Psychosurgery is generally considered to be a form of surgery which was performed on a person's brain to treat severe cases of mental illness. Frontal Lobotomy is a surgical procedure severing the connection between the prefrontal cortex and the rest of the brain.
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 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.
How and Why
One of the theories behind psychosurgery was that these nerves were somehow malformed or damaged, and if they were severed they might regenerate into new, healthy connections. The main indications for psychosurgery included severe chronic anxiety, depression with risk of suicide, incapacitating obsessive-compulsive disorder and high levels of aggression. However, contrary to popular belief, the operation was not only used on psychiatric patients. Many people were lobotomized for intractable pain, such as chronic, severe backaches or agonizing headaches.
Registered Nurses were often assigned to special the lobotomy patients during the initial 48 hours after surgery. As soon as possible, the patients were returned to their own ward. Staff then had to feed, bathe and dress these patients, as considerable time was needed to re-educate a lobotomy patient to care for himself.
The three most popular types of psychosurgery were prefrontal leucotomy, prefrontal lobotomy and transorbital lobotomy.
The leucotomy (developed by Portuguese surgeon Egas Moniz) basically involved drilling holes in the skull in order to access the brain. Once visible, the surgeon would sever the nerves using a pencil-sized tool called a leucotome. It had a slide mechanism on the side that would deploy a wire loop or loops from the tip. The idea was to be able to slide the pencil into the pre-drilled holes in the top of skull, into the brain, then use the slide to make the loop(s) come out. The surgeon could sever the nerves by removing cores of brain tissue, slide the loop back in, and the operation was complete.
A lobotomy also utilized drilled holes, but in the upper forehead instead of the top of the skull. It was also different in that the surgeon used a blade to cut the brain instead of a leucotome.
The infamous transorbital lobotomy was a blind operation, in that the surgeon did not know for certain if he had severed the nerves or not. A sharp chisel-like object would be inserted through the eye socket between the upper lid and eye. When the doctor thought he was at about the right spot, he would hit the end of the instrument with a hammer.
Also known as the "ice pick lobotomy", this unpleasant procedure was developed and made particularly popular in the U.S. by one Walter Freeman. Freeman literally used an ice pick and rubber mallet to perform his fine work. In what is 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.
Throughout 1930-1950 Freeman purportedly travelled around in a van, (which he called his "lobotomobile"), demonstrating the procedure in many medical centers. Leaving no visible scars, the ice pick lobotomy was hailed as a great advance in "minimally invasive" surgery, with some operations performed reportedly using only local anaesthesia.
Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in children. Up to 50,000 patients may have been lobotomised during this time.
It is possible that some patients did benefit from the later forms of psychosurgery. What were considered 'good'results at the time often came down to changes in personality and reduced spontaneity, including making the person quieter and decreasing their libido. Some forms of schizophrenia may have responded favourably, where there were theories regarding frontal lobe involvement.
However, certain types of inappropriate behaviours increased from the resulting lowered impulse control. The surgery also often decreased ones ability to function as a member of the community, through a diminishing of problem-solving skills and reductions in flexibility and adaptiveness.
Interestingly the operations semed to have no bearing on IQ, except with respect to problem solving.
There was a strong division amongst the medical profession as to the viability of the treatment and also concern over the irreversible nature of the operation. There was also concern regarding the appropriateness of extending the the surgery into the treatment of unsuitable cases, such as drug and alcohol dependence and sexual disorders.
By the 1960s, the number of operations was in decline as the procedure became much less fashionable.
Improvements in psychopharmacology and behaviour therapy gave the opportunity for more effective and less-invasive treatment.
The era of lobotomy is now generally regarded as a somewhat barbaric episode in psychiatric history.
Most of this article is true..
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