Lobotomy 46187 224023993 2008-07-06T23:49:06Z Therefore 266340 /* Literary and cinematic portrayals */ wikilink [[biopic]] & italics {{Expert-subject|Anatomy}} {{wiktionary}} [[Image:Human brain frontal (coronal) section.JPG|thumb|right|200px|An intact human brain.]] [[Image:Leucotomy.jpg|right|thumb|200px|A [[human brain]] that has undergone lobotomy.]] [[Image:Icepicks1.jpg|right|thumb|200px|Close up of "ice picks"]] A '''lobotomy''' ([[Greek language|Greek]]: lobos: [[Frontal lobe|Lobe]] of [[brain]], tomos: "cut/slice") is a form of [[psychosurgery]], also known as a '''leukotomy''' or ''leucotomy'' (from Greek leukos: clear or white and tomos meaning "cut/slice"). It consists of cutting the connections to and from the [[prefrontal cortex]]. These procedures often result in major personality changes and possible mental disabilities. Lobotomies were used in the past to treat a wide range of severe [[mental illness]]es, including [[schizophrenia]], [[clinical depression]], and various anxiety disorders, as well as people who were considered a nuisance by demonstrating behaviour characterised as, for example, "moodiness" or "youthful defiance". After the introduction of the [[antipsychotic]] [[Thorazine]], lobotomies fell out of common use<ref>{{cite book | last = Braslow | first = Joel T. | title = Mental ills and bodily cures psychiatric treatment in the first half of the twentieth century | publisher = University of California Press | date = 1997 | pages = 169 | url =http://books.google.com/books?id=ozPLJPqQpmgC&pg=PA169&lpg=PA169&dq=lobotomy+thorazine&source=web&ots=Y04f7BAc2Q&sig=ixTKjmjs7byrZ3eSdiidfRLMa-8 | isbn = 0520205472}}</ref> and the procedure has since been characterized "as one of the most barbaric mistakes ever perpetrated by mainstream medicine".<ref>http://www.pbs.org/wgbh/amex/lobotomist/program/</ref> ==History== In 1890, Dr. [[Gottlieb Burckhardt]] removed pieces of the frontal lobes of six patients in a [[psychiatric hospital]] in [[Switzerland]]. One died after the operation, and another was found dead in a river 10 days after release (whether by accident, suicide, or crime is unknown). The others exhibited altered behavior. These experiments marked one of the first forays into the field of psychosurgery. The Portuguese physician and [[neurologist]] [[Egas Moniz|António Egas Moniz]] pioneered a surgery called prefrontal leucotomy in 1935. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later improved the technique using a surgical instrument called a [[leucotome]] that cut brain tissue with a retractable wire loop.<ref name="jansson">{{cite web |url=http://nobelprize.org/nobel_prizes/medicine/articles/moniz/ |title=Controversial Psychosurgery Resulted in a Nobel Prize |accessdate=2008-03-30 |last=Jansson |first=Bengt |date=1998-10-29 |work=Nobelprize.org |publisher=Nobel Web AB }}</ref> Moniz won the [[Nobel Prize in Physiology or Medicine|Nobel Prize for medicine]] in 1949 for this work.<ref name="nobel">{{cite web|url=http://nobelprize.org/nobel_prizes/medicine/laureates/1949/|title=The Nobel Prize in Physiology or Medicine 1949|accessdate=2008-03-30|work=Nobelprize.org |publisher=Nobel Web AB}}</ref> The American [[neurologist]] and [[psychiatrist]] [[Walter Freeman]] was intrigued by Moniz's work, and with the help of his close friend, a [[neurosurgeon]] named [[James W. Watts]], he performed the first prefrontal leucotomy in the U.S. in 1936. Freeman and Watts gradually refined the surgical technique, and created the Freeman-Watts procedure (the "precision method," the standard prefrontal lobotomy). The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so it had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed that this surgery would be unavailable to the patients who needed it most: those that lived in state mental hospitals with no operating rooms, no surgeons, no [[anesthesia]], and very little money. Freeman wanted to simplify the procedure so that it could be carried out by [[psychiatrists]] in [[mental asylums]], which housed roughly 600,000 American inpatients at the time. Freeman decided to access the frontal lobes through the eye sockets, instead of through drilled holes in the scalp. In 1945, he took an [[icepick]] from his own kitchen and began to test the new surgical technique on [[cadavers]]. The technique was called "transorbital lobotomy," and it involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called a leucotome or [[orbitoclast]]) under the eyelid and against the top of the eyesocket. A hammer or mallet was then used to drive the leucotome through the thin layer of bone and into the brain. The leucotome was then moved from side to side, to sever the nerve fibers connecting the frontal lobes to the [[thalamus]]. In selected patients, the butt of the leucotome was pulled upward, sending the tip farther back into the brain and producing a "deep frontal cut," a more radical form of lobotomy. The leucotome was then withdrawn, and the procedure was repeated on the other side. Walter Freeman first performed a transorbital lobotomy on a live patient in 1946. This new form of psychosurgery was intended for use in State mental hospitals that often did not have the facilities for anesthesia, so Freeman suggested using [[electroconvulsive therapy]] to render the patient unconscious.<ref>{{cite book | last = El-Hai | first = Jack | title = The Lobotomist | publisher = Wiley | date = 2005 | isbn = 0471232920}}</ref> Concerns about lobotomy steadily grew. The [[USSR]] banned the procedure in 1950.<ref>Приказ МЗ СССР 1003 (9 дек. 1950). <u>Невропатология и психиатрия</u> 20, no. 1 (1951): 17-18.</ref> Doctors in the Soviet Union concluded that the procedure was "contrary to the principles of humanity", and, that it turned "an insane person into an idiot".<ref>http://facstaff.unca.edu/ddiefenb/lobotomy.html</ref> Numerous countries subsequently banned the procedure, including [[Yugoslavia]], [[Germany]] and [[Japan]], as did several U.S. states. Lobotomy was legally practiced in controlled and regulated U.S. centers and in Finland, Sweden, Norway (2,005 known cases<ref>{{cite web | title=Norway compensates lobotomy victims | publisher=BMJ | url=http://www.bmj.com/cgi/content/full/313/7059/708/a}}</ref>), the United Kingdom, Spain, India, Belgium and the Netherlands. In 1977, the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that [[psychosurgery]] — including lobotomy techniques — was used to control minorities and restrain individual rights. It also investigated after-effects of the surgery. The committee concluded that some extremely limited and properly performed psychosurgery could have positive effects. By the early 1970s the practice had generally ceased, but some countries continued small-scale operations through the late 1980s. In France, 32 lobotomies were performed between 1980 and 1986 according to an IGAS report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.<ref>{{cite news | title=La neurochirurgie fonctionnelle d'affections psychiatriques sévères | publisher=Comité Consultatif National d'Ethique |date=2002-04-25 | url=http://www.comite-ethique.fr/docs/fr/avis071.pdf|language=French|format=PDF}}</ref> ==Scale== Quantitatively, most lobotomy procedures were done in the United States, where approximately 40,000 persons were so treated. Great Britain performed procedures on 17,000 people, and the three Scandinavian countries had a combined figure of approximately 9,300 people treated.<ref>{{cite journal | title=Lobotomy in Norwegian Psychiatry |url=http://www.geocities.com/jordotradini/fil24.pdf | format=PDF | last=Tranøy | first=Joar | coauthors=Blomberg, Wenche | year=2005 | month=03 | journal=History of Psychiatry | volume=16 | issue=1 | publisher=SAGE Publications | location=London, Thousand Oaks, Calif., and New Delhi| doi=10.1177/0957154X05052224 | accessdate=2008-03-31 | pages = 107}}</ref> Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the United States.<ref>{{cite journal|first=Joar | last=Tranøy | publisher=University of Oslo | journal=The Journal of Mind and Behavior | month=Winter | year=1996 | issue=1 | pages=pp. 1&ndash;20 | issn=0271—0137 | title=(unknown title) |volume=17 | doi=10.1177/0957154X05052224}}</ref> ==Cases== *[[Rosemary Kennedy]], the sister of President [[John F. Kennedy]], was given a lobotomy when her father complained to doctors about the 23-year-old's moodiness. Dr. [[Walter Freeman]] personally performed the procedure. Rather than any improvement, however, the lobotomy reduced Rosemary to an infantile mentality including [[incontinence]]. Her verbal skills were reduced to unintelligible babble. Her father hid the nature of Rosemary's affliction for years and described it as the result of mental retardation. Rosemary's sister [[Eunice Kennedy Shriver]] founded the [[Special Olympics]] in her honor in 1968.<ref>[http://www.specialolympics.org/Special+Olympics+Public+Website/English/About_Us/History/default.htm Special Olympics - History]</ref> *[[Howard Dully]] had a lobotomy at 12, after his stepmother was simply tired of his "youthful defiance". At the age of 56 he said, "I've always felt different -- wondered if something's missing from my soul. I have no memory of the operation". Late in his life, Dully uncovered the story of his lobotomy. Crown Publishers published Dully's memoir (co-written by Charles Fleming), ''My Lobotomy''<ref>[http://www.mylobotomy.net My Lobotomy | Howard Dully and Charles Fleming]</ref>, in September 2007.<ref>{{cite web | title='My Lobotomy': Howard Dully's Journey | publisher=NPR | url=http://www.npr.org/templates/story/story.php?storyId=5014080 | date=November 16, 2005}}</ref><ref>{{cite book | date = [[March 6th]], [[2008]] | title = My Lobotomy | last = Dully | first = Howard | publisher = [[Ebury Press]] | id = ISBN 9780091922122 }}</ref> *[[New Zealand]] author and poet [[Janet Frame]] was due to have a lobotomy because of a diagnosis of mental illness. She was saved from this procedure by receiving a literary award the day before her operation was to take place. *French Canadian singer [[Alys Robi]] was renowned worldwide during the 1940s. In the 1950s, following many cases of violence and disturbance, she was admitted to a Quebec mental hospital where she underwent a lobotomy. She was later released and pursued her career. *Swedish modernist painter [[Sigrid Hjertén]] died following a botched lobotomy in 1948. *The older sister of playwright [[Tennessee Williams]], Rose, received a lobotomy, which left her incapacitated for life. ==Literary and cinematic portrayals== <!-- DO NOT ADD EXAMPLES TO THIS SECTION WITHOUT A VERIFIABLE CITATION. Additions without a citation are subject to removal. If a citation link is broken, please replace it with one that works. --> <!-- PLEASE DO NOT ADD NON NOTABLE EXAMPLES TO THIS SECTION An example needs to be relevant to the subject -- how a work of art portrays lobotomy and in what way. Do not include references to songs, television shows that happen to use the word "lobotomy" as a metaphor or a passing mention or as a trivial plot device such as a horror movie. --> Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it. The 1946 novel ''[[All the King's Men]]'' by [[Robert Penn Warren]] described a lobotomy in such nauseating detail "that [it] would have made a Comanche brave look like a tyro [novice] with a scalping knife". The surgeon is portrayed as a repressed person who couldn't change others with love but instead resorted to "high-grade carpentry work".<ref name="meg">{{cite journal | last = Grenader | first = M. E. | title = Of Graver Import Than History: Psychiatry In Fiction | journal = Journal of Libertarian Studies | volume = 2 | issue = 1 | pages = 42–44 | publisher = Pergamon Press | location = Great Britain | date = 1978 | url = http://www.mises.org/journals/jls/2_1/2_1_3.pdf | format = PDF | accessdate = 2008-01-22 | doi = 10.1177/0957154X05052224}}</ref> In [[Tennessee Williams]]'s 1958 play, ''[[Suddenly, Last Summer]]'', the protagonist is threatened with a lobotomy to stop her from telling the truth about her cousin Sebastian.<ref>{{cite book | last = Bigsby | first = C. W. E. | title = A Critical Introduction to Twentieth-Century American Drama: Volume 2 | publisher = Cambridge University Press | date = [[January 25]] [[1985]] | pages = p. 100 | url = http://books.google.com/books?id=BBQhZKBIiZAC&pg=PA100&dq=%22Suddenly,+Last+Summer%22+lobotomy&as_brr=3&ei=tUqWR-XjPJ6EiQHerMivAQ&sig=8yGp36z9s2JwjhMbpJNFUedZggU | isbn = 978-0521277174 | accessdate=2008-01-23}}</ref> The surgeon said, "I can't guarantee that a lobotomy would stop her—<i>babbling</i>!!!" To which her aunt responded, "That may be, maybe not, but after the operation who would <i>believe</i> her, Doctor?"<ref>{{cite book | last = Williams | first = Tennessee | authorlink = Tennessee Williams | title = Suddenly Last Summer | publisher =Dramatists Play Service | date = January 1998 | pages = p. 15 | url = http://books.google.com/books?id=MvX7y3Rb4osC&pg=PA15&dq=%22Suddenly,+Last+Summer%22+lobotomy&as_brr=3&ei=tUqWR-XjPJ6EiQHerMivAQ&sig=HnaPPHbEm_DKuGqwXFEfiAsyYh8#PPA15,M1 | isbn = 978-0822210948 | accessdate=2008-01-23}}</ref> A most damning portrayal of the procedure is found in [[Ken Kesey|Ken Kesey's]] 1962 novel ''[[One Flew Over the Cuckoo's Nest (novel)|One Flew Over the Cuckoo's Nest]]'' and the [[One Flew Over the Cuckoo's Nest (film)|subsequent 1975 movie adaptation]]. [[Randle McMurphy]] was lobotomized after he angrily attacked [[Nurse Ratched]]. The operation is described as brutal and abusive, a "frontal-lobe castration". [[Chief Bromden]] is shocked: "There's nothin' in the face. Just like one of those store dummies." Another patient's surgery changed him from an acute to a chronic condition. "You can see by his eyes how they burned him out over there; his eyes are all smoked up and gray and deserted inside."<ref name="meg" /> Other sources include [[Sylvia Plath]]'s depiction of a young woman, Valerie, who was lobotomized in her 1963 novel ''[[The Bell Jar]]''. The character Esther reacts with horror to her "perpetual marble calm".<ref name="meg" /> [[Elliott Baker]]'s 1964 novel and 1966 film version ''[[A Fine Madness]]'' portrayed the dehumanizing lobotomy of a womanizing, quarrelsome poet who, in the end, is just as aggressive as ever. The surgeon is portrayed as inhumane and a crackpot.<ref>{{cite book | last = Gabbard | first = Glen O. | last2 = Gabbard | first2 = Krin | title = Psychiatry and the Cinema | edition = 2nd Edition | publisher =American Psychiatric Publishing, Inc. | date = March 1999 | pages = pp. 119–120 | url = http://books.google.com/books?id=D42m3IIrEDoC&pg=RA1-PT90&lpg=RA1-PT90&dq=%22a+fine+madness%22+lobotomy&source=web&ots=ytyYDV9RfE&sig=NVV7ip_SueduPAituYR_uwj25Sk#PRA1-PT90,M1 | isbn = 978-0880489645 | accessdate=2008-01-23}}</ref> The 1982 [[biopic]] ''[[Frances]]'' included a fictional, disturbing scene of the eponymous actress [[Frances Farmer]] undergoing transorbital lobotomy. Whether a lobotomy ever occurred or whether it was performed by Dr. Freeman himself is a matter of much debate.<ref>{{cite book | last = Bragg | first = Lynn | title = Myths and Mysteries of Washington | publisher =TwoDot | edition = 1st Edition | date = [[June 1]] [[2005]] | pages = pp. 72–75 | url = http://books.google.com/books?id=A2IzPOb0AfYC&pg=PA75&dq=Frances+farmer+lobotomy&num=100&ei=Z3uWR70smb6zA_6yiJQF&sig=vhrbRdLvjL7GLFBLC4grlkUUY9A#PPA75,M1 | isbn = 978-0762734276 | accessdate=2008-01-23}}</ref> ==See also== * [[Frontal lobe injury]] *For an example of the personality changes associated with damage to the [[frontal lobe]] not related to a surgical leukotomy, see the famous case of [[Phineas Gage]]. *[[Elliot Valenstein]], author of ''Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness'' == References == {{reflist}} ==External links== <!-- dead link as of 1/21/08 *[http://www.cerebromente.org.br/n02/historia/lobotomy.htm The History of Lobotomy] --> *[http://facstaff.unca.edu/ddiefenb/lobotomy.html University of North Carolina Asheville: Lobotomy] *[http://soundportraits.org/on-air/my_lobotomy/ My Lobotomy Radio story] *[http://psychosurgery.org/ Psychosurgery.org] *Article on the Lobotomy and its effects: {{cite news|title="Mental cruelty"|publisher=The Sunday Times |url=http://www.timesonline.co.uk/tol/life_and_style/article729403.ece?token=null&offset=0|date=[[2006-02-19]]}} *[http://www.findarticles.com/p/articles/mi_m1511/is_n10_v18/ai_19758746/pg_1 "Lobotomy's back - controversial procedure is making a comeback"] *[http://www.npr.org/templates/story/story.php?storyId=5014080 'My Lobotomy': Howard Dully's Journey] *[http://www.faosd.com/sites/mylobotomy/ 'My Lobotomy': Howard Dully's Story, co-authored by Charles Fleming] {{Neurosurgical procedures}} [[Category:Neurosurgery]] [[Category:History of neuroscience]] [[Category:Medical ethics]] [[Category:Mind control]] [[Category:History of mental health]] [[Category:Psychiatry]] [[Category:Brain]] [[cs:Lobotomie]] [[da:Lobotomi]] [[de:Lobotomie]] [[es:Lobotomía]] [[fr:Lobotomie]] [[ko:뇌엽 절제술]] [[it:Lobotomia]] [[he:לובוטומיה]] [[lt:Lobotomija]] [[nl:Lobotomie]] [[ja:精神外科]] [[no:Lobotomi]] [[pl:Lobotomia]] [[pt:Lobotomia]] [[ru:Лоботомия]] [[sk:Lobotómia]] [[sr:Lobotomija]] [[fi:Lobotomia]] [[sv:Lobotomi]]