Tuesday, March 25, 2008

GUEST POST: Lobotomy Revisited (by Brian Carty)

The second guest post from Brian Carty of Hot Medical News, covering the... well, less-covered side of medicine! Enjoy "the history of the lobotomoy"! There's a great video that goes along with this post. Watch it here.

By Brian Carty, MD, MSPH
March 25, 2008

Do you remember Rosemary Kennedy, John F. Kennedy's sister? Maybe not, since she spent most of her life hidden away in an institution in the Midwest. She had a lobotomy, a brain operation for mental illness, in 1941 when she was 23. Her father, Joseph Kennedy, arranged the operation. The procedure left her mentally incapacitated. Whether she was mentally ill, mentally retarded, or both, is unclear, but her disruptive behavior led to the operation and its unfortunate outcome. She died of natural causes on January 7, 2005 at the age of 86.

The lobotomy, also called leucotomy, was devised in 1935 by the Portuguese neurologist Egas Moniz for the treatment of various psychiatric disorders. In this procedure, holes were drilled in the skull and a blade was used to cut nerve fibers from the frontal lobes (the front of the brain, just behind the forehead) to the rest of the brain. The term lobotomy came to include a variety of surgical procedures on the frontal lobes which were performed for psychiatric disorders.


An estimated 50,000 lobotomies were performed in the US in the 1930s and 40s. Although electroconvulsive therapy was introduced in the 1930s, it is useful mainly for the treatment of depression. Otherwise, before effective psychiatric drugs were available in the 1950s, the only other treatments for the severely mentally ill were incarceration and physical restraint.

By today’s standards, conditions in the mental hospitals of the time were unimaginable. Many patients were severely agitated, extremely violent, and incontinent. The hospitals were dirty, overcrowded, and understaffed.

Many severely ill patients benefited from lobotomy with decreases in violence and agitation. However, lobotomy often caused serious adverse effects, including disturbances of mood and personality, euphoria, poor judgment, impulsivity, loss of initiative, intellectual deficits, and seizures.

For many patients, however, a decrease in agitation and violence, even when accompanied by neurologic injury from frontal lobe surgery, was understandably considered an improvement. When the first effective antipsychotic drug, Thorazine (chlorpromazine), was introduced in the US in 1954, the number of lobotomies performed plummeted.

Surgery for psychiatric disorders is still performed rarely today. The procedures have become more selective and less extensive and now include deep brain stimulation with implanted electrodes. Similar surgical procedures and deep brain stimulation are sometimes done for movement disorders and chronic pain. Surgery for psychiatric disorders is still controversial and, when performed, is most often used for treatment-refractory obsessive-compulsive disorder (OCD). OCD is a disorder characterized by obsessive thoughts and compulsive behaviors such as repeated hand washing or checking to see if doors are locked. OCD can severely affect functioning and quality of life.

It is worth noting again that surgery for psychiatric disorders must be judged with reference to conditions which existed at the time the procedures were introduced. Although lobotomy is viewed by many as barbaric, the operation gave many patients a limited improvement which was otherwise unobtainable. The wisdom of hindsight should be applied sparingly; newly introduced medical treatments often cause unintended harm. The history of lobotomy should remind us that future generations will inevitably view our current best treatments as primitive.

5 comments:

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seller said...

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ativan said...

I have trouble in watchin brain photos.

Anonymous said...

Brian Carty, MD, MSPH - -( BFD )

Well sir, you sound like a perfect apologist for the system in the mid-20th century. Would you have defended the reputation of Torquemada as well, for judging by the times and historical context he wasn't so bad then?

Irreversible surgical procedures are easy to dismiss - - for those that did not experience them. I doubt you would be so blase if your ass was confined against your will to a state hospital, and the procedure performed on you without your consent. Such is the nature of being "powerless".

If you have not ever, or have not recently, read Michel Foucault's "Madness and Civilization: A History of Insanity" or "The Birth of the Clinic: An Archaeology of Medical Perception" then you are doing a dis-service to your profession.


And thanks for the blog post in 2008. I needed a picture of a lobotomy in 2011.

Signed,
SUCKERPUNCHed

agibson217 said...

its mentally challenged... not mentally retarded. Takes away from the whole point of saying "mentally" if you are just going to say retarded.