Lobotomy
The rise and decline of frontal lobotomies and their alternatives
Frontal lobotomy was seen as a breakthrough treatment for mental illness (especially for the serious ones such as schizophrenia and psychosis). Antonio Egas Moniz developed the procedure in 1936, known as leucotomy back then. It was developed when other interventions were also very popular such as insulin coma therapy (or insulin shock therapy) and electroshock therapy (or electroconvulsive therapy). Insulin coma therapy is exactly what it sounds like -- a coma induced by insulin. A high dosage of insulin is injected to the patient which causes a lapse into a hypoglycemic coma. Then, an injection of glucose essentially 'revived' the patient -- it was thought that the brief coma "short-circuited" the abnormal 'psychotic/schizophrenic' brain into a normal brain. A single patient could be induced into a countless number of comas as a form of treatment. Electroconvulsive therapy involved administration of either camphor or metrazol to induce a seizure. Later, electroshocks were used to induce seizures (hence the name electroshock therapy). A common side effect was memory loss, which was sometimes very severe (Well, yeah, the brain is fried with hundreds of volts of electricity -- of course it will affect memory).
Moniz won the Nobel Prize in Medicine in 1949 for his "breakthrough intervention", but Walter Freeman was the one who made it popular in the United States. To be specific, he developed a procedure called transorbital lobotomy, also known as ice pick lobotomy. It is called this because he used an ice pick, shoved it above the patient's eye in the eye socket to reach the brain, and wiggled the ice pick around with a hammer to sever the frontal lobes.
Here is a segment of a PBS documentary on Walter Freeman and his ice pick lobotomy. I warn that the video can be disturbing to some people -- indeed it can be gruesome:
Today, I'm not sure if actual "lobotomies" take place -- the last 'lobotomy' may have taken place in the 1980's, which isn't too long ago. If any modified form of lobotomy does take place, I'm sure (and hope) that the instances are extremely rare. Instead, there are alternative procedures, such as a bilateral cingulotomy which is defined online as "a surgical procedure which may be performed in cases of treatment-resistant mental illnesses." The target areas are the cingulate gyrus and the frontal lobe. The cingulate gyrus is targeted because it is thought to control emotions. The way it works is -- a gamma knife or an electrode is guided to the cingulate gyrus through stereotactic magnetic resonance imaging. A 1/2 inch lesion is made there. Basically, dime-sized lesions are burned/cooked in the cingulate gyrus or the frontal lobes of the brain in order to reduce the afflicted symptoms of serious 'mental illnesses' such as depression, bipolar disorder, generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). One side effect is seizures, but headaches, nausea, and vomiting are much more common.
NOTE: I have also included the full documentary on Walter Freeman below if anyone is interested in watching the whole thing. It's about an hour long:
I like how you went into the history of how lobotomy got started and the other procedures that were going around in that era. I always thought Freeman was the one that invented this procedure. It makes me sick and sad to see that many people went through this procedure expecting to feel better. If that wasn't enough he even performed a procedure to a 4 year old! In my opinion this doctor was the one that needed the lobotomy.
ReplyDeleteIt's incredible that such procedures like these were done back then and patients believed they would get better. The history of these procedures is quite interesting and encouraged me to watch the documentary. It's sad to see how patients with a mental illness were treated. Just like every week, great post!
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