Tuesday, June 20, 2017

Frontal lobotomy 2

20,000 Lobotomies in the United States

Medscape: The story that I wanted to focus on was "turning the mind inside out"—the chapter that addressed lobotomies and how they developed. From my perspective, what was most shocking about this topic is that lobotomies were still being performed, I believe, until about 1970. Is that correct?

Dr Offit: That's right.

Medscape: That is kind of amazing, in a terrible way. And it started with a couple of experiments with chimps, Becky and Lucy, in 1935. Can you tell our readers a little bit about those experiments and why the procedure jumped to humans so quickly?

Dr Offit: The experiment was done originally by two Yale physiologists, named Fulton and Jacobson. They found that when they tried to teach chimps how to get food with sticks, there was one chimp who was good at it and a chimp who wasn't particularly good at it. And when the chimp who wasn't good at it wasn't able to get the food, she would do such things as throw her feces at the researchers and jump up and down.

What they were really interested in was trying to understand the role of the frontal lobe in memory. So they then did an experiment where they essentially severed the chimp's frontal lobe from the rest of the brain. And they found that the chimp who used to get very anxious about not being able to perform the task wasn't anxious anymore. It was as if, as they said, "[s]he had joined a happiness cult." And so they had created a surgical procedure to eliminate anxiety.

When they presented that finding at a neurology meeting, there was a neurologist from Portugal named Egas Moniz, who said, "Well, sure. Let's do this in people." And then he did just that. He would essentially try to sever the frontal lobe from the rest of the brain, either surgically or just by infusing alcohol. He claimed that the results were great. He called it a "leukotomy," when, across the Atlantic Ocean, it was ultimately called a "lobotomy," for which he won a Nobel Prize.

But it is important to put this in context. This was the 1930s, when people who had severe mental disorders were hospitalized. At that time, more people in the United States were hospitalized with mental disorders than for all other diseases combined. The state institutions were bursting at the seams. The level of sanitation and hygiene in these institutions was woeful. The number of physicians versus the number of patients was also woeful in those settings. So, people were desperate to do something—anything—to make it better.

At the time, they had electroshock therapy, insulin shock therapy, and metrazol shock therapy. But these were all "therapies of despair," and somehow lobotomy seemed more reasonable—the idea that you can actually surgically make things better. Psychosurgery was born.

Over the years, we did 20,000 lobotomies in this country—7000 by one man, a Philadelphian, named Walter Jackson Freeman, who trained at my own institution, the University of Pennsylvania School of Medicine.

He eventually developed the drive-through lobotomy, where he would essentially insert an icepick into the upper inner aspect of the eye, the orbit.

He eventually developed the drive-through lobotomy, where he would essentially insert an icepick into the upper inner aspect of the eye, the orbit. He took a small hammer and drilled the icepick about 3 inches into the brain. He first did it on one side, and then he did it on the other side. He did it without anesthesia. He did it without sterilization. And it would take him only 5-7 minutes to do it.
He could do 20 or 25 procedures in a day. And that's what he did. It was a tough time.

Medscape: I'm sure it was amazing to you that he continued doing that for so long. And from what I read, so much of the problem was that he included a very short period of follow-up when he reported his results. He didn't give complete or totally factual information when he presented his data.

Dr Offit: Yes; he appealed to the sense of desperation at the time. People wanted to believe him and were willing to ignore some of the warnings that were starting to surround lobotomies, and one of those people was Joe Kennedy.

Medscape: Remind us of that story.

Dr Offit: Joseph Kennedy was the father of John F. Kennedy and Robert F. Kennedy. He was also the father of Rosemary Kennedy, who today would be considered mildly developmentally delayed. Even though he'd been warned against lobotomy, he wanted to believe that there was a quick and easy way to make his daughter like his other children, who were bright, active, and politically ambitious. And Rosemary wasn't. She could read, she could write, she could go to parties. But she would occasionally get angry and flap her arms up and down. He wanted all that to go away.

So, that's what Walter Freeman was able to appeal to—the sense of wanting to believe that he could do a magic trick. As it ended up, after the procedure, Rosemary was pretty much vegetative for the rest of her life. And neither of her parents really visited her for the last 25 years of her life. The only person who visited her was John F. Kennedy, during a sort of whistle-stop tour, when he was traveling through Wisconsin.


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