Lobotomy

Lobotomy There are many types of brain lesions, some from genetic defects, some from disease, and others from trauma. A lobotomy or leukotomy is a lesion of the brain that does not occur in any of those instances. A lobotomy is a surgical procedure intentionally performed on an individual in an attempt to help correct psychological problems. Since its inception in 1888, it has been a much studied thought in controlling psychosis in severely disturbed patients. In 1935, it became a prevalent procedure for the next two decades, sparking much interest, controversy, and further medical study. This essay will outline the various updates in procedures and the minds that have been analyzing this idea; some of the controversies surrounding the concept and provide a general overview of this procedure which literally slices into the brain to sever connections. One of the pioneers in this procedure was Antonio Egas Nomiz. He won the Nobel Prize for Physiology or Medicine of 1949 "for his discovery of the therapeutic value of leucotomy in certain psychoses “ Antonio Nomiz was responsible for coining the term psychosurgery. Nomiz’s lobotomy originally began as the drilling of holes into a patients head and destroying tissue in the frontal lobe first by the injection of alcohol. In later years, Nomiz (carried out through the hands of neurosurgeon Pedro Alemeida) , changed his technique by cutting the brain tissue of the frontal lobe using a rotating retractable wire loop called a leucotome. Between November 1935 and February 1936, Nomiz and Alemeida carried out his procedures of a lobotomy on twenty patients, publishing their findings in the same year. He was cited as saying “The removal of these aberrant and fixed pathological brain circuits, therefore, might lead to some improvement in mental symptoms.” Moniz believed that the brain would be able to adapt to such injury and in essence, repair the damaged pathways. Another pioneer in the area of the lobotomy was an American neurologist and psychiatrist by the name of Walter Freeman. He was intrigued by the work of Moniz and performed his first prefrontal lobotomy in 1936. He began his own procedure by entering the brain through the eye cavity rather than through the skull. His experimentation began on grapefruit in his own kitchen using an ice pick and graduating to cadavers using an instrument of the same orientation. Freeman hoped to turn lobotomies into a procedure that could be done without anesthesia and in a clinical setting rather than surgical setting. This new procedure of Freemans was referred to as a “trans orbital” lobotomy and involved lifting the upper eyelid and placing the surgical instrument (orbitoclast – similar to the ice pick Freeman first experimented with) under the eyelid and against the top of the eye socket. A mallet was then used to drive the instrument through the layer of bone and into the brain along the bridge of the nose, roughly 15 degrees toward the longitudinal fissure…”The orbitoclast was mallated five centimeters into the frontal lobes, and then pivoted forty degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimeters into the brain, before being pivoted around twenty eight degrees each side, to cut outwards and again inwards (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of interhemispherical fissure; the "Deep frontal cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus”. The orbitoclast was then withdrawn and the procedure repeated on the other side. Such an extreme procedure in the attempt to control psychological disorders as you can imagine, did not continue without much criticism. This procedure was relatively crude and involved cutting large areas of white matter tracts. It was used quite frequently in the 1950’s and as early as 1944 an author in the Journal of Nervous and Mental Disease remarked: "The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance.” It became a topic of conversation after the portrayal of Jack Nicolson in the movie “One Flew over the Cuckoo’s Nest” in 1975. President John F. Kennedy’s sister, Rosemary, underwent a lobotomy at the age of 23 and was rendered incapacitated as a result of the procedure. The USSR banned the procedures in 1950 and in 1977 the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research created the US Congress investigated psychosurgical research (to include lobotomies) and determined that the procedure could have a positive effect but in a very limited realm. The practice of lobotomies had all pretty much ceased at this time. Nancy Andreasen, M.D., Ph.D., describes modern psychosurgery in her book from 1984 called “The Broken Brain: The Biological Revolution in Psychiatry,” as such. "Whereas the older technique of `prefrontal lobotomy' involved cutting large amounts of white-matter tracts, the modern technique of psychosurgery emphasizes the selective cutting of very tiny and quite specific portions of the tracts connecting the cingulate gyrus to the remainder of the limbic system. This technique is assumed to break up the reverberating circuits of the limbic system and thereby stop the self-perpetuating cycle of emotional stimulation [emphasis added]" (Harper & Row, p. 214). The manipulation of the brain will continue on, whether in the form of a lobotomy or neurological mapping via PET scans. One thing is for certain. Technology has made much advancement in the understanding of the human brain from the days of Moniz and Freeman. An assistant to Freeman was noted in saying that he would not even leave the room in which a patient’s lobotomy was performed; he would simply shock them to the point of losing consciousness, wait for the convulsions to cease, perform the lobotomy and wait for the next patient to be wheeled in. His description of a patients behavior and appearance after the procedure is shocking. Fortunately, science has made many advancements and procedures as radical as this must undergo much more research as to side effects and possible risks than were available in earlier years. Our understanding of the human brain has evolved greatly from the days of Phineas Cage and his “accidental lobotomy.” Back in the 1950’s, a lobotomy was a cutting edge procedure. Imagine where we will be in another 60 years.