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Lobotomy

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A lobotomy is a method of brain surgery designed to reduce or eliminate the severity of mental illnesses accomplished through the process of severing neural connections in the frontal lobe of the brain. Initially, lobotomies were preformed to aid those suffering from schizophrenia and other related mental illnesses. In many countries, preforming a lobotomy is an illegal process and is considered unproven to produce consistent beneficial results.[1] In about twelve countries, including the U.S.A and Great Britain, lobotomies are still utilized to treat anxiety and epilepsy. It is only prescribed, however, after every other medically sound option has been exhausted.[2]

Reasons for Prescription

A lobotomy is prescribed to a patient for a variety of mental and physical maladies. Some of the most common mental illnesses that required a lobotomy were schizophrenia and depression. As the apparent successes of lobotomies were publicized, the procedure became a common practice for dealing with rowdy or bellicose individuals.[1] The youngest of these individuals being twelve-year-old Howard Dully for rebelliousness towards his parents. Dully received his lobotomy in the year 1960.[3] A lobotomy was also administered to mitigate chronic lasting pain. Psychosurgeons of its heyday, such as Walter Freeman, claimed it was a panacea to all mental health problems. This growing "cure-all" view at times caused a lobotomy to be prescribed for less humanitarian reason, such as preforming on patients in order make more room in hospitals. In modern day, a lobotomy is usually only prescribed to individuals suffering from epilepsy, but only as a final resort.

History

Egas Moniz, inventor of the lobotomy

Before the development of the lobotomy, there were no formal guidelines of proper surgery on the brain. A popular belief of the time was that by modifying the structure of the brain, one could produce a desired effect on the patient's personality. [1] On Swiss surgeon, Gottlieb Burckhardt, dabbled with various methods of psychosurgery on six patients starting in the year 1888. By removing sections of their cerebral cortex, Burckhardt hoped to decrease the severity of the symptoms these six patients suffered from as a result of their mental illness. Due to his limited understanding of the brains function and less-than-optimal operating tools, only one patient of the six reported a positive result of the process. The remaining five either remained unchanged or were worse off than before.[4] Burckhardt was forced to halt any further experimental operations due to huge backlash from the medical community regarding the risk associated with his technique. Other psychologists and surgeons attempted other methods of psychosurgery, but were met with little result.

It was not until 1935 when Portuguese neurologist António Egas Moniz preformed the first lobotomy (referred to at the time as a leucotomy). [5] Moniz was inspired to pursue psychosurgery on humans after witnessing a procedure on two chimpanzees. These two chimpanzees exhibited a calm demeanor and few aggressive tenancies after their frontal lobes were removed surgically. Moniz figured a similar procedure could be preformed on humans as a treatment method for those suffering from mental illness or combative abidance. In November of 1935, Moniz and his assistants drilled several holes into the foreheads of patients to gain access to the brain. At first, alcohol was injected into the frontal lobe, but when this proved minimally effective they instead used an instrument with a wire (dubbed the leucotome) to sever neural connections in the frontal lobe. Moniz deemed most of the procedures a success after many patients exhibited lower levels of paranoia and schizophrenic episodes. Many of those same patients, however, appeared less interested in life in general as a result. The rise of mental illnesses during this time created a demand for lobotomies in medicine, restricting the sufficient amount of time needed to properly improve the procedure. By February of the following year, Moniz and his colleagues preformed a total of twenty lobotomies. [6] Psychologists took notice of Moniz's apparent success and began to develop different styles and methods for preforming lobotomies based on Moniz's work.

Types of Lobotomies

Pre-frontal

To preform a pre-frontal lobotomy, the neurosurgeon begins by drilling two holes through the patient's skull. Then, the doctor will insert a blunt knife through the holes and scrape away the white matter on the front of the brain. Originally, alcohol was injected to sever the synapses and their connections found in the white matter, but when this method proved less effective, it was replaced by the blunt edged tool. Dr. Egas Moniz helped to develop this method which gradually became known as the Freeman-Watts method as it further developed.[7] This method became standard procedure up until 1945 when the transorbital lobotomy became the new standard.

Transorbital

The transorbital lobotomy was first developed by Amarro Fianberti, an Italian psychiatrist, who injected alcohol through the eye sockets as opposed to newly drilled holes in the skull. This method was revised and popularized in America by Walter Freeman. Freeman's new method consisted of first rendering the patient unconscious through a series of electroshock treatments lasting two to three minutes. Next, the doctor continued by inserting a flat tool resembling an ice pick through the eye sockets above the eyes. To push the tool through to reach the brain, the end of the tool was struck repeatedly with a hammer to break through the thin section of bone. Once the tool, an orbitoclast, came in contact with the white matter, the doctor would move the tool up and down and side to side, thus scraping away the synapses within the brain. When the tool was pulled out, the lobotomy was complete. On occasion, the flimsy orbitoclasts would break off inside the patient's head during the procedure, forcing the doctor to retrieve it. Nevertheless, the speed and simplicity of the method (a typical transorbital lobotomy only took around ten minutes) caused the process to gain popularity in the United States.[8] [1]

Thorazine

The popularity of the lobotomy began to decline in the 1950s in part due to a new chemical drug on the market known to the public as thorazine.[7] Properly referred to as Chlorpromazine, is not a true lobotomy in the fact that there is not physical intrusion upon the brain through the use of a knife. Instead, thorazine blocks many post-synaptic receptors which transmit dopamine and other neurotransmitters, prompting a feedback loop. Since this drug achieves many of the same desired effects of a lobotomy, particularly schizophrenia, all without the goriness of transorbital intrusion has caused the drug to replace the medical practice of lobotomies in modern times. [9]

Side-Effects and Criticism

Rosemary Kennedy, sister of John F. Kennedy, received a lobotomy at a young age.

One of the most notable side-effects of lobotomies is the loss of cognitive abilities in a lobotomized patient. Soviet Russia went so far as to ban lobotomies for this reason in 1953. Those who receive lobotomies are commonly described as acquiring a mental state of aloofness, or general absent-mindedness. A loss of long-term memory has also been associated with lobotomies. [1] Lobotomized patients are also apparently unable to respond to an imaginary situation, and can only react to events occurring before their eyes.[10] Lobotomized patients further could not express a full range of emotions, occasionally suffered of epilepsy, incontinence, and decreased motor function.[11] In rare cases, patients die following a lobotomy. [12]

Ever since the introduction of the lobotomy into the medical realm, it has received criticisms from various groups. The criteria associated with prescribing a lobotomy was very loose; criminals were involuntarily given lobotomies hoping they would make the patient less inclined to commit crimes. Veterans from World War II were subjected to lobotomies as a quick fix to mentally fatigued individuals in order to free up space within hospitals.[1] Rosemary Kennedy, sister of former president John F. Kennedy, provides a notable example of a botched lobotomy. Rosemary was prescribed the lobotomy in attempt to curb her rebellious teenage behavior. Following the process, however, she was unable to speak understandably and her mental capacity was reduced to that of a two-year-old. In response to the tragedy, her sister, Eunice Kennedy, founded the U.S. Special Olympics in 1963. [2]

Video

The process and history of the transorbital lobotomy.

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Freeman, Shanna. How Lobotomies Work. How Stuff Works. Web. Accessed 29 March 2014.
  2. 2.0 2.1 Henley, Jon. The forgotten Kennedy. The Guardian. Web. Published 12 August 2009.
  3. Tartakovsky, Margarita. The Surprising History of the Lobotomy. PsychCentral. Web. Accessed 29 March 2014.
  4. Stone, James. Dr. Gottlieb Burckhardt the Pioneer of Psychosurgery. Taylor & Francis Online. Web. Published 20 May 2004.
  5. Tierney, Anne. Egas Moniz and the Origins of Psychosurgery: A Review Commemorating the 50th Anniversary of Moniz's Nobel Prize. Taylor & Francis Online. Web. Published 9 August 2010.
  6. Unknown Author. Moniz develops lobotomy for mental illness 1935. Public Broadcasting Service. Web. 29 March 2014.
  7. 7.0 7.1 “Mo”. The rise & fall of the prefrontal lobotomy. Science Blogs. Web. Published 24 July 2007.
  8. Acharya, Hernish. The Rise and Fall of the Frontal Lobotomy. University of Calgary. Web. Accessed 29 March 2014.
  9. Scott, Katherine. A Short History of Thorazine. KatherineScott. Web. Published 3 February 2011.
  10. Dewey, Russ. Effects of Lobotomies. IntroPsych. Web. Accessed 29 March 2014.
  11. Tarvin, Becca. The Lobotomy: An Old-school Mental Health Treatment. The Quad. Web. Published 16 April 2010.
  12. Duchen, Jessica. Music's boy wonder: Composer, conductor, singer... and he's only fifteen. The Independent. Web. Published 6 February 2008.

Mental illnesses