Lobotomy

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Background information on Lobotomy

Psychosurgery is a term for surgeries of the brain or autonomic nervous system involving the severance of neural pathways to effect a change in behaviour, usually to treat or alleviate severe mental illness. The procedures typically considered psychosurgery are now almost universally shunned as inappropriate, due in part to the emergence of less invasive methods of treatment such as psychiatric medication. Although the term psychosurgery might imply a broad class of treatments, in reality, it is confined to variations on two themes:

leucotomy/prefrontal lobotomy/cingulotomy - the intentional severing of the pre-frontal cortex from the thalamic region of the brain
sympathectomy - the intentional severing of the sympathetic nerve trunk

Psychosurgery should not be confused with neurosurgery, though they may seem similar; neurosurgery is surgery intended to treat or alleviate neurological disorders, which may or may not manifest mental illnesses as symptoms. Psychosurgery should also not be confused with the practice of psychic surgery -- surgery purportedly performed by paranormal means.

History

There is evidence that trephining (or trepanning)—the practice of drilling holes in the skull for pseudo-medical reasons—has been in widespread, if infrequent, use since 5000 BCE. This may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example after head injuries; several documented cases of healed wounds indicate that such crude surgery could be survived back then. However, psychosurgery as understood today was not commonly practised until the early 20th century.

The first systematic attempts at psychosurgery in humans occurred from 1935, when the neurologist Egas Moniz teamed up with the surgeon Almeida Lima at the University of Lisbon to perform a series of prefrontal leucotomies - a procedure severing the connection between the prefrontal cortex and the rest of the brain. This procedure is commonly (and incorrectly) called a "lobotomy", although this name should refer to a whole class of unrelated surgeries (that is, a lobotomy should refer to the removal of a lobe of the brain, not merely the severing of interconnections).

Moniz and Lima claimed fair results, especially in the treatment of 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 US, as a treatment for previously incurable mental conditions. Moniz received a 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, depression with risk of suicide and incapacitating obsessive-compulsive disorder were the main symptoms treated. The original leucotomy was a crude operation and the practice was soon developed into a more exact, stereotactic procedure where only very small lesions were placed in the brain.

The procedure was popularized in the United States when Walter Freeman invented the "icepick lobotomy" procedure, which literally used an icepick and rubber mallet instead of the standard surgical leucotome. Leaving no visible scars, the icepick lobotomy was heralded as a great advance in "minimally invasive" surgery, and was eventually done under only local anaesthesia.

In a minimally invasive procedure, Freeman would hammer the icepick into the skull just above the tear duct and wiggle it around. Between 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. He reputedly even performed a few lobotomies in hotel rooms.

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 almost 10,000 patients claimed 41% were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off (Tooth, et al 1961). Lobotomies gradually became unfashionable with the development of antipsychotics and are no longer performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history.

It is possible that some patients did benefit from the more precise psychosurgery, but there was a strong division amongst the medical profession as to the viability of the treatment and concern over the irreversible nature of the operation and the extension of the surgery into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders etc). Whatever the truth, psychosurgery was offered in only a few centres and by the 1960s the number of operations was in decline. The signal improvements in psychopharmacology and behaviour therapy gave the opportunity for more effective and less invasive treatment.

Neurological impact

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 area is involved in impulse control, judgement, 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 lowering their sex-drive). Certain processes related to schizophrenia are also believed to occur in the frontal lobe, and may explain some success. However, certain types of inappropriate behaviours increased, as a function of reduced impulse control (in some respects they became more child-like). Further, it decreased their ability to function as a member of the community by reducing their problem solving and planning abilities and making them less flexible and adaptive. It usually had no impact on IQ except with respect to problem-solving.

Present day

Psychosurgery today is almost entirely limited to endoscopic thoracic sympathectomy (ETS surgery). While this is normally used for somatic conditions, many patients with anxiety disorder report significant reduction in fear and alertness after this intervention (Teleranta, Pohjavaara, et al 2003,2004).

Today, lobotomy is very infrequently practised. It may be a treatment of last resort of OCD sufferers, and may also be used for people suffering chronic pain. In the latter case, the surgery does not act on the perception of pain, but leads to a lack of concern about the pain. The procedure usually involves a 2-3cm lesion in the cingulum, near the corpus callosum. The efficacy is not high, with improvement in 5 of 18 patients (Baer et al., 1995). Lobotomy is no longer used as a treatment for schizophrenia.

From Wikipedia

News Articles on Lobotomy

Ten ways for estate agents to set their house in order  -  05 Apr 2008
Telegraph.co.uk,Show us something that it wouldn't require a lobotomy to buy. Several times a week during the height of last year's boom I would receive letters from one or

Daniel G. Stewart, MD, and Kenneth L. Davis, MD  -  Apr 1, 2008
Am J Psychiatry (subscription)If someone today were to suggest a frontal lobotomy as a means of relieving mental anguish, the responses might include sardonic laughter, revulsion,

Nigel Hawkes reviews two new books about the brain  -  Mar 21, 2008
Times Online,Freeman was the evangelist of lobotomy, criss-crossing the United States armed with an ice pick, which he drove into the brains of the mentally ill through

'I Remember Tennessee'  -  Mar 31, 2008
The Times-Picayune - NOLA.com,Incapacitated by a lobotomy at age 28, she remained a source of both guilt and creative inspiration to Williams throughout his life. It was a loose,

Cripes! Boris Johnson reveals heâ€™sa serious buffer after all  -  Mar 14, 2008
Times Online,I cannot perform a kind of public auto-lobotomy and become something Iâ€™m not, and that would be difficult. But all I can say is, I have been extremely

Teenage Fiction: Nightmare Academy: Charlie's Monsters  -  Mar 14, 2008
Financial Times,A shadowy organisation, the Nightmare Division, offers him a choice: learn to use his talent properly and work for them, or suffer a lobotomy-like process.

Time off helps Wilson take lead  -  Mar 27, 2008
2TheAdvocate,...â€œJust a little lobotomy,â€? he said with a laugh, â€œwhich is what I needed.â€? Actually, he said, the key was taking a couple of weeks off from the Tour after he

Bunch of wet nurses turned me right off  -  Mar 8, 2008
Stuff.co.nz,And speaking of those lobotomy jobs Rowing NZ should have all their oars broken in half for trying to keep this athletic orgasm to themselves.

The Kids Are Alright  -  Mar 27, 2008
RealFootball365.com,They may take a quarterback (if Parcells has a lobotomy between now and April 26). They may take one of eight players on the board (Matt Ryan,

NHS loses Buckingham Palace mental health records  -  Mar 19, 2008
The Spoof (satire),According to Whitehall sources details of Prince Charles' successful 1979 vasectomy and Prince Philip's 1982 partial lobotomy are also included in the

Spray Q&A: Alex Sim-Wise  -  Mar 18, 2008
hecklerspray,They need to get a proper job and/or a lobotomy. What would be your super power of choice? Super farts that could jet power me places.

Slow down, you move too fast  -  Mar 18, 2008
Marketing Web,..."It's a slow and steady lobotomy that we're willingly subject to," says Chang. And we suffer from the time warp - we think everything is urgent.

Leslie J. Sacks  -  Apr 3, 2008
Weekly Blitz,...eminently civilized advances and do likewise in our societies so urgently in need of this Middle Eastern censorship, this sensitizing cultural lobotomy.

ASPARTAME IS NEUROTOXIC GENOTOXIC MOLECULAR FOOD & VACCINE ...  -  Apr 3, 2008
OpEdNews,...functionally interfering with the ability to learn new tasks and causing a functional frontal lobotomy of those suffering toxicity.

MS is dead meat: reader comment from michael_o  -  Mar 14, 2008
CNET Blogs,Even their managers are clueless: it's like they had a corporate lobotomy. Ballmer has Guy Kawasaki -- the guy who unapologetically gave us Gator ("Look: I

Review: Styx at the Star of Texas Fair and Rodeo  -  Mar 7, 2008
Austin 360 (subscription),...really was all about how it once was; before â€œno-talentsâ€? like the Ramones, and later the ghastly White Stripes, gave rock â€˜nâ€™ roll a frontal lobotomy.

People Canâ€™t Afford Their Houses Anymore  -  Mar 6, 2008
FITSNews,Weâ€™ve tried everything we know to do short of a lobotomy, but there it is. UPDATE - Thank you, Hinder. Your song â€œGet Stonedâ€? has finally gotten rid of our

Men, Love And The Monkeyboy  -  Mar 31, 2008
Sydney Morning Herald,..."I'd need a lobotomy," rejoins Phillip. Or perhaps something stronger. Dad, aka Robbo (John McNeill in a gloriously uncompromising primal bloke performance)

Daylight sleeping not so dreamy  -  Apr 3, 2008
Powell River Peak,I just want to sit there like some character from Night of the Living Dead who's had a full-scale lobotomy. Working nights is necessary, of course.

Facility mends minds and lives  -  Mar 30, 2008
Salt Lake Tribune,...such as "One Flew Over the Cuckoo's Nest," in which Jack Nicholson's character is cruelly subjected to electroshock therapy and, eventually, a lobotomy.

Actually, Hillary, Britney is the New Rocky  -  Apr 2, 2008
Radar Online,...living under papa Jamie's watch, limiting herself to a strict $1500 a week budget, undergoing a lobotomy, er, sticking to her meds.

MCPD course review for Insider Training programming and or ...  -  Apr 2, 2008
Reviewboard Magazine,Soon you too will refuse to sit in any boring classroom for a 40 hour week or give yourself the boot camp lobotomy. Most of Insider Training offerings are

Dishin' Di - No fan of country western music  -  Apr 2, 2008
Suburban Journals,...inspired by songs like â€œIf My Nose Were Full of Nickels, Iâ€™d Blow It All On You,:" or â€œIâ€™d Rather Have a Bottle in Front of Me Than A Frontal Lobotomy.

Self vs. Curry: Worthy of binoculars  -  Mar 29, 2008
Chicago Sun-Times,In most cases, I'd suggest a lobotomy for anyone paying to squint in the end-zone upper deck. Starting next spring, right here in downtown Detroit,

Denver to California by rail  -  Mar 29, 2008
Times Online,It gives you the chance not only to brush your teeth without performing an accidental lobotomy, but also to enjoy some mini-excursions â€“ perhaps a boat

'Jersey Joe' may be just what Dems hope for  -  Mar 19, 2008
NorthJersey.com,This has caused a 'lobotomy' of new ideas." Pennacchio, who would soon put his foot on the first rung of his political career, spilled out a gumbo of raw,

He's 49 And Just A Kid  -  Mar 21, 2008
Seattle Post IntelligencerHe paints protests in a post-lobotomy, smiley-face style. The politically insensitive word for it is primitive. If he were living in poverty in Alabama and

LSD, Ketamine and Cannabis could treat conditions from headache to ...  -  Mar 21, 2008
Times Online,...the medical benefits of such substances, when taken in a controlled setting, shows no signs of slowing down. My Lobotomy: A Memoir, by Howard Dully.

DiMasi hits the jackpot by blocking casino plan  -  Mar 20, 2008
Boston Globe,...(Now, one might argue that a doctor isn't required to perform a lobotomy on himself at his patient's request, but that would be churlish.

'Sweet Charity' channels Fosse to a perfect tee  -  Mar 29, 2008
nwitimes.com,...the method of his death, has invited Dr. Cukrowicz (Peter Robel), a doctor from the state hospital, to evaluate Catherine as a candidate for a lobotomy.

No Confidence  -  Mar 28, 2008
BicyclingUse your brain, or what little of it there may be left after your willing full-frontal lobotomy by your master. You're driving cycling into the ditch.

Utah College Teams A Joke? Please... Let Me Respond!  -  Mar 28, 2008
KUTV,No one thinks the Mountain West is anything more than a mid major; and if they do, they need a full frontal lobotomy STAT. However, to say that schools like

Wilson Takes Lead in Zurich Classic  -  Mar 28, 2008
Cybergolf NationalDEAN WILSON: No, just a little lobotomy, which is what I needed. DEAN WILSON: A little bit, to tell you the truth. You know, it's -- when I haven't shot too

Dean Wilson takes first-round lead in Zurich Classic of New ...  -  Mar 28, 2008
WorldGolf.com,..."Just a little lobotomy," Wilson said. "Which is what I needed." Wilson enters Friday's second round with a one-stroke lead over Briny Baird, Peter Lonard

"Come and see..."  -  Mar 27, 2008
saWorship.com,A lobotomy is not a prerequisite of discipleship. Following Christ demands faith, but not blind faith. "Come and see," the angel invites. Shall we?

Art and soul  -  Mar 7, 2008
Guardian,Although the Russians liberated him after two years, Arthur was given a partial lobotomy back in England. It failed to alleviate his depressions,

'College Road Trip' like old TV sitcom  -  Mar 7, 2008
MLive.com,...along with the recently released "Welcome Home Roscoe Jenkins," suggests Lawrence may have submitted to a show-biz version of prefrontal lobotomy.

Chilling and terrifying  -  Mar 27, 2008
Southtown Star,But putting Catherine, the niece, away, isn't enough for Mrs. Venable, who attempts to bribe Dr. Cukrowicz into performing a lobotomy on the girl to shut

Dennis Miller on Super Tuesday II  -  Mar 6, 2008
FOXNewsNow, I know there are always cultural scholars that theorize that, apres the lobotomy, Randall McMurphy would, indeed, fall in love with Nurse Ratchet.

Leafs languish in 12th  -  Mar 26, 2008
Vancouver Province,Visit www.kurtenblog.com to vote for either Scott Stevens and his destruction of Slava Kozlov or Brian Campbell's blunt-force lobotomy of RJ Umberger.

Can Obama cure TV's Blitzeritis?  -  Mar 25, 2008
Variety,Granted, doing live TV is tantamount to flying without a net and merits some slack; still, that's no excuse for the lobotomy performed on ABC's latenight

Kitty Dukakis makes her case for shock therapy  -  Mar 24, 2008
Daily Breeze,..."And it wasn't even ECT that was given to Jack Nicholson, it was a lobotomy. That's what is so frustrating." During an ECT procedure, one or both sides of

Quincyâ€™s blues rockers Ramblinâ€™ Souls are never out of style  -  Mar 21, 2008
Wicked Local Quincy,MUSIC TV: Check out a cool Web site, www.soniclobotomy.com, which has segments from the Danvers Community Access Television show â€œSonic Lobotomy.

Laura on Life... Fashion blind...  -  Mar 20, 2008
Pine Journal,They want to give me a frontal lobotomy, dress me in Vera Wang, and install me in a Macyâ€™s display window. That should answer your questions as to whether

Confident Warriner wins  -  Mar 17, 2008
Regina Leader-Post,Given the word lobotomy in another round, Warriner said, "That reminds me of a funny story," before going on to ace the spelling. He's come a long way since

Bragging and Begging: SXSW Friday  -  Mar 15, 2008
New York Press-Follow The Leader BlogNow expanded to include a touring violinist and trumpet player, they played with an unsmiling intensity, crazed deer-in-the-post-lobotomy-lights eyes

RB Conn Jr., 80, physician, educator  -  Mar 13, 2008
Philadelphia Inquirer,Dr. Conn met his future wife, Victoria Sellens, at Yale, where she was a nurse working in the school's lobotomy clinic. They married in 1950 and had three

Mexican Primera Division Round-Up  -  Mar 11, 2008
Soccer365,Unfortunately, such a loss is only unthinkable for lobotomy patients: the Cement Men themselves are flying high at the moment after moving into fourth place

Wade getting healthy more important  -  Mar 10, 2008
MiamiHerald.com,That sounds like something related to a lobotomy, or a page from the Michael Vick School of Canine Discipline. That the Heat believes shock wave therapy is

It Really is Time to Wake Up  -  Mar 9, 2008
Israel Hasbara Committee (subscription),We offered to amputate more â€“ Camp David II, version Barak, included a lobotomy. To no avail. Intifada II. Major warfare. Hundreds of civilians and IDF

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