Frontal lobotomy

It’s not clear who first quipped “I’d rather have a bottle in front of me than a frontal lobotomy,” but it’s not just a joke. Almost anything would be preferable to a frontal lobotomy. It was a barbarous procedure with catastrophic consequences, and yet it was once widely accepted and even earned a Portuguese doctor a Nobel Prize. In the annals of medical history, it stands out as one of medicine’s biggest mistakes and an example of how disastrously things can go wrong when a treatment is put into widespread use before it has been adequately tested.

A new book by Janet Sternburg, White Matter: A Memoir of Family and Medicine, puts a human face on the suffering of mentally ill patients and their families, and helps us understand why they agreed to lobotomies. It is the affecting story of how her relatives made the difficult but misinformed decision to lobotomize two of her mother’s five siblings, one for schizophrenia and the other for depression, and the consequences of that decision.
She says “even as a child I had a slight awareness, compounded from fear and pity, that something wrong had been done, that it couldn’t be right for people to be this way, expressionless and indifferent to anything around them.” As an adult, she questioned how good, kind people like her aunts could have done this to their siblings, and how they could have authorized a lobotomy on a second family member after they had seen its effects on the first...

In 1935 a Portuguese doctor, Egas Moniz, attended a conference where he learned of an experiment where the frontal lobes of two chimpanzees were removed and they changed from violent and difficult to handle to docile and compliant. It gave him the idea that mental illness in humans might be treated surgically. He devised a leucotome, an instrument for dividing the white matter in the brain, and he experimented on 11 female patients from the Lisbon insane asylum (no informed consent in those days!). He found that they became more docile and seemingly content, just like the chimpanzees. He rushed to publish a paper proclaiming his procedure a success. Several months later, many of his patients relapsed, as did one of the chimpanzees; this follow-up information was not publicized.

An article that re-evaluated Moniz’s research pointed out numerous flaws (for instance, inaccurate description of the technical parameters, lacking angle values and variable depths of insertion)...

Although undesirable effects arose in almost every intervention, they were only described as temporary. These were, in particular, increased temperature, vomiting, bladder and bowel incontinence, diarrhea, and ocular affections such as ptosis and nystagmus, as well as psychological effects such as apathy, akinesia, lethargy, timing and local disorientation, kleptomania, and abnormal sensations of hunger. Moniz did not admit to having detected a decrease in intelligence and memory performance, whereby it is unclear how he could have come to this conclusion.

Moniz displayed unconscionable haste, presenting his results at a conference only 4 weeks after the first operation and publishing them a few weeks later. And other doctors around the world displayed equally ill-advised haste in adopting the operation based on this very preliminary evidence...

In 1949 Egas Moniz was awarded the Nobel Prize in Medicine for his discovery of lobotomy. They called it:

…one of the most important discoveries ever made in psychiatric therapy because through its use a great number of suffering people and total invalids have recovered and have been socially rehabilitated...

He was no longer violent, and the family no longer had to fear him; but he didn’t speak a word, he barely moved, and he didn’t react to anything or anyone. He was incapable of taking care of himself and required constant supervision. He had eruptions of inappropriate sexual behavior with family members. He would do odd things in public like whirling on the sidewalk like a dervish in a slow trance. He even had to be reminded not to swallow food whole without chewing. After 15 years he suddenly recovered the ability to speak but then subjected the family to a surrealistic nonstop flood of fragmented thoughts. He had become “a head without the czar inside.”...

After surgery, she could indeed live alone and care for herself, but she was reduced to a person who would phone her mother with pride to announce that she had made a TV dinner all by herself. She compulsively gulped down any pills she could find and tried to destroy the evidence of what she had done; they couldn’t tell whether she was trying to kill herself or not. She was apathetic and unreactive. Like Bennie, she had been “erased” and turned into a sort of zombie. She had not wanted the operation, but after it was done she never even mentioned it...

Bennie died at the age of 59 in a nursing home. He had been twirling in the hallway until an attendant turned him toward the dining room for lunch. At lunch, he tried to swallow a handful of peanuts all at once and choked to death. That same year, Walter Freeman performed a third lobotomy on one of his earliest patients who had relapsed for the second time. He tore a blood vessel in her brain and she hemorrhaged to death. His surgical privileges were taken away.

There was an increasing backlash against lobotomy, with publicity about prominent victims like JFK’s sister Rosemary, described as “just a bit slow, a bit difficult.” She came out of her lobotomy permanently disabled, paralyzed on one side, incontinent, and unable to speak coherently. She required constant care by a private nurse for the rest of her life...

Sternburg started her investigation with the assumption that the operation turned everyone into zombies, but she learned otherwise: “[It] sometimes provided genuine relief to people who, to my surprise, were able to be aware of their situations, even to compare them with the past and say how much better they were. One trade-off, though, remained constant: the lobotomized remained indifferent.” She describes Bennie as “a person at the farthest reaches of not being at home in the world, in the midst of a tribe that had damaged him and also kept him safe.”

That raises serious philosophical and ethical questions. Is a life without feeling preferable to one spent in torment? Who is to decide? Can psychotic patients give informed consent? In a modern world concerned about terrorism, “the possibility of dehumanizing people is always with us, at least as great a terror.”

 https://www.sciencebasedmedicine.org/frontal-lobotomy-zombies-created-by-one-of-medicines-greatest-mistakes/#more-38810