Posted on: July 24, 2007 7:48 PM, by Mo
LOBOTOMY (from the Greek lobos, meaning lobes of the brain, and tomos,
meaning cut) is a psychosurgical procedure in which the connections the
prefrontal cortex and underlying structures are severed, or the frontal
cortical tissue is destroyed, the theory being that this leads to the
uncoupling of the brain's emotional centres and the seat of intellect
(in the subcortical structures and the frontal cortex, respectively).
The lobotomy was first performed on humans in the 1890s. About half a
century later, it was being touted by some as a miracle cure for mental
illness, and its use became widespread; during its heyday in the 1940s
and '50s, the lobotomy was performed on some 40,000 patients in the
United States, and on around 10,000 in Western Europe. The procedure
became popular because there was no alternative, and because it was seen
to alleviate several social crises: overcrowding in psychiatric
institutions, and the increasing cost of caring for mentally ill
patients.
Although psychosurgery has been
performed since the dawn of civilization, the origins of the modern
lobotomy are found in animal experiments carried out towards the end of
the nineteenth century. The German physiologist Friedrich Goltz
(1834-1902) performed ablations of the neocortex in dogs, and observed
the changes in behaviour that occurred as a result:
I have mentioned that dogs with a large lesion in the anterior part of the brain generally show a change in character in the sense that they become excited and quite apt to become irate. Dogs with large lesions of the occipital lobe on the other hand become sweet and harmless, even when they were quite nasty before.
These findings inspired the physician Gottlieb
Burkhardt (1836- ?), the director of a small asylum in Prefargier,
Switzerland, to use ablations of the cortex to try and cure his mentally
ill patients. In 1890, Burkhardt removed parts of the frontal cortex
from 6 of his schizophrenic patients. One of these patients later
committed suicide, and another died within one week of his surgery.
Thus, although Burkhardt believed that his method had been somewhat
successful, he faced strong opposition, and stopped experimenting with
brain surgery.
It was not until the 1930s that lobotomy was again
performed on humans. The modern procedure was pioneered at that time by
the Portugese neuropsychiatrist Antonio Egas Moniz, a professor at the
University of Lisbon Medical School. While attending a frontal lobe
symposium in London, Moniz learned of the work of Carlyle Jacobsen and
John Fulton, both of whom were experimental neurologists at Yale
University.
Jacobsen and Fulton reported that frontal and
prefrontal cortical damage in chimpanzees led to a massive reduction in
aggression, while complete removal of the frontal cortex led to the
inability to induce experimental neuroses in the chimps. Here, they
describe the post-operational behaviour of a chimp named "Becky", who
had previously got extremely distressed after making mistakes during the
task she had learnt:
The chimpanzee...went to the experimental cage. The usual procedure of baiting the cup and lowering the opaque screen was followed...If the animal made a mistake, it showed no evidence of emotional disturbance but quietly awaited the loading of the cups for the next trial. It was as if the animal had joined the "happiness cult of the Elder Micheaux," and had placed its burdens on the Lord!
On hearing the presentation by Jacobsen and Fulton,
Moniz asked if the surgical procedure would be beneficial for people
with otherwise untreatable psychoses. Although the Yale researchers were
shocked by the question, Moniz, together with his colleague Almeida
Lima, operated on his first patient some three months later.
On November, 12th, 1935, Moniz and Lima performed for
the first time what they called a prefrontal leucotomy ("white matter
cutting"). The operation was carried out on a female manic depressive
patient, and lasted about 30 minutes. The patient was first
anaesthetized, and her skull was trepanned
on both sides (that is, holes were drilled through the bone). Then,
absolute alcohol was injected through the holes in the skull, into the
white matter beneath the prefrontal area.
In this way, two of the bundles of nerve fibres
connecting the frontal cortex and the thalamus were severed. (The
thalamus is a subcortical structure that relays sensory information to
the neocortex, and the thalamo-cortical projections are called the
corona radiata.) Moniz reported that the patient seemed less anxious and
paranoid afterwards, and pronounced the operation a success.
Subsequently, he and Lima used a knife, which, when inserted through the
holes in skull and moved back and forth within the brain substance
would sever the thalamo-cortical connections. They later developed a
special wire knife called a leucotome, which had an open steel loop at
its end; when closed, the loop severed the nerve tracts within it.
These procedures were "blind" - the exact path of the
leucotome could not be determined, so the operations produced mixed
results. In some cases, there were improvements in behaviour; in others,
there was no noticable difference; and in yet others, the symptoms
being treated became markedly worse. In all, Moniz and Lima operated on
approximately 50 patients. The best results were obtained in patients
with mood disorders, while the treatment was least effective in
schizophrenics.
In 1936, Moniz published his findings in medical
journals, and travelled to London, where he presented his work to others
in the medical community. In 1949, he was shot four times by one of his
patients (not one who had been lobotomized); one of the bullets entered
his spine and remained lodged there until his death some years later.
In the same year as the shooting, Moniz was awarded the Nobel Prize for
Medicine, for his innovations in neurosurgery.
The American clinical neurologist Walter Freeman
(1895-1972) had been following the work of Moniz closely, and had also
attended the symposium on the frontal lobe. It was Freeman who
introduced the lobotomoy to the United States, and who would later
become the biggest advocate of the technique. With neurosurgeon James
Watts, Freeman refined the technique developed by Moniz. They changed
the name of the technique to "lobotomy", to emphasize that it was white and grey matter that was being destroyed.
The Freeman-Watts Standard Procedure was used for the
first time in September 1936. Also known as "the precision method",
this involved inserting a blunt spatula through holes in both sides of
the skull; the instrument was moved up and down to sever the
thalamo-cortical fibers (above). However, Freeman was unhappy with the
new procedure. He considered it to be both time-consuming and messy, and
so developed a quicker method, the so-called "ice-pick"lobotomy, which
he performed for the first time on January 17th, 1945.
With the patient rendered unconscious by
electroshock, an instrument was inserted above the eyeball through the
orbit using a hammer. Once inside the brain, the instrument was moved
back and forth; this was then repeated on the other side. (The ice-pick
lobotomy, named as such because the instrument used resembled the tool
with which ice is broken, is therefore also known as the transorbital
lobotomy. The photograph at the top shows Freeman performing the
procedure on an unidentified patient.)
Freeman's new technique could be performed in about
10 minutes. Because it did not require anaesthesia, it could be
performed outside of the clinical setting, and lobotomized patients did
not need hospital internment afterwards. Thus, Freeman often performed
lobotomies in his Washington D.C. office, much to the horror of Watts,
who would later dissociate himself from his former colleague and the
procedure.
Freeman happily performed ice-pick lobotomies on
anyone who was referred to him. During his career, he would perform
almost 3,500 operations. Like the leucotomies performed by Moniz and
Lima, those performed by Freeman were blind, and also gave mixed
results. Some of his patients could return to work, while others were
left in something like a vegetative state.
Most famously, Freeman lobotomized President John F.
Kennedy's sister Rosemary, who was incapacitated by the operation, which
was performed on her when she was 23 years of age. And, on December
16th, 1960, Freeman notoriosly performed an ice-pick lobotomy on a
12-year-old boy named Howard Dully, at the behest of Dully's stepmother, who had grown tired of his defiant behaviour.
My stepmother hated me. I never understood why, but it was clear she'd do anything to get rid of me...If you saw me you'd never know I'd had a lobotomy.
The only thing you'd notice is that I'm very tall and weigh about 350 pounds. But I've always felt different - wondered if something's missing from my soul. I have no memory of the operation, and never had the courage to ask my family about it.
So [recently] I set out on a journey to learn everything I could about my lobotomy...It took me years to get my life together. Through it all I've been haunted by questions: 'Did I do something to deserve this?, Can I ever be normal?', and, most of all, 'Why did my dad let this happen?'
Howard Dully during his ice-pick lobotomy, Dec. 16th, 1960.
(George Washington University Gelman Library)
(George Washington University Gelman Library)
Dully's mother had died when he was 5
years old, and his father subsequently remarried a woman named Lou.
Freeman's notes later revealed that Lou Dully feared her stepson, and
described him as "defiant and savage-looking". According to the notes:
He doesn't react to either love or punishment. He objects to going to to bed but then sleeps well. He does a good deal of daydreaming and when asked about it says 'I don't know.' He turns the room's lights on when there is broad daylight outside.
Freeman recorded the events leading up to Dully's lobotomy:
[Nov. 30, 1960] Mrs. Dully came in for a talk about Howard. Things have gotten much worse and she can barely endure it. I explained to Mrs. Dully that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband, that I would have to talk with him and make it stick.
[Dec. 3, 1960] Mr. and Mrs. Dully have apparently decided to have Howard operated on. I suggested [they] not tell Howard anything about it.
Following the operation, the notebook reads:
I told Howard what I'd done to him...and he took it without a quiver. He sits quietly, grinning most of the time and offering nothing.
Now in his late
fifties, Dully works as a bus driver in California. About 40 years after
his lobotomy, he discussed the operation with his father for the first
time. He discovered that it was his stepmother who had found Dr.
Freeman, after being told by other doctors that there was nothing wrong,
and that his father had been manipulated by his second wife and Freeman
into allowing the operation to be performed.
It was largely because
of Freeman that the lobotomy became so popular during the 1940s and
'50s. He travelled across the U. S., teaching his technique to groups of
psychiatrists who were not qualified to perform surgery. Freeman was
very much a showman; he often deliberately tried to shock observers by
performing two-handed lobotomies, or by performing the operation in a
production line manner. (He once lobotomized 25 women in a single day.)
Journalists were often present on his "tours" of hospitals, so that his
appearance would end up on the front page of the local newspaper; he was
also featured in highly popular publications such as Time and Life. Often, these news stories exaggerated the success of lobotomy in alleviating the symptoms of mental illness.
Consequently, the use
of lobotomies became widespread. As well as being used to treat the
criminally insane, lobotomies were also used to "cure" political
dissidents. It was alleged that the procedure was used routinely on
prisoners against their will, and the use of lobotomies was strongly
criticised on the grounds that it infringed the civil liberties of the
patients.
An excellent account of
the effects of lobotomy, and of the ethical implications of the use of
the procedure, can be found in Ken Kesey's book One Flew Over the Cuckoo's Nest. (This was made into a film
in 1975, by Milos Forman, who received the Academy Award for Best
Director. Jack Nicholson won the award for Best Actor in a Lead Role.)
The use of lobotomies
began to decline in the mid- to late-1950s, for several reasons.
Firstly, although there had always been critics of the technique,
opposition to its use became very fierce. Secondly, and most
importantly, phenothiazine-based neuroleptic (anti-psychotic) drugs,
such as chlorpromazine, became widely available. These had much the same
effect as psychosurgery gone wrong; thus, the surgical method was
quickly superseded by the chemical lobotomy.
