Who invented lobotomy




















Nothing sophisticated," says senior archivist Lesley Hall. These spikes once represented the leading edge of psychiatric science. They were the operative tools in lobotomy, also known as leucotomy, an operation which was seen as a miracle cure for a range of mental illnesses.

For millennia, mankind had practised trepanning, drilling holes into skulls to release evil spirits. The idea behind lobotomy was different.

The Portuguese neurologist, Egas Moniz, believed that patients with obsessive behaviour were suffering from fixed circuits in the brain. In , in a Lisbon hospital, he believed he had found a solution. His original technique was adapted by others, but the basic idea remained the same.

Surgeons would drill a pair of holes into the skull, either at the side or top, and push a sharp instrument - a leucotome - into the brain. The surgeon would sweep this from side to side, to cut the connections between the frontal lobes and the rest of the brain. Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in , then spreading it across the globe.

Walter Freeman, a professor of neurology at George Washington University, was next. He had no surgical training and no Connecticut medical license, so he was operating illegally—not that such a minor matter seemed to bother anyone present. Freeman was working on developing an assembly-line approach so that lobotomies could be performed quickly and easily. His technique allowed him to perform 20 or more operations in a single day. He proceeded to use shocks from an electroconvulsive therapy machine to render his female patient unconscious and then inserted an ice pick beneath one of her eyelids until the point rested on the thin bony structure in the orbit.

A few quick taps with a hammer broke through the bone and allowed him to sever portions of the frontal lobes using a sweeping motion with the ice pick. The instrument was withdrawn and inserted into the other orbit, and within minutes, the process was over.

It was, Freeman boasted, so simple an operation that he could teach any damned fool, even a psychiatrist, to perform it in 20 minutes or so.

Tens of thousands of lobotomies were performed in the United States from onward, and both these men would continue operating for decades. Major medical centers in the United States—Harvard, Yale, Columbia, the University of Pennsylvania—regularly performed variations on the basic operation well into the s. It has become fashionable in recent years among some medical historians to argue that the operation was not the medical horror story that popular culture portrays it as being.

These scholars suggest that, when considered within the context of the times, lobotomy was perhaps a defensible response to massively overcrowded mental hospitals and the therapeutic impotence of the psychiatry of the time. On these points, at least, both men were for once correct. Dittrich devotes considerable space to this remarkable surgical contest in Hartford, which he views with a suitably skeptical eye.

But he opens his narrative much earlier, with the story of an accident that befell Henry Molaison, a young boy of six or seven, one summer evening.

En route home for dinner, Henry stepped into the street and was struck from behind by a bicycle. The impact threw him through the air, and he landed on his head, sustaining a concussion that temporarily rendered him unconscious. Henry eventually recovered from his injuries, but only partially. He began to suffer from epileptic seizures that increased in frequency and severity as the years went by and made his life a misery.

Unlike most of the other patients subjected to psychosurgery, Henry was sane. Scoville informed the family that the epilepsy might be tamed by the brain surgery he was pioneering, and within a matter of months, Henry was wheeled into the operating theater. What occurred next made him one of the most famous patients of the 20th century. His target on this occasion, however, lay further back, behind the frontal lobes that he usually targeted for his lobotomies. The electroencephalograph had failed to reveal any epileptic focus.

Now, using a flat brain spatula, Scoville pushed aside the frontal lobes to expose deeper structures in the temporal lobe—the amygdala, the uncus, the entorhinal cortex—searching for any obvious defects or atrophied tissue.

At this point, a cautious surgeon would have cut the surgery short, since there was no obvious lesion to justify further intervention. Scoville was not such a person. I like to see results. Using a suction catheter, Scoville proceeded to destroy all three regions of the temporal lobe bilaterally. Patient H. Though his intellect remained intact, he had in those few minutes lost all but the very shortest of short-term memory.

While a small percentage of people supposedly showed improved mental conditions or no change at all, for many patients, lobotomy had negative effects on their personality , initiative, inhibitions, empathy and ability to function on their own, according to Lerner. People could no longer live independently, and they lost their personalities, he added. Mental institutions played a critical role in the prevalence of lobotomy.

At the time, there were hundreds of thousands of mental institutions, which were overcrowded and chaotic. By giving unruly patients lobotomies, doctors could maintain control over the institution, Lerner said.

That's exactly what unfolds in the novel and film "One Flew Over the Cuckoo's Nest," in which Randle Patrick McMurphy, a violent but sane man who declares himself insane to avoid a prison sentence, is sent to mental hospital and given a lobotomy that leaves him mute, unresponsive and vacant-eyed.

But in this case, it was "disturbingly real," he said. Lobotomies declined in popularity in the s, as their undesirable side effects became more well-known. Criticism of the procedures also grew among medical professionals who said the doctors who performed lobotomies were not neurosurgeons, neglected to report negative outcomes for many of their patients, and overall had "a lack of scientific rigor," according to the Frontiers in Neuroscience study.

By the mids, scientists had developed psychotherapeutic medications such as the antipsychotic chlorpromazine, which was much more effective and safer for treating mental disorders than lobotomy. Nowadays, mental illness is primarily treated with drugs and psychotherapies. In cases where drugs or talk therapy are not effective, people may be treated with electroconvulsive therapy, a procedure that involves passing electrical currents through the brain to trigger a brief seizure, according to the Mayo Clinic.

Lobotomy is rarely, if ever, performed today, and if it is, "it's a much more elegant procedure," Lerner said. This article was updated on Oct. Live Science. Jump to: When was the first lobotomy?



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