Frontal lobotomy meets neuromatrix

It’s sobering to ponder the story of frontal lobotomy every now and then and reflect on how far we have come.

Brain mashing
For those who have come in late, frontal lobotomy is a psychosurgery which was widely carried out in the US and Europe in between the 1930s and 1960s. “The lobotomy was not a procedure on the fringe of science. It was a mainstream treatment advocated by many highly-educated physicians and prestigious institutions. Praised in breathless news articles, and touted as an amazing neurosurgical advance” (Psychosurgery 2009). In 1948 the New York Times called it “surgery for the mind”. While some techniques involved drilling into the skull and mashing brain with a bit of wire, (little different to stone age trepanning), the most widely used technique was to push a small knife under the eyelid, hammer it into the brain through the cribiform plate and then wiggle the knife, essentially cutting or mashing connections to the frontal lobe.

WARNING – graphic content, it made us feel sick
Here is a video clilp of the operation performed by the US lobotomy protagonist, Dr Walter Freeman. It is worth watching as you ponder how far we have come or not come.

The “lobotomobile”
The operation become famous as Egas Moniz, the first performer of lobotomy on humans, won the 1949 Nobel Prize. It is estimated that 40,000 Americans have had frontal lobotomies. Freeman travelled the West Coast of the US in his “lobotomobile” and “cured” delinquent children (Freeman performed 19 lobotomies on patients under 18) and housewives who had lost their passion for domestic work. We couldn’t find a picture of the lobotomobile but I envisage one of those scary big cars with a big bonnet that kind of smiles at you. The most famous patient was President Kennedy’s sister, Rosemary Kennedy, a moody, if not depressed 23 year old girl who was lobotomised in 1941. She spent her remaining 64 years incapacitated, incontinent, and staring at walls. Howard Dully was diagnosed by Freeman (a non-licensed psychiatrist) with schizophrenia after 4 visits at 12 years of age. Howard was one of the youngest lobotomy victims. Western movie aficionados may be interested to know that the “Cisco Kid” was lobotomised (I always thought he was a bit slow on the draw!).

Forty years on – what have we learnt?
It’s revolting of course, and it wasn’t that long ago the practice of lobotomy generally ceased (1970s). I was studying biology in high school when Walter Freeman was forcibly stopped from performing lobotomies (patient number 3000 haemorrhaged on the operating table during her third lobotomy). Remember that science was advanced enough to send a man to the moon around the same time.

Medical omnipotence: neglect of basic sciences
No matter how you look it, lobotomy does not make sense, then (operating blindly on something you don’t know about) and now. These procedures were continued without follow up and were supported by anecdote a fawning media and surely an omnipotent surgeon. Such practitioner arrogance persists – the “operation went fine, it must be your fault you are not better” or “we have shown you how to tighten your tummy muscles, it’s your fault, you are not trying hard enough”. Are we still guilty of continuing techniques and research without asking the question “does it make sense from broad basic sciences?”. Does it make sense to invest in studies of techniques like single muscle activation or prolotherapy for chronic pain? Not if we were giving out the research money.

The lobotomised patients had chronic problems. It should be clear that most chronic problems such as chronic pain have multiple causes and are often related to what the person thinks and does about the initial issue. Cutting one bit will not help. The relentless hunt for single causes for chronic pain persists in society, a feature which probably makes many worse. I can’t help seeing a MRI on a truck, and think of the relentless searches for the disc bulges in chronic pain states at the expense of a wider psychosocial search, and I think back to the lobotomobile.

Easy in hindsight?
But then again, there wasn’t much else back then. The daughter of an apparently successful lobotomy patient made the comment . “That’s the thing, people who are looking at it now don’t understand, they didn’t have anything else and nobody was coming up with anything.” Have we haven’t advanced that much past Thorazine – the chemical lobotomy that signified the decline of the surgical lobotomy- ? We still overmedicate (biomedical) and de-humanise medical conditions. The non-pharmacological and surgical community do not stand up and sprout loudly enough about what they can do in terms of education, movement therapies and brain retraining therapies. The public still doesn’t know and the media still lead – once a month, a “new” pain treatment will appear on my television.

Looking forward
I believe that watching the lobotomy clip now should evoke more repulsion than it would have ten years ago. This should be a sign that some progress has been made. “That is incredibly useful brain being mashed and it has many other uses other than to contribute to a pain or psychosis neurosignature, its changeable, its plastic, stop, stop you nutter”: went through my brain. We are now aware that the strict modular views of the brain are not correct and that various areas of the brain can have overlapping function or take over the role of another part. Brains consist of mainly association neurones, not neurones dedicated to a singular function. Destroying a brain part will not necessarily remove a neurosignature such as pain. There should lessons here about how the neurosignature works.

Surgery for pain still persists despite limited evidence. In 2001 there were, for example, 70 lobotomies performed in Belgium, even 15 per year at Massachusetts General Hospital in Boston. However, today surgeries like the lobotomy are most commonly used to treat severe obsessive compulsive disorder.

With a view that pain is an output of the brain, like love, we are perhaps fortunate that surgery for love is not commonplace.

Finally – at least the lobotomists were ahead of their time in one area – pain is ultimately in the brain.

References
Psychosurgery: Remembering the Tragedy of Lobotomy, 2009 [online]
Kessler, R. (1997). Sins of the Father: Joseph P. Kennedy and the Dynasty He Founded. Warner Books, New York.
French National Consultative Committee on Ethics, opinion #71: Functional neurosurgery of severe psychiatric conditions 2002, 04-25.
Dully, H. and Fleming, C. (2007). My Lobotomy. New York, Crown Publishing Group, division of Random House Inc, New York.
Atkins, L. (2009). A radical treatment for obsessive compulsive disorder patients. The Guardian. London. [online]

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One Response to “Frontal lobotomy meets neuromatrix”

  1. Howard Dully Says:

    Interesting and well written

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