I know so many bad jokes.
At least I didn’t invent them. Jimmy McKenzie was a bloody pest at the mental hospital because he went around shouting back at his voices. We could only hear one end of the conversation, of course, but the other end could be inferred in general terms at least from: “Away tae fuck, ye filthy bastard!”
It was decided at one and the same time to alleviate his distress and ours by giving him the benefit of a leucotomy. An improvement in his condition was noted. After the operation, he went around no longer shouting abuse at his voices, but: “What’s that? Say that again! Speak up ye buggers, I cannae hear ye!”
R.D. Laing, “The Bird of Paradise.”
1890 – Friederich Golz calms dogs by cutting their brains.
1935 – Following demonstration by Jacobson and Fulton that frontal lobe mutilation produced a “calming effect” in monkeys, Antonio Egas Moniz cut the frontal lobes of 20 of his psychiatric patients and reported a similar “calming” effect.
1936 – Walter Freeman and James Watts introduce a surgical technique for frontal lobe lobotomy into the USA. Early techniques involved drilling burr holes; later Freeman developed his transorbital approach, pushing an icepick into the brain via the eye sockets.
1942 – The icepick lobotomy has spread worldwide and approximately 5,000 people are lobotomised each year during the 1940s.
1949 – Egas Moniz wins the Nobel Prize for his lobotomy techniques.
Is lobotomy a thing of the past? According to Kaplan and Sadock (1997), we have the following “facts”:
- “The major indication for psychosurgery (lobotomy) is the presence of a debilitating, chronic mental disorder that has not responded to any other treatment.”
- “A reasonable guideline is that the disorder should have been present for five years…”
- “Chronic intractable major depressive disorder and obsessive-compulsive disorder are two disorders reportedly most responsive to psychosurgery.”
- “The presence of vegetative symptoms and marked anxiety further increases the likelihood of a successful therapeutic outcome.”
- “When patients are carefully selected, between 50 and 70 per cent have significant therapeutic improvement with psychosurgery.”
- “As measured by intelligence quotient scores, cognitive abilities improve after surgery…”
Rosemary Kennedy, sister of J.F. Kennedy, was given the miracle cure of the frontal lobotomy to help “cure” her aggressive impulses. The operation was considered a success, and Rosemary was sent off to a convent for care, owing to the small detail that she was totally unable to care for herself.
Rose Williams, the sister of Tennessee Williams, also had a lobotomy in 1943 following a series of mental breakdowns and a diagnosis of schizophrenia. The operation was considered a failure, and Rose was disabled for life. Tennessee Williams later became an alcoholic.
Walter Freeman found that the easiest method of lobotomy involved only a local anaesthetic and a slight tap of a hammer to drive the icepick through the eye orbit and into the skull. A swift swishing motion would render the patient subdued, possibly permanently. Modern techniques claim to be more efficient and less damaging, involving radioactive implants, proton beams, cryogenesis, and ultrasonic waves.
Between 1939 and 1951, over 50,000 lobotomies were performed in the US alone. The enthusiasm for lobotomies in Europe provided many more surgically adjusted brains and, thus, more adjusted citizens. The Japanese recommended it for difficult children, and many countries offered the procedure to convicts.
It is often said in defence of lobotomy that the vigour with which it was taken up reflects the desperation of the medical profession in attempting to treat chronically ill psychiatric patients. Hmmm…
The earliest procedures involved open operations with excision of both frontal lobes or disconnection of the frontal lobes from the remaining brain using a blunt instrument. These procedures were associated with high complication rates, including intellectual impairment, personality change, seizures, paralysis, and death.
Walter Freeman, himself with no surgical qualifications, recorded details of 3,439 lobotomies he carried out. His final lobotomy in 1967 resulted in a fatal haemorrhage. Freeman died in 1972 at the age of 76.
Probably fewer than 20 psychosurgical operations are now carried out each year in the United States. These procedures use laser or radiation to create lesions in the cingulate gyrus, a region associated with obsessive-compulsive disorder. Based on Fulton’s ideas, Moniz proposed cutting fibres connecting the frontal cortex to the thalamus to inhibit repetitive thoughts.
Moniz, who developed many neurological techniques, including cerebral angiography, took early retirement after being confined to a wheelchair, having been shot in the spine by one of his patients.