Abstract

My scientific controversy paper is about lobotomy, a surgical procedure commonly used in the mid-twentieth century to treat psychiatric disorders. This paper explores the origins of lobotomy and its reputation as a breakthrough yet controversial practice in medicine. Furthermore, the benefits and most of all, the adverse effects stemming from the procedure are also discussed. The last part examines the aftermath and legacy of lobotomy.

 

Lobotomy: A Breakthrough Procedure or a Medical Mishap?

            Lobotomy is a surgical technique that was utilized to treat patients with mental illness (Terrier et al. 211). From its peak in the 1940s to 1950s, this procedure was considered as a groundbreaking method to alleviate symptoms of psychosis, depression, and anxiety, among other indications (212). However, it was controversial because of the manner it was performed and its diverse results. While it gave promising outcomes to some patients, a large group of them suffered from debilitating consequences and had personality changes after the surgery (211). By the 1960s and with the advent of antipsychotic medications, lobotomy was rendered obsolete and is rarely performed by medical professionals today (Caruso and Sheehan 1).

ORIGINS OF LOBOTOMY

In 1936, Antonio Egas Moniz, a neurologist from Portugal, introduced the surgical procedure he called leucotomy as a treatment for patients with mental illness (Terrier et al. 211). A year prior to that, he was captivated by a study presented at a neurology conference in London (Tan and Yip 175). With its frontal lobes removed, a once agitated and combative chimpanzee was able to follow commands and complete tasks (175). This inspired him to develop a procedure that can correct the same symptoms in humans. Moniz hypothesized that human emotions, obsessions, and mood are connected to the frontal lobes and when these parts are severed, an improvement of symptoms will result (175-176). With the absence of effective treatments at that time, leucotomy was heralded as a breakthrough procedure in the field of psychiatric medicine. In 1949, Moniz received the Nobel Prize in Physiology or Medicine for his “discovery of the therapeutic value of leucotomy in certain psychoses” (Nobel Prize, “The Nobel Prize in Physiology or Medicine 1949”).

An American neurologist named Walter Freeman took note of this technique and refined its method. Together with neurosurgeon James Watts, Freeman performed the first leucotomy in the United States and renamed it lobotomy (Caruso and Sheehan 1). He popularized the procedure in the US and polished the transorbital lobotomy and called it the “Icepick” method (3). With patients under local anesthesia, the frontal lobe of the brain is detached by inserting an instrument through the perforated roof of the orbit (see figure 1). By 1960, Freeman performed over 3,000 lobotomies in the United States and was teaching and demonstrating the procedure to other physicians in the country (1).

Figure 1. Transorbital lobotomy from Carla Garnett; “When Faces Made the Case for Lobotomy”; nihrecord.nih.gov, 1 November 2019.

CONTROVERSY

With the increase of psychiatric patients in hospital wards and mental institutions in the United States, physicians opted to use lobotomy to control and pacify them. Positive results were seen in some patients as the incidence and severity of their anxiety, depression and psychoses diminished (Caruso and Sheehan 3). However, a large number of them had negative outcomes. From being volatile and unstable, patients now displayed a flat affect and were then easy to manage by their caregivers and families (Terrier et al. 215). Others had personality changes and were acting inappropriately in certain situations. They would giggle often or respond erotically (214-215). Worst of all, some patients were left paralyzed after the surgery and others died because of complications such as brain hemorrhage and stroke (Caruso and Sheehan 6). Those who survived ended up being institutionalized because they had become dependent on others for self-care. Residual effects such as seizures and chronic headaches were also reported (Terrier et al. 215).

Doctors who were not convinced of this treatment voiced their concerns over the results of Dr. Freeman’s procedures. Indeed, there was a lack of comprehensive research as well as clinical trials before lobotomy was introduced to the public (Terrier et al. 216-217). There were speculations in the medical community that Dr. Freeman’s publications and results were grossly inflated and that he only reported patients with positive outcomes (215). Post-surgical reassessment was not strongly enforced that is why the immediate and long-term effects of the procedure were not properly documented (215). There were too many patients to evaluate and not enough staff equipped and trained to handle the responsibilities.

In addition, informed consent was almost non-existent because patients were not told of the possible consequences that can stem from the surgery (“My Lobotomy: Howard Dully’s Journey”). The physicians failed to give a thorough explanation to the patients and their families. In some cases, patients were even coerced by family members who were desperate for a cure to their illness (“My Lobotomy: Howard Dully’s Journey”).

CONCLUSION

Lobotomy in the early days was a risky neurosurgical procedure. This technique was embraced by physicians because no other effective treatment for mental illness was available. Patients and families were in dire need of help and lobotomy offered them hope for a better quality of life. While the procedure was developed with the best intentions in mind, the method itself is very unsafe and inhumane. Furthermore, scientific data could not support its efficacy.

Clearly, patients suffering from mental illness endured physical, psychological, emotional, and ethical abuse. It cannot be denied that the use of lobotomy violated the human rights of vulnerable people. This highlights the power of authority in decision-making that affects the weak and helpless. It is a physician’s obligation to educate the patients and their families so that the latter can make sound and informed decisions. Patients deserved the right to know the truth about their health and well-being. Moreover, it would have been beneficial if institutional review boards and ethics committees were in place during this period so that questionable invasive procedures and their respective clinical trials were thoroughly studied and screened for inconsistencies. In this way no patients would have been harmed.

In 1952, the first antipsychotic medication, chlorpromazine, was introduced in France (Terrier et al. 211). Gradually, the use of lobotomy declined and the procedure was considered too invasive and outdated. This paved the way for new and safer regimens in psychiatric treatment.

 

Works Cited

Caruso, James P., and Sheehan, Jason P. “Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy.” Neurosurgical Focus, vol. 43, no. 3, September 2017. MEDLINE Complete, doi:10.3171/2017.6.FOCUS17257. Accessed 14 October 2020.

Garnett, Carla. “When Faces Made the Case for Lobotomy.” NIH Record, vol. 71, no.22, 2019, nihrecord.nih.gov/2019/11/01/when-faces-made-case-lobotomy. Accessed 17 October 2020.

“My Lobotomy: Howard Dully’s Journey.” 16 November 2005. https://www.npr.org/2005/11/16/5014080/my-lobotomy-howard-dullys-journey. Accessed 11 October 2020.

Tan, Siang Yong, and Yip, Angela. “Antonio Egas Moniz (1874-1955): Lobotomy pioneer and Nobel laureate.” Singapore Medical Journal, vol.55, no.4, 2014, pp.175-176. MEDLINE Complete, doi: 10.11622/smedj.2014048. Accessed 14 October 2020.

Terrier, Louis-Marie, et al. “Brain Lobotomy: A Historical and Moral Dilemma with No Alternative?” World Neurosurgery, vol.132, 2019, pp. 211-218. MEDLINE Complete, doi.org/10.1016/j.wneu.2019.08.254. Accessed 14 October 2020.

The Nobel Prize in Physiology or Medicine 1949. NobelPrize.org. Nobel Media AB 2020.  . https://www.nobelprize.org/prizes/medicine/1949/summary/. Accessed 18 Oct 2020.