«A lobotomy, or leucotomy, is a form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex.[2] Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed. It was used for psychiatric and occasionally other conditions as a mainstream procedure in some Western countries for more than two decades, despite general recognition of frequent and serious side effects. While some people experienced symptomatic improvement with the operation, the improvements were achieved at the cost of creating other impairments. The procedure was controversial from its initial use in part due to the balance between benefits and risks. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.
The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the "discovery of the therapeutic value of leucotomy in certain psychoses",[n 1] although the awarding of the prize has been subject to controversy.[5]
The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States and proportionally more in the United Kingdom.[6] The majority of lobotomies were performed on women; a 1951 study of American hospitals found nearly 60% of lobotomy patients were women; limited data shows 74% of lobotomies in Ontario from 1948–1952 were performed on women.[7][8][9] From the 1950s onward lobotomy began to be abandoned,[10] first in the Soviet Union[11] and Europe.[12] The term is derived from Greek: λοβός lobos "lobe" and τομή tomē "cut, slice".
The purpose of the operation was to reduce the symptoms of mental disorders, and it was recognized that this was accomplished at the expense of a person's personality and intellect. British psychiatrist Maurice Partridge, who conducted a follow-up study of 300 patients, said that the treatment achieved its effects by "reducing the complexity of psychic life". Following the operation, spontaneity, responsiveness, self-awareness and self-control were reduced. Activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range.
The consequences of the operation have been described as "mixed". Some patients died as a result of the operation and others later committed suicide. Some were left severely brain-damaged. Others were able to leave the hospital, or became more manageable within the hospital. A few people managed to return to responsible work, while at the other extreme people were left with severe and disabling impairments. Most people fell into an intermediate group, left with some improvement of their symptoms but also with emotional and intellectual deficits to which they made a better or worse adjustment. On average, there was a mortality rate of approximately 5 percent during the 1940s.
The lobotomy procedure could have severe negative effects on a patient's personality and ability to function independently. Lobotomy patients often show a marked reduction in initiative and inhibition. They may also exhibit difficulty putting themselves in the position of others because of decreased cognition and detachment from society.
Immediately following surgery, patients were often stuporous, confused, and incontinent. Some developed an enormous appetite and gained considerable weight. Seizures were another common complication of surgery. Emphasis was put on the training of patients in the weeks and months following surgery.
Walter Freeman coined the term "surgically induced childhood" and used it constantly to refer to the results of lobotomy. The operation left people with an "infantile personality"; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the "personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist". He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who couldn't remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behaviour, Freeman advised a system of rewards (ice-cream) and punishment (smacks).
In the early 20th century, the number of patients residing in mental hospitals increased significantly[n 3] while little in the way of effective medical treatment was available.[n 4] Lobotomy was one of a series of radical and invasive physical therapies developed in Europe at this time that signaled a break with a psychiatric culture of therapeutic nihilism that had prevailed since the late nineteenth-century.[28] The new "heroic" physical therapies devised during this experimental era, including malarial therapy for general paresis of the insane (1917),deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938),[31] helped to imbue the then therapeutically moribund and demoralised psychiatric profession with a renewed sense of optimism in the curability of insanity and the potency of their craft.[32] The success of the shock therapies, despite the considerable risk they posed to patients, also helped to accommodate psychiatrists to ever more drastic forms of medical intervention, including lobotomy.
The clinician-historian Joel Braslow argues that from malarial therapy onward to lobotomy, physical psychiatric therapies "spiral closer and closer to the interior of the brain" with this organ increasingly taking "center stage as a source of disease and site of cure." For Roy Porter, once the doyen of medical history, the often violent and invasive psychiatric interventions developed during the 1930s and 1940s are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the vast number of patients then in psychiatric hospitals and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors. Many doctors, patients and family members of the period believed that despite potentially catastrophic consequences, the results of lobotomy were seemingly positive in many instances or, at least they were deemed as such when measured next to the apparent alternative of long-term institutionalisation. Lobotomy has always been controversial, but for a period of the medical mainstream, it was even feted and regarded as a legitimate if desperate remedy for categories of patients who were otherwise regarded as hopeless.[36] Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights.
Before the 1930s, individual doctors had infrequently experimented with novel surgical operations on the brain of those deemed insane. Most notably in 1888, the Swiss psychiatrist, Gottlieb Burckhardt, initiated what is commonly considered the first systematic attempt at modern human psychosurgery.[37] He operated on six chronic patients under his care at the Swiss Préfargier Asylum, removing sections of their cerebral cortex. Burckhardt's decision to operate was informed by three pervasive views on the nature of mental illness and its relationship to the brain. First, the belief that mental illness was organic in nature, and reflected an underlying brain pathology; next, that the nervous system was organized according to an associationist model comprising an input or afferent system (a sensory center), a connecting system where information processing took place (an association center), and an output or efferent system (a motor center); and, finally, a modular conception of the brain whereby discrete mental faculties were connected to specific regions of the brain. Burckhardt's hypothesis was that by deliberately creating lesions in regions of the brain identified as association centers a transformation in behavior might ensue. According to his model, those mentally ill might experience "excitations abnormal in quality, quantity and intensity" in the sensory regions of the brain and this abnormal stimulation would then be transmitted to the motor regions giving rise to mental pathology. He reasoned, however, that removing material from either of the sensory or motor zones could give rise to "grave functional disturbance". Instead, by targeting the association centers and creating a "ditch" around the motor region of the temporal lobe, he hoped to break their lines of communication and thus alleviate both mental symptoms and the experience of mental distress.
Intending to ameliorate symptoms in those with violent and intractable conditions rather than effect a cure, Burckhardt began operating on patients in December 1888,[42] but both his surgical methods and instruments were crude and the results of the procedure were mixed at best. He operated on six patients in total and, according to his own assessment, two experienced no change, two patients became quieter, one patient experienced epileptic convulsions and died a few days after the operation, and one patient improved.[n 5] Complications included motor weakness, epilepsy, sensory aphasia and "word deafness". Claiming a success rate of 50 percent, he presented the results at the Berlin Medical Congress and published a report, but the response from his medical peers was hostile and he did no further operations.» (wikipedia)