Hello everyone and welcome to this week's blog post. In this week's blog post, will be discussing a type of psychosurgery called a lobotomy. I will first explain what psychosurgery and a lobotomy is. I will then explore the history of this operation and the effects it has had on our society.
Psychosurgery
Psychosurgery is a field of surgery that aims at treating neurological disorders by severing connections between the frontal lobe and the rest of the brain. This type of surgery is also known as 'neurosurgery for psychiatric and mental health disease'. Developed in the 19th century, this type of surgery was often used to treat mental health disorders in the 20th century, especially those that were thought to involve the frontal lobe.
During much of the 20th century, psychosurgery was a common therapy used in mainstream psychiatric treatment. It was based on the idea that mental illnesses (such as feeling depressed and melancholic) were caused by defective synapses (i.e. connections between neurones) in the brain that allowed these 'diseased' thoughts to circulate. Doctors who practised this type of treatment hoped that by surgically severing these supposedly faulty synapses, the brain would be able to grow new, healthy synapses to replace them.
What is the history of the lobotomy?
The lobotomy was a type of psychosurgery that aimed to treat mental health disorders by removing the connections between the prefrontal cortex and the rest of the brain. The prefrontal cortex, which is the area of the brain that covers part of the frontal lobe, is the area of the brain that is involved in decision making, moderating social behaviour, expressing personality and complex behaviour that requires a lot of thinking. These functions are sometimes summarised by the term 'executive function'.
According to a report published in World Neurosurgery, humans have attempted to use physical techniques to alter mental states since the beginnings of recorded history. This may have begun with humans attempting to expose brain tissue by hitting the skull with flints, as early as 6,500 BCE. Nonetheless, the development of psychosurgery seems to have been started in the 19th century, by the Swiss psychiatrist Dr Gottlieb Burckhardt.
From 1888, Burckhardt conducting psychosurgery on six different patients (the first patient, for example, received 4 different procedures, which targeted different areas of their brain). Five of these patients had been diagnosed with 'primare Verrucktheit'. According to a paper published in the Journal of Neurosurgery, if these patients were alive today, it is likely that they would have been diagnosed with schizophrenia. Of these patients, Burckhardt reported that three saw an improvement in their symptoms, while one patient tragically died.
While Burckhardt discontinued this work after having published his research in 1891, this work likely encouraged future research into psychosurgery. Consequently, psychosurgery had developed into a neurological speciality by the early 20th century.
Although Burckhardt was likely the first doctor to experiment with psychosurgery, the Portuguese neurologist Dr Egas Moniz is attributed as the doctor responsible for psychosurgery becoming part of mainstream medicine.
One of Moniz's first contributions to psychosurgery was the invention of a type of surgery called the prefrontal leucotomy, which later became the lobotomy In collaboration with the surgeon Dr Pedro Lima, they drilled holes into the sides of patients skulls and used ethanol to destroy some white matter fibres connecting the frontal lobes to the rest of the brain. Later, Moniz changed the technique of the procedure to use a leuctome instead. This device contained a loop of wire, which allowed surgeons to remove brain tissue more precisely.
It is important to note that, according to the Guardian, Moniz only advised that this procedure be used as a last possible resort. Indeed, one of the reasons that this type of operation became so popular was that there were very few alternatives for treating schizophrenia and compulsive disorders. In many cases, patients were locked up in padded cells and forced to wear straitjacket in mental hospitals. This is one of the reasons that The Nobel Foundation still defends the controversial decision to award Moniz the Nobel Prize in 1949.
After Moniz published his research, the prefrontal leucotomy (also known as the lobotomy) increased in popularity, especially in the United States and in Italy. In addition, many other techniques of this procedure were developed. For example, the American neurosurgeons Walter-Freeman and James Watts developed the 'Freeman-Watts lobotomy'. In this procedure, holes were drilled in the skull and a rotating knife was used to destroy brain cells. These procedures, which aimed to cure mental diseases by severing links between the thalamus and prefrontal lobes in the brain, were often done blind (i.e. without imaging). This meant that the surgeons often didn't know exactly what they were cutting into.
In addition, an Italian doctor called Amarro Fiamberti developed a procedure that involved operating on the prefrontal lobes through the eye sockets. According to the Live Science magazine, this resulted in Freeman developing the 'transorbital lobotomy'. This procedure was radically different to the others as it did not require a surgeon, an operating room or anaesthesia. Instead, a modified ice pick (called an orbitoclast) was inserted through the eye socket and used disconnect the thalamus from the frontal lobes.
What was the impact of the lobotomy on society?
The lobotomy became a very common operation throughout the 1940s and 1950s. It is estimated that around 50,000 were performed in the United States alone, with Freeman performing as many as 5000 of them. In addition, the lobotomy also became a mainstream operation in the UK, with more than 1000 being conducted each year at its peak.
These operations had a huge impact on patients. Whilst some patients had some improvements in their condition, a huge proportion lost mental capabilities - a side effect known as 'mental dullness'. This meant that patients were not able to live independently, nor express their own personalities.
Despite some opposition to these procedures during the 1940s and 1950s, they remained central to psychaitric practice. As I mentioned before, one of the reasons for this could have been that there simply weren't many other treatment options for these diseases. Nonetheless, following the development of psychoactive drugs in the 1950s, the lobotomy was gradually removed from clinical practice.
In the 21st century, the lobotomy is a relatively rare proecudre. In stark contrast the the 1000s of lobotomies carried out each year at its peak, fewer than 150 psychosurgical operations are conducted in the United States each year. These operations, which aim to target specific areas of the frontal lobes are only used as a last resort if other techniques have been unsuccessful. For psychosurgery to be carried out today, doctors must feel that the risks of side effects do not outweigh the likely benefit from the procedure.
Sources:
Mashour, G., Walker, E., & Martuza, R. (2005). Psychosurgery: past, present, and future. Brain Research Reviews, 48(3), 409-419. doi: 10.1016/j.brainresrev.2004.09.002
Manjila, S., Rengachary, S., Xavier, A., Parker, B., & Guthikonda, M. (2008). Modern psychosurgery before Egas Moniz: a tribute to Gottlieb Burckhardt. Neurosurgical Focus, 25(1), E9. doi: 10.3171/foc/2008/25/7/e9
Robison, R., Taghva, A., Liu, C., & Apuzzo, M. (2012). Surgery of the Mind, Mood, and Conscious State: An Idea in Evolution. World Neurosurgery, 77(5-6), 662-686. doi: 10.1016/j.wneu.2012.03.005