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{{ClinPsy}}
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{{expert}}
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'''Psychosurgery''' is a term for [[surgery|surgeries]] of the [[brain]] involving procedures that modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe [[mental illness]]. Historically, the procedure typically considered psychosurgery, [[leukotomy|prefrontal leukotomy]] is now almost universally shunned as inappropriate, due in part to the emergence of less-invasive or less-objectionable methods of treatment such as [[psychiatric medication]] and modified [[electroconvulsive therapy]]. In modern neurosurgery however, more minimally invasive techniques like [[gamma knife]] irradiation and foremost [[deep brain stimulation]] has arisen as a novel tool for psychosurgery.
  
  ⚫
{{dablink|The medical procedure of psychosurgery should not be confused with [[psychic surgery]]—surgery purportedly performed by [[paranormal]] means.}}
   
  ⚫
'''Psychosurgery''' is a term for [[surgery|surgeries]] of the [[brain]] involving procedures that modulate the performance of the brain, and thus effect changes in [[cognition]], with the intent to treat or alleviate severe [[mental illness]]. It was originally thought that by severing the nerves, that give power to ideas, you would achieve the desirable result of a loss of [[affect]] and an [[emotional flattening]] which would diminish [[creativity]] and [[imagination]]; the idea being that those are the human characteristics that are disturbed. Historically, the procedure typically considered psychosurgery, [[leukotomy|prefrontal leukotomy]] is now almost universally shunned as inappropriate, due in part to the emergence of less-invasive or less-objectionable methods of treatment such as [[psychiatric medication]] and modified [[electroconvulsive therapy]]. In modern neurosurgery however, more minimally invasive techniques like [[gamma knife]] irradiation and foremost [[deep brain stimulation]] have arisen as novel tools for psychosurgery.
⚫
Psychosurgery should not be confused with the practice of [[psychic surgery]]—surgery purportedly performed by [[paranormal]] means.
  
   
⚫
==History==
  
⚫
There is evidence that [[trephining]] (or [[trepanning]])—the practice of drilling holes in the skull for pseudomedical reasons—has been in widespread, if infrequent, use since [[5th millennium BC|5000 BC]]. This may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example, after head injuries. (Several documented cases of healed wounds indicate that such crude surgery could be survived back then.) However, psychosurgery as understood today was not commonly practiced until the early 20th century.
  
   
⚫
The first systematic attempts at human psychosurgery occurred from [[1935]], when the neurosurgeon [[Egas Moniz]] teamed up with the surgeon [[Almeida Lima]] at the [[University of Lisbon]] to perform a series of prefrontal lobotomies ([[leukotomy|leukotomies]]) —a procedure severing the connection between the [[frontal lobe|prefrontal cortex]] and the rest of the [[brain]].
 
   
  +
==List of psychosurgery procedures==
⚫
Moniz and Lima claimed fair results, especially in the treatment of [[clinical depression|depression]], although about 6% of patients did not survive the operation, and there were often marked and adverse changes in the patients' personality and social functioning. Despite the risks the process was taken up with some enthusiasm, notably in the [[United States|U.S.]], as a treatment for previously incurable mental conditions. Moniz received a [[Nobel Prize/Physiology or medicine|Nobel Prize]] in [[1949]].
  
  +
*[[Leukotomy]]
  +
*[[Lobectomy]]
  +
*[[Lobotomy]]
  +
*[[Thalamotomy]]
  +
*[[Sympathectomy]]
  +
*[[Tractotomy]]
   
  ⚫
==History==
⚫
The initial criteria for treatment were quite steep—only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, [[clinical depression|depression]] with risk of [[suicide]] and incapacitating [[obsessive-compulsive disorder]] were the main symptoms treated. The original leucotomy was a crude operation and the practice was soon developed into a more exact [[stereotactic surgery|stereotactic]] procedure where only very small lesions were placed in the [[brain]].
  
  ⚫
There is evidence that [[trepanation|trepanning]] (or trephining)—the practice of drilling holes in the skull for pseudomedical reasons—has been in widespread, if infrequent, use since [[5th millennium BC|5000 BC]]. This may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example, after head injuries. (Several documented cases of healed wounds indicate that such crude surgery could be survived back then.) However, psychosurgery as understood today was not commonly practiced until the early 20th century.
   
  ⚫
The first systematic attempts at human psychosurgery occurred from [[1935]], when the neurosurgeon [[Egas Moniz]] teamed up with the surgeon [[Almeida Lima]] at the [[University of Lisbon]] to perform a series of prefrontal [[lobotomy|lobotomies]] —a procedure severing the connection between the [[frontal lobe|prefrontal cortex]] and the rest of the [[brain]].
⚫
The procedure was popularised in the United States when [[Walter Freeman]] invented the "ice pick lobotomy" procedure, which literally used an [[ice pick]] and [[rubber mallet]] instead of the standard surgical [[leukotomy]]. Leaving no visible scars, the ice pick lobotomy was heralded as a great advance in "minimally invasive" surgery, and was eventually done under only local anaesthesia.
  
   
  ⚫
Moniz and Lima claimed fair results, especially in the treatment of [[clinical depression|depression]], although about 6% of patients did not survive the operation, and there were often marked and adverse changes in the patients' personality and social functioning. Despite the risks the process was taken up with some enthusiasm, notably in the [[United States|U.S.]], as a treatment for previously incurable mental conditions. Moniz received a [[Nobel Prize/Physiology or medicine|Nobel Prize]] in [[1949]].
⚫
In a minimally invasive procedure, Freeman would hammer the ice pick into the skull just above the [[tear duct]] and wiggle it around. Between [[1936]] through the [[1950s]], he advocated lobotomies throughout the [[United States]]. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in many medical centres. He reputedly even performed a few lobotomies in hotel rooms.
  
   
  ⚫
The initial criteria for treatment were quite steep—only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, [[clinical depression|depression]] with risk of [[suicide]] and incapacitating [[obsessive-compulsive disorder]] were the main symptoms treated. The original lobotomy was a crude operation and the practice was soon developed into a more exact [[stereotactic surgery|stereotactic]] procedure where only very small lesions were placed in the [[brain]].
⚫
Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in [[children]]. Ultimately between 40,000 and 50,000 patients were lobotomised. A follow-up study of almost 10,000 patients claimed 41% were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off (Tooth, et al. 1961). Lobotomies gradually became unfashionable with the development of [[antipsychotic]]s and are no longer performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history.
  
   
  +
==="Ice pick lobotomy"===
⚫
It is possible that some patients did benefit from the more precise psychosurgery, but there was a strong division amongst the medical profession as to the viability of the treatment and concern over the irreversible nature of the operation and the extension of the surgery into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders, etc). Whatever the truth, psychosurgery was offered in only a few centres, and by the 1960s the number of operations was in decline. The signal improvements in [[psychopharmacology]] and [[behaviour therapy]] gave the opportunity for more effective and less-invasive treatment.
  
  +
[[Image:Icepicks1.jpg|right|thumb|200px|Close up of "ice picks"]]
  ⚫
Psychosurgery was popularised in the United States when [[Walter Freeman]] invented the "ice pick lobotomy", a procedure which literally used an [[ice pick]] and a [[rubber mallet]] instead of standard surgical equipment to perform a [[wikt:transorbital|transorbital]] [[lobotomy]]. Leaving no visible scars, the ice pick lobotomy was heralded as a great advance in surgery, and was eventually done under [[local anesthesia]] accomplished through [[Electroconvulsive therapy|electroshock]] administered to the patient moments before the procedure.{{Fact|date=February 2007}}
   
  ⚫
In what is now widely considered to be a highly invasive procedure, Freeman would hammer the ice pick into the skull just above the tear duct and wiggle it around. From 1936 through the 1950s, he advocated lobotomies throughout the United States. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in many medical centres.<ref name="abnormal psyc">{{cite news | title=Essentials of Abnormal Psychology, 4th edition | author=V. Mark Durand & David H. Barlow | publisher=Thomson Wadsworth | date=2006 |url=http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24}}</ref> He reputedly even performed a few lobotomies in hotel rooms.{{Fact|date=February 2007}}
⚫
==Legal restrictions==
  
⚫
In [[1977]], the US Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery, including lobotomy techniques, was used to control minorities, restrain individual rights or that it had unethical after-effects. It concluded that, in general, psychosurgery had positive effects. However, concerns about leukotomy steadily grew, and countries such as [[Germany]], [[Japan]] and several US states prohibited it.<ref name="ethic">{{cite news | title=La neurochirurgie fonctionnelle d'affections psychiatriques sévères | publisher=Comité Consultatif National d'Ethique | date=April 25, 2002 | url=http://www.ccne-ethique.fr/francais/avis/a_071.htm}}</ref>
  
   
  ⚫
Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in [[children]]. Ultimately between 40,000 and 50,000 patients were lobotomised. A follow-up study of almost 10,000 patients claimed 41% were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off (Tooth, et al. 1961).
⚫
In [[Australia]], psychosurgery is performed by a select group of [[neurosurgeons]]. In [[Victoria (Australia)|Victoria]], each individual operation must receive the consent of a Review Board before it may proceed.
  
   
 
==Neurological effect==
  
==Neurological effect==
−
The [[frontal lobe]] of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or [[prefrontal cortex|prefrontal]] area is involved in impulse control, judgement, language, memory, motor function, problem solving, sexual behaviour, socialization and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour.
 +
The [[frontal lobe]] of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or [[prefrontal cortex|prefrontal]] area is involved in impulse control, judgement with everyday life and situations, language, memory, motor function, problem solving, sexual behaviour, socialization and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour.
   
−
Thus, the efficacy of psychosurgery was often related to changes in personality and reduced spontaneity (this included making the person quieter and lowering their sex drive). Certain processes related to [[schizophrenia]] are also believed to occur in the frontal lobe, and may explain some success. However, certain types of inappropriate behaviours increased as a function of reduced impulse control (in some respects they became more childlike). Further, it decreased their ability to function as a member of the community by reducing their problem solving and planning abilities and making them less flexible and adaptive. It usually had no bearing on [[IQ]] except with respect to problem solving.
 +
Thus, the efficacy of psychosurgery was often related to changes in personality and reduced spontaneity (this included making the person quieter and decreasing their craving to be sexually active). Certain processes related to [[schizophrenia]] are also believed to occur in the frontal lobe, and may explain some success. However, certain types of inappropriate behaviours increased as a function of reduced impulse control (in some respects they became more childlike). Further, it decreased their ability to function as a member of the community by reducing their problem solving and planning abilities and making them less flexible and adaptive. It usually had no bearing on [[IQ]] except with respect to problem solving.
   
 
==Present day==
  
==Present day==
   
  ⚫
Lobotomies gradually became unfashionable with the development of [[antipsychotic]] drugs and are rarely performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history. There was a strong division amongst the medical profession as to the efficacy of the treatment, and concern over both the irreversible nature of the operation and to its extension into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders, etc). Psychosurgery was offered in only a few centres, and by the 1960s the number of operations was in decline. Signal improvements in [[psychopharmacology]] and [[behaviour therapy]] provided the opportunity for more effective and less-invasive treatment.
−
Today, lobotomy is not as frequently practiced as it was in the 1930s, 40s, 50s and 60s. It may be a treatment of last resort for [[OCD]] sufferers; and [[eating disorders|anorexic]] patients in Chile, the United States, Sweden and Mexico.
  
   
−
In the case of people suffering chronic pain, the surgery does not act on the perception of pain, but leads to a lack of concern ''about the pain''. The procedure usually involves a 2&ndash;3 cm lesion in the [[cingulum]] near the [[corpus callosum]]. The efficacy is not high, with improvement in 5 of 18 patients (Baer et al., 1995).
+
Today, psychosurgery may be a treatment of last resort for [[OCD]] sufferers, and for [[eating disorders|anorexic]] patients in Chile, the United States, Sweden and Mexico. The efficacy is not high: one study of cingulotomy (which usually involves a 2–3 cm lesion in the [[cingulum]] near the [[corpus callosum]]) found improvement in 5 out of 18 patients (Baer et al., 1995).
   
−
Leukotomy is legally practiced in controlled and [[regulation|regulated]] US centers, or in Finland, Sweden, United Kingdom, Spain, India, Belgium and Netherlands. In France, 32 lobotomies were made between 1980 and 1986 according to a [[IGAS]] report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston. <ref name="ethic" />
 +
Psychosurgery is legally practiced in controlled and [[regulation|regulated]] U.S. centers, or in Finland, Sweden, United Kingdom, Spain, India, Belgium and Netherlands. In France, 32 psychosurgical operations were made between 1980 and 1986 according to an [[IGAS]] report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.<ref name="ethic" />
   
−
Some consider use of [[endoscopic thoracic sympathectomy]] (ETS surgery) for patients with [[anxiety disorder]] to be psychosurgery, despite it not being surgery of the brain. ETS surgery disrupts brain regulation of many organs normally affected by emotion, such as the heart. A large study demonstrated significant reduction in "alertness" and "fear".[http://herkules.oulu.fi/isbn9514274571/index.html?lang=en] Although ETS for anxiety is mass marketed by surgeons on the internet [http://www.endsweat.com/socialphobia.html][http://privatix.magenta.net/], most psychologists now use medication and counseling.
+
Some consider use of endoscopic sympathetic block (a form of [[endoscopic thoracic sympathectomy]]) for patients with [[anxiety disorder]] to be a psychiatric treatment, despite it not being surgery of the brain. There is also renewed interest in using it to treat [[schizophrenia]].[http://www.springerlink.com/content/rya8yguqxfddw9pb/]. ESB disrupts brain regulation of many organs normally affected by emotion, such as the heart and blood vessels. A large study demonstrated significant reduction in "alertness" and "fear" in patients with social phobia as well as improvement in their quality of life [http://herkules.oulu.fi/isbn9514274571/index.html?lang=en]. ESB for anxiety is advocated as an alternative by surgeons on the internet [http://www.endsweat.com/socialphobia.html][http://privatix.magenta.net/], most psychologists, however, prefer medication and counseling.
   
  ⚫
==Legal restrictions==
  ⚫
In [[1977]], the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery, including lobotomy techniques, was used to control minorities, restrain individual rights or that it had unethical after-effects. It concluded that, in general, psychosurgery had positive effects. However, concerns about lobotomy steadily grew, and countries such as [[Germany]], [[Japan]] and several U.S. states prohibited it.<ref name="ethic">{{cite news | title=La neurochirurgie fonctionnelle d'affections psychiatriques sévères | publisher=Comité Consultatif National d'Ethique | date=April 25, 2002|url=http://www.ccne-ethique.fr/francais/avis/a_071.htm}}</ref>
   
  ⚫
In [[Australia]], psychosurgery is performed by a select group of [[neurosurgeons]]. In [[Victoria (Australia)|Victoria]], each individual operation must receive the consent of a Review Board before it may proceed.
−
==Famous people who underwent lobotomy==
  
−
*[[Phineas Gage]]: Famously suffered an accident in [[1848]] which severely damaged his frontal lobe. The effects were comparable to a surgical lobotomy.
  
−
*[[Josef Hassid]]: Polish violin prodigy and schizophrenic who died at 26.
  
−
*[[Rosemary Kennedy]]: Sister of [[John F. Kennedy]].
  
−
*[[Rose Williams]]: Sister of [[Tennessee Williams]].
  
   
  +
The [[Soviet Union]] made lobotomies illegal in 1950.<ref>http://www.psychiatry.ru/en/history.html</ref>.
−
==Fictional examples==
  
  +
−
*[[Frances Farmer]]: Though Farmer is the person perhaps best associated in the public mind with lobotomy due to its depiction in the fictionalized biographical film [[Frances]], archival medical and other records have conclusively proven Farmer never underwent the procedure. The author who initially alleged the lobotomy later admitted in court he had made it up.[http://jeffreykauffman.net/francesfarmer/sheddinglight.html] (Footnoted site contains court transcripts which are also available through [[LexisNexis]].
  
  ⚫
==See also==
−
*[[Ken Kesey]]'s famed fictional character, Randle Patrick McMurphy, in ''[[One Flew Over the Cuckoo's Nest (novel)|One Flew Over the Cuckoo's Nest]]'' who was, in the movie, played by [[Jack Nicholson]].
  
  ⚫
* [[Anti-psychiatry]]
−
*J. Frank Parnell, erratic driver of the radioactive Chevy Malibu in the movie ''[[Repo Man]]''.
  
  ⚫
* [[Frontal lobe]]
−
*''[[A Hole in One]]'', a [[2004]] movie about a young lady who wants an ice pick lobotomy during the height of its popularity.
  
  +
* [[History of psychosurgery in the United Kingdom]]
−
* Rat Korga, major character in [[Samuel R. Delany]]'s [[science fiction]] novel ''[[Stars in My Pocket Like Grains of Sand]]'', voluntarily opts for psychosurgery to make him content to be a slave.
  
  ⚫
* [[Medical torture]]
−
* Several victims of a serial killer named [[Gerry Schnauz]] in an episode of ''[[The X-Files]]'' entitled "[[The X-Files (season 4)#Unruhe|Unruhe]]".
  
  ⚫
* [[Neurosurgery]]
−
* ''[[Session 9]]'', a [[2001]] horror movie about a group of men hired to remove the [[asbestos]] from a defunct mental hospital. Without spoiling the movie, it can be said that lobotomies are involved.
  
  +
* [[Physical treatment methods]]
−
* ''[[Hannibal (movie)|Hannibal]]'', in which [[Hannibal Lecter]] lobotomizes [[Paul Krendler]], played by [[Ray Liotta]].
  
−
* In the book ''The Bell Jar'' by [[Sylvia Plath]], the character Esther Greenwood meets a girl named Valerie in the asylum who has had a lobotomy.
  
−
* ''[[Iron Maiden]]'''s famous fictional mascot, [[Eddie the Head|Eddie]], was lobotomised on-stage during one of Maiden's live shows; this concert was filmed for German TV but that particular segment was cut out due to being deemed "Too violent". The cover of their fourth album ''[[Piece of Mind (Iron Maiden)|Piece of Mind]]'' (and many of the following releases) shows Eddie after being lobotomised.
  
−
* In the book ''[[Cyteen]]'' by [[C.J. Cherryh]], psychosurgery involves the use of drugs that bring the mind into a state where it is very receptive to audio and/or visual cues, which help the psychosurgeon to reprogram the individual. This procedure is non-invasive, and involves administering drugs versus actual surgery.
  
−
* In the television miniseries [[Kingdom Hospital]], the character Mary was killed by a botched lobotomy. In the companion book, ''The Journals of Eleanor Druse'', Eleanor had a transorbital lobotomy in her childhood.
  
   
 
==References==
  
==References==
Line 72: Line 72:
 
*Pohjavaara P (2004): "Social Phobia, Etiology, Course and Treatment with Endoscopic Sympathetic Blockade (ESB)" [http://herkules.oulu.fi/isbn9514274571/isbn9514274571.pdf]
  
*Pohjavaara P (2004): "Social Phobia, Etiology, Course and Treatment with Endoscopic Sympathetic Blockade (ESB)" [http://herkules.oulu.fi/isbn9514274571/isbn9514274571.pdf]
   
  +
⚫
==See also==
  
⚫
* [[Anti-psychiatry]]
  
⚫
* [[Frontal lobe]]
  
⚫
* [[Neurosurgery]]
  
⚫
* [[Medical torture]]
  
   
 
==External links==
  
==External links==
Line 88: Line 84:
 
* [http://www.ship.edu/~cgboeree/lobotomy.html A Brief History of the Lobotomy]
  
* [http://www.ship.edu/~cgboeree/lobotomy.html A Brief History of the Lobotomy]
 
* [http://www.rotten.com/library/medicine/lobotomy/ Rotten Library] Article on the Lobotomy
  
* [http://www.rotten.com/library/medicine/lobotomy/ Rotten Library] Article on the Lobotomy
−
* [http://www.truthaboutets.com "Truth About ETS"] - ETS education, editorials, and testimonials. Extensive documentation of sympathectomy side effects.
  
 
* [http://www.npr.org/templates/story/story.php?storyId=5014080 "My Lobotomy"] - a 22-minute piece from [[National Public Radio]]'s [[All Things Considered]] about a 56-year-old man exploring a lobotomy he had at the age of 12.
  
* [http://www.npr.org/templates/story/story.php?storyId=5014080 "My Lobotomy"] - a 22-minute piece from [[National Public Radio]]'s [[All Things Considered]] about a 56-year-old man exploring a lobotomy he had at the age of 12.
  +
−
* [http://jeffreykauffman.net/francesfarmer/sheddinglight.html "Shedding Light on Shadowland"] - in-depth essay exploring the propagation of the Frances Farmer lobotomy legend
  
  +
   
 
[[Category:Neurosurgery]]
  
[[Category:Neurosurgery]]
−
[[Category:Controversial surgeries]]
 +
[[Category:Physical treatment methods]]
  +
[[Category:Psychosurgery]]
   
  +
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{{enWP|Psychosurgery}}
  
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The medical procedure of psychosurgery should not be confused with psychic surgery—surgery purportedly performed by paranormal means.

Psychosurgery is a term for surgeries of the brain involving procedures that modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe mental illness. It was originally thought that by severing the nerves, that give power to ideas, you would achieve the desirable result of a loss of affect and an emotional flattening which would diminish creativity and imagination; the idea being that those are the human characteristics that are disturbed. Historically, the procedure typically considered psychosurgery, prefrontal leukotomy is now almost universally shunned as inappropriate, due in part to the emergence of less-invasive or less-objectionable methods of treatment such as psychiatric medication and modified electroconvulsive therapy. In modern neurosurgery however, more minimally invasive techniques like gamma knife irradiation and foremost deep brain stimulation have arisen as novel tools for psychosurgery.


List of psychosurgery procedures

History

There is evidence that trepanning (or trephining)—the practice of drilling holes in the skull for pseudomedical reasons—has been in widespread, if infrequent, use since 5000 BC. This may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example, after head injuries. (Several documented cases of healed wounds indicate that such crude surgery could be survived back then.) However, psychosurgery as understood today was not commonly practiced until the early 20th century.

The first systematic attempts at human psychosurgery occurred from 1935, when the neurosurgeon Egas Moniz teamed up with the surgeon Almeida Lima at the University of Lisbon to perform a series of prefrontal lobotomies —a procedure severing the connection between the prefrontal cortex and the rest of the brain.

Moniz and Lima claimed fair results, especially in the treatment of depression, although about 6% of patients did not survive the operation, and there were often marked and adverse changes in the patients' personality and social functioning. Despite the risks the process was taken up with some enthusiasm, notably in the U.S., as a treatment for previously incurable mental conditions. Moniz received a Nobel Prize in 1949.

The initial criteria for treatment were quite steep—only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, depression with risk of suicide and incapacitating obsessive-compulsive disorder were the main symptoms treated. The original lobotomy was a crude operation and the practice was soon developed into a more exact stereotactic procedure where only very small lesions were placed in the brain.

"Ice pick lobotomy"

Icepicks1

Close up of "ice picks"

Psychosurgery was popularised in the United States when Walter Freeman invented the "ice pick lobotomy", a procedure which literally used an ice pick and a rubber mallet instead of standard surgical equipment to perform a transorbital lobotomy. Leaving no visible scars, the ice pick lobotomy was heralded as a great advance in surgery, and was eventually done under local anesthesia accomplished through electroshock administered to the patient moments before the procedure.[How to reference and link to summary or text]

In what is now widely considered to be a highly invasive procedure, Freeman would hammer the ice pick into the skull just above the tear duct and wiggle it around. From 1936 through the 1950s, he advocated lobotomies throughout the United States. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in many medical centres.[1] He reputedly even performed a few lobotomies in hotel rooms.[How to reference and link to summary or text]

Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in children. Ultimately between 40,000 and 50,000 patients were lobotomised. A follow-up study of almost 10,000 patients claimed 41% were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off (Tooth, et al. 1961).

Neurological effect

The frontal lobe of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or prefrontal area is involved in impulse control, judgement with everyday life and situations, language, memory, motor function, problem solving, sexual behaviour, socialization and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour.

Thus, the efficacy of psychosurgery was often related to changes in personality and reduced spontaneity (this included making the person quieter and decreasing their craving to be sexually active). Certain processes related to schizophrenia are also believed to occur in the frontal lobe, and may explain some success. However, certain types of inappropriate behaviours increased as a function of reduced impulse control (in some respects they became more childlike). Further, it decreased their ability to function as a member of the community by reducing their problem solving and planning abilities and making them less flexible and adaptive. It usually had no bearing on IQ except with respect to problem solving.

Present day

Lobotomies gradually became unfashionable with the development of antipsychotic drugs and are rarely performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history. There was a strong division amongst the medical profession as to the efficacy of the treatment, and concern over both the irreversible nature of the operation and to its extension into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders, etc). Psychosurgery was offered in only a few centres, and by the 1960s the number of operations was in decline. Signal improvements in psychopharmacology and behaviour therapy provided the opportunity for more effective and less-invasive treatment.

Today, psychosurgery may be a treatment of last resort for OCD sufferers, and for anorexic patients in Chile, the United States, Sweden and Mexico. The efficacy is not high: one study of cingulotomy (which usually involves a 2–3 cm lesion in the cingulum near the corpus callosum) found improvement in 5 out of 18 patients (Baer et al., 1995).

Psychosurgery is legally practiced in controlled and regulated U.S. centers, or in Finland, Sweden, United Kingdom, Spain, India, Belgium and Netherlands. In France, 32 psychosurgical operations were made between 1980 and 1986 according to an IGAS report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.[2]

Some consider use of endoscopic sympathetic block (a form of endoscopic thoracic sympathectomy) for patients with anxiety disorder to be a psychiatric treatment, despite it not being surgery of the brain. There is also renewed interest in using it to treat schizophrenia.[1]. ESB disrupts brain regulation of many organs normally affected by emotion, such as the heart and blood vessels. A large study demonstrated significant reduction in "alertness" and "fear" in patients with social phobia as well as improvement in their quality of life [2]. ESB for anxiety is advocated as an alternative by surgeons on the internet [3][4], most psychologists, however, prefer medication and counseling.

Legal restrictions

In 1977, the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery, including lobotomy techniques, was used to control minorities, restrain individual rights or that it had unethical after-effects. It concluded that, in general, psychosurgery had positive effects. However, concerns about lobotomy steadily grew, and countries such as Germany, Japan and several U.S. states prohibited it.[2]

In Australia, psychosurgery is performed by a select group of neurosurgeons. In Victoria, each individual operation must receive the consent of a Review Board before it may proceed.

The Soviet Union made lobotomies illegal in 1950.[3].

See also

References

  1. ↑ includeonly>V. Mark Durand & David H. Barlow. "Essentials of Abnormal Psychology, 4th edition", Thomson Wadsworth, 2006.
  2. ↑ 2.0 2.1 includeonly>"La neurochirurgie fonctionnelle d'affections psychiatriques sévères", Comité Consultatif National d'Ethique, April 25, 2002.
  3. ↑ http://www.psychiatry.ru/en/history.html
  • Baer, L., et al. (1995). Cingulotomy for intractable obsessive-compulsive disorder. Archives of General Psychiatry, 52, 384-392.
  • G. Rees Cosgrove, Scott L. Rauch: "Psychosurgery" Neurosurg. Clin. N. Am. 1995; 6:167-176 online version
  • Davison, G. C., & Neale, J. M. (1998) Abnormal Psychology (7th Ed.). New York, John Wiley.
  • Pohjavaara P, Telaranta T, Vaisanen E. The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block? Nord J Psychiatry 2003;57:55-60. PMID 12745792.
  • Renato M.E. Sabbatini: The History of Psychosurgery. Brain & Mind, September 1997.
  • Pohjavaara P (2004): "Social Phobia, Etiology, Course and Treatment with Endoscopic Sympathetic Blockade (ESB)" [5]


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