In this video I describe how improved understanding of the relationship between regions of the brain and emotion led to the dark history of the lobotomy. Initially developed as the leucotomy by Egas Moniz, the frontal lobotomy was spread in the United States by Walter Freeman, who believed it could help to calm patients suffering from psychiatric illnesses. Throughout the 1940s and 1950s tens of thousands of lobotomies were performed on patients, often with disastrous results. The practice was eventually banned and remains a cautionary tale against the use of psychosurgery in the treatment of mental illness.
In China, Brain Surgery Pushed on the Mentally Ill – The Wall St. Journal (2007) https://www.wsj.com/articles/SB119393…
Controversial Surgery for Addiction – TIME (2012) http://healthland.time.com/2012/12/13…
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Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In the past two videos we’ve looked at areas of the brain and pathways in the brain that are involved in emotional processes but unfortunately improved understanding of the relationship between connections in the brain and emotional responses has a dark side.
This brings us to the frontal lobotomy. So this was a procedure in which connections in the brain were severed to try to blunt emotional responses. You might recall the research I mentioned by Heinrich Kluver and Paul Bucy in which rhesus monkeys had their temporal lobes surgically disconnected and this disconnection also disconnected some areas of the limbic system. And one of the results of this was that the monkeys became incredibly calm; they no longer showed fear when they were handled by the researchers and they became more docile.
So one idea that emerged around this time was that this type of procedure could be used on human patients who were suffering from psychiatric illnesses; people who were very emotionally reactive and had strong emotional outbursts. Perhaps we could help to calm these patients by severing connections in their brains. This brings us to the work of a Portuguese neurosurgeon named Egas Moniz and in 1936 Moniz developed a technique that he called the leucotomy. And here’s a picture of Moniz here, and the leucotomy involved drilling a hole in the skull then inserting an instrument and this allowed him to separate connections between certain areas of the frontal lobes and the thalamus. This was done on patients suffering from psychiatric illnesses and Moniz received the Nobel Prize for this work in 1949, although in recent years some people have called unsuccessfully for the prize to be rescinded.
In the United States Moniz’s procedure was adopted by a neurologist named Walter Freeman and in 1937 Freeman paired up with neurosurgeon James Watts and began performing this procedure which he called the lobotomy. Here’s a picture of Freeman here, and Freeman and Watts soon found hundreds and then thousands of patients. Perhaps their most famous patient was Rosemary Kennedy, the sister of John F. Kennedy who would go on to become the 35th President of the United States. Kennedy underwent this lobotomy when she was 23 years old and unfortunately it did not go well, and she remained institutionalized for the rest of her life.
Now Freeman later simplified his procedure to what he called the “transorbital lobotomy” and in this procedure an icepick-like instrument was inserted through the eye socket. This meant that it was no longer necessary to drill a hole in the skull. Freeman thought that this would allow more people to undergo this procedure because it was now faster and simpler. Now around this time, James Watts ended his relationship with Freeman but this didn’t stop Freeman because he began performing the procedure himself, even though he was not a neurosurgeon. And so he would render his patients unconscious using electric shocks and then insert this instrument and essentially just sort of swirl it around to sever connections. And so you should get the idea that this was not a particularly precise procedure that he was doing. It’s really just destroying many connections and hoping for the best.
It’s estimated that about 40,000 lobotomies were performed in the United States, most of them during the 1940s and 1950s, and by that time it began to become clear that there were a number of horror stories about lobotomies and that perhaps it was not as effective as some people were claiming. It began to be banned in a number of places, although it remained legal in some states in the United States until the 1970s, by which time it was banned everywhere. Freeman himself personally claimed to have performed at least 3,500 procedures.
Now this should give an indication that Freeman really believed in what he was doing. I don’t think he was a monster who set out to destroy people’s lives although it’s certainly true that lobotomies did destroy people’s lives in many cases. But I think he really believed that he was helping people and in some ways this should be a demonstration or a reminder of the potential for hubris. Belief, that if we really believe that we’re doing something good and that we’re helping people, we might ignore any evidence to the contrary. Now because of this history of the lobotomy most psychosurgery is rare today and with this recognition that the potential for irreversible damage to the brain is simply too great.
And so psychosurgery is really only used in rare cases and so there are types of psychosurgery that still exist today; they’re not nearly as common as the lobotomy was, and they’re used for extreme cases of violent behavior or aggression. In some cases they’ve been used for severe cases of obsessive-compulsive disorder and depression. And so one procedure that’s still in use today is the cingulotomy and this involves the lesioning of areas of the anterior cingulate cortex, which is part of the limbic system.
In China some types of psychosurgery are still used. There’s recently been some media reports regarding use of psychosurgery to treat things like drug addiction and mental illness and some criticism of a practice in which the heated needle is used to destroy some areas of the nucleus accumbens in order to try to treat things like addiction. I’ll post some links in the video description where you can read more about some of these procedures and some of the controversies surrounding them. So I hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!
