Many people think psychosurgery is a thing of the past, and it’s true that lobotomies have become rare. However, psychosurgery is very much alive. Neurosurgeons are trying to rehabilitate the practice, and they may be succeeding.
Because of its dark history, psychosurgery has been restricted and forced to take a low profile. But in 2010, with a new name–“functional neurosurgery for psychiatric disease”–and new techniques like deep brain stimulation, some clinicians are predicting a comeback.
History of Psychosurgery
Modern psychosurgery was born in 1888, when Swiss psychiatrist Gottlieb Burckhardt started performing “topectomies,” which involved cutting out several pieces of a patient’s brain. Burckhardt said three of his six cases were successes (one patient died), but, as George A. Mashour and colleagues write in “Psychosurgery: Past, Present, and Future” (2004), criteria for success were “ambiguous.”
The early 20th century saw growing interest in somatic therapies for mental illness, including convulsive therapy and insulin shock, and doctors continued to experiment with psychosurgery, testing the effects of lesions in various areas of the brain. In 1935, Dr. Egas Moniz of Portugal told a group of neurologists to aim for the frontal cortex.
After experimenting with injecting ethyl alcohol into the brain, Moniz developed a procedure where he inserted a looped wire rod into the brain and rotated it to destroy an area of brain tissue. After 100 such operations, Moniz said the procedure was successful. However, his follow-up was sketchy, and many patients were returned to asylums, never to be seen again.
For his work, Moniz received the Nobel Prize in 1949.
In the 1930s, there were few treatment options for the mentally ill, and asylums were overflowing. Perhaps this explains the enthusiasm that greeted Dr. Walter Freeman.
Freeman and his colleague Dr. James Watts modified the procedure developed by Moniz, and came up with a quicker, easier version called transorbital lobotomy.
Freeman would first anesthetize the patient using electroconvulsive treatment. Then he would pull up an eyelid and insert an instrument resembling an ice pick, hammer it into the brain, and wiggle it around to destroy portions of the prefrontal cortex.
Freeman was not a surgeon, and he was not permitted to operate under hospital regulations, but this was generally overlooked, as was his expressed contempt for sterile procedure.
Freeman’s colleague Watts was one doctor who could not overlook the problems, and the two became estranged.
Freeman was an enthusiastic promoter, and an enthusiastic lobotomist. Once he tracked down a patient at a motel room, and, after police forced the patient to the ground, he performed a lobotomy in less than 10 minutes.
Next: Psychosurgery, Part 2 – from lobotomy to deep brain stimulation