Lobotomy

I have heard of the crude treatments in the field of psychotherapy such as the use of electrocution and psychoactive drugs. However, lobotomies must top my list of horrific attempts to “cure” the mentally ill. The section in this chapter about Philieas Gage and the accident that damaged his prefrontal cortex sparked my curiosity about how scientist have attempted to purposely damage this area of the brain as treatment of mental ailments.

A lobotomy is a psychosurgical procedure in which the connections within and around the prefrontal cortex are severed, or the frontal cortical tissue is destroyed. The surgery is done with the goal of uncoupling the brain’s emotional center (the subcortical structure) from the “seat of intellect” (the frontal cortex), with goals of subduing aggressive behavior.

Lobotomies became a popular form of treatment for mental illness in the 1940s and 1950s. An estimated 40,000 patients underwent the procedure in an effort by the state to alleviate overcrowding in psychiatric institutions and reducing the cost of caring for mentally ill patients.

The first evidence of a link between the severing of the prefrontal cortex from the rest of the brain and increased docility was recorded by a German physiologist Friedrich Goltz. Goltz experimented on dogs and noted that the ones that underwent surgery became “sweet and harmless, even when they were quite nasty before”.

How this “crude” procedure made its transition from dogs to humans is a mixture of socio-economic forces that are difficult to appreciate from hindsight. There were indeed mixed results, proponents of the procedure touted how patients could be more easily controlled, less aggressive, and seemed to be more at ease. But patients also reported a loss of initiative and inability to process complex tasks. Some even suffer the same symptoms as Phileas Gage who develops a completely different personality.

Opponents of the operation pointed to crude methods of the procedure such as the “ice pick” method. This is whenthe patient rendered unconscious by electroshock, and an instrument was inserted above the eyeball through the orbit using a hammer. Once inside the brain, the instrument was moved back and forth; to sever and damage the tissues. The operation gained such popularity that a twelve-year-old boy was subject to an ice-pick lobotomy because of his stepmother could not deal with his rebellious behavior.

However, we should not be too quick to judge. This weekend I watched Martin Scorsese’s Shutter Island for the first time. At the end of the film, it is implied that Leonardo Dicaprio’s character be subject to a lobotomy as the cure of last-resort after his remission back into insanity. Before he walks away to the light house he says, “Which would be worse, to live as a monster or to die as a good man?” This is question that only the patient can ultimately answer, however, it is debatable whether the patient can even make a rational analysis after the procedure?

I think the film is a good statement for those that are quick to dismiss lobotomies as a crazy science-experiments that render patients into vegetables. Based on the information available at the time, it was a completely reasonable treatment option. The fact that was it was cost-effective, and easily performed only added to its popularity. What’s more, who’s to know that the operations we are performing today from liposuction to breast implants are not damaging to our health; or that genetic experiments concerning longevity and stem cells are not equally compelling moral hazards?