Lobotomy

A lobotomy, or leucotomy, is a form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex. Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed. It was used for psychiatric and occasionally other conditions as a mainstream procedure in some Western countries for more than two decades. This was despite general recognition of frequent and serious side effects. While some people experienced symptomatic improvement with the operation, the improvements were achieved at the cost of creating other impairments. The procedure was controversial from its initial use in part due to the balance between benefits and risks. Today, lobotomy has become a disparaged procedure, a byword for medical barbarism and an exemplary instance of the medical trampling of patients' rights. The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the 'discovery of the therapeutic value of leucotomy in certain psychoses', although the awarding of the prize has been subject to controversy. The use of the procedure increased dramatically from the early 1940s and into the 1950s; by 1951, almost 20,000 lobotomies had been performed in the United States alone and proportionally more in the United Kingdom. The majority of lobotomies were performed on women; a 1951 study of American hospitals found nearly 60% of lobotomy patients were women; limited data shows 74% of lobotomies in Ontario from 1948–1952 were performed on women. From the 1950s onward lobotomy began to be abandoned, first in the Soviet Union and Europe. The term is derived from Greek: λοβός lobos 'lobe' and τομή tomē 'cut, slice'. The purpose of the operation was to reduce the symptoms of mental disorder, and it was recognized that this was accomplished at the expense of a person's personality and intellect. British psychiatrist Maurice Partridge, who conducted a follow-up study of 300 patients, said that the treatment achieved its effects by 'reducing the complexity of psychic life'. Following the operation, spontaneity, responsiveness, self-awareness and self-control were reduced. Activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range. The consequences of the operation have been described as 'mixed'. Some patients died as a result of the operation and others later committed suicide. Some were left severely brain-damaged. Others were able to leave the hospital, or became more manageable within the hospital. A few people managed to return to responsible work, while at the other extreme people were left with severe and disabling impairments. Most people fell into an intermediate group, left with some improvement of their symptoms but also with emotional and intellectual deficits to which they made a better or worse adjustment. On average, there was a mortality rate of approximately 5 percent during the 1940s. The lobotomy procedure could have severe negative effects on a patient's personality and ability to function independently. Lobotomy patients often show a marked reduction in initiative and inhibition. They may also exhibit difficulty putting themselves in the position of others because of decreased cognition and detachment from society. Immediately following surgery, patients were often stuporous, confused, and incontinent. Some developed an enormous appetite and gained considerable weight. Seizures were another common complication of surgery. Emphasis was put on the training of patients in the weeks and months following surgery. Walter Freeman coined the term 'surgically induced childhood' and used it constantly to refer to the results of lobotomy. The operation left people with an 'infantile personality'; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the 'personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist'. He described one 29-year-old woman as being, following lobotomy, a 'smiling, lazy and satisfactory patient with the personality of an oyster' who couldn't remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behaviour, Freeman advised a system of rewards (ice-cream) and punishment (smacks).