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Nobelmen: the lobotomy

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The Prize:

The 1949 Nobel Prize in Physiology or Medicine was shared between Walter Rudolf Hess for “his discovery of the functional organization of the interbrain as a coordinator of the activities of the internal organs” and Antonio Caetano de Abreu Freire Egas Moniz for “his discovery of the therapeutic value of leucotomy (lobotomy) in certain psychoses.”

The Science:

It’s hard to imagine that lobotomy was once considered a revolutionary achievement worthy of the Nobel Prize considering it is so maligned today. The 1962 novel, One Flew Over the Cuckoo’s Nest, characterized the procedure as a “frontal-lobe castration” for the vegetative state that some patients experience after surgery. Yet between 1930 and 1970 as many as 100,000 people worldwide underwent lobotomies, the popularity of which peaked in the 1940s.
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At the beginning of the 20th century, there was wide acceptance that through lobotomies, mental illness could be reversed, that such illness was a result of aberrant physiology, and that the mentally ill could be treated and cured.

Of course, the treatments of the day were no less appealing. Patients were shocked with a variety of mechanisms—insulin to induce hypoglycemic shock, cardiazol (a stimulant) for seizures, malaria to induce fever (awarded a Nobel Prize in 1927), and of course, electro-convulsive therapy—all as a means of treating psychiatric disorders. Mental asylums at this time were understaffed, crowded places full of patients with little hope of ever leaving.

In 1927, two scientists demonstrated that chimpanzees that had undergone lobotomy (severing the neural connections to and from the front part of the brain) were more passive than they had been before surgery.

The same type of surgery had been performed on humans since the late 19th century, with mixed results until 1935, when Egas Moniz began developing the modern lobotomy in Lisbon, Portugal. Moniz’s surgery, performed by a neurosurgeon, involved drilling through a patient’s skull and into the frontal lobe of the brain. The brain was exposed to a solution of alcohol, or a specialized instrument Moniz developed to destroy the brain tissue. This resulted in a brain injury that Moniz believed would remove the diseased brain circuits and allow the brain to recover healthy function.

Although Moniz was not the first to develop this type of surgery, his work was certainly the best received. He was already well known in the medical community for developing cerebral angiography, a technique using X-rays to view blood vessels in the brain. This early success delivered his lobotomy results a large, captive audience.

The patients Moniz treated with what he called psychosurgery suffered from debilitating mental illnesses such as depression, mania, schizophrenia, and panic disorder in a time when few alternative treatments existed. Among his first patients, 35 per cent saw improvement in their symptoms. An additional 35 per cent improved little, and the final 30 per cent of patients showed no change at all in their conditions.

After a lobotomy, patients with obsessive-compulsive disorder seemed to feel relief from their symptoms, while patients with anxiety and mood disorders appeared more like themselves. However, studies of post-operation success rates are often flawed by the doctor’s bias. A lobotomy can calm a patient to make them easier to manage in asylums, but whether this improved the patient’s life is still hotly debated. Many patients experience side-effects of extreme docility (almost zombie-like), childishness, apathy, and in some cases, aggressive tendencies.

The surgery was further developed by neurologist-neurosurgeon team, Walter Freeman and James Watts, in America. Freeman and Watts heard of Moniz’s results and decided to bring the surgery home to America—albeit with some changes. The Freeman-Watts prefrontal lobotomy became known as the “precision” method.

Freeman, inspired by an ice pick from his kitchen, evolved the lobotomy procedure using a specialized instrument to drive through to the brain via the eye-socket. Once in the brain, the instrument cut the connections between the frontal lobe and the thalamus. This became known as the “transorbital” lobotomy. Freeman developed this method to reduce the expense and time required for a neurosurgeon to perform a lobotomy. A psychiatrist could perform the transorbital lobotomy in the mental asylums where afflicted patients lived.

Doctors sometimes performed transorbital lobotomies on patients that had not been anaesthetized. Instead, these patients were knocked unconscious by electroconvulsive therapy before their lobotomy. This new method and turning lobotomy into a simple “office procedure” so offended Watts that it ended the Freeman-Watts partnership.

In the 1940s, the lobotomy was a popular choice for the treatment of mental illness. In 1952, the number of lobotomies dropped drastically with the development of chlorpromazine, the first anti-psychotic drug effective against schizophrenia and mania.

The Significance

From its very beginnings, lobotomy was controversial. Many psychiatrists felt that the procedure was too crude to be used widely. Others felt that it had only a small chance of relieving mental illness and a high risk of further complicating a disorder or drastically changing the personality of the patient. By 1950 it was banned in the USSR and slowly phased out in many other countries.

At its height, pre-frontal lobotomy was performed on all types of mental illness. After the Second World War, mental asylums were full of homosexuals, women with “sexual dysfunctions,” people with epilepsy, and returning soldiers suffering from post-traumatic stress disorder. Lobotomy was thought of a way to manage a large number of these patients, as well as make them able to return home.

During the ’70s and ’80s, lobotomies were performed on children with ADD, drug addicts, and “undesirables,” allegedly as a method of controlling the otherwise uncontrollable. In 1977, U.S. Congress appointed a committee to investigate complaints from civil rights groups that lobotomies were being performed on minority groups as a method of control.

It’s difficult to evaluate how many lobotomies are performed in Canada today, as numbers on individual surgeries are not readily available. They are still performed in some difficult-to-manage cases, but patients are thoroughly screened and the procedure is much more precise. It is covered by provincial health coverage and a number of centres across the country will perform them.