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Lobotomy

Lobotomy The process of lobotomy was based on several decades of experimental and clinical evidence. Lobotomy is a neurosurgical procedure in which the nerve fibers in the bundle of white matter in the frontal lobe of the brain are severed to interrupt the transmission of various affective responses. It is seldom performed, because it has many unpredictable and undesirable effects. This includes personality change, aggression, socially unacceptable behavior, incontinence, apathy, and lack of consideration for others. Because lobotomy is simple to perform, it was over used in the treatment of mentally ill patients in the past. This process is a form of psychosurgery. The effectiveness of such procedures has never been adequately evaluated. The availability of many antipsychotic drugs has greatly reduced the use of this surgery. A few surgeons still use it for severe emotional problems. In all states of the United Sates there are special boards that review all of the proposed operations. A Portuguese neurologist Egas Moniz experimented with the fact that, the frontal lobes led to psychiatric disease. Disrupting these connections could lead to a cure. He performed this 1935, he injected the white frontal lobes with alcohol. In 1949 he received the Nobel Prize for this new discovery. This new procedure spread like wild fire throughout the U.S. By 1950 286 hospitals were using this procedure on 18,000 patients. At a conference in London, John Fulton brought in two chimpanzees. He had completely removed the entire frontal lobes from these two animals. They seemed to be very calm and quiet. Moniz and Freeman were both in attendance that day. In September 1935 Moniz participated in the first surgery with Almeida Lima. Thy injected alcohol into the frontal lobes, they were trying to destroy the fiber that connected the frontal lobes. They concluded that that area had something to do with social behavior. Moniz was somewhat disappointed because they seemed a lot duller than before. He also noticed many more side affects of nausea disorientation and sluggishness. Later on he director of the hospital put an end to the experimentation due to moral rights and controversy of the time. Egas Moniz popularized the procedure in 1935 to control overly aggressive behavior or violent behavior. In some cases the individuals became inactive. There is also a story about an Irishman named Phineas Gage, in a rock explosion he had an iron bar go through his brain. It was extracted. But his personality had changed drastically. This started new interest. Doctors started to experiment with this area of the brain. In 1890 Gottlieb Burkhart drilled holes in the heads of six patients and extracted parts of the brain. Two of them died but the others had survived and had changes in their behavior. Dr. Walter Freeman practiced lobotomy with much enthusiasm. He also invented new ways of extracting the brain such as the ice pick procedure. Freeman followed in the footsteps of Moniz after studying his reports and the lobotomies. Freeman and Watts came together and performed the surgery, which consisted of making six holes in the head. The woman was sixty-three. Later after the surgery she was fine. A week later she seemed to lose control and couldn’t function as properly as before a week later she was fine and her speech returned to normal. All of their patients who included the next six had the following in common: worry, apprehension, anxiety, insomnia, nervous tension. After the surgery the doctors reported that they no longer had disorientation, confusion, phobias, hallucinations, and delusions had been relieved. The original procedure was modified in 1937 to involve severing almost all the nerve tracts connecting the prefrontal lobes with the rest of the brain. Although the operation was hailed as a major advance in treating severely emotionally ill patients, physicians realized in the late 1940s that many patients were transformed by the lobotomy into inactive individuals without initiative. Some out of the many surgeons and psychosurgeons included in this phenomenon were Dr. Freeman, Dr. Moniz and Dr. Watts. Watts was the surgeon and Freeman often observed ad made sure everything was okay. During the latter part of 1937 they, dr. Freeman and dr. Watts came up with the “Freeman-Watts Standard Lobotomy.” The brain was approached from the lateral surface of the skull rather than the top, as in the Moniz procedure. “Burr” holes were drilled in both sides of the cranium at points designated by distances in millimeters from “landmarks” on the skull. A six-inch cannula, the tubing from a heavy gauge hypodermic needle, was inserted through one hoe and aimed toward the hole on the opposite side of the head. The cannula was inserted about two and a half inches into the brain and, if no fluid oozed out (fluid indicating that the anterior horn of the lateral ventricle had been penetrated), it was lowered to the bony (sphenoidal) ridge at the base of the skull. The cannula was then withdrawn, and a blunt spatula-much like the calibrated butter knife-was inserted about two inches into the track left by the cannula. Care had to be taken to avoid damaging major arteries located near the midline of the brain. After the spatula was inserted, it’s handle was swung upward so that the blade could be drawn along the base of the skull, and a cut was made as far to the side as possible. The spatula was than withdrawn, and the site was rinsed. That was the first of four quadrants to be cut-two on each side of the brain. They worked under local anesthesia. They often spoke to their patients and asked them to sing or subtract simple numbers. (149-151) There were many other procedures besides that of Freeman and Watts. Other doctors used fluids for prefrontal lobotomy and others used and open surgery approach so they could look directly at the nerves they were cutting. They also were credited for the ice-pick procedure. It was a trans-orbital way. Which meant penetrating the orbital bone, which meant through they eye socket. This meant no holes and only a headache and black eyes for the patient. They were trying to go through the eye sockets and then do the job to the brain but they couldn’t figure out how to get tin there. Then one-day freeman thought of using a simple ice pick. And t worked. With a few minor adjustments to the ice pick they stared to perform the ice pick lobotomy. At this point freeman started to experiment on his own. Watts found that this procedure was very brutal and threatened to break off working with Freeman. A neurosurgeon in Jacksonville Florida developed a procedure that made it possible to the brain area being destroyed. J G Lyerly approached the brain from the top of the skull. He created the opening in the depth of the brain by using long tweezers or forceps. Then he would use light and a small knife he would cut the nerve fibers under direct observation. (151) Nearly half of his patients consisted of prison inmates. A specific hospital, Stockton State Hospital, had about four thousand patients and eleven physicians. The physicians needed order to concentrate on patients with major problems. Some patients simply were out of control. In order to calm patients down they would perform lobotomy due to the lack of staff in the hospital. This procedure did not always work on patients. In some cases lobotomy was performed more than once. During these times women were supposed to be a certain way, therefore they performed the surgery on more women than men. Bibliography: Work Cited Braslow, Joel. The Western Journal of Medicine. British Medical Association, 1999 http://Galenet.galegroup.com. Lewis, Thomas H. Psychosurgery: Damaging the Brain to save the Mind. JAMA, The Journal of the American Medical Association, Feb. 24, 1993. Academic Search Premier. EBSCO Publishing Berkeley College Lib., West Paterson, NJ. 23 Nov. 2001. http://search.epnet.com. Resnick, Susan Kushner. In the Graveyard of Western Medicine-Lobotomy. East West Natural Health. May-June 1992. Academic Search Premier. EBSCO Publishing. Berkeley College Lib., West Paterson, NJ. 23 Nov. 2001. http://search.epnet.com. Valenstein, Elliot S. Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. New York: Basic Books, Inc., Publishers, 1986. Vertosick Jr., Frank T. Lobotomy’s Back. Discover, Oct.97, Vol. 18 Issue 10. Academic Search Premier. EBSCO Publishing. Berkeley College Lib., West Paterson, NJ. 23 Nov. 2001. http://search.epnet.com. Youngson, Robert and Ian Schott. Medical Blunders: The History of Lobotomy. http://www.scc.net/~1kcmn/lobotomy/lobo/brif.html.

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