The History of Frontal Lobotomy

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The word lobotomy comes from two Greek terms lobos which means the brain’s robes, and tomos which means to cut. Lobotomy is a psychosurgical practice that involves destroying the connections of the prefrontal cortex of the brain. It originated from Europe in the early twentieth century (Dully & Fleming 76).

The theory behind this procedure is that, the destruction causes some form of detachment in the brain’s emotional basis which is found in the sub-cortical structures. Lobotomy was done on the first human beings around 1890. During that period, it was viewed as a miraculous cure for mental illness. This view increased its popularity and led to its extensive usage. In the1940s, about 40,000 patients underwent lobotomy in America, and about10, 000 patients went through the operation in Europe.

The popularity of lobotomy increased greatly as most people believed that it was the solution to numerous social problems such as overcrowding in asylums as well as the long-term costs that were incurred while caring for patients with mental problems. Moreover, several psychiatrists viewed lobotomy as less severe than other therapies such as insulin.

Modern lobotomy originated from animal experiments in the early 19^th century. Friedrich Goltz, a German physiologist, performed surgeries in the neocorrtex of dogs. This was done between1834 and 1902. In his report, Goltz wrote that, the dogs with big lesions in their front part of their brain presented a universal change in character, in that, they became agitated and relatively become furious. On the other hand, he noticed that the dogs with bigger lesions on their occipital lobe were charming and harmless even though some were previously very cruel.

Gottlieb Burkhardt, who owned a hospital for the mentally ill in Switzerland, was provoked by Goltz’s findings, to involve cutting of the cortex while treating his patients. In 1890, Burkhardt performed this surgery in the brains of six mental cases. Later, one of these patients passed on while another on took away his own life.

The two deaths happened within one week after the surgery. Gottlieb published an account of his operations and presented his outcomes to the Berlin Therapeutic Congress. However, he encountered severe hostility and opted to discontinue with this kind of brain surgery, even though he felt that his attempt was fairly successful (Menninger & Nemiah 44).

A Portuguese neurologist named as António Egas Moniz brought about tremendous improvement within the leucotomy practice. He was among the founders of this form of brain surgery and was awarded a Nobel Prize in the field of medicine in 1949 for discovering the significance of lobotomy in dealing with some psychological problems (Valenstein 23).

The advancement of leucotomy by Moniz came at a time when other therapeutic measures were considered to be intense, temporal and presenting grave danger to the patients’ wellbeing. In 1927, Moniz was greatly applauded for his work on brain angiography which involved a radiographical practice of the brain’s blood vessels. He was able to achieve this even though he had very little experience in clinical psychiatry. Moniz is also known for inventing the word psychosurgery (Menninger & Nemiah 48).

Moreover, in the year 1935 in Santa Marta Hospital in Lisbon, Moniz came up with prefrontal leucotomy, which was performed by the neurosurgeon Pedro Almeida Lima under his instructions. The process entailed piercing a few openings in a patients’ cranium and adding alcohol through these openings with the aim of destroying the affected tissue in the front part of the brain. Later on, Moniz came up with another technique which involved the use of a leucotome, a surgical device meant for cutting the affected brain tissue.

In 1936 Moniz in collaboration with Lima executed the operations on about twenty one patients, majority of whom were middle aged and availed their findings within the same period.

According to their findings, a third of the patients recorded tremendous improvement, another third improved fairly, while no transformation was noticed among the other patients. Among these surgeries, the best results were recorded in the patients who presented mood problems while the most discouraging outcomes were recorded in schizophrenic individuals.

The majority of these patients were diagnosed with cases of depression, catatonia, schizophrenia, obsessions, panic disorders as well as frenzied depression. Most of the patients were seen to portray outstanding indications of anxiety and temper. In addition, majority of the patients had a record of a relatively short duration of the illness prior to the procedure.

However, a few had been ill for a longer period of time, ranging from one to twenty two years. Follow-up sessions took place soon after the surgery. The side effects noticed were not as much as those in Burckhardt’s operations, as no seizures or casualties were recorded. Fever was the only form of complication with a high record (Dully & Fleming 81).

The theoretical bases of Moniz’s psychosurgery were to a great extent similar to those in Burckhardt’s theories during the nineteenth century. Moniz analyzed his new neurological study with regards to the old psychological approach of associationism, even though he referred to both Ivan Pavlov’s conditioned reflex theory as well as Ramón y Cajal’s neuron theory in his findings.

This notwithstanding, moniz varied significantly from Burckhardt in that, he did not think that there were any physical anatomical pathology in the brains of the mentally ill. According to him, their neural pathways were only involved in fixed and harmful courses. In 1936, Moniz wrote that mental problems are related to the development of cellulo-connective structures. The cellular bodies are likely to remain ordinary and their cylinders lack anatomical changes.

However, their numerous links which are variable in the normal individuals may portray some fixed arrangements, which relate to constant thoughts and deliria in some melancholic intuitive situations. Moniz was for the view that the brain would adjust to such damage functionally. His operations presented mixed feelings among the public. All in all, Moniz operated on about fifty patients after which he wrote his findings and presented them to other doctors in London. He died in1949 after being shot by one of his patients (Lutz 23).

After the death of Moniz, another neurologist, Walter Freeman came to the limelight in regards to lobotomy. Freeman had been a keen follower of Moniz and was later to become the chief supporter of lobotomy in America. In 1936, together with another neuralsurgeon James Watts, Freeman polished the procedure developed by Moniz.

They came up with the word lobotomy to stress the fact that only the grey and white matters were being damaged. Their refined procedure involved putting a blunt appliance inside some holes formed through the cranium and moving them to destroy the thalamo-cortical fibers.

However, this did not go on for long as Freeman regarded this procedure as chaotic and slow. He therefore came up with a faster procedure known as ‘ice-pick’ lobotomy and executed it in 1945. The procedure was known as ‘ice-pick as the appliance used looked like the one used to break ice. This new method was faster and involved making the patient to lose consciousness through the use of an electric shock and inserting a gadget over the eyeball by means of a hammer.

On entering the brain, the gadget was repeatedly moved sideways. This process was also referred to as transorbital lobotomy. Besides being faster, the procedure had other advantages. For instance, it did not involve the use of anaesthesia, and it could be done far from the hospital environment where patients did not need any hospital confinement later (Lutz 28).

Habitually, Freeman did his operations in his office in Washington D.C, something that annoyed his colleague Watts, who detached from him and the lobotomy practice. During his career, Freeman operated on about 3,500 patients who presented both positive and negative end results. At one instance, Freeman performed a lobotomy on Rosemary, a sister to the former US President John F. Kennedy. However, this operation was not successful as Rosemary was incapacitated during the process.

In general, Freeman highly contributed to the widespread of lobotomy. As a matter of fact, he travelled widely in an attempt to teach the procedure to other psychiatrists. In some occasions, he shocked people by performing very many lobotomies in a day. These tours were often characterized by the presence of journalists who published his work.

As a result, the use of lobotomy spread widely. It was performed on a variety of patients who included political rebels as well as people who were criminally insane. It was said that the operations were even done to unwilling prisoners. By the year 1951, about twenty thousand cases of lobotomies had been executed in America.

The popularity of lobotomies began to drop in the late 1950s. For one, the procedure was said to violate the patient’s civil rights and thus was highly discouraged. On the other hand, during this period, there was a rampant introduction of anti-psychotic medication in psychiatry which had the same effect as lobotomies and was thus preferred by many. These factors led to the gradual extinction of lobotomy (Valenstein 23).

In conclusion, the innovation of lobotomy led to a reduction of asylum usage whose therapeutic measures on mental patients were extreme and paused severe health risks. It also led to the reduction of the overall cost of caring for people with mental problems.

As a matter of fact, the innovation of lobotomy enhanced psychiatrists’ intellectual environment in the medicine field, allowing most surgical procedures to emerge as practical endeavors. Moreover, since the adoption of lobotomy, many psychiatrists have gained more confidence in handling the interior part of the brain.

Works Cited

Dully Howard, and Fleming, Charles. My Lobotomy. New York: Broadway, 2008. Print.

Lutz, Peter. The Rise of Experimental Biology: An Illustrated History. New Jersey: Humana Press, 2010. Print.

Menninger, Roy and Nemiah, John. American Psychiatry After World War II. Washington, D. C: American Psychiatric Press, 2000. Print.

Valenstein, Elliot. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York : Basic Print.

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The History of Frontal Lobotomy

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