patients often experienced increased amounts of apathy and loss of interest. In spite of all of these horrible tragedies, lobotomies evolved into a broader category of treatment called psychosurgery, which is still used today. Psychosurgery is the attempt to treat mental disorders by performing different types of brain surgery. (The Editors of Encyclopædia Britannica. “Psychosurgery.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 1 Nov. 2013, www.britannica.com/topic/psychosurgery.)

The pain associated with patients who have experienced brain surgery is, amazingly, not very well studied by the medical community until an alarming study was performed on 37 subjects. All of the subjects have experienced brain surgeries of some kind. Worryingly, 60% of those subjects have experienced acute pain after the operation. Of those patients, two-thirds of them labeled their pain moderate to severe. Unsurprisingly, the pain was usually experienced within two days after the surgery, but many of the patients experienced pain after this period.

Oddly enough, both age and sex were directly related to this phenomena. Both younger patients and females were more likely to experience pain after the operation than males or older patients. (Benedittis, Surgery De, et al. “Postoperative Pain in Neurosurgery: A Pilot Study in Brain Surgery | Neurosurgery | Oxford Academic.” OUP Academic, Oxford University Press, 1 Mar. 1996, academic.oup.com/neurosurgery/article-abstract/38/3/466/2843670.)

In other words, the enormous amount of people that experienced a much more primitive form of psychosurgery- a lobotomy, for example- would be even more likely to experience pain due to the crude methods available at the time.

In spite of all of these failures, lobotomies are performed on animals for experimental purposes and used for humans in extreme cases. Rats, for example, were used in a study in which they were conditioned to be anxious by shocking them in a box. When undergoing a lobotomy- approximately one-third of the length between the occipital poles and the frontal poles- the rats did not show anxiety when placed in the same box that had shocked them. In fact, their lack of anxiety even surpassed the control group. (Smith, Kendon, and Jack M Streb. “Frontal lobotomy and the elimination of conditioned anxiety in the rat.” American Psychological Association, American Psychological Association, psycnet.apa.org/record/1956-01271-001.)

As for the use of lobotomy in humans for mental illness, the uses are nonexistent save for only the most extreme cases and as a last resort for treatment. However, a recent study states that those with severe schizophrenia symptoms improve regardless of if they have a lobotomy performed as a therapeutic procedure. In spite of that fact, those with severe schizophrenia that have had lobotomies experience a higher rate of symptom improvement than those who have not. Anxiety-as seen in previous experiments by others- and paranoid behavior decreases. Normal behavior increases, and specialized and careful use of the lobotomy on the very mentally ill schizophrenics shows promise. (“EFFECTS OF PREFRONTAL LOBOTOMY ON PATIENTS WITH SEVERE CHRONIC SCHIZOPHRENIA.” American Journal of Psychiatry, ajp.psychiatryonline.org/doi/abs/10.1176/ajp.111.2.84)

Another promising study on schizophrenia and the surgical procedure of lobotomies comes by a study by David Rothschild and Abraham Kaye. These men studied the results of frontal lobotomies in one hundred people that received the treatment because of their severe symptoms. Out of those one hundred patients, ten of those patients were ‘much improved’ after the operation, thirty-two of the patients were ‘improved’ after the operation, and forty-two of the patients were ‘slightly improved’ after the operation. Only fourteen of the patients were ‘unimproved’ after the operation and only two patients were worse. In spite of these promising results, the men who performed the study recommend that this extreme treatment should only be used for those who have suffered for four to five years or longer. (Rothschild, David, and Abraham Kaye. “THE EFFECTS OF PREFRONTAL LOBOTOMY ON THE SYMPTOMATOLOGY OF SCHIZOPHRENIC PATIENTS.” American Journal of Psychiatry, 1 Apr. 2006, ajp.psychiatryonline.org/doi/abs/10.1176/ajp.105.10.752.)

In conclusion, the history of the surgical procedure known as a lobotomy is a very grim one indeed. While the surgery has been proven to have positive effects in ‘calming’ the patient, history warns us to use caution. Throughout the history of the procedure, the lobotomy has evolved from experiments performed by a man named Gottileib Burkhardt on schizophrenic patients in the asylum that he supervised to the precise surgeries on schizophrenic patients that we can even see today- in extreme cases, of course. The past warns us not to abuse the power given to us by medical experiments, and we must not forget the pinnacle of morality when performing these procedures: empathy. The experimental procedures that are used today are designed from decades of hard and appaling work, but they are much more concise and delicate procedures. Let us remember those who have helped us to this point: the patients that were given repugnant surgeries have given us something remarkable. Although more research is needed, the mentally ill of the past have given us a rankenstinean cure.

Bibliography

“THE EFFECTS OF PREFRONTAL LOBOTOMY ON THE SYMPTOMATOLOGY OF SCHIZOPHRENIC PATIENTS.” American Journal of Psychiatry, ajp.psychiatryonline.org/doi/abs/10.1176/ajp.105.10.752.

The Editors of Encyclopædia Britannica. “Lobotomy.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 29 Oct. 2014, www.britannica.com/topic/lobotomy.

The Editors of Encyclopædia Britannica. “Psychosurgery.” Encyclopædia Britannica, Encyclopædia Britannica, inc., 1 Nov. 2013, www.britannica.com/topic/psychosurgery.

Smith, Kendon, and Jack M Streb. “Frontal lobotomy and the elimination of conditioned anxiety in the rat.” American Psychological Association, American Psychological Association, psycnet.apa.org/record/1956-01271-001.

Sabbatini, Renato M.E. “The History of Psychosurgery.” Sabbatini, R.M.E.: The History of Psychosurgery (Brain & Mind Magazine, 1(2), June/August 1997, www.cerebromente.org.br/n02/historia/psicocirg_i.htm.

Sabbatini, Renato M.E. “The History of Lobotomy.” Sabbatini, R.M.E.: The History of Lobotomy, www.cerebromente.org.br/n02/historia/lobotomy.htm.

Rothschild, David, and Abraham Kaye. “THE EFFECTS OF PREFRONTAL LOBOTOMY ON THE SYMPTOMATOLOGY OF SCHIZOPHRENIC PATIENTS.” American Journal of Psychiatry, 1 Apr. 2006, ajp.psychiatryonline.org/doi/abs/10.1176/ajp.105.10.752.

Freeman, Shanna. “How Lobotomies Work.” HowStuffWorks Science, HowStuffWorks, 27 Oct. 2008, science.howstuffworks.com/life/inside-the-mind/human-brain/lobotomy1.htm.

“EFFECTS OF PREFRONTAL LOBOTOMY ON PATIENTS WITH SEVERE CHRONIC SCHIZOPHRENIA.” American Journal of Psychiatry, ajp.psychiatryonline.org/doi/abs/10.1176/ajp.111.2.84.

Benedittis, Surgery De, et al. “Postoperative Pain in Neurosurgery: A Pilot Study in Brain Surgery | Neurosurgery | Oxford Academic.” OUP Academic, Oxford University Press, 1 Mar. 1996, academic.oup.com/neurosurgery/article-abstract/38/3/466/2843670.

 

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