Psychosurgery
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2008-06-13T14:05:17Z
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:''For the [[Tourniquet (band)|Tourniquet]] album, refer to [[Psycho Surgery]].''
{{dablink|The medical procedure of psychosurgery should not be confused with [[psychic surgery]]—surgery purportedly performed by [[paranormal]] means.}}
'''Psychosurgery''' is a subset of [[neurosurgery]] ([[surgery]] of the [[brain]]) intended to modulate the performance of the brain, and thus effect changes in cognition, with the intent to treat or alleviate severe [[mental illness]]. It was originally thought that by severing the nerves that give power to ideas you would achieve the desirable result of a loss of affect and an emotional flattening which would diminish creativity and imagination; the idea being that those are the human characteristics that are disturbed. Historically, the procedure typically considered psychosurgery, [[leukotomy|prefrontal leukotomy]] is now almost universally shunned as inappropriate, due in part to the emergence of less-invasive or less-objectionable methods of treatment such as [[psychiatric medication]] and modified [[electroconvulsive therapy]]. In modern neurosurgery however, more minimally invasive techniques like [[gamma knife]] irradiation and foremost [[deep brain stimulation]] have arisen as novel tools for psychosurgery{{Fact|date=March 2008}}.
==History==
There is evidence that [[trepanation|trepanning]] (or trephining)—the practice of drilling holes in the skull—has been in widespread, if infrequent, use since 5000 BC{{Fact|date=March 2008}}. This may have been done in an attempt to allow the brain to expand in the case of [[raised intracranial pressure|increased brain fluid pressure]], for example, after head injuries. However, psychosurgery as understood today was not commonly practiced until the early 20th century.
The first systematic attempts at human psychosurgery occurred from 1935, when the neurosurgeon [[Egas Moniz]] teamed up with the surgeon [[Almeida Lima]] at the [[University of Lisbon]] to perform a series of prefrontal [[lobotomy|lobotomies]] —a procedure severing the connection between the [[frontal lobe|prefrontal cortex]] and the rest of the [[brain]].
Moniz and Lima claimed fair results, especially in the treatment of [[clinical depression|depression]], although about 6% of patients did not survive the operation, and there were often marked and adverse changes in the patients' personality and social functioning. Despite the risks the process was taken up with some enthusiasm, notably in the [[United States|U.S.]], as a treatment for previously incurable mental conditions. Moniz received a [[Nobel Prize/Physiology or medicine|Nobel Prize]] in 1949.
The initial criteria for treatment were quite steep—only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, [[clinical depression|depression]] with risk of [[suicide]] and incapacitating [[obsessive-compulsive disorder]] were the main symptoms treated. The original lobotomy was a crude operation and the practice was soon developed into a more exact [[stereotactic surgery|stereotactic]] procedure where only very small lesions were placed in the [[brain]].
==="Ice pick lobotomy"===
{{main|Lobotomy}}
[[Image:Icepicks1.jpg|right|thumb|200px|Close up of "ice picks"]]
Psychosurgery was popularised in the United States when [[Walter Freeman]] invented the "ice pick lobotomy", a procedure which literally used an [[ice pick]] and a [[rubber mallet]] instead of standard surgical equipment to perform a [[wikt:transorbital|transorbital]] [[lobotomy]]. Leaving no visible scars, the ice pick lobotomy was heralded as a great advance in surgery, and was done under [[local anesthesia]] or, when performed in mental hospitals lacking surgical facilities, after using [[Electroconvulsive therapy|electroshock]] to render the patient unconscious.<ref>{{cite book
| last = El-Hai
| first = Jack
| title = The Lobotomist
| publisher = Wiley
| date = 2005
| isbn = 0471232920}}</ref>
In what is now widely considered to be a highly invasive procedure, Freeman would hammer the ice pick into the skull just above the tear duct and wiggle it around. From 1936 through the 1950s, he advocated lobotomies throughout the United States. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in many medical centres.<ref name="abnormal psyc">{{cite news | title=Essentials of Abnormal Psychology, 4th edition | author=V. Mark Durand & David H. Barlow | publisher=Thomson Wadsworth | date=2006 |url=http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24}}</ref> He reputedly even performed a few lobotomies in hotel rooms. <ref>Sutherland J. (2004) Should they de-Nobel Moniz? The Guardian. London.</ref>{{refcheck|date=March 2008}}
Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in [[children]]. Ultimately between 40,000 and 50,000 patients were lobotomised. A follow-up study of [[England|English]] and [[Wales|Welsh]] lobotomies performed between 1942 and 1954 claimed 41% of patients were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off <ref>Tooth GC, and Newton, MP: Leukotomy in England and Wales 1942-1954. London, Her Majesty's Stationary Office, 1961.
</ref>.
==Neurological effects==
The [[frontal lobe]] of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or [[prefrontal cortex|prefrontal]] area is involved in impulse control, judgement with everyday life and situations, language, memory, motor function, problem solving, sexual behaviour, socialization and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour.
Thus, the efficacy of psychosurgery was often related to changes in personality and reduced spontaneity (this included making the person quieter and decreasing their craving to be sexually active). Certain processes related to [[schizophrenia]] are also believed to occur in the frontal lobe, and may explain some success.
==Present day==
Lobotomies gradually became unfashionable with the development of [[antipsychotic]] drugs and are rarely performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history. There was a strong division amongst the medical profession as to the efficacy of the treatment, and concern over both the irreversible nature of the operation and to its extension into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders, etc). Psychosurgery was offered in only a few centers, and by the 1960s the number of operations was in decline. Signal improvements in [[psychopharmacology]] and [[behaviour therapy]] provided the opportunity for more effective and less-invasive treatment.
Today, psychosurgery may be a treatment of last resort for [[OCD]] sufferers, and for [[eating disorders|anorexic]] patients in Chile, the United States, Sweden and Mexico. The efficacy is not high: one study of cingulotomy (which usually involves a 2–3 cm lesion in the [[cingulum]] near the [[corpus callosum]]) found improvement in 5 out of 18 patients <ref>Baer, L., et al. (1995). Cingulotomy for intractable obsessive-compulsive disorder. ''Archives of General Psychiatry, 52'', 384-392</ref>.
Psychosurgery is legally practiced in controlled and [[regulation|regulated]] U.S. centers, or in Finland, Sweden, United Kingdom, Spain, India, Belgium and Netherlands. In France, 32 psychosurgical operations were made between 1980 and 1986 according to an [[IGAS]] report{{Fact|date=March 2008}}; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.<ref name="ethic" />
Some consider use of endoscopic sympathetic block (a form of [[endoscopic thoracic sympathectomy]]) for patients with [[anxiety disorder]] to be a psychiatric treatment, despite it not being surgery of the brain. There is also renewed interest in using it to treat [[schizophrenia]].<ref>Teleranta T. [http://www.springerlink.com/content/rya8yguqxfddw9pb/ Psychoneurological applications of endoscopic sympathetic blocks (ESB)]</ref>. ESB disrupts brain regulation of many organs normally affected by emotion, such as the heart and blood vessels. A large study demonstrated significant reduction in "alertness" and "fear" in patients with social phobia as well as improvement in their quality of life<ref>Pohjavaara P. [http://herkules.oulu.fi/isbn9514274571/index.html?lang=en Social phobia: aetiology, course and treatment with endoscopic sympathetic block (ESB)]</ref>. Most psychologists, however, prefer medication and counseling.
==Legal restrictions==
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, restrain individual rights or that it had unethical after-effects. It concluded that, in general, psychosurgery had positive effects. However, concerns about lobotomy steadily grew, and countries such as [[Germany]], [[Japan]] and several U.S. states prohibited it.<ref name="ethic">{{cite news | title=La neurochirurgie fonctionnelle d'affections psychiatriques sévères | publisher=Comité Consultatif National d'Ethique | date=April 25, 2002|url=http://www.ccne-ethique.fr/francais/avis/a_071.htm}}</ref>
In [[Australia]], psychosurgery is performed by a select group of [[neurosurgeons]]. In [[Victoria (Australia)|Victoria]], each individual operation must receive the consent of a Review Board before it may proceed.
The [[Soviet Union]] made lobotomies illegal in 1950.<ref>[http://www.psychiatry.ru/en/history.html Dead link]</ref>.
==Individuals who underwent lobotomy==
* [[Josef Hassid]]: Polish violin prodigy and schizophrenic who died at 26{{Fact|date=March 2008}}.
* [[Rosemary Kennedy]]: Sister of [[John F. Kennedy]]{{Fact|date=March 2008}}.
* [[Rose Williams]]: Sister of [[Tennessee Williams]]{{Fact|date=March 2008}}.
*[[Howard Dully]]: One of Walter Freeman's youngest patients, author of ''[[My Lobotomy]]'' (2007){{Fact|date=March 2008}}
==Fictional examples==
* [[Frances Farmer]]: Though Farmer is the person perhaps best associated in the public mind with lobotomy due to its depiction in the fictionalized biographical film [[Frances]], archival medical and other records have conclusively proven Farmer never underwent the procedure. The author who initially alleged the lobotomy later admitted in court he had made it up{{Fact|date=March 2008}}.[http://jeffreykauffman.net/francesfarmer/sheddinglight.html] (Footnoted site contains court transcripts which are also available through [[LexisNexis]].)
* [[Ken Kesey]]'s famed fictional character, Randle Patrick McMurphy, in ''[[One Flew Over the Cuckoo's Nest (novel)|One Flew Over the Cuckoo's Nest]]'' who was, in the movie, played by [[Jack Nicholson]].
* J. Frank Parnell, erratic driver of the radioactive Chevy Malibu in the movie ''[[Repo Man]]''.
* ''[[A Hole in One]]'', a 2004 movie about a young lady who wants an ice pick lobotomy during the height of its popularity.
* Rat Korga, major character in [[Samuel R. Delany]]'s [[science fiction]] novel ''[[Stars in My Pocket Like Grains of Sand]]'', voluntarily opts for psychosurgery to make him content to be a slave.
* Several victims of a serial killer named [[Gerry Schnauz]] in an episode of ''[[The X-Files]]'' entitled "[[The X-Files (season 4)#Unruhe|Unruhe]]".
* ''[[Session 9]]'', a [[2001]] horror movie about a group of men hired to remove the [[asbestos]] from a defunct mental hospital.
* ''[[Hannibal (movie)|Hannibal]]'', in which [[Hannibal Lecter]] lobotomizes [[Paul Krendler]], played by [[Ray Liotta]].
* In the book ''The Bell Jar'' by [[Sylvia Plath]], the character Esther Greenwood meets a girl named Valerie in the asylum who has had a lobotomy.
* ''[[Iron Maiden]]'''s famous fictional mascot, [[Eddie the Head|Eddie]], was lobotomised on-stage during one of Maiden's live shows; this concert was filmed for German TV but that particular segment was cut out due to being deemed "Too violent". The cover of their fourth album ''[[Piece of Mind (Iron Maiden album)|Piece of Mind]]'' (and many of the following releases) shows Eddie after being lobotomised.
* In the book ''[[Cyteen]]'' by [[C. J. Cherryh]], psychosurgery involves the use of drugs that bring the mind into a state where it is very receptive to audio and/or visual cues, which help the psychosurgeon to reprogram the individual. This procedure is non-invasive, and involves administering drugs versus actual surgery.
* In the television miniseries [[Kingdom Hospital]], the character Mary was killed by a botched lobotomy. In the companion book, ''The Journals of Eleanor Druse'', Eleanor had a transorbital lobotomy in her childhood.
* In the novel [[Project 17]] the Denver State Hospital is rumored to have been the founding of lobotomy.
* In [[science fiction]], psychosurgery is typically presented as far more advanced than its modern day counterparts, often including such things as selective memory erasure, direct alteration of thoughts, and generally having a higher effectiveness than in reality. Examples of it can be found in books by [[Alastair Reynolds]], [[Richard Morgan (author)|Richard Morgan]], and others.
==References==
<references />
* G. Rees Cosgrove, Scott L. Rauch: "Psychosurgery" Neurosurg. Clin. N. Am. 1995; 6:167-176 [http://neurosurgery.mgh.harvard.edu/Functional/psysurg.htm online version]
* Davison, G. C., & Neale, J. M. (1998) ''Abnormal Psychology (7th Ed.)''. New York, John Wiley.
* Pohjavaara P, Telaranta T, Vaisanen E. ''The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?'' Nord J Psychiatry 2003;57:55-60. PMID 12745792.
* [[Renato M.E. Sabbatini]]: [http://www.cerebromente.org.br/n02/historia/psicocirg_i.htm The History of Psychosurgery]. [http://www.cerebromente.org.br/ Brain & Mind], September 1997.
*Valenstein, Elliot S. (1986). Great and desperate cures the rise and decline of psychosurgery and other radical treatments for mental illness. New York, NY: Basic Books.
*Fins JJ. From Psychosurgery to Neuromodulation and Palliation: History’s Lessons for the Ethical Conduct and Regulation of Neuropsychiatric Research. Neurosurgery Clinics of North America 2003;14(2): 303-319.
==See also==
* [[Anti-psychiatry]]
* [[Frontal lobe]]
* [[Neurosurgery]]
* [[Phineas Gage]], who famously suffered an accident in [[1848]] which destroyed one or both frontal lobes.
==External links==
* [http://www.psychosurgery.org Psychosurgery.org]
** [http://www.psychosurgery.org/psychosurgery_files/page0015.htm "Oral Histories"] from Psychosurgery.org
* [http://www.lobotomy.info/ Website dedicated to Walter Freeman and the "Ice-Pick Lobotomy"]
* [http://content.nejm.org/cgi/content/short/353/2/119 New England Journal of Medicine article]
* [http://www.bbc.co.uk/radio4/science/brainsurgery.shtml Brain surgery to cure the mind] - [[BBC Radio 4]] documentary on modern psychosurgery
* [http://www.mcmanweb.com/article-122.htm "Father of the Lobotomy"]
* [http://www.idiom.com/~drjohn/lobotomy.html Lobotomy Criticism]
* [http://www.ship.edu/~cgboeree/lobotomy.html A Brief History of the Lobotomy]
* [http://www.rotten.com/library/medicine/lobotomy/ Rotten Library] Article on the Lobotomy
* [http://www.npr.org/templates/story/story.php?storyId=5014080 "My Lobotomy"] - a 22-minute piece from [[National Public Radio]]'s [[All Things Considered]] about a 56-year-old man exploring a lobotomy he had at the age of 12.
* [http://jeffreykauffman.net/francesfarmer/sheddinglight.html "Shedding Light on Shadowland"] - in-depth essay exploring the propagation of the Frances Farmer lobotomy legend
* [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://online.wsj.com/article/SB119393867164279313.html Wall Street Journal. November 2, 2007 The surgeon,... says he has performed nearly 1,000 such procedures(brain surgery), mostly for schizophrenia.]
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