Psychosurgery.org

American Experience

2008-01-21T18:43:00.001-05:00

It has been some time since I posted to this blog or updated this site. Frankly I had to turn away for a while - it was too hard to keep it up. But tonight something is happening. My family, along with Howard Dully, are being featured on PBS's American Experience. Here is a clip of my aunt and mother:

http://www.pbs.org/wgbh/amex/lobotomist/stories/jones_qry.html

This has been a long time in coming. Howard Dully has a book out called "My Lobotomy". My family has had the chance to honor my grandmother Beulah Jones and make her story known to the world. I have accomplished what I set out to do. Beulah did not die forgotten.

I will post again after the show.

More than anything I am honored, incredibly honored and humbled, to have our family and Beulah's story remembered as an integral part of American history.

Edith and the Rampton leucotomies

2006-12-06T11:55:00.000-05:00

In May 1938 sixteen-year-old Edith Haithwaite was up before the magistrates in Ripon, Yorkshire, on a charge of larceny. Edith admitted to the crime and was bound over for twelve months. Within a couple of months she had broken the conditions of her bond by associating with "a certain person". So she was up before the magistrates again and this time the punishment was harsher. Edith was remanded to an approved school. Evidently she didn't settle at the approved school because a couple of months later the magistrates were again considering her case. This time they committed her to an institution as a mental defective. She was to spend the next eighteen years incarcerated for her crime of larceny. And during that incarceration she underwent a leucotomy.
Mental defectives had a relatively brief existence in Britain. They were created by the Mental Deficiency Act of 1913 and abolished by the Mental Health Act of 1959. They were divided into three different categories: the "imbeciles" and "idiots" who would nowadays be considered to have a learning disability and the more nebulous group of "feeble-minded". The latter included people of average intelligence who had somehow fallen by the wayside, the "socially inefficient" as they were called in those days. They often arrived at their diagnosis of mental deficiency via extreme childhood adversity and institutional care or, like Edith, the courts.
In 1920 there were about 10,000 mental defectives in institutions in England and Wales; by 1946 that number had grown to nearly 60,000 with a further 43,000 under statutory supervision in the community. There were two State Institutions for "violent and dangerous" mental defectives: Rampton near Nottingham and Moss Side near Liverpool. Usually the inmates of Rampton and Moss Side had been transferred from other mental deficiency institutions and the violence and danger often consisted of self-harm, suicide attempts or window smashing. It was in Rampton that Edith ended up.
In 1927 the Mental Deficiency Act, which applied only to those in whom a defect was supposed to have been present since birth, was amended to include post-encephalitics, survivors of the encephalitis lethargica pandemic who were sometimes left with destructive and anti-social tendencies as a result of the illness.
Mental Deficiency legislation had originally received support from politicians of all parties (Liberal MP Josiah Wedgewood - the "last of the radicals" - was a notable opponent of the Act) as it was seen as a more humane alternative to incarceration in lunatic asylums, workhouses or prisons. But by the 1940s there was widespread concern about the numbers of people being held under the Act and the National Council for Civil Liberties led a campaign which exposed abuses of the Act and accused authorities of using the inmates of mental deficiency institutions as a source of cheap labour. One teenage girl featured in the NCCL's campaign had been found to be working ten-hour days in an institution's laundry and kitchen for a shilling a week, most of which was taken back to pay for a sweet ration.
George W Mackay, the Medical Superindent of Rampton, together with Sheffield neurosurgeon James Hardman introduced leucotomy into the institution in 1947. Within little more than a year twenty operations had been carried out and George Mackay had written an article for the Journal of Mental Science entitled "Leucotomy in the treatment of psychopathic feeble-minded patients in a state mental deficiency institution". The diagnosis of psychopathic in those days was given to patients who self-harmed and smashed things. Typical was AVT, a young man who had been admitted to Rampton at the age of 13 from a children's institution after two suicide attempts. An very good chess player, his only crimes were to have violent outbursts in which he smashed crockery and to be "given to homosexual practices". Following leucotomy at the age of 23 he was employed in the ward pantry and was able to look after crockery without smashing it, putting him in the "markedly improved or recovered" category. Young women could earn the label of psychopathic by showing "emotional instability" or "moral deficiency". Of the first twenty patients operated on, two had epilepsy and five were post-encephalitics. One patient was just fourteen years old and had been admitted to Rampton aged nine. Mackay was pleased with the results in this girl, saying "from being a depraved and hopeless little animal she is now quite a sociable, clean child." She had also gained a lot of weight and "would go on eating indefinitely if not stopped". One patient died and five were unchanged or worse but Mackay was not deterred and ended his article by expressing his intention to operate on "a wider group of clinical types".
Edith had agreed to a leucotomy because she had been told that it would lead to her release. It didn't. Instead it was her sister's writ of habeas corpus which finally led to her freedom when the High Court decided that her eighteen-year detention as a mental defective had been illegal as the Ripon magistrates had overstepped their authority.

"A commendable act of humility"

2006-11-23T12:58:00.000-05:00

John Sutherland writing in the British newspaper The Independent last month:

"We should be humble in assuming that our therapies, whatever stage scientific knowledge may have reached, can do what we think they can do. It is to me strange, for example, that Stockholm has never seen fit to withdraw, retroactively, the Nobel Prize it awarded Egas Moniz, in 1949. Moniz invented prefrontal lobotomy. He was, the committee said, "a wonderful man". Many, then, might have agreed. Now, few would.
The operation, which involved scooping lumps out of the brain, as if it were ice-cream, was subsequently popularised in the US by Walter Freeman who trundled round in his "lobotomobile", demonstrating his "ice pick and hammer technique" to any hospital that would let him in, and knocking off 10 ops a day in hotel rooms. Nothing could stop his campaign to make America mentally "healthier".
It would be a commendable act of humility, and an admission that mental health is difficult to define and fiendishly difficult to manufacture, were Stockholm to respectfully rescind that award to Moniz." (more...)

Harvey Jackson deals with his conscience

2006-11-18T07:32:00.000-05:00

In an article about Egas Moniz, author João Sodré criticised Portuguese psychiatrists who try to justify leucotomy with claims that it is more humane than ECT. They are not the only ones. British neurosurgeon Harvey Jackson describes in 1954 how he overcame his doubts about leucotomies:

"When originally I undertook to perform leucotomy it was not without a feeling rather of reproach, for mutilation no doubt it must be. However I first of all went to watch my psychiatrist colleagues applying chemical or electric convulsive therapy - so disturbing was the exhibition at the time that thereupon I decided that the surgical approach was probably a less traumatic measure."

And American neurosurgeon William Beecher Scoville felt that psychosurgery "is preferred to shock treatment in those depressions requiring more than short courses of shock treatment because of less emotional blunting, memory loss and relapses."

News from Portugal

2006-11-14T09:20:00.000-05:00

The Portuguese radio and TV station, RTP, is running a poll to find the greatest ever Portuguese. In January there will be a programme featuring the ninety people who collected the most votes and the ten finalists will be announced - each will have their own documentary. Egas Moniz is of course amongst those nominated. A Portuguese doctor defends Moniz's Nobel Prize on the RTP website; whilst acknowledging that leucotomy could be damaging he points out that Nobel Prizes are awarded not for therapeutics but for the advancement of knowledge. Nobel Prizes for medicine and physiology are indeed usually won in the laboratory - neither of this year's winners (Andrew Z Fire and Craig C Mello) are doctors of medicine. They are awarded for discoveries and Moniz's prize was awarded for "the discovery of the therapeutic value of leucotomy" and so the therapeutic value, or lack of it, is relevant. And how exactly, in any case, was leucotomy supposed to have advanced our knowledge of either the frontal lobes or mental illness?
Another Portuguese website, Portuguese lives, has an interesting biography of Egas Moniz with quite a few illustrations. The author, João Sodré, says that Egas Moniz is not held in high regard by the people of Portugal; the friends, taxi drivers, bartenders, coffee-drinkers and passers-by he spoke to all expressed a negative opinion of the Nobel Prize winner (let's hope they have been voting). Sodré criticises Portuguese psychiatrists for defending leucotomy as a more humane treatment than ECT and wonders how far leucotomy would have got if its inventor had followed Bazett-Haldane principles of not subjecting others to medical experimentation that you wouldn't want to be subjected to yourself. Finally he tackles a popular myth about Egas Moniz - that he was murdered by a patient. He was injured but survived. It was another well-known Portuguese psychiatrist, Miguel Bombarda, who was killed by a patient.

"An impetus for revival"

2006-10-31T09:55:00.000-05:00

Some of the big names of psychosurgery in the USA and Belgium are out in force in the October issue of the journal Neurosurgery. Neurosurgeons Ali Rezai (Cleveland Clinic), Bart Nuttin (Catholic University of Leuven), Chris Heller and Michael Apuzzo (University of Southern California), and Arun Amar and Charles Lui (Yale University) are joined by psychiatrist Benjamin Greenberg (Butler Hospital/Brown University) and medical ethicist Joseph Fins (Cornell University) to write an editorial and two articles.
I haven't read the articles yet, but the abstract of one, "Surgery of the mind and mood: a mosaic of issues in time and evolution" by the Yale and University of Southern California authors, sounds worrying enough:

"The prevalence and economic burden of neuropsychiatric disease are enormous. The surgical treatment of these psychiatric disorders, although potentially valuable, remains one of the most controversial subjects in medicine, as its concept and potential reality raises thorny issues of moral, ethical, and socioeconomic consequence.
This article traces the roots of concept and surgical efforts in this turbulent area from prehistory to the 21st century. The details of the late 19th and 20th century evolution of approaches to the problem of intractable psychiatric diseases with scrutiny of the persona and contributions of the key individuals Gottlieb Burckhardt, John Fulton, Egas Moniz, Walter Freeman, James Watts, and William Scoville are presented as a foundation for the later, more logically refined approaches of Lars Leksell, Peter Lindstrom, Geoffrey Knight, Jean Talaraich, and Desmond Kelly. These refinements, characterized by progressive minimalism and founded on a better comprehension of underlying pathways of normal function and disease states, have been further explored with recent advances in imaging, which have allowed the emergence of less invasive and technology driven non-ablative surgical directives toward these problematical disorders of mind and mood.
The application of therapies based on imaging comprehension of pathway and relay abnormalities, along with explorations of the notion of surgical minimalism, promise to serve as an impetus for revival of an active surgical effort in this key global health and socioeconomic problem.
Eventual coupling of cellular and molecular biology and nanotechnology with surgical enterprise is on the horizon."

"The new lobotomy?"

2006-10-27T09:50:00.000-04:00

Today's cover story at the The Tyee is "The new lobotomy?", an article by Canadian journalist Danielle Egan. The article takes a much more interesting and critical look at DBS (deep brain stimulation) than most articles on the subject do.

"Eights months ago, surgeons drilled two holes into the skull of a wide-awake Vancouver man and inserted spaghetti-sized electrical wires down through the two sides of his frontal lobes. They left behind a remote control brain pacemaker, which regularly shocks his brain with three volts of electricity, 24 hours a day, seven days a week, powered by a battery pack that sits on his neck. The device is meant to treat his severe depression. It's part of a controversial clinical trial of a procedure called deep brain stimulation (DBS) that's jointly run by UBC and VGH, and being partly funded by B.C. health care.

As part of the trial, which is co-sponsored by a Texas-based medical device manufacturer, researchers will also implant five other British Columbia patients through a multi-centre trial also happening in Toronto and Montreal. DBS is also being tested at centres all over the globe, as a treatment for obsessive-compulsive disorder, anxiety, eating disorders, addictions and even violent behaviour. But emerging data on this new technology is raising questions about the effectiveness of the procedure, the link between health care and profits, and the ethics of quick-fix psychological treatments....

It's the same physiological rationale used to describe lobotomies and their modern counterparts, known as psychiatric neurosurgeries, which are said to be making a comeback at select centres round the globe, including a UBC program started in 2000. DBS is being held up as a good alternative to psychiatric neurosurgeries, because it doesn't involve permanently destroying pieces of the brain, and because the device can be turned off." (more...)

"And sometimes not"

2006-10-27T08:59:00.000-04:00

In his book about Henry Cotton (Madhouse: A Tragic Tale of Megalomania and Modern Medicine)Professor of Sociology and Science Studies Andrew Scull muses on the trust we place in psychiatrists:

"As members of a healing profession that likes to trace its lineage back at least as far as classical Greece and the fabled Hippocrates, physicians pronounce themselves the guardians of our physical welfare - and, in the case of that subordinate branch once called by the derisive term of "mad-doctors" and now preferring to own to the title "psychiatrist", our mental welfare as well. Like all of those who make the most well-founded and broadly socially accepted claim to the title of professional, medical men (and these days medical women) operate in an arena where the ordinary disciplines of the marketplace seem to fail, or to perform poorly. As lay people, we lack access to their specialized knowledge and expertise, even though the content of their cognitive world may be quite literally of life and death importance to us. In a poor position to second guess their expert judgments or even, in many instances, to grasp the foundations on which their diagnoses and prescriptions are based, and ill-equipped to assess the quality of the care we are about to receive, we are perforce at their mercy. Elaborate social rituals persuade us to grant these strangers our trust, and reassure us that they are motivated, not by the self-interest of the marketplace - the hidden hand that allegedly guides so much of civil society - but by a higher ethical standard, a genuine concern for our well-being and survival and a willingness to subordinate their interests to ours. And so it sometimes proves.
And sometimes not." (Madhouse: A Tragic Tale of Megalomania and Modern Medicine.Yale University Press, page 276)

The author has this to say about psychosurgery: "Lobotomy, in my judgment, even by the standards of the 1940s ought ultimately to be seen as indefensible, as a number of informed and perspicacious critics argued at the time. But a proper examination of that issue is a debate place and another time." (page 285)

I hopefully asked Professor Scull if he was thinking of writing a book about the history of psychosurgery but sadly it is not on his list of things to do in the immediate future.

Sir Wylie McKissock, Part II: the patients

2006-10-12T11:14:00.000-04:00

Wylie McKissock’s patients came from all walks of life, from doctors and nurses to rag and bone men and domestic servants. They ran the gamut of psychiatric diagnoses from schizophrenia and affective psychosis to neurosis and personality disorder. (A few had no psychiatric diagnosis and were operated on for the relief of pain or tinnitus.) Some had been incarcerated for years, some had never been in a mental hospital. In age they ranged from teens to seventies.
Many were – one way or another – casualties of war: a veteran of the Normandy campaign, physically and mentally injured in the front line; an elderly woman bombed out of her home who found it difficult to settle in a new area; a nursing sister who broke down under the stress of trying to protect her patients from enemy bombardment; a widow unable to cope when her son was posted overseas; a blind man who became obsessive about switching off lights after being prosecuted for contravening blackout regulations; a prostitute who was arrested and certified after being found sleeping on War Department land.
Some patients, especially those with a diagnosis of schizophrenia or mental deficiency, were leucotomised in the hope not so much of a cure and return to life outside an institution, but in an attempt to render them less of a management problem within the institution. “The patient who showed great improvement” wrote Dr Cook of Bexley Hospital, Kent, where by 1943 McKissock had leucotomised 13 violent schizophrenic patients (one died), “was a typical example of the use of leucotomy in chronic schizophrenia. The patient was by far the most violent, animal-like catatonic whom even the most senior nurses in the hospital could remember, and after twelve years of “unapproachableness” she had for over a year been up and about, playing the piano, knitting and doing embroidery. She was still as mentally ill as she ever was, but the nursing relief was very great and she was much happier”.
But psychiatrists at St Lawrence’s Hospital, Caterham, were less impressed with the results on their mental defectives and decided to put an end to the visits of McKissock and his assistant McColl after 5 of 43 leucotomy patients (nearly all under the age of forty) died and others suffered mental deterioration or epilepsy.
It was this particular use of leucotomy – to control the behaviour of institutionalised patients – that was curtailed by the discovery of new drugs in the 1950s. McKissock himself noticed that by 1958 there had been “a marked diminution in the number of deteriorated schizophrenics offered for surgery although a number of dangerous or disturbed patients are still referred and can often be adequately sedated by a standard prefrontal operation”, but he doesn’t appear to have made the connection with the introduction of major tranquillisers. In fact, he generally showed little interest in psychiatry or indeed in the fate of his own psychiatric patients.
Women outnumbered men by three to two amongst those leucotomised by McKissock and, although they were found in all diagnostic categories, they especially dominated the depressed group. Many had unhappy marriages and a few appreciative words from their husband post-leucotomy could catapult them into the recovered category (“he rather likes the severe frontal lobe deficit syndrome” or “Barbara is undoubtedly a much pleasanter companion to live with”). Their misfortune was to fall into the hands of psychiatrists before the advent not of a new drug but of a means of escape via easier divorce and more financial independence for women

Sir Wylie McKissock

2006-09-30T08:38:00.000-04:00

Part I: the surgeon

By the late 1950s an estimated 20,000 leucotomies had been carried out in Britain. A few were performed by general surgeons, a few by psychiatrists, but the vast majority were performed by neurosurgeons. And of these neurosurgeons Sir Wylie McKissock (1906-1994) was probably the most prolific, responsible for at least 3,000 leucotomies.
McKissock, who in spite of his Scottish name hailed from Staines in Surrey, is remembered for his achievements in neurosurgery including the treatment of head injuries (he received an OBE for his wartime work) and the treatment of subarachnoid haemorrhages and intracranial aneurysms; and for setting up the world-famous Atkinson Morley's neurological service. He became President of the Society of British Neurosurgeons and received a knighthood on his retirement in 1971. But his contributions to British psychosurgery seem to have been quietly forgotten.
When McKissock died in 1994, obituaries in the The Times and The Independent newspapers made no mention of psychosurgery. Other tributes were likewise reticent on the subject. For example, psychosurgery was entirely absent from an 800 word article in the Journal of Surgical Neurology in 1988 even though the author Alan Richardson was himself a practitioner of psychosurgery, and a ten page reminiscence in the British Journal of Neurosurgery two years after McKissock's death containes only the following brief reference to psychosurgery:

"His links to psychiatry were related to his large practice in the 1940s and 1950s as a leucotomist of extraordinary surgical speed, associated with a peripatetic service visiting major institutions in the UK in his motor car with the instrument set in the boot".

These expeditions in his motor car took McKissock all over the South of England and Wales; among his destinations were St Andrews in Northampton, Graylingwell in Chichester, St Lawrence's in Caterham, Pen-y-Val in Abergavenny. The institutions (many of them Victorian Asylums) were often situated in pleasant rural locations and in those days the roads were comparatively empty. A visit from a well-known neurosurgeon would have been quite an event and doubtless the red carpet was laid out for McKissock. The operations themselves were quickly done - 15 to 30 minutes each - and so all-in-all these excursions must have been a reasonably agreeable way for McKissock to supplement his income.
Why did McKissock travel round the country rather than having the patients brought to his neurosurgical unit? In the early days of psychosurgery he claimed it was "owing to the extremely unpleasant and dangerous habits of the unfortunates who have been submitted to me for operation, and to the lack of proper facilities for dealing with the habits of such patients in my own neurosurgical unit." By the 1950s he had become more circumspect, claiming instead it was out of consideration for patients who could be treated in familiar surroundings and receive visits from relatives.
McKissock doesn't seem to have troubled himself much over the ethics of psychosurgery, although his excursions sometimes resulted in death or disability (some patients were left in what McKissock himself described as a "harmless vegetable state"). What little he wrote on the subject of psychosurgery is largely confined to notes on technique. He admitted that the operation was "academically and scientifically unsound" but felt it was justified if the "experienced psychiatrists" who selected patients felt there was no chance of a cure with other methods of treatment or a spontaneous recovery.
In the early years of his career as a psychosurgeon McKissock used the standard Freeman-Watts technique of leucotomy, drilling two burr holes in the side of his patients' skulls and severing the connections to the frontal lobes. He was scornful of specially designed leucotomes, referring to John Crumbie's as a "mechanical egg-whisk" and preferring to operate with an ordinary brain needle. In the late 1940s, as psychosurgeons were experimenting with different techniques in an attempt to avoid some of the complications and devastating effects on personality associated with the standard leucotomy, McKissock devised the "rostral leucotomy" in which holes were drilled in the top of the skull and the cut made in a downwards direction, undercutting Brodmann's areas 9 and 10 of the frontal cortex. Neuropathologists commented that the resulting lesion was similar to that of Freeman's transorbital leucotomy although McKissock approached from the opposite direction to Freeman. McKissock had little time for Freeman's transorbital operation, considering it an offence against "established aseptic surgical principles". The rostral leucotomy did not however entirely replace the standard procedure; even at the end of the 1950s McKissock was still using the standard technique on a minority of patients.
The last sighting of McKissock in the literature is an appearance at the November 1958 meeting of the Neurological Section of the Royal Society of Medicine where he talked about having performed 125 rostral and 19 standard leucotomies the previous year.

The dark side of the healing volt

2006-09-28T09:46:00.000-04:00

Last week, as Kitty Dukakis (twenty-six year amphetamine habit from the age of twenty; then some problems with alcohol and depression; in recent years a few short courses of unilateral ECT) was promoting the book (Shock: the healing power of electroconvulsive therapy) she has written with journalist Larry Tye, an altogether darker story of ECT emerged from the Appellate Division of the Supreme Court of New York.
Simone D, a Spanish-speaking woman, has been a resident of Creedmore Psychiatric Hospital for twelve years. Over this period she has received several courses of ECT (a total of 148 treatments) under court order. One course in 1996 was stopped because of the damage it was doing, but the courts continued to authorize further treatments even though there appears to be little hope that Simone will ever recover sufficiently to leave hospital or be allowed to make her own decisions about treatment. On this occasion the court voted, by a three to two majority, not to allow an appeal against the latest permission to administer ECT. One of the two dissenting judges had this to say:

"Simone D. was first admitted to Creedmoor Psychiatric Center in 1994 and suffers from a severe depressive disorder. Since 1995, she has undergone, over her objection but pursuant to previous court orders, at least 148 ECT treatments. Prior efforts to help her with medication failed to improve her condition. After two unsuccessful applications in July and September 2005 for permission to administer ECT to Simone D., the petitioner applied again in November 2005. The petition and supporting papers showed that without ECT Simone D. becomes depressed, stops eating and drinking, and requires nasogastric tube feeding. Allegedly, the ECT will diminish her assaultive behavior, enable her to eat, enhance self-care, and promote her ability to socialize. At a hearing on the petition, the court rejected the request of Simone D.'s counsel that it appoint an independent psychiatrist. The petitioner called one of its psychiatrists, Dr. Ella Brodsky, who opined that Simone D. lacked the capacity to make a reasoned treatment decision and that ECT is the least restrictive alternative because there is no other choice..." Read more

Primetime DBS

2006-09-15T10:48:00.000-04:00

Last Thursday, ABC’s Primetime broadcast a report about DBS (Deep Brain Stimulation) at the Cleveland Clinic, Ohio. It featured neurosurgeon Ali Rezai and his patient Cindy Warren, who will already be familiar to viewers of the Pittsburgh Channel and readers of The Plain Dealer. Also appearing were Florida neurosurgeon Kelly Foote and his patient “Kelly”.

Emotions Via Remote Control
However, generating emotions in the operating room is not the true test of this medical trial. That comes later, when Cindy and Kelly head to their psychiatrists' offices to have the electrodes turned on in such a way that will, they hope, alleviate some of their symptoms. It means they will need permanent pacemakers to power the signals, too.
Using a handheld device that looks similar to a TV remote, Malone [psychiatrist Donald Malone] adjusts the voltage on Cindy's pacemaker.
"I can actually get to the point where I feel like laughing. I feel kind of giddy, tingly," she said.
Malone said he's aware of the power he holds in his hands. "It's humbling," he said. "And scary."
And, amazingly, it's also a mystery as to why deep-brain stimulation works. But scientists theorize that the electrical currents emanating from the implanted wires scramble the old neural pathways that carried Cindy's depressive thoughts and patterns. Read more...

Well, something at least has not changed much in seventy years of psychosurgery. Egas Moniz theorized in a very similar sort of way.

The Cleveland Clinic used to perform ablative psychosurgery until a patient successfully sued them four years ago:

Failure to obtain informed consent for experimental surgery
Verdict for a woman who suffered brain damage and a brain infection after undergoing brain surgery. She and her husband sued the hospital, alleging battery, fraud, and medical negligence. Among other things, plaintiffs claimed that the treating surgeon had performed a combined cingulotomy and capsulotomy-the latter a procedure that was unconsented to and experimental in nature. Plaintiffs were represented by *Robert F. Linton Jr., *Mark W. Ruf, and Stephen T. Keefe Jr., all of Cleveland, Ohio.
Zimmerman v. Cleveland Clinic Found., Ohio, Cuyahoga County C.C.P., No. 399411, June 12,2002.

The Napsbury lobotomies

2006-09-09T08:16:00.000-04:00

Lobotomy came to Britain via the United States and in the early days most of the operations were of the Freeman-Watts standard type, where burr holes are made in the side of the temples, and an instrument inserted and pivoted up and down to slice through the white matter in the frontal lobes, thus severing the fronto-thalamic connections. British surgeons however didn't adopt Freeman's term "lobotomy", preferring to use Moniz' original term "leucotomy".
British surgeons soon began experimenting with modified procedures in an attempt to find an operation that would do less damage than the standard Freeman-Watts standard prefrontal operations. In the 1940s Hugh Cairns in Oxford, for example, experimented with cingulotomy (an operation that is still used in Scotland) while the peripatetic Wylie McKissock devised the rostral leucotomy. But Freeman's own particular modification, the transorbital lobotomy in which an instrument is inserted through the eye socket, never became popular in Britain perhaps because it dispensed with the need for a neurosurgeon and neurosurgeons in Britain had already gained control of psychosurgery. Wylie McKissock certainly wasn't going to relinquish his profitable week-end excursions into the English and Welsh countryside: "Freeman's latest development of transorbital leucotomy", McKissock wrote, "is mentioned only to be condemned: the whole technique offends established aseptic surgical principles". What is more, he questioned its effectiveness: "From the number of patients so leucotomised who have come to me for more extensive operations, the results do not appear very satisfactory." Wylie McKissock's own rostral leucotomy was designed to cut much the same area of white matter as the transorbital operation, but McKissock approached from above through burr holes in the top of the head, while Freeman approached from below via the eye socket, where the skull is thin enough for the instrument to be hammered through without the need for a drill or a neurosurgeon.
There were, however, a few psychiatrists in Britain who experimented with transorbital lobotomy. John Walsh at Tone Vale Hospital in Taunton, Somerset, operated on eight women in 1949, even on three occasions following Freeman's example and using electroconvulsive shock as anaesthetic. On one of these occasions the operation was given as a demonstration at a meeting of the south-western division of the Royal Medico-Psychological Association. Walsh was disappointed with the results, finding "no definite clinical improvements" in any of the patients.
Meanwhile, in Napsbury Hospital near St Albans, Hertfordshire, more extensive experiments with transorbital lobotomy were being carried out by psychiatrist Alan Edwards. Napsbury was one of the three "Middlesex in Hertfordshire" county asylums, opened in 1905 to house the pauper lunatics of Middlesex, where suitable sites with sufficient grounds to provide inmates with work, exercise, and recreation were in short supply due to the urban nature of the county (Middlesex now forms part of London). During the first World War, Napsbury became a war hospital; poet and musician Ivor Gurney stayed there briefly. During the 1930s cat artist Louis Wain spent the last years of his life in Napsbury. The hospital closed in 1999.
Alan Edwards operated on seventy-one patients between February 1949 and February 1950, following the Freeman's technique (although Edwards baulked at using electronvulsive shock as an anaesthetic, preferring intravenous pentothal). Edwards found that the operation was only one third as effective as a standard leucotomy, two-thirds when he adopted Freeman's "full frontal sweep".

After leucotomy

2006-08-26T12:04:00.000-04:00

A lobotomy (or leucotomy as it was called in Britain) wasn't necessarily the last resort for patients in the 1940s. Doctors sometimes had other dangerous and bizarre treatments (as well as second or third leucotomies) in store for those who remained in hospital.
At Mapperley hospital in Nottingham, England, Paul Weil experimented with "regressive electroplexy" for the treatment of schizophrenia. Patients were given electroconvulsive treatments at half-hourly or hourly intervals (up to nine a day) on a daily basis until they were "in a state of complete confusion and utter apathy, mute, incontinent and unable to take food without assistance". It took up to two weeks of treatment for patients to reach this state. Six of the eighteen patients subjected to this experimental treatment had already undergone leucotomy. One twenty-eight year old man who had had a leucotomy died three days after regressive electroplexy treatment. So did one of the patients who hadn't had a leucotomy.
The surviving patients were described as somewhat more co-operative than before treatment but soon relapsed. Two who were discharged from hospital were readmitted within months. Paul Weil admitted that the results were "unfavourable" and decided not to repeat the experiment.

Helen Mayberg wants guinea pigs

2006-08-26T11:39:00.000-04:00

If you are within reach of Atlanta, Georgia, and are depressed (but not suicidal) and would like to have electrodes implanted in your brain then you could volunteer to be an experimental subject for Helen Mayberg and colleagues at Emory University.

"The purpose of the proposed study is to evaluate the safety, feasibility and efficacy of chronic, high frequency stimulation of the subgenual cingulate white matter (Cg25WM) using the ANS Totally Implantable Deep Brain Stimulation System as an adjunctive treatment for severe treatment-refractory Major Depression in twenty TRD patients, and to investigate potential mechanisms of action of this intervention."

More details here...

"Walking amid flowers"

2006-08-18T11:07:00.000-04:00

This month's edition of Scientific American Mind contains an article about Helen Mayberg and her experiments with Deep Brain Stimulation on depressed people. The article is called "Turning off depression" and can be read on the author's website.

The tone of the article is enthusiastic, both about Professor Mayberg

"Eat dinner with Helen Mayberg, as I happily did, and you are treated not just to a good meal (for she appreciates good food as much as good ideas) but an infectious intellectual excitement. Lively of manner, with big eyes and a ready smile, Mayberg has a knack for stretching a meal while making the time pass quickly. At 50 she combines the enthusiasm of a freshly inspired grad student with the literate veteran’s appreciation of history."

and about her experiments

"The results were stunning. Some patients felt profound relief as soon as [neurosurgeon] Lozano turned on the electrodes, and two-thirds returned to essentially normal mood and function within months. They saw better, thought better, felt better. They talked of walking amid flowers; of “the noise” stopping; of a horrid weight lifting. Side effects were almost negligible."

We shall see.

"A Satisfied Mind"

2006-08-08T08:49:00.000-04:00

If you happen to be in Leipzig, Germany, this month, why not go along to the Pierogi gallery where a video work by American artist Amy Patton can be seen.

"Amy Patton’s video work A Satisfied Mind leads us on a journey into an obscure narrative landscape. It is the product of work with three small excerpts of unrelated 16mm films found tangled together in a garbage bag in Austin, Texas. The three films, one showing early aviation disasters (c.1929), one discussing amnesia among psychosurgery and electro-shock therapy patients (ca. 1969), and one showing two children who take a ride on a greyhound bus (ca. 1966), were “hijacked”, so to speak, into a narrative framework of the artist’s design."

"They cut away his conscience"

2006-08-04T08:27:00.000-04:00

In 1951 the Saturday Evening Post published a two-part article about lobotomy by Irving Wallace. The author's original title of "They cut away his conscience" had been changed to the less controversial "The operation of last resort".

The article tells the story of Princeton graduate "Larry Cassidy" who had had a breakdown when drafted into the army. Discharged six months later he returned home but continued to suffer from anxiety and depression. Psychoanalysis didn't help; neither did insulin and electric shock treatment and Larry and his family, encouraged by some psychiatrists and discouraged by others, sought a lobotomy. The operation was carried out in 1947, five years after his original breakdown, by private doctors in Boston (who didn't want to be named in the article).

Wallace describes the effect of the operation on Larry. At first it seemed successful - Larry appeared to have become more cheerful and even-tempered but it soon became apparent that he had no interest in anything and no concept of socially appropriate behaviour. His wife left him and his brother had him committed to a mental hospital. His brother Jack reflects: "Now he is dulled, no longer the person that they once knew. On the other hand, some of him is still that same person. And the rest of him is happier, and enjoys certain pleasures, and does not mind what he has become. Perhaps that is better than nothing".

Wallace summarizes the controversy surrounding lobotomy:

"Thus, in the years since its inception, prefrontal lobotomy has been the center of a heated, worldwide controversy. The neuropsychiatrists who favor the operation can back up their stand with the fact that pre-frontal lobotomy prevents insanity and suicide and alleviates pain by reducing anxiety and removing worry....On the other hand, there is the school of thought that can prove, also from factual evidence, that prefrontal lobotomy converts patients into docile, inert, often useless drones, stripping them of their old powers, giving them convulsive seizures, making them indifferent to social amenities, filling them with aggressive misbehaviour, and impairing their foresight and insight. Then, there are those who feel the operation tampers with the God substance, who feel that if it cuts out a man's cares, it also cuts out his soul and his conscience....Neither side in the disagreement is able to marshal adequately decisive statistics as evidence - although, currently, the Veterans Administration Psychiatric Division, which has performed 1,200 of these lobotomies, is in the process ofmaking a survey of the results. Their findings may, one day, help evaluate the operation's merits and settle the controversy. But, while surveys may seem to show whether or not the results justify the attendant changes in personality, it is doubtful if statistics will ever actually be able to solve the human equation involved. For, in trying to determine, if an operation has been good or bad, what absolute measuring stick or standard can be used to judge? And from whose point of view can judgment be made? From the point of view of the patient? Or from the point of view of those around him? Or from the point of view of the doctor in the case?"

The story, under its original title "They cut away his conscience", was included in Wallace's 1966 collection "The Sunday Gentleman". In a postcript to Wallace describes the response when the Saturday Evening Post published the article:

"Whereas an average article or essay might bring me a half-dozen letters from appreciative or critical readers, the travail of Larry Cassidy inspired a small mountain of mail. Much of the mail was congratulatory; readers were deeply moved. Some of the letters, from physicians and clergymen, questioned or discussed the wisdom of Larry's psychosurgery. Other letters came from parents or relatives of mentally ailing persons, tragic, heartrending letters, asking for more factual information, inquiring for the real names and addresses of Dr Leon Goldsmith and Dr Raymond Rogers. The editors of the Saturday Evening advised me that the double-length feature had drawn a record amount of mail, and was, in this respect, among the two or three most provocative stories they had published in a decade."

And there is an update on what had happened to Larry in the intervening years. He had discharged himself from hospital and returned to New York where a his old college room-mate found him a small apartment. A series of unskilled jobs never lasted more than a few days due to his eccentric behaviour and inability to concentrate. Larry eventually married again and survived on a his veteran's pension, spending his days reading, watching TV and fruitlessly looking for a job.

Sweden

2006-07-25T12:22:00.000-04:00

Kenneth Ögren, who writes about the early history of lobotomy in Sweden and who has previously featured on this blog, has had another article published in the Swedish medical journal Lakartidningen.
The article expands on a paper Ögren delivered at the tenth annual meeting of the International Society for the History of the Neurosciences last year, and describes a quarrel between geneticist Gunnar Dahlberg and the psychosurgery team of psychiatrist Snorre Wohlfahrt and neurosurgeon Olof Sjöqvist over Dahlberg's rather unflattering definition of lobotomy. Here is the abstract:

"A less honorable way of expressing oneself on lobotomy

Kenneth ÖGREN
University of Umeå, Sweden

“Recently, doctors started using a procedure in which a hole is drilled in the skull of the patient, thereafter a knife is inserted into the holes and than it is whipped around in the brain until the frontal lobes stops to function.”
The above quotation was published in 1947, in Sweden, in the Tidens Kalender, a widely distributed year book that among other important societal subjects covered science and medicine. Professor Gunnar Dahlberg, a well-respected chief of the Swedish Race Biology Institute, edited Tidens Kalender. Since the end of the 1930s, besides his work as a physician and researcher within the Institute, Dahlberg was a well-known publisher of popular texts on medical matters.
Why did Dahlberg define psychosurgery in this way? In 1949, the year of the nomination of Moniz for the Nobel Prize in medicine, a Swedish pioneer of lobotomy, the psychiatrist, Dr Snorre Wohlfahrt, in collaboration with the neurosurgeon Olof Sjöqvist, reacted sharply to Dahlberg’s definition of lobotomy. These two professionals joined together in short but strong criticism of Professor Dahlberg’s crude description of the procedure that would soon become honored by the Nobel committee. It is conceivable that two lobotomists spoke out against a colleague who used sloppy language about what they regarded an established new method in medicine. But, it is less understandable why Professor Dahlberg chose to belittle lobotomy in the way he did.
This paper is aimed at an analysis of what might have been a kind of psychosurgery debate in Sweden hidden within some popular publications."

From Nobel Prize to worst ever idea in 57 years

2006-07-22T10:53:00.000-04:00

At an event jointly organised by the Royal Institution and the Institute of Psychiatry last week in London, leucotomy was voted the worst ever idea from psychiatric history. Edgar Jones steered leucotomy to a narrow victory over post-trauma counselling. Psychoanalysis and drug company advertising were the other losing ideas. Thank you Professor Jones.

VNS in the Wall Street Journal

2006-07-22T10:39:00.000-04:00

Last Tuesday's edition of the Wall Street Journal had an article by David Armstrong about the failure of medical journals to publish authors' conflicts of interests. It featured the case of the journal Neuropsychopharmacology which had failed to warn readers that eight of the nine authors of an enthusiastic review of VNS (vagal nerve stimulation) were consultants for Cyberonics, the company that manufactures the equipment. The ninth author was a paid employee of Cyberonics, a fact which was revealed in the article. The lead author, Charles Nemeroff, is also editor of Neuropsychopharmacology.

"Charles Nemeroff, one of the nation's most prominent psychiatrists, edits the journal Neuropsychopharmacology, which this month favorably reviewed a controversial new treatment for depression.

But Tuesday, the journal said it plans to publish a correction because it failed to cite the ties of the article's eight academic authors to the company that makes the treatment, including the article's lead author: Dr. Nemeroff.

The journal's nondisclosure of the financial ties of its own editor as well as those of the other authors highlights the failure of many respected medical journals to identify relationships between academic researchers and medical companies that may benefit from positive research reports. A spate of recent lapses is prompting calls for more journals to ban offending authors from publication. In addition, medical schools are being urged to regulate relationships between their researchers and industry more closely...." More

"A sinister little pamphlet"

2006-07-17T08:13:00.000-04:00

"Days from a Different World" is the BBC world affairs editor John Simpson's memoir of his early childhood in post-war Britain. Simpson takes one day from each year between 1943 and 1951 and interweaves his own recollections with family events and stories from the newspapers of that day.

Wednesday 12th February 1947: it was the coldest winter since 1867. Johnny visits his grandmother in the snow. And the Board of Control publishes their report on leucotomy. Simpson writes:

"A sinister little pamphlet called "Pre-frontal Leucotomy in 1000 Cases" was published that day by the Stationery Office at a price of sixpence. Based on the theory that "[s]omething must be done in some mental illnesses to break the connexion between the patient's thoughts and his emotions", it examined the results in a wide variety of patients. When successful, it said, cutting the physical links between one part of the brain and the rest had enabled a third of the people whose cases were recorded to resume their everyday activities "without that emotional tension and preoccupation with hallucinations and phantasies which has hitherto handicapped them". Another third had shown signs of improvement, though not to the point where they could be discharged from hospital. And the rest? No details were available, except that 3 per cent of them had died. It showed, said one medical writer, that the operation was well worth while in carefully selected cases. Today, pre-frontal leucotomy would be regarded by many surgeons and psychiatrists as a quite unnecessary form of torture."

The Stockton lobotomies

2006-07-13T12:06:00.000-04:00

Stockton State Hospital, originally called the California Asylum for the Insane, was built in the 1850s at Stockton, eighty miles east of San Francisco, and by 1950 housed over four thousand patients. It was the first state hospital in California to perform a lobotomy and between March 1947 and June 1954 a total of 232 patients were operated on.

Psychiatrist and historian Joel T Braslow studied the Stockton archives for the two chapters on lobotomy in his book (originally a PhD thesis) Mental Ills and Bodily Cures: psychiatric treatment in the first half of the twentieth century (Berkeley: University of California Press, 1997).

The patients operated on at Stockton ranged in age from 19 to 88. Nearly eighty per cent of them had the diagnosis of dementia praecox (schizophrenia). Eighty-five per cent were women, even though men with the diagnosis of dementia praecox outnumbered women at Stockton. And twelve of the thirteen people who underwent a second lobotomy were women. Typically the operation was performed on violent, disruptive and unco-operative women who were subjected to frequent restraint (although Braslow found no evidence that psychosurgery was used as punishment for a single violent act).

Braslow describes how the decision to operate was made at a special clinical case conference, the "lobotomy board", which would attended by the director of clinical services, the surgeon, the hospital superintendent and the patient’s ward physician. The patient would be interviewed and then dismissed so the doctors could discuss their case and decide their fate. The proceedings were recorded by a stenographer.

In order to comply with the law, doctors then had to seek permission to operate from the patient’s relative. Braslow quotes from the letter sent to relatives:

"All forms of medical and psychiatric treatment have not been of more than temporary benefit…. Unless a more drastic therapy is carried out, there will be little hope of any further improvement….the most advanced form of treatment that is now available….The treatment suggested is a delicate brain operation performed by a qualified neuro-surgeon, which involves cutting certain nerve pathways controlling the basic emotions. This is known technically as psychosurgery or prefrontal leucotomy…In selective cases, in which there is much emotional suffering, patients who have this operation may be relieved of prolonged mental anguish, with much improvement in their basic behaviour."

Braslow estimates the mortality rate due to psychosurgery at Stockton as about 12 per cent. And most of the survivors remained in hospital. “In fact” he writes, “ during the 1950s almost an equal percentage of lobotomy patients left the hospital dead as alive (21 % vs 23%).”

But the operation was considered a success if the patient became more manageable on the ward. Braslow notes:

"Stockton physicians transformed what now would be considered neurologic sequelae into measures of effectiveness, as the following discussion among three physicians suggests.
Dr Adams:…[before lobotomy] she was regressed an awful lot – she was in restraint most of the time, would spit at people and break things up.
Dr Toller: It leaves them all pretty flat and indifferent about things. It seems to be characteristic –
Dr Adams: There is not much animation any more.
Dr Batko: Maybe that is what cures them (from a Stockton clinical case conference in 1949)".

Four of the lobotomized women also had their clitoris removed. Braslow quotes from the case history of "Rose", a young woman who was admitted to Stockton in 1944, underwent a lobotomy five years later, then had her clitoris cauterized twice and finally had all her teeth removed as she bit people.

Braslow’s father, a surgeon, worked for a while at Camarillo State Hospital, California, in the 1950s and performed lobotomies. Braslow writes at the beginning of his book:

One of his favourite stories, perhaps because of his brush with fame, recounted Walter Freeman teaching him how to perform a transorbital lobotomy. With a certain amount of flair and drama he described the procedure: “One takes a thing that looks just like an ice-pick and positions it right above the eye. Using a hammer, the pick is pounded into the skull. Then ping!!! the bone breaks enough to let the ice pick slide easily into the patient’s brain. You then swing the pick back and forth, cutting the nerves that connect to the front of the brain. That’s it.”
For my father, this memory and its recitation reaffirmed his skills as a surgeon and his belief in himself as a healer; even in spite of lobotomy's infamous history, he tells the story with pride. For myself, the story was more ambiguous. On the one hand, I found myself wanting to identify with him as a physician, and, later on, my decision to become a doctor was motivated by a positive identification with him. On the other hand, the tale increasingly perplexed me; I wondered how my father's desire to heal coexisted with his performance of this seemingly mutilating operation. My book aimed at understanding this contradiction. In the very human and often tragic dramas in that story, I tried to give voice to both doctors and patients in order to comprehend the meaning of often seemingly incomprehensible acts.

Walter Freeman describes his technique

2006-06-29T17:53:00.000-04:00

In July 1948 American psychosurgeon Walter Freeman visited the Burden Neurological Institute in Bristol, England, and delivered a lecture on transorbital lobotomy. The paper was published in The Lancet later that year. In this extract he describes his surgical technique.

"We have found that transorbital leucotomy* can be performed satisfactorily in the postconvulsive phase of electro-shock. Electro-shock appears to have a generally disrupting effect on cortical activity, temporarily abolishing the psychotic manifestations and bringing the patient into a brief period of increased adaptability. When leucotomy is also performed, the effects of the electro-shock seem to be at least protracted, and often permanent. A few operations under ordinary anaesthesia have been performed by others, however, and equivalent results are reported. Nevertheless, electro-shock requires so little preparation and is so familiar to the psychiatrist that it seems to be the method of choice.

To maintain the patient in a somewhat prolonged phase of coma, two convulsive doses of electricity are given, the second about one or two minutes after the first convulsion has subsided. After the second convulsion a towel is placed over the patient's nose and mouth to prevent contamination by saliva and nasal secretions. The upper eyelid of the patient is pinched between thumb and finger, bringing it away from the eyeball. The point of the transorbital leucotome is then introduced into the conjunctival sac and moved around against the roof of the orbit until the top of the vault is encountered. The leucotome is brought parallel with the bony ridge of the nose, and its base is tapped lightly with a hammer to drive it through the orbital plate. To aim the leucotome properly the shaft must press rather strongly on the eyeball, but no harm to the globe has been noted except for occasional subscleral haemorrhage.

The transorbital leucotome consists of a tool-steel shaft 12 cm. long and 4 mm. in diameter, tapering for the last 6 cm. to a rather fine point with a slight bevel. Its handle is 7 cm. long and 8 mm. in diameter and equipped with a cross-arm at the base. The shaft is graduated in centimetres, a double line being marked at 7 cm. which is the most frequently used point.

When the leucotome has reached the 4 cm. level, its handle is pushed laterally as far as the margins of the orbit will permit to sever the fibres in the lower portion of the thalamofrontal radiation. It is again returned to mid-position and gently driven to a depth of 7 cm. always in the plane of the bony ridge of the nose. At this depth it is possible, by swinging too far, to lacerate arteries in the depth of fissures on either the medial or the lateral surface of the frontal lobe; and, since the thalamofrontal radiation is a rather narrow band in the region, a movement of only 15-20 degrees laterally and medially is sufficient. When the sweeps of the instrument have been made, it is withdrawn, and moderate pressure is maintained over the eyelids for several minutes to prevent excessive bleeding into the orbit.

Unless the patient is still deeply unconscious, an additional electroconvulsive shock should be administered before the other side is operated on. Patients seem to tolerate multiple convulsions quite well. In view of the refractory period, it is usually necessary to increase the time of passage of the electric current by repeated tripping of the switch until the convulsive threshold is reached. No complications have been encountered in doing this. After the convulsion has subsided, the other side is operated on in the same way." (W Freeman, Transorbital leucotomy, The Lancet, 4 September 1948, 371-373)

Although Freeman had coined the term "lobotomy" some years previously, he (or perhaps the editors of The Lancet) reverted to Moniz's term leucotomy for a British audience.

Monkeys like Becky

2006-06-17T13:37:00.000-04:00

The Catalan Culture in New York festival earlier this year included a showing of Joaquim Jordà and Núria Villazán's 1999 film "Monos como Becky" ("Monkeys like Becky"):

"One of the mainstays of the Barcelona School of the 60s, Joaquim Jordà later turned his talents to screenwriting before returning to direction in the 90s. Monkeys Like Becky shows his old subversive spirit still shines brightly. One of the oddest mixtures of reality and fiction recently seen, the film is based on the true story of the Nobel Prize winning Portuguese neurologist Egaz Moniz. In the early 30s, Moniz attended a conference in London in which an American biologist presented a docile, rather charming monkey named Becky; the biologist then showed a film in which Becky was shown to have been formerly a wild, savage beast. The transformation was said to be caused by an incision into the central lobe of the Becky's brain. It dawns on Moniz that such a procedure might prove effective with schizophrenics, and thus the practice of mental lobotomies was born. Using both staged sequences and documentary footage, Jordà and Villazán wryly capture the intersection of science, psychiatry and social control."

The All Movie Guide entry for "Monkeys like Becky" says that director Joaquim Jordà himself underwent a psychosurgical operation. Other reviews say the same about Jôao Maria Pinto, the actor who plays Egas Moniz and one review says that they both had lobotomies, so I don't know what to believe.

Physiologist John Farquar Fulton who, along with psychologist Carlyle Jacobsen, conducted the experiments on Becky claimed to have been the inspiration behind Egas Moniz' decision to operate on mental patients. Here he relates his account in the Alpha Omega Alpha lecture read at the Montreal Neurological Institute, 8 January 1948:

"The operation of frontal lobotomy was introduced as a result of a brief report made at the International Neurological Congress at London in 1935 by Carlyle Jacobsen and myself on behavioral changes which developed in two of our chimpanzees, Becky and Lucy, following bilateral ablation of the frontal association areas. Their story can be briefly told.
In the summer of 1933 we had word from Dr Perrin Long of Johns Hopkins that he wished to dispose of two tame chimpanzees which had been used for the common cold project. He said that they were both accustomed to human beings, having been brought up in the laboratory since their early infancy. The opportunity to use these animals for frontal lobe studies seemed ideal for they could be readily managed. One was a very affectionate animal (Becky) and the other a crotchety old maid who had resisted Dr Long's advances for some three years. Dr Carlyle Jacobsen, who at that time was developing training techniques for a study of the frontal lobe function, took the two animals for a period of intensive training which continued from October, 1933 to March, 1934. The chimpanzees proved ideal subjects, co-operating effectively in all of the training procedures which consited of the delayed-reaction test, problem boxes, and another, more involved, procedure known as the stick-and-platform problem that Dr Malmo has no doubt described to you.
Both animals were operated upon in March, 1934, within a few days of one another, one frontal area being removed in each instance (areas 9, 10, 11, and 12 in the Brodmann scheme). The animals were then tested for another trhee months but no sign of deficit or behavioral change could be detected. In June, the second frontal area was removed from each animal, again within a day or two of one another, and every effort was made to have the lesions both symmetrical and equivalent for each animal. Following this procedure there was no sign of reflex change in either animal and on superficial inspection their cage behaviour did not seem to have altered particularly. On closer scrutiny, however, it was evident that a profound change had occurred, for prior to the second operation both animals showed frustrational behaviour, i.e., when unrewarded after having made the wrong choice in the discrimination test or in the delayed re-action procedure, both animals had temper tantrums and, if unrewarded many times in succession, signs of experimental neurosis became apparent. Following the second operation the animals seemed devoid of emotional expression. If a wrong choice were made, the animal shrugged its shoulders and went on dooing something else - as Jacobsen said picturesquely: "It was as if the animal had joined the happiness cult of the Elder Micheaux and placed its burdens on the Lord." Animals with bilateral ablation also failed the double stick-and-platform test....
Following the paper in which the behavioral changes in our two chimpanzees were described at London in August of 1935, Dr Egaz Moniz of Lisbon arose and put the question that if frontal lobe removal prevents the development of experimental neuroses in animals and eliminates frustrational behaviour, why would it not be feasible to relieve anxiety states in man by surgical means? At the time I was a little startled by the suggestion for I had envisaged a bilateral lobectomy which, though possible, would be a very formidable undertaking in a human being. Dr Moniz, as you are well aware, had other ideas and within a year he had developed his leucotome, carried out leucotomies on some 50 cases and published a book on the subject."

Egas Moniz himself however downplayed the contribution of Becky and Lucy to the development of psychosurgery. In his 1956 account, "How I succeeded in performing the prefrontal leukotomy", he devotes only seven lines to the work of Fulton and Jacobsen in the midst of a wider discussion of experiments on animals and the results of damage to the frontal lobes in humans. There is no mention of the conference in London.

"Vegetables don't cry"

2006-06-09T09:41:00.000-04:00

Psychiatrist Eileen Walkenstein describes a lobotomy she witnessed in 1949:

Yes, sadism in medicine and neurosurgery and psychiatry is, alas, still rearing its ugly head and destroying human heads in its wake.
My own introduction to modern neurosurgery occurred in my second or third year in edical school - occurred, literally, in one fell swoop, cutting its way into my own brain and leaving the scar even now, some twenty years later.
I refer to the transorbital lobotomy, otherwise known as the ice pick operation. Techniques of this wounding were perfected to such a degree that all that was required was an ice pick-like instrument - no sutures, no bandages - internal bleeding and destruction of nerve pathways and irrevocable death of brain cells with just a thrust of the ice pick... and all that's evident on the outside are two black eyes - that clear up in time - and memory loss - that doesn't clear up so well... and a state of docile vegetation - that goes on forever. With a flick of the wrist the animal gets changed into a plant - modern alchemy!
My medical school class was invited to see a demonstration of such a transorbital lobotomy, one of the several type of lobotomies. The neurosurgeon, on the staff of a university medical school, stood before the class strutting in a sedate, self-important manner. I remember how good looking and smooth he appeared, a typical Hollywood symbol of the handsome doctor whose patients go ga-ga over him... and how entirely devoid of character he was. He was meticulously groomed, hair perfectly in place, skin very white and smooth shaven - a perfect representative of White Anglo-Saxon America. He wore a suit and tie and looked as if he were addressing a businessmen's luncheon meeting of the Kiwanis Club. After some introductory remarks he opened the door and the nurse and orderly pushed a stretcher into the room. Walking in with them was an attractive young black man, eighteen years old, looking frightened and bewildered. The neurosurgeon paid no attention to him but continued discussing with us how the operation would be conducted, and he seemed proud of the fact that they didn't even need anesthesia for the operation - that knocking the patient out with "a couple of electric shock treatments would be adequate anesthetization". (I guess when you're contemplating slashing up the brain substance, a little cell damage more or less is not too relevant.)
The young black man in wrinkled hospital garb stood cowering in the corner in sharp contrast with the urbane, smooth, self-possessed, polished physician. Finally the doctor turned to the patient, mentioned his diagnosis... Schizophrenic Reaction...and that he was a recent hospital admission... and told him to get up on the stretcher. The young man backed up, his shoulders hunched like a scared cat being attacked by a growling bulldog, his eyes darting this way and that in a futile attempt to seek some way of escape from the inevitable. The nurse and orderly then held his arms, brought him to the stretcher, and somehow managed to get him to lie down on it, shackling his wrists and ankles. The doctor applied the electrodes to the young man's temples, the current was turned on, and the young man's body jerked convulsively for several seconds. The doctor said smoothly, as though nothing had just happened, that he thought he'd give another dose of electric current to be sure he's knocked out completely. Again the current was turned on, again the captured victim was convulsively responding with his entire body to the electricity searing through his brain cells.
(This patient - if he were not poor, not black, not welfare-experimental-animal material - what treatment would then have been meted out to him?... need one ask such an obvious question? What treatment for this young black man had he been in the doctor's own family, for instance? This is the criterion. If you treat me, no matter who I am, in any way different from the way you would treat your family members and colleagues and peers, then you don't deserve to be in a service profession - get out and get into business! In business you treat everyone with equal contempt, independent of their blood realtionship to you - business is business. So get out of the service and helping professions, you doctors, educators, priests, et al. who would dehumanize us - get into the material world - unadulteratedly corrupt - and practice your corruptions on my pocketbook but not of my flesh, my intellect, my spirit!)
I find it very difficult to get back and face that patient who has just had his second electroconvulsive assault. Since leaving him there I have just now busied myself with phone calls, checking my calendar, eating a homemade milk-and-honey popsicle, and just plain vacating for a while. The subsequent scene is so horrible not only in itself but in all its ramifications that I've been avoiding delving in and confronting it.
Well, back again - that patient was, after the second electric shock, completely limp and "anesthetized". (I have never, neither before nor since tha incident, heard of using electricity for anesthesia!) The surgeon then took an instrument from his pocket in a pointedly and overly nonchalant manner and showed the ice-pick-like tool to the class. He then lifted one eyelid of the patient's an stuck the pick up - he made a point of showing that he was having some trouble getting the pick through the skull and into the brain at the first try and he grimaced at the class and said something about the "thickness of the boy's skull". A few of the more obvious racists in the class gave him his anticipated reply by snickering - some of the students, already uncomfortable, had their discomfort increased at this remark. After the pick penetrated the skull, he flicked his wrist back and forth with the pick slashing into the brain substance, severing forever, in an instant, those connections that nature had labored to achieve over millions of years. The Brain-Killer, named Neurosurgeon, repeated the ceremony via the patient's other eye socket.
I was not the only one who gasped at the outrage I had just witnessed. One girl, Dottie, her head probably full of the sterile operative techniques with sterilization of instruments we'd been taught to observe prior to and during the operation, raised her hand and asked about using an unsterilized instrument, to which the surgeon retorted with a pretty-boy smile: "Well, I didn't wipe it on my bootstrap."
Who was there to raise the bigger question - by what right had this surgeon, knowing almsot nothing about the patient except that he was black, eighteen, on welfare, and a new hospital admission, butchered this young man's brain for the education of a class of young doctors-to-be. Who were all those responsible for all the steps required to bring that patient's brain in contact with that butcher's ice pick?
The show was over - the showman strutted in front of the room, titillated at his own performance - at the suave, nonchalant way he imposed a gruesome spectacle on a class of horrified doctors-to-be.
The young man, never to be whole again, lying stretchered out before us, was wheeled out of the room, out of most of our lives. He will always be a part of mine - seared forever in my brain, in my guts.
May, as Goethe promised, the pain be halved now that I've shared it with you...may the load of it be lighter for me. It will never be lighter for that young man - he is beyond weights and measures - beyond the pain of butcheries - vegetables don't cry.

"Vegetables don't cry" was published in Blue jolts (true stories from the cuckoo's nest), edited by Charles Steir, New Republic Books, Washington DC, 1978.

The New York Times on DBS

2006-06-06T10:33:00.000-04:00

Vera Hassner Sharav of the Alliance for Human Research Protection criticises a recent New York Times Magazine article on Deep Brain Stimulation:

"The surgical implant has been tested in 12 severely depressed patients in an uncontrolled trial —with no placebo comparator. This is the sole basis for the claim made that this treatment works in 8 out of 12 treatment resistant patients. In the “success” case example of the article, Deanna Benjamin, a 41 year old former nurse who underwent the experimental surgical implantation, she continues to take a combination of powerful drugs—the antidepressant, Effexor and antipsychotic, Seroquel...

As has been documented by science writer, Robert Whitaker, no matter how radical or unsubstantiated the claims, whenever psychiatry has launched a new treatment—such as, lobotomy, insulin coma, electro-shock, new generation antidepressants (SSRIs), second generation neuroleptics (‘atypical antipsychotics’)—the uncritical press, most especially The New York Times—enthusiastically endorsed every one of them. Indeed, the Times has a long record of allowing its pages to be used by medically licensed salesmen who, in true snake oil sales tradition, were in the business of selling hope rather than scientifically proven safe and effective treatments."

More...

Marie Mandy's grandmother

2006-05-30T10:50:00.000-04:00

Belgian film-maker Marie Mandy has made a documentary about her grandmother Madeleine who underwent a lobotomy at the hands her psychiatrist husband in the 1950s.

The film, Madeleine au Paradis (Madeleine in Heaven), was shown at the Reel madness film festival in London in 2003:

"At the age of 90 Madeleine reflects on her life and impending death. A gentle and poetic meditation on life's great themes - childhood, love, marriage and war interwoven with a rich narrative, which chronicles experiences of mental breakdown and psychosurgery. This intimate documentary honours all aspects of human experience."

You get to vote!

2006-05-28T17:06:00.000-04:00

If anyone is in London on Tuesday 18th July why not got along to the Royal Institution where an event called "From Bad to worst: the worst ideas on the mind" is being held.

"From bad to worse: the worst ideas on the mind

Prof Edgar Jones , Dr Joanna Moncrieff , Richard Webster , Prof Simon Wessely

The human mind is complex, mysterious and vital to who we are, so it's probably no surprise that over the years some treatments for mental conditions have turned out to be complicated, ridiculous and damaging to patients. In this fun and interactive event four experts will each name and shame an idea from psychiatric history and try to get the audience to name it ‘worst idea on the mind’.

As ideas on the mind go, it’s tough to get much bigger than psychotherapy. Invented by the psychological legend Sigmund Freud in the 1890s, it’s been one of the most common mental therapies ever since. But has it led to more sagging therapist’s couches than actual good? Leucotomy is better known as a prefrontal lobotomy, and is a famously radical surgical therapy that can dramatically change a patient’s behaviour. It hasn’t been practised widely since the 1950s – could it be the worst-ever idea on the mind?

It might be surprising to see post-trauma counselling nominated as the worst idea – or even a bad idea – on the mind. But some studies have shown that forcing people to talk to therapists soon after a traumatic event may actually hinder their natural coping mechanisms and make them more likely to develop psychological problems in the future. Finally, drug company advertising may be a new idea, but it’s also been nominated as the worst. If you’ve ever been exhorted to ‘ask your doctor’ about a new medication you might want to come along and see what our panel has to say.

So which of these ideas on the mind should never have entered our heads? In the end it will be the audience who decides as it all goes to a vote and one idea takes the most dubious honour in psychiatry."

Judging from the brief biographies of the participants, it is diffult to see who will be presenting the case against leucotomy. Joanna Moncrieff will presumably be paired up with drug advertising; and Richard Webster with Freud. But that leaves Simon Wessely and Edgar Jones, both of whom have a particular interest in military psychiatry and neither of whom, as far as I know, have ever written anything about psychosurgery.

Lobotomised orphans

2006-05-26T05:56:00.000-04:00

The following article appeared in the Montreal Mirror in November 2000.

The Kristian Perspective
Lobotomized by the state
by KRISTIAN GRAVENOR
I'm running my fingers through the bristly black hair of 48-year-old Paul Saint-Aubin, an illiterate hunchback sitting at a breakfast table in Joliette. My index finger feels a series of parallel grooves that run diagonally to his forehead, almost meeting the souvenirs of two other surgical incisions that stand perpendicular to his bushy eyebrows.

He's an exceptionally easygoing guy considering the journey that followed the day the Grey Nuns told his mother--a native from the Wolinak reserve--that he died as a baby. The nuns kept him in an orphanage until age 11, then sold him into farm slavery along with six other boys where, for six years, Saint-Aubin was forced to subsist on horse and pig feed. One day when he was caught eating raw eggs in the chick coop, the man of the house tossed him onto a fence, resulting, he says, in permanent damage that has caused his back to slant dramatically forward.

As a 17 year old in 1969, Saint-Aubin pulled a Barrabas against his brutal overlords. The police came, and although being of sound mind, he was deemed "profoundly retarded" and was sentenced "indefinitely" to a mental hospital. Although effectively mute at the time, he was offered no legal representation before being sent away.

Once inside the cuckoo bin, he was doped with dozens of different medications, including Largatil, known as "the liquid straitjacket," suffered electroshock, isolation, sexual abuse and experimental brain surgery. "I was forced into straitjackets and they made me sleep in the worst section of the hospital, full of piss and shit," he says.

In 1987, after 18 years inside, his mother, who ran a pet grooming operation in Laval, used new access to information laws to find out about her long-dead son. She discovered that the nuns had lied about his fate. The two were reunited for just three years before she died of cancer in 1990.

The heart-wrenching saga might merit a skeptical ear were it not for the immaculately documented records kept by his friend, Rod Vienneau. In the last three years, the middle-aged Joliette native has doggedly researched and written a thousand letters to elected officials around the world publicizing the cause of Saint-Aubin and of other so-called Duplessis Orphans that up until the mid-'70s were tossed into psych wards with no justification.

"The province would give the nuns 75 cents a day per child in the orphanage, but they gave $2.75 a day if they were in psychiatric hospitals," says Vienneau. A UQÀM report from last year estimates that the Catholic Church made $70-million (in 1999 dollars) from the manoeuvre.

Vienneau points out that parallel victims, such as Mount Cashel or natives sterilized in Alberta were compensated for their sufferings, yet in June of this year, Premier Bouchard declared the Duplessis Orphan issue closed. "Premier Bouchard is in a clear conflict of interest," says Vienneau. "He represented the Church in court in 1961 and several members of his family are important members of the Quebec clergy."

Sitting calmly at the table is Vienneau's wife--and mother of his six children--who recounts how, after her mother died of tuberculosis, she too was forced into six years in a Catholic-run insane asylum. She tells of the ice-baths, nights spent on a bare-spring mattress, sexual abuse and other memories of her own private hell. She was sprung after her younger sister escaped to tell her father of the shocking turn of events. Amazingly, the nuns wrote to the village priest to have the sisters recommitted.

Saint-Aubin, and the thousands of others whose lives were shattered at the hands of the Church seem no closer to the compensation that they are so rightly due. Saint-Aubin, who now works inserting rubber rings inside twist-off caps, shyly makes a last sad request. "If you could ask your readers, I don't have a television and I'd really like to have one." (Montreal Mirror, 23/11/2000)

Paul Saint-Aubin's lobotomy scars can be seen on this 2004 CBC-TV news programme.
According to CBC=TV, about 350 of the Duplessis orphans were given lobotomies.

It's been done before...

2006-05-20T05:30:00.000-04:00

Scotland recently legislated to put DBS (deep brain stimulation) in the same category as psychosurgery, making it a treatment that can only be given with a person's consent. England and Wales have done nothing, although experiments in the treatment of depression and OCD (obsessive compulsive disorder) are starting at the University of Bristol and Queen Elizabeth's Hospital, Welwyn Garden City respectively. In the absence of specific legislation DBS could be carried out on people without their consent or even a "second opinion" from a Mental Health Act Commission psychiatrist.

The treatment must therefore fall within the scope of section 63, for which neither consent nor a second opinion is required. Even though we doubt that any doctor would, in practice, implant electrodes in a detained patient without that patient's consent, this would seem to make such action theorectically legal, if perhaps particularly vulnerable to challenge under human rights law" (Mental Health Act Commission Tenth Biennial Report 2003).

The Mental Health Act Commission may consider the use of DBS without consent unlikely, but it has been done before.

In a 1980 article Robert G Heath of Tulane University in New Orleans and co-authors described the case of an anorexic patient who was opposed to the operation: "Initially, she refused to wear the pacemaker, and restraints were required to keep it operating. During the past year, however, she has showed gradual change. Compulsive rituals have been significantly reduced, and she states she now wants to wear the pacemaker because it makes her feel pleasant and relaxed." (R G Heath, R C Llewellyn and A M Rouchell,The cerebellar pacemaker for intractable behavioural disorders and epilepsy: follow-up report, Biological Psychiatry vol 15, no 2, 243-256) However, she still had to be tube-fed and was described by the authors as only "minimally improved".
Read the article here

And more about Robert Heath's experiments here.

Naomi Ginsberg

2006-05-14T04:50:00.000-04:00

Allen Ginsberg's mother Naomi underwent a lobotomy in New York's Pilgrim State Hospital in 1947. Allen signed the papers. Naomi remained incarcerated, dying nine years later in New Jersey's Greystone State Hospital.
Naomi was the subject of one of Allen's best known poems, "Kaddish for Naomi Ginsberg 1894-1956".

And who is going to hold 50,000 clickers?

2006-05-12T08:30:00.000-04:00

The November/December 2005 issue of Mother Jones contained an article by Lauren Slater about Deep Brain Stimulation (DBS) entitled "Who holds the clicker?" The title was taken from the following exchange at a meeting of the President's Council on Bioethics

DR. COSGROVE: It's a little computer that's telemetry, via telemetry, the same way you do cardiac pump pacemakers, the same technology.
And the neurologist or the psychiatrist, as we do for patients with Parkinson's disease, you can select which contacts, the current, the pulse duration, the frequency, and you do that all through the little hand held device that is superimposed over the pulse generator.
PROF. SANDEL: Who holds the clicker? Like where is that, in the doctor's office?
DR. COSGROVE: The doctor has that, yeah, yeah.
The patient can turn the device on or off with a magnet that they just pass over the device. So they only have the ability to turn it on or off. The physician is the one who has the ability to program.

The Guardian recently published an article about DBS, written by the paper's science correspondent Alok Jha, which, in its uncritical enthusiasm for the procedure, was reminiscent of early media coverage of psychosurgery. This topic was covered by Gretchen Diefenbach and co-authors in their analysis "Portrayal of Lobotomy in the Popular Press: 1935-1960" (Journal of the History of Neuroscience1999 Apr;8(1):60-9). They noted that: "in most cases mention of negative side effects was either absent or cursory." In the Guardian article there is no mention at all of any risks or side effects to brain surgery. Just as the early articles on psychosurgery stressed the precision of the operations ("the psychosurgeon… cuts at exactly the right angle in exactly the right plane") so too does the Guardian article ("Brain scans are used to pinpoint which parts of the brain are acting incorrectly"). It may be possible with modern scanning techniques to accurately locate structures inside the brain, but can we be sure they are acting incorrectly? Do we even know what correct is?

The Guardian article claims that an "estimated 50,000 people in the UK who suffer from depression but cannot be helped by drugs or electroconvulsive therapy" are potential candidates for DBS. But it doesn't say how they arrived at that estimate. If these people haven't been helped by ECT, then they must be taken from the ranks of ECT survivors and there are probably some 200,000 of those in the UK. So 50,000 who hadn't been helped (and were prepared to continue with evermore invasive treatment) would represent quite a high failure rate for ECT.

The true purpose of the article is revealed in the following passage:

Identifying suitable volunteers for the trial will be crucial. "It can either be people referring themselves or health professionals referring them," said Dr Malizia. "They must have good medical information from the past and they must be anchored to a local clinical service that will carry on looking after them."

But if there are really 50,000 candidates for DBS in the UK there should be over 300 in the Bristol area. So why do Andrea Malizia and his colleagues need the help of the Guardian to recruit eight patients?

Although the Burden Neurological Institute wasn't mentioned in the article, Andrea Malizia and David Nutt are part of the Bristol Neuroscience Group which includes the BNI, and Nik Patel is a neurosurgeon at the Frenchay Hospital, where the BNI is based. It is a shame that Alok Jha didn't even glance into the bizarre history of brain experiments at the BNI (coming to this blog soon!).

In response Sophie Corlett (the acting chief executive of MIND) urged caution - "Regrettably, miracle cures invariably aren't" and pointed out "If the NHS cannot currently fund comparatively cheap treatments such as therapy, how are we to expect that 50,000 people will be able to benefit from an expensive, invasive operation?"
She also mentions something Alok Jha ignored - the ethical problems associated with DBS:

And who's to say that deep brain stimulation is the solution for these people? A narrow medical model of depression, a complex problem, fails to do justice to human psychology and the human condition. We hope that this research leads to positive results, but we also hope no one will ever suggest that using "hair-thin electrodes" to apply electricity "into the core of the brain" will be a substitute for a cohesive and holistic approach to mental wellbeing.

Matthew Collings' father

2006-04-29T04:20:00.000-04:00

British art critic and broadcaster Matthew Collings has written about his father who underwent a leucotomy and committed suicide.

In an article in the Independent Newspaper, "Sculpted time", (3 April 2006, page 39) Collings writes:

"Among his crowd in Chelsea he was seen as a romantic figure, good-looking like a film star, moody, fascinated by art. He fulfilled a stereotype. It was partly the culture of the time, which was literary existentialism inherited from Paris. Partly it came from what was going on is society generally: the aftermath of the Second World War, all the tragedy, death, bravery, etc. I suppose it was a way of positively mythologizing a horror to which there really couldn't be any answer. In any case, my father was a romantic bohemian type but he was also ill - he'd had an unsuccessful brain operation and he'd received a head injury in the war. Plus, unknown to anyone, a part of his brain that hadn't been attended to during his operation was being attacked. After his death an autopsy revealed a tumour. It could have been removed by surgery if it had ever been diagnosed while he was alive. It may have been the cause of his symptoms.

The brain operation was a leucotomy, performed immediately after the war. He came back depressed from a POW camp. It was in East Germany - the Russian army liberated him. I think he signed up for the RAF partly because he had some emotional disturbance in his life. Perhaps he was already suicidal. He had an alcoholic father and a domineering mother - the father walked out and never returned. When war broke out Arthur was in a reserved occupation, working as a draughtsman for the Admiralty. However, he joined the Pathfinders as a navigator. The Pathfinders was known to be a particularly dangerous section of the RAF. They flew ahead of bombers laying down flares to light the target. He was shot down, his parachute failed to open correctly and his head was injured.

He was in the camp for two years. He suffered a breakdown. He thought he was Jesus. He gave away his blankets. In Britain a psychiatrist examined him - he was free now so why wouldn't he pull himself together? He was accused a malingering. He punched a psychiatrist in the face. Later the leucotomy was done...

Arthur's depression didn't clear up. He had girlfriends, he socialised and he was good company, interested in ideas and culture and history, and in psychology and what made everything tick. But he had dark moods, terrible headaches, he couldn't concentrate, he couldn't work with any ambition or intensity. His inability to keep an even keel gradually caused him to be self-pitying and cruel. He caused scenes. He disappeared for days on drink binges...."

After a broken engagement with the sculptor Elisabeth Frink who made a portrait bust of him, Arthur met and married Matthew's mother, a nurse. Collings continues:

"When my father died my mother was seven months pregnant. He just went out one day and never returned. The the police called and said he was dead on one of the Channel Islands. He'd been secretly saving up the sleeping pills my mother served him each night, one by one, in a Swan Vesta matchbox. He took them all..."

Psychosurgery in France

2006-04-21T10:22:00.000-04:00

France, along with Germany, Spain, Scotland, Wales, Belgium, the Netherlands, Finland, Sweden and Italy (that I know of, there may be others) is one of the Western European countries that still practises psychosurgery. Along with, for example, Spain and Italy it is one of the few where agressive behaviour in psychiatric patients is still considered an indication for surgery.

In 2002 the National Committee for Medical Ethics (CCNE) produced a report on psychosurgery, Opinion no 71. The report was prompted by two different requests for guidance on the ethical implications of psychosurgery. One concerned the following case:

"a 20 year old patient, suffering from severe psychiatric disorders (agitation, hetero-aggressivity, threatened self-mutilation) for which he had been hospitalised almost continuously since 1995. Since his condition is proving refractory to the usual psychiatric medication, surgical procedures are being considered so as to try and reduce his potential for violence and make him less dangerous to others. The health caring team hopes in this way to be able to provide more humane treatment than the almost prison-like incarceration which is his present lot."

The other request came from neurosurgeons in Grenoble who use Deep Brain Stimulation to treat people with Parkinson's disorder and want to expand into psychiatric disorders.

Opinion no 71 was largely favourable to psychosurgery, with the usual caveats about consent, committees and follow-ups, although they stopped short of recommending its use for agressive behaviour.

The report provoked a critical response from one French psychiatrist, Alain Bottero, who wrote a spirited twenty-page article, L'ethique au secours de la psychochirurgie? (When medical ethics come to the aid of psychosurgery), in the French psychiatric journal L'evolution Psychiatrique, vol 70, 2005. Bottero expresses his disappointment at his fellow psychiatrists' silence in the face of the report - apparently psychiatrists in France have traditionally been less enthusiatic than neurosurgeons about psychosurgery.

Bottero begins his article with a scathing attack on the National Committee for Medical Ethics (CCNE) for having produced a report that is rambling, repetitive, error-ridden and at times incoherent. Was there, he asks, so much pressure from neurosurgeons who were waiting for the go-ahead to operate on psychiatric patients that there was no time to proofread the document? If, he points out, Boileau was right in saying "Whatever we well understand we express clearly", then there are certainly some doubts about the Committee's understanding of psychosurgery.

The author criticises the report for claiming that new functional neurosurgery treats symptoms whilst leaving the personality intact, unlike old lobotomies. New techniques are just less mutilating, and they are not even new, he says.

Bottero takes the Committee to task for its failure to address the concerns of psychiatrists, in particular the lack of a scientific rationale for psychosurgery (and here he points out that the hypotheses of the neurosurgeons haven't advanced much since the 1940s)and the lack of evidence for both the efficacy and safety of psychosurgery.

Finally, Bottero takes issue with the concept of "treatment-resistant" disorders. Psychosurgery is usually justified - and Opinion no 71 is no exception to this - by stressing the intolerable suffering of the patients and their failure to respond to other treatments. But Bottero argues that neurosurgeons are ill-equipped to understand the fluctuating course of mental disorders and their responsiveness to environmental influences. The best response to treatment failures, he says, is not necessarily ever more drastic treatment until the treatment of "last resort" is reached; a completely different approach may be called for in order to build up a therapeutic relationship which will give the patient hope.

In conclusion:

"The CCNE has been too hasty in taking up its position on neurosurgery for mental disorder. It is up to psychiatrists to make it clear that such interventions remain ethically dubious for at least three reasons that can no longer be ignored. Their efficacy remains unproven; they are dangerous and have serious irreversible side-effects; there are other therapeutic options available which, even if proof of their efficacy is lacking, should nevertheless be actively explored and encouraged because they are a lot less dangerous.... Consent and protocols won't change anything when it comes to a question that still has no satifactory response: the lack of scientific validity for interventions that carry with them the risk of breaching the integrity of the personality."(Bottéro A. L'éthique au secours de la psychochirurgie ? Evol. psychiatr. 2005 ; 70)

Oregon State Hospital

2006-04-12T14:27:00.000-04:00

Oregon State Hospital, Salem, was the setting for Ken Kesey's book "One flew over the cuckoo's nest" and the film was shot on location at the hospital.

In an article in the New York Times, Richard Levine described being given a conducted tour of the hospital whilst filming was taking place in 1975:

Dr. Brooks [the hospital director], however, felt that the therapeutic and financial advantages for those patients who got to work on the movie - as actors, technicians or maintenance people - far outweighed any disadvantages, although he insisted that the film be set in 1963 instead of the present and that a disclaimer be included saying that it is not a factual representation of life in a mental ward. ''I just hope people realize that this is an allegory about how a man can be caught up in the System and allowed to undergo electroshock and a lobotomy,'' Dr. Brooks said. ''Why, except for the one that was done two years ago, we haven't had a lobotomy in this hospital since 1958.''

One of the people who underwent a lobotomy at Oregon State Hospital was the train robber and killer Roy DeAutremont. According to one source, the operation left him easier to control but severely damaged. He died in Oregon State Hospital in 1983. Salem newspaper The Stateman Journal marked the eightieth anniversary of the robbery with an article:

Ray, Roy and Hugh DeAutremont held up a Southern Pacific mail and passenger train near Ashland on Oct. 11, 1923. After dynamiting the mail car and killing four men, they fled empty-handed and remained at large for four years.
The brothers eventually were arrested and sentenced to life in the Oregon State Penitentiary. All three were released before their deaths....
Ray worked in the prison flax mill. He learned several languages and taught French, Spanish and Latin in the prison school. He also learned to paint, and several of his landscapes won awards in local exhibits.
Hugh founded a monthly magazine called “Shadows,” which twice won national honors for best prison publication.
Roy worked as a barber and contributed to his brother’s magazine. He later was diagnosed with schizophrenia and was transferred to the Oregon State Hospital, where he had a lobotomy.(Capi Lynn, 1923 botched train holdup nears anniversary, Statesman Journal, October 7, 2003)

Alys Robi

2006-04-01T13:06:00.000-05:00

The Canadian 1940s singer Alys Robi underwent a lobotomy at the age of 29 in 1952. She had become depressed after she was injured in a car crash, and spent five years in a Quebec mental hospital. She described the experience in her book "Long Cri dans la nuit: Cinq Années à l'Asile" (Montreal 1990). Although she was terrified at the prospect of a lobotomy, she credited it with giving her a chance of recovery: "Je me réveillai guérie et j'ai compris plus tard que j'avais été un des rares cas réussis de lobotomie" (I woke up better and later understood that I was one of the rare success stories). She returned to singing, but not quite as successfully as before; the Canadian Encyclopaedia refers to her attempting "several comebacks 1952-74".

A film was recently made about Alys Robi's life.

BITTERSWEET MEMORIES
Directed by Denise Filiatrault, Starring Pascale Bussières, Michel Barrette, Serge Postigo.
Is it officially a genre now, biopics about gifted, glamorous women who go mad? If it isn’t, it should be. To the true stories of Marilyn, Billie Holiday, Frances Farmer and Piaf, add Quebecoise chanteuse Alys Robi. Like those other beautiful ruins, Alys Robi came from humble roots, was too strong and too talented to stay home, but not strong enough to survive in the world she went into.

The movie opens with Alys (Pascale Bussières) in a Quebec hospital, about to have a lobotomy to "cure" her manic depression, then flashes back to her childhood in the 1920s, following her rise from small-town singing sensation to international star. She was only 13 when she left home to go to Montreal to pursue her singing career. There, she changed her name from Alice Robitaille to Alys Robi, joined the National Theater, and was mentored by musical comedy star Rose Ouellette. It was in Montreal that she later became involved with comedian Olivier Guimond (Serge Postigo), her first love and a married man, whom she later derided for his lack of ambition. Her ambition led her to leave him for Toronto and the orchestra leader Lucio Agostino (Denis Bernard)–another married man with children back in Montreal. A pregnancy resulted, leading to an abortion that was very traumatic for Robi and forcefully brought to the surface the crippling religious guilt drummed into her in Catholic Quebec.

Professionally, the collaboration with Agostino was a fruitful one. She became the toast of Montreal, Toronto, London and Hollywood. As Robi’s star was rising, her family back in Quebec was struggling. Her beloved brother became ill with a crippling spinal disease that put him in a wheelchair and ultimately killed him, despite Alys’ efforts and expenditures to save him. This sent Robi into a tailspin. Already temperamental and prone to stage fright, she began to have irrational, diva-like fits of temper, and to make mistakes on stage. She felt hunted by paparazzi and gossip. Then the affair with Agostino imploded, and so did Robi, leading her father to have her committed to a mental institution for a lobotomy, against her will.

The story follows the genre’s formula pretty closely, and while he movie doesn’t go deep enough into her mental illness, its compelling storytelling provides a tantalizing look at Robi’s talent, exposing it to a whole new audience.

Pascale Bussières does a good job as Robi, and evidently does her own singing for the movie. She has a wonderful voice: I would have liked to have heard even more of it. And is it my imagination, or is Quebec producing some exceptional cinematographers and production designers these days? This is a richly beautiful film, a real treat for the eyes. From the hardscrabble hometown with its small comforts to the dazzling color of Robi’s big city life, every detail is right.

Alys Robi: Bittersweet Memories, has a much better title in French. Translated, it is My Life in Cinemascope, an apt metaphor for the wide-screen, larger than life Alys Robi. Too sensitive for the slings and arrows of stardom, yet too sensitive for the rigors and common tragedies of her family life back in Quebec, Robi seemed to have nowhere to go but mad.

SPARKLE HAYTER (SEE magazine, July 21 2005)

"I can prove I'm not mad...."

2006-03-29T15:49:00.000-05:00

From The Herald, 29 March

Sanity clause
SQUADRON-Leader Eric Foster, who died aged 102 at the weekend, escaped seven times from German prisoner-of-war camps, thereby inspiring Steve McQueen's character in The Great Escape, Virgil Hilts. Eric's most successful escape was from Stalag Luft III. Having studied medical textbooks in the Stalag's library, Eric earned repatriation by faking mental illness. Unfortunately, on returning to Britain, Eric was consigned to an asylum. He soon proved his insanity was a ruse, however, being given a War Office certificate confirming the fact. He used to tell folk who argued with him: "I can prove I'm not mad – can you?"

Christopher May's story

2006-03-26T15:01:00.000-05:00

Christopher May from Sussex, England, has talked about his experience of undergoing psychosurgery for Gilles de la Tourette syndrome:

I JUST CAN'T STOP SWEARING
His Own Story By Christopher May

PEOPLE usually cross the road when they see me coming - or they look away and pretend I'm not there.

It's something I've become used to over the years, and my pride has long gone.

Involuntary swearing, screeching, squealing and howling very loudly are just some of the gestures I feel compelled to make, because I suffer from Tourette's syndrome.

It's a neurological disorder that was first reported back in 1825, and then named after a French neurologist Dr George Gilles de la Tourette.

An estimated 29,000 people suffer from it in the UK alone.

It's more common in males and it has no cure.

Tourette's is characterised by tics and these vary in severity - anything from head jerking to more vocal tics like mine.

I also suffer from Obsessive Compulsive Disorder, known as OCD and, as well as the tics, I have compulsions to do things like go in cupboards for a particular length of time, or perhaps stare at the same letter on a page when reading.

At one stage, I had an uncontrollable urge to lift up my eyelid and poke my finger into my eyelid and eventually I damaged my eyesight.

I've also forced my finger up my nose so far, it's ended up bleeding.

Tourette's is hereditary, and I believe I probably inherited it from my grandmother who was diagnosed as having St Vitus Dance, which is similar to Tourette's.

I have to take various drugs to help counteract it's worst effects, ranging from anti-depressants and anti-psychotic tranquillisers, to sleeping pills and a drug to prevent me having fits.

Throughout my childhood, no-one really understood what was wrong with me, and I was just labelled as a disruptive element at school.

My mum didn't know how to handle me, and I left home at the age of 17.

Surgery

It wasn't until I was 19 that my condition was properly diagnosed.

My aunt read an article about Tourette's and posted it to us, as she thought it sounded just like me.

I saw my GP and finally my unusual behaviour was formally recognised.

By now, my condition had worsened to the extent that I needed 24-hour care for over six months to stop me hurting myself as the OCD became stronger.

In 1987, at the age of 21, I was the first person in the UK to undergo brain surgery to try and alleviate the symptoms.

The operation, called a cingulotomy, was performed at the Atkinson Morley Hospital in Wimbledon.

The microsurgery involved destroying a piece of the frontal lobes of my brain.

After a further two months at the National Hospital for Nervous Diseases, I was pleased to discover the surgery had been successful in preventing the urge to poke my eyes at least.

Although the effects of the operation were minimal to begin with, my condition has improved slightly over the years.

I've been married twice, but both were short-lived.

My first marriage to my childhood sweetheart when I was 27, lasted just nine months, although she was very supportive for a while.

Support

The final straw came when she found me in the kitchen in a pool of blood after I had stabbed myself all over with a fork.

I married six months later on the rebound, but the condition led to the break-up of that marriage after six months.

I did hold down a couple of jobs for a short while when I first left school, including an office job with the Inland Revenue.

But my twitching and the strange noises I made caused concern amonst staff and eventually, they contacted my mother because they thought I'd perhaps had been sniffing glue.

It's now impossible for me to work because of the difficulties caused by my condition, and I have to rely on sickness benefit.

I live alone in a flat and spend a great deal of time at a day centre run by the Shoreham and District Mental Health Association.

Indian Head Massage is an alternative therapy that I've found particularly useful to access at the day centre too.

The staff there and my support workers have been fantastic, and are currently helping me to get some sound-proofing for my flat, because I know my constant involuntary screeching and swearing bothers my neighbours.

People don't always understand that it's something I can't control.

I was thrilled to secure a £1600 grant from The Scarman Trust, a charity that helps people bring about a change in their community.

I'm now looking forward to running a local support group helping other sufferers in whatever way I can.

I've learned to live with the unkind remarks and prejudices from those who've so little understanding of the illness.

I hope by telling my story it will increase awareness of this frustrating condition, which really does control my life.

As told to Suzanne Roberts

(From the Weekly News, March 30th 2004)

The interview, with photos, can be seen here and another article can be read here.

The interesting career of John Harding Price

2006-03-17T09:30:00.000-05:00

Last week the Irish Sunday Times ran an article about psychiatrist John Harding Price who has been struck-off the Medical Registrar in the UK but is still able to practise in the Irish Republic.

A DISGRACED psychiatrist banned from working in Britain is now operating a part-time private practice from a Dublin hotel.
John Harding Price, 74, was struck off the medical register in Britain five years ago after three female patients made allegations of sexual misconduct against him. Unable to practise in Britain, he moved to Ireland and worked as a locum doctor in psychiatric hospitals in Clonmel and Kilkenny.....

John Harding Price worked as a locum in two Irish hospitals in 2000, applying for the first post as soon as he was suspended from the UK Medical Register pending a full investigation of the allegations against him. He was the only applicant, was able to produce two recent letters of reference from fellow-psychiatrists and was offered the post without an interview. In January 2001 the full investigation of the UK General Medical Council took place and Harding Price was duly struck off the UK Medical Register. (He was later to lose an appeal to the Privy Council) By this time, thanks to an alert secretary who had spotted an article about the psychiatrist in an English newspaper, the Irish Department of Health was aware of the situation and didn't offer him further employment. However he remains on the Irish Medical Register.
The Irish Independent published an article about Harding Price entitled "Consultant banned as 'risk to public' by UK council" (Oct 31 2001)

WHEN consultant psychiatrist John Harding Price was engaged by the South Eastern Health Board he brought with him a lengthy history of charges, allegations and admonishments over events dating back to 1972, most of which was unknown to the health board at the time.
It was only after his contract with the South Eastern Health Board ended last year that Britain's General Medical Council removed him from the register, deeming him to be "a risk to the public".
Dr Price has appealed this decision and he is awaiting the outcome of that appeal.
The 72-year-old doctor was also "admonished in the strongest terms" by Britain's General Medical Council in 1986 for "serious professional misconduct".
This followed a whole series of charges in 1986 which included persuading a patient with dementia to sign over share certificates, falsely billing NHS patients, and wrongly directing patients to his own, unregistered nursing home for profit. Some additional charges were rejected for "lack of evidence".
He was finally struck off with immediate effect by the doctors' ruling body last December 2000 for "inappropriate" and "improper" conduct and "serious professional misconduct", which included fondling the breasts of a 19-year-old female patient referred to him for treatment for persistent nightmares.
After being struck off, he immediately lodged an appeal, which was heard by the Privy Council in Downing Street earlier this month. Judgment was reserved and will be delivered in the next few weeks.
The GMC said it found "a serious deficiency in both (Harding Price's) communication skills and attitude towards patients" and considered him a "risk to the public".
The vulnerable young woman, one of several to complain, was told by Harding Price to strip to her underwear. He then cupped and fondled her breasts after undoing her bra, put his hand in her pants and slapped her bottom during the consultation in 1998.
The charges which eventually saw him struck off included an incident on August 22, 1998 when a "Ms X" attended his Lincoln medical and he removed her bra without consent; unnecessarily kept her undressed; removed her underwear without consent while pretending to examine her back.
On March 10, 1998 he caused distress to a "Mrs Y" by persisting in asking detailed and intimate questions about her sex life with her husband without offering any purpose or relevance.
He then wrote to her husband with details of the exchanges without her knowledge or permission.
On June 6, 1999, as duty doctor at Grimsby Primary Care Centre, he persistently quizzed a young woman who complained of severe headache, about her sex life and financial position.
In 1986 the General Medical Council formally admonished Harding Price. In 2000, the GMC wasted no time in immediately "erasing" him from its register.
Bernard Purcell, London Editor

I have been unable to find any information about Harding Price's behaviour in the 1970s, but two court cases reveal something of his financial misconduct in the 1980s.
One concerned a woman who had had a leucotomy. The court described her as having "suffered episodes of a mental illness which originated in her being a victim of wartime bombing in London." She was said to have been a patient of Dr John Harding Price for many years. In 1983 she gave him 73,000 pounds to invest in his nursing home business. The money was returned to her on the insistence of her solicitors, and Harding Price was suspended from his job as a consultant psychiatrist at the Lawns Hospital, Lincoln. (The court case was actually the women suing her solicitors. She appears to have remained loyal to Harding Price.)
The second case concerned two properties in Florida, which Harding Price bought from a patient for a knock-down price (about half their market value). The man later sued for the return of the houses and the High Court found in his favour, ruling that Harding Price had exploited the trust placed in him, and ordering him to return the houses. However the case took a long time to come to court - 9 years from writ to judgement plus a couple for the unsucessful appeal - and Harding Price took his case to the European Court, claiming his rights under Article 6.1 of the European Convention of Human Rights had been violated. (Article 6.1 states that "In the determination of his civil rights and obligations or of any criminal charge against him, everyone is entitled to a fair and public hearing within a reasonable time...) Harding Price won, but the Court awarded him only 1,000 euros (about 1,200 US dollars) in damages, instead of the more than half a million pounds, plus exemplary damages, he had asked for.

But it was Harding Price’s inappropriate interest in his patients’ sex lives and not his property dealings that finally led to him being struck of the Medical Register. Thirty years earlier, Harding Price had authored a textbook called “Psychiatric Investigations” in which he shows rather too much interest in patients’ sex lives in a not very nice way.

Harding Price remains the Press Officer at the Society of Clinical Psychiatrists, which was chaired by Michael Haslam until he was jailed for sex offences against patients.

Psychiatric Hospitals for Chinese Dissidents

2006-03-16T13:34:00.000-05:00

The former Soviet Union was known to have dissidents declared "insane" as an excuse to lock them away and have them tortured. It's pretty easy to do since so many accepted psychiatric treatments are fairly brutal and designed to break the will. It was no surprise to read in today's New York Times that China does the same thing:

Dutch Doctors Say Dissident Did Not Belong in Chinese Asylum

BEIJING, March 16 — Dutch psychiatrists have determined that a prominent Chinese dissident who spent 13 years in a police-run psychiatric institution in Beijing did not have mental problems that would justify his incarceration, two human rights groups said today.

The psychiatrists spent two days testing the dissident, Wang Wanxing, in Germany, five months after China released him and sent him abroad. They said in a statement that their examination "did not reveal any form of mental disorder."

The report could add fuel to charges that the Chinese police use a network of psychiatric prisons to silence political dissidents, often without trial or right of appeal.

Mr. Wang, now 56, was confined to the psychiatric facility after he was detained in 1992 for unfurling a banner that criticized the Communist Party.
The authorities determined that he had "delusions of grandeur, litigation mania, and conspicuously enhanced pathological will," which Western human rights groups say are diagnoses officials have used to lock up troublesome dissidents who have not broken any laws.

After his release in 2005, Mr. Wang described widespread abuses in the mental asylum, known as the Beijing Ankang. He said he lived in cells with psychotically-disturbed inmates convicted of murder and was forced to swallow drugs to blunt his will. He also said that the facility use electrified acupuncture needles to punish patients while other inmates were made to watch.
...
Human Rights Watch says it has documented 3,000 cases of psychiatric punishment of political dissidents since the early 1980's. The group contends that the use of penal mental asylums to confine dissidents has increased in recent years, as the police have sought ways to punish followers of banned religious sects, political dissidents and persistent petitioners without channeling them through the court system.

link

Shocking Teens

2006-03-14T09:02:00.000-05:00

This is from today's New York Newsday. I love how shock treatment has now evolved into an "aversion therapy":

Family suing over therapy
Freeport teen's mom alleges Mass. center used excessive shock treatment on her son, violating his civil rights

The family of a Freeport teenager is accusing the school district of violating his civil rights by sending him to a Massachusetts facility for troubled youths that uses electric shock therapy.

Antwone Nicholson, 17, and his mother, Evelyn, say he has suffered emotional and physical injuries as a result of being repeatedly shocked at the Judge Rotenberg Center in Canton, Mass., according to the notice of their intent to sue the school district filed last week.

...

An attorney for the Rotenberg Center said the facility tried other therapies on Mitchell, who is diagnosed with attention deficit hyperactivity disorder and obsessive-compulsive disorder, before using shock therapy as "a last resort."

...

Between August 2004 and February, according to legal papers and Mollins, Nicholson was sometimes shocked as many as six times a day with a device that is strapped to students like a small backpack and delivers a 45-milliampere jolt.

Michael Flammia, the attorney for Rotenberg, said students who receive the aversion therapy get shocked an average of once a week for two seconds.

"I've had [the shock] and it feels like a bee sting," Flammia said. "It hurts, but it has no side effects."

link

Psychosurgery in China

2006-03-08T18:00:00.000-05:00

The history of psychosurgery in China has followed that of its former communist ally, Russia (although without the very early attempts at operating on the brains of mental patients). Psychosurgery was used in China in the 1940s and early 1950s then, after a gap of about 30 years, taken up again in the 1980s and, more recently, used as a treatment to cure drug addicts.

In 2003, Guodong Gao and colleagues at the Tangdu Hospital in Xian published an article about their use of psychosurgery for drug addiction in the Journal of Stereotactic and Functional Neurosurgery. They operated on 28 patients, all of whom had been addicted to drugs (mostly heroin, opium and opioids) for more than 3 years, had had more than 3 previous attempts at detoxification, and consented to surgery. The target of surgery was the nucleus accumbens (unlike in Russia where it is the cingulate gyrus). The average age of the patients was 31, and all but two were men.

The authors appear to be generally enthusiastic about the results of surgery, claiming a high rate of success and low incidence of side effects. However, the article is so confusingly written (or perhaps translated), the terminology so bizarre, the results presented in such a vague and contradictory way, that it is impossible to draw any useful conclusions from it.

The Dundee psychosurgery team's verdict on this article was: "There is insufficient clinical detail in this report to permit a rigorous analysis of the robustness of these reported positive outcomes".

In 2004 the Ministry of Health decided to ban the use of psychosurgery on addicts - possibly following the Russian example, or in response to public concern about the treatment. More than 500 addicts had already undergone surgery. It is not clear if the ban applies only to psychosurgery for addiction or to all psychosurgery in China.

The People's Daily Online, reports on the ban:

The Health Ministry also said the treatment was only allowed for scientific study but banned for clinical practice as it considers the surgery has not become a mature technology suitable for wide clinical application.
Drug addiction can have such a devastating impact on addicts and families that some are willing to pay any price to rid themselves of the evil, and that is why the surgery has gained so much popularity so quickly.
But people willing to undergo surgery cannot possibly have a complete idea about the potential risks, on which even experts have not reached a consensus.
There are other downsides. Already the surgery has been manipulated by people intending to make profit from it.
It is therefore the responsibility of the authorities to remind the public of the side- effects and possible dangers, in medical terms and in medical ethics terms.
Drug-users are living flesh and blood. They have their own rights and dignity that should be taken good care of. Drug abuse may be against our traditional values, but nobody should deny drug addicts the help they need to get over their addiction and the right to enjoy life. If they are deprived of such rights because of the method of their rehabilitation, the question is whether such rehabilitation is moral.
The Health Ministry has done a proper job in issuing the ban in time, which, despite its harsh words, has a great sense of humanity.

Read the whole article here

Psychosurgery in Russia

2006-02-28T16:46:00.000-05:00

In an article published in 1993, Professor of Neurosurgery B L Lichterman divides the history of psychosurgery in Russia into three periods:

The first period starts at the turn of the century under the initiative of Bekhterev. His pupil and one of the fathers of Russian neurosurgery Puusepp performed leucotomy-like cuttings of frontal association fibers in manic-depressive cases and psychic equivalents of epileptics as early as 1906-1910. The second period includes the time from the late 1930ies till the late 1940ies. The classical leucotomy of Moniz and Lima, with some modifications, was used for treatment of schizophrenia and severe pain. In 1950 psychosurgery was prohibited by the special order of the Minister of Health of the USSR for ideological reasons. The third period starts in the early 1980ies with the acceptance of modern stereotactic techniques for treatment of intractable pain and obsessive-compulsive disorders. (On the history of psychosurgery in Russia, Acta Neurochirugie [Wien], 1993, vol 125: 1-4)

In 1998 doctors in Russia found a new indication for psychosurgery - drug addiction. Actually, it wasn't a completely new indication - stereotactic cingulotomy (the operation used in Russia) has been used in India as a treatment for addiction and in the UK (and presumably in other countries) a small number of addicts have been operated on, although not in recent years. Over a four-year period doctors at the Institute of the Human Brain in St Petersburg, under the leadership of
the Institute's director, Sviatoslav Medvedev, operated on 348 heroin addicts aged between 17 and 35. The results were published in the Journal of Human Physiology (S V Medvedev, A D Anichkov, and Yu I Polyakov, 2003, Physiological mechanisms of the effectiveness of bilateral stereotactic cingulotomy against strong psychological dependence in drug addicts, Human Physiology, vol 29, 492-97). The authors describe a consent procedure that sounds similar to that used in the UK, with the "elimination commission" taking the place of the Mental Health Act Commission panel (although there is no indication that the Russian commission was independent):

The duration of drug addiction varied from 2 to 15 years. All of the patients claimed that they were repeatedly treated in licensed medical institutions by noninvasive methods, but without results....

All patients that turned to the Institute of the Human Brain were examined by an elimination commission, which ascertained the strong wish of a patient to get out of drug dependence and determined the presence of an obsessive-compulsive component in the structure of psychological dependence, the absence of contraindications for the stereotactic surgery, and the presence of real prospects for social rehabilitation after the treatment. If there were any doubts that these conditions were met, the patient was denied hospitalization. The elimination commission explained to the patients the essence and details of the surgery, as well as possible alternatives and complications, which, in principle, are possible in the case of surgery. If the patient was accepted and agreed to the surgery, the clinic and the patient signed a contract containing exhaustive information on the condition of treatment and possible complications. This contract served as the patient's informed consent to the surgery.

The authors claimed good results, with over half of the patients who were followed up for more than two years remaining completely drug free, and most of the rest showing some improvement. Only 14 per cent were unchanged. Postoperative complications were rare, occuring in 1.4 per cent of patients, and the authors also reported a general improvement in the patients' mental state.

We observed improvements in attention and emotional state, an increase in motivation, and compensatory and adaptive changes in personality structure.

In 1999 the Observer newspaper in the UK published an article entitled "Russian addicts cured by surgery: removing part of the brain under local anaesthetic is a revolutionary cure that seems to work", which in its enthusiasm for the procedure is reminiscent of newspaper and magazine articles from the very early days of psychosurgery. The article reported Dr Medvedev's claims of an eighty per cent success rate and spoke to a grateful patient who said:"The day I had this operation, I was born again. I'd recommend anyone addicted to heroin to have it. Otherwise, I would have died". Dr Medvedev is quoted as saying: "We take out a cubic millimetre from one hemisphere and another cubic millimetre from the other hemisphere and that stops the addiction", which is strange since bilateral cingulotomies usually destroy about 2,000 times this amount of brain.

However, trouble was in store for the Institute of the Human Brain. In 2002 a patient who was not cured of his heroin addiction and suffered a postoperative wound infection and headaches sued the doctors and won. He was awarded damages to cover the cost of the operation, about 8,700 dollars, and the Institute of the Human Brain was told to stop doing the operations. The case was covered in an article in the Guardian newspaper entitled "Russia bans brain surgery on addicts". The "revolutionary cure" has now become a "controversial brain operation".

The Institute of the Human Brain appealed against the authorities' ban on the operation. From their website it is not clear whether psychosurgery for drug addiction, or other diagnoses, is still carried out. They have this to say about it:

Valuable contribution to practice was made through application of the theoretical concepts into most up-to-date line of medicine — psychosurgery. Institute of the Human Brain. On the basis of formulated and developed common theory of stereotactics targeting and to ensure this work, the first Russian computerized stereotactic system POANIK, produced now in series, as well as the cryosurgical device using the solid dioxide carbon were developed (A. D. Anichkov). Using stereotactic system POANIK, the most effective modern method of obsessive-compulsive syndrome treatment of patients with drug addiction was worked out (A. D. Anichkov, Y. I. Polyakov).

In the USA and the UK patients have won lawsuits against doctors who performed psychosurgery on them (one case that I know of in each country), but, unlike in Russia, it has not led to attempts to call a halt to the operations.

Manuel Gonzalez Serrano

2006-02-27T17:33:00.000-05:00

The Mexican artist Manuel Gonzalez Serrano (1917-1960) spent the last few years of his life in a State Asylum in San Pedro del Monte. He underwent a psychosurgical operation and died of a heart attack shortly afterwards, at the age of 43.
Paintings by Manuel Gonzalez Serrano can be seen at the Andres Blaisten virtual museum.

Mexico still has a psychosurgery programme. This newspaper article, for example, describes the case of a 21 year old patient who was operated on for anorexia.

Lobotomy on film

2006-02-26T16:39:00.000-05:00

The National Library of Medicine in Bethesda, Maryland, has several films and videos relating to psychosurgery, including:

Author(s): Freeman, Walter, 1895-1972.; Watts, James W (James Winston), 1904-; Pennsylvania State College. Psychological Cinema Register.; George Washington University. Dept. of Neurology. Title(s): Prefrontal lobotomy in the treatment of mental disorders [motion picture] / from the Psychological Cinema Register of the Pennsylvania State College ; from the Department of Neurology, George Washington University ; by Walter Freeman and James W. Watts. Publisher: State College, Pa. : The Register, [1942] Description: Answer print : 1 film reel of 1 (438 ft.) : sd., col. ; 16 mm. Language: English Summary: This film describes and demonstrates a prefrontal lobotomy, an operative procedure employed in mental disorders resistive to other methods of treatment. Procedure consists of cutting the white matter in each frontal lobe in the plane of the coronal suture. This passes just anterior to the frontal horn of the ventricle and interrupts the anterior thalamic radiation. This film includes a written description of the procedure, review of landmarks on the skull and frontal lobe ona demonstration skull and brain, operation on a live patient, and X-rays taken after the operation. Filmed with cooperation of George Washington University.
MeSH: Frontal Lobe/surgery*
Psychosurgery/methods*
Publication Type(s): Instruction
Notes: Date is production date.
Last inspected: Answer print: 1981. Condition complete; warped.
Last inspected: Videoreel: Apr. 1987. Condition complete; good.
Received: (date unknown) as a donation from Psychological Cinema Register of Pennsylvania State University.
Country of Producing Entity: United States.
Credits: Photography by Guild Photographers.
NLM ID: 8800490A [Motion picture, Videorecording]

Author(s): Bennett, Abram Elting, 1898-; Bishop Clarkson Memorial Hospital (Omaha, Neb.). Psychiatric Dept.; Pennsylvania State College. Psychological Cinema Register. Title(s): Prefrontal lobotomy in chronic schizophrenia [motion picture] / from the Psychiatric Department of the Bishop Clarkson Memorial Hospital. Publisher: [State Colleege, Pa. : Psychological Cinema Register of the Pennsylvania State College, c1944. Description: Master positive : 1 film reel of 1 (488 ft.) : si., b&w ; 16 mm. Language: English Summary: This film shows the recovery that can be made by prefrontal lobotomy in chronic psychotics. Four patients are shown before and after operation. Patients include one 25 year old aggressive female, one 22 year old aggressive male, one female who had been catatonic for five years, and one 26 year old Ph. D. who had catatonic lapses in the last three years. All patients appeared calmer and more sociable after operation. Only the 5 year catatonic female had to continue hospitalization after the lobotomy, although she had improved greatly. Filmed at the Bishop Clarkson Memorial Hospital, Omaha, Nebraska. Donated film is B-wind.
MeSH: Frontal Lobe/surgery*
Psychosurgery*
Schizophrenia/surgery*
Publication Type(s): Case Reports
Instruction
Notes: Copyright: 1944, Psychological Cinema Register of the Pennsylvania State College.
Live.
Last inspected: Apr. 1986. Condition complete; good.
Country of Producing Entity: United States.
Credits: A.E. Bennett.
Received: (date unknown); donation; from Psychological Cinema Register of Pennsylvania State University.
NLM ID: 8601165A [Motion picture, Videorecording]

The library at West Virginia University has a film about transorbital lobotomy

Title: Transorbital lobotomy
Library: Downtown Library, Media Services
Call Number: MEDIA DV1033 AV LIB
Subject: Frontal lobotomy., , Catatonia.,
Abstract: Part one outlines the process of transorbital lobotomy. Demonstrates the scientific reasoning and after effects of surgery. Includes actual surgical footage of a female patient. Part two shows a 19-year-old male catatonic before and after treatment by transorbital lobotomy and insulin shock. Anxious, delusional, hallucinated before treatment, patient largely lost symptoms after therapy, although still considered odd, found employment as musician and salesman. Operation and recovery shown in still photography. Gross dissection of frontal lobes after death, 11 months post-operatively, concludes presentation.

Sunday London Times

2006-02-19T20:24:00.000-05:00

There is a fascinating article in the Sunday London Times written by Christine Toomey and Steven Young. It features Psychosurgery.org member Derek Hutchinson and mentions the Shaw family and even has a quote from me. Here's an excerpt:

Mental cruelty

The lobotomy is deemed one of the worst crimes in medical history. But a modern form of it is still practised in Britain - and may soon be performed without the patient's consent. By Christine Toomey and Steven Young

The flashbacks come late at night. First comes the recollection of intense physical pain, as if the bones in his arms are being snapped like twigs. Then he hears the voice of the neurosurgeon applying an electric current to metal pins implanted in the tissue of his brain. "How do you feel, Derek?" the surgeon Arthur E Wall asks, while peering into Derek Hutchinson's eyes to see if his pupils have yet dilated with fear.

When Hutchinson swears at the surgeon, Wall administers another electric shock to nerve centres located in the hypothalamus at the centre of his patient's brain. At this, Hutchinson's pupils dilate and he screams: "You're going to kill me, you bastard!" Hutchinson's medical records, written by Wall over 30 years ago, confirm that his patient "felt funny - as if he was dying". But as he screamed, Hutchinson recalls Wall leaning in close to his face and leering: "And I thought you were a bit of a tough guy."

His next recollection is of Wall giving orders for surgical implements to be passed. Hutchinson feels the metal pins inserted through nylon balls lodged in cavities bored into the front of his skull being replaced by thicker electrodes he says felt like "broom handles". "After that I started, I start to feel warm all over and quickly feel as if I have fallen into a vat of molten metal, as if I am, quite literally, frying," says Hutchinson, tellingly confusing tenses as he describes the brain surgery he underwent in 1974 yet still relives up to a dozen times a day and in frequent nightmares.

Throughout the surgery, Hutchinson was kept conscious; his head held in a brace, his hands and feet strapped to the operating table. Hutchinson, a 27-year-old father of three at the time of the operation, says he had not given his written consent to the operation being performed; neither had his wife - his next of kin. Instead his mother, an alcoholic, had been visited at home, in the late evening, after she had been drinking, and had been asked to sign the form. "My mother thought doctors were gods," Hutchinson says. "She'd have signed anything they asked."

More

Kings Park Murals

2006-02-19T10:29:00.000-05:00

Here is an interesting article in New York's Newsday which discusses the murals found in the now abandoned Kings Park Psychiatric Hospital. To the right of the story there is a link that allows you to view all the murals.

Record compensation for Australian woman

2006-02-17T15:26:00.000-05:00

Australian Louise Crockett was awarded four and a half million Australian dollars (about 3 million US dollars) in 2002 when she successfully sued the doctors who failed to promptly diagnose and treat a brain infection following psychosurgery. The case did not involve the doctors who carried out the operation. Her award was the largest ever paid by the Tasmanian State. It took nearly twenty years for the case to be settled.

Louise became depressed following the birth of her second daughter, who was diagnosed with a heart condition. Although surgery for her daughter's heart condition was successful, Louise continued to feel depressed. She went to see a psychiatrist and was given tranquillisers and antidepressants. Then she was admitted to hospital and given electroconvulsive treatment. Then her psychiatrist recommended psychosurgery and the operation was carried out in May 1983 at the Alfred Hospital, Melbourne, New South Wales, just over two years after Louise's first consultation with a psychiatrist.

The operation was pronounced a success (her nursing notes recorded comments such as "quite cheerful", "very cheerful" and "talkative") and Louise was discharged after six days and returned to her home in Tasmania. But two days later the wound started to swell and Louise began to behave oddly and was taken to her local hospital.

It was a delay in diagnosing and treating a brain abscess that led, in the judge's opinion, to Louise's respiratory arrest and subsequent brain damage. She was left with movement difficulties, memory loss, and personality problems. Her husband left her.

The award included 700,000 Australian dollars (about 500,000 US dollars) for loss of earnings. I think perhaps Justice Underwood was being optimistic in believing that, following psychosurgery, Louise would have been able eventually to take up "some paid employment involving accounting or the like".

The judgement can be read here.

We are in the studentBMJ

2006-02-16T16:34:00.000-05:00

The January 2006 issue of the studentBMJ (British Medical Journal) includes an article entitled The white cut: Egas Moniz, lobotomy, and the Nobel prize, written by medical student Seye Abimbola.

In 1949 the Nobel prize was awarded to Egas Moniz, the neurologist who carried out the first lobotomy, a procedure that caused severe physical and psychological impairment. Seye Abimbola investigates the ongoing debate.
The closest most medical students get to learning about lobotomy is during their psychiatry or possibly neurosurgery rotations, although there is more chance for those who do an elective in medical history. However, the story of Egas Moniz and lobotomy exemplifies some of the important events and contemporary issues of social relevance in the history of medicine.

At the end of a well-researched (several quotes from psychosurgery.org) article, Abimbola concludes:

I don’t think it makes sense to withdraw a prize awarded over half a century ago. It would be good if the World Health Organization could dedicate a day to remember the tragedy of lobotomy. And following the example of Norway, which has awarded compensation to all surviving lobotomy patients,4 nothing stops the Swedish Academy from recognising the negative impact of lobotomy on the lives of thousands of patients and their families around the world. My suspicion is that prefrontal lobotomy was just an excuse to award Moniz the deserved prize for cranial angiography he repeatedly missed in 1928 and 1933.

How much brain is destroyed?

2006-02-14T13:39:00.000-05:00

In anterior cingulotomy, one of the most commonly used psychosurgical operations nowadays (used in recent years in for example the USA, Canada, Scotland, South Korea, Russia, France, Poland, and Australia), the aim is to "produce lesions of approximately 1x1x2 cm within the anterior cingulate cortex of each hemisphere (ie total lesion volume = ~ 4cc)"

(A magnetic resonance imaging study of regional cortical volumes following stereo tactic anterior cingulotomy, S L Rauch et al. CNS Spectrums 2001 6(3) 214-222)

Professor Rees Cosgrove misleads the President's Council on Bioethics

2006-02-11T16:33:00.000-05:00

On Friday June 25 2004 Professor Rees Cosgrove M.D., Associate Professor of Surgery (Neurosurgery), Harvard Medical School, and Attending Neurosurgeon, Massachusetts General Hospital, addressed the President’s Council on Bioethics on the subject of psychosurgery. (Professor Rees Cosgrove carries out the psychosurgical operations done at the MGH.)

The modern era of psychosurgery was begun by this man, Egas Moniz, who is a very celebrated and famous Portuguese neurologist who experimented by injecting alcohol into the frontal lobes of 20 institutionalized psychiatric patients and thought that 16 of the 20 were favorably improved.

Moniz, or rather his neurosurgeon colleague, Dr Almeida Lima, didn’t inject alcohol into the frontal lobes of all 20 patients; he injected ten with alcohol but ten were operated on with a leucotome. One was subjected to both procedures. Moniz thought that 14, not 16, of the 20 were improved (but that might be a transcription error - Professor Rees Cosgrove gets it right on the MGH /Harvard Medical School Neurosurgical website.)

But, more importantly, were Moniz' original twenty psychosurgery patients really institutionalised? In fact, only 9 of the 20 had been in the local mental hospital, the Bombarda Asylum, for over a year. Five had been there for six months or less and six had never been in the asylum but had consulted Moniz at his clinic.

The first seven patients had spent between two and eight-and-a-half years in the Bombarda Asylum before they underwent surgery. They were all still in the asylum at follow-up after surgery (the maximum follow-up period was two months).

Patients Eight and Nine also came from the asylum but had been there for just five months and one month respectively. Both were still in the asylum at follow-up, although one of them had been given permission to return home.

Patient Ten had never been in a mental hospital. She consulted Moniz at his clinic, the Santa Marta, and was diagnosed as suffering from an anxiety neurosis.

Patient Eleven had never been in an institution either, having been taken to the Santa Marta in an excited state on 26 December 1935, he was diagnosed as schizophrenic and operated on a week later.

Patient Twelve was diagnosed as suffering from a “cardiac neurosis”. She had never been in a mental hospital.

Patient Thirteen had never been in a mental hospital but was brought to the Santa Marta Clinic by her son who said she had been excited for three months. She was operated on immediately and again a couple of weeks later.

Patient Fourteen had been in the Santa Bombarda Asylum for two years.

Patient Fifteen had never been in a mental hospital.

Patients Sixteen, Seventeen and Eighteen came from the Santa Barbara Asylum (one of them via prison), but had been there a year or less.

Patient Nineteen, suffering from depression and anxiety, had never been in a mental hospital. Her family had heard about the operation and brought her into the Santa Marta Clinic.

Patient Twenty had been admitted to the Bombarda Asylum six weeks before she was operated on.

Professor Rees Cosgrove repeats the claim on the MGH/Harvard Medical School Neurosurgical website:

Moniz reported that 14 of 20 severely ill, institutionalized patients showed "worthwhile" improvement after operation and coined the phrase "psychosurgery" to describe his interventions. ( Moniz, 1937) At that time, few satisfactory treatment options existed and the asylums for the insane were overflowing with the chronic mentally ill. Therefore, despite the lack of objective data and long term follow-up, an enthusiastic response was obtained from the medical community. This response resulted in Moniz receiving the 1949 Nobel Prize in Medicine and Physiology.

Here, Professor Rees Cosgrove makes the usual apologies for the early psychosurgeons: the mental institutions were overflowing and few treatments existed. But only one of the nine patients who had been in hospital for over a year was able to return home following surgery. He was suffering from depression and had been in the Bombarda Asylum for two years. Although he was allowed to go home, he was described at follow-up as lacking in initiative and confused about his age, time and money. Three patients, two suffering from mania and one from depression, who had been in hospital for only a brief period before surgery, were able to go home. None of the seven schizophrenics got to leave hospital, and only two were described as improved.

In fact, Moniz’ results were very typical of what was to follow. Psychosurgery was never going to empty the mental hospitals. Long-term patients who could leave the hospital following surgery were few and far between; those who could work and live independently were even fewer and further between. The majority of cures were obtained with the least ill patients - people who were suffering from anxiety and depression and sometimes hadn’t been ill for very long. Even Moniz, in the 1937 article cited by Professor Rees Cosgrove, admits that “Deteriorated patients obtain slight or no benefit from the treatment”.

Professor Rees Cosgrove opened his address to the President’s Council of Bioethics with the following words:

What I would like to do briefly this morning is give a very short historical perspective because I think that's paramount to understanding some of the moral and ethical issues that are involved with surgery for psychiatric illness;

For precisely this reason, it is important not to misrepresent the past.

Psychosurgery in Australia

2006-02-10T06:11:00.000-05:00

Psychosurgery is still carried out on one or two people a year in Australia. In 2002 the Radio National programme “All in the Mind” featured a discussion about psychosurgery. Taking part were Melbourne, Victoria, neurosurgeon Professor Jeffrey Rosenfeld; and former Chair of the Victoria Psychosurgery Review Board Beth Wilson.

Jeffrey Rosenfeld stresses the differences between lobotomy and modern operations, while Beth Wilson defends the early practitioners of psychosurgery.

Beth Wilson: They saw the incredible suffering of people, particularly in the southern States of America, Negro soldiers who were languishing, not able to go home, hideously ill, very little treatment. The treatments comprised straightjackets, seclusion, insulin shock and electric shock treatment, that was it.

There is a mention of Dr Harry Bailey, who was prominent in psychosurgery in Australia in the 1970s. The operation he favoured for his patients was the anterior cingulotomy, which is still used, for example, at Massachusetts General Hospital in the US and at Ninewells Hospital, Dundee, Scotland. Harry Bailey committed suicide in 1985 rather than face an enquiry into his practice at Chelmsford private hospital, where he used Deep Sleep Treatment and ECT.

The number of lobotomies, or leucotomies, fell dramatically after the 1950s, as drugs became available, especially for schizophrenia. But as recently as the 1970s, in Australia we faced our own controversies surrounding psychosurgery. In 1974, an ABC-TV ‘Four Corners’ investigation into the procedures being used, in part re-ignited public concern. And at the centre of the debate was one Dr Harry Bailey of Chelmsford and ‘Deep Sleep’ therapy notoriety.

Presenter: In Australia, habitual thieves, sex offenders, drug addicts, and people with chronic obsessional behaviour, have undergone psychosurgery by a team of doctors in Sydney’s Macquarie Street.

The team, headed by psychiatrist Dr Harry Bailey, has carried out more than 150 brain operations over the past seven years. They include, among others, Case 1: a 26-year-old housewife with a germ mania who washed her hands at 3 to 5 minute intervals and used one cake of soap a day. Case 2: a 42-year-old accountant, who after sexual intercourse with his girlfriend, would compulsively exhibit himself to a girl on the street 10 minutes later. Case 3: an 18-year-old nurse, suicidal, two overdose attempts, who stated, ‘My last two years have been hell. I only want to die. The voices are screaming at me.’

The programme also contained extracts from Janet Frame’s book, an Angel at My Table (1984) in which she describes how she was saved from a leucotomy at the last moment when the medical superintendent of the hospital saw in a newspaper that one of her books had won a literary award. Janet Frame went on to be nominated several times for the Nobel Prize in literature, demonstrating that the outlook for patients considered for psychosurgery in those days was not, contrary to what the defenders of lobotomy say today, necessarily so bleak.

Reader: My mother had been persuaded to sign permission for me to undergo a leucotomy. I know she would not have done so had not the experts wielded heavily weighted arguments. The experts, who over the years, as my history was accumulating, had not spoken to me at one time for longer than 10 or 15 minutes, and in total time, over 8 years, for about 80 minutes; who had administered no tests, not even a physical test of EEG, or X-rays, apart from a chest X-ray whenever there was a new case of tuberculosis, a disease prevalent in the mental hospitals then. I listened, trying to avoid the swamping wave of horror, when Dr Burt, a likeable, overworked young doctor who had scarcely spoken to me except to say 'Good Morning, how are you?', and not wait for a reply as he would whisk through the ward, found time to explain that I would be having a leucotomy operation, that it would be good for me, that, following it, I would be out of hospital in no time.

I listened also with a feeling that my erasure was being completed, when the ward sister, suddenly interested that something was about to be done with, and to me, painted her picture of how I would be when it was all over. ‘We had one patient who was here for years until she had a leucotomy, and now she’s selling hats in a hat shop. I saw her just the other day, selling hats, as normal as anyone. Wouldn’t you like to be normal?’

Everyone felt that it was better for me to be normal, and not have fancy intellectual notions about being a writer.

My friend Nola, who unfortunately had not won a prize, whose name did not appear in the newspaper, had her leucotomy, and was returned to the hospital where, among the group known as ‘the leucotomies’, some attempt was made to continue with personal attention, the process of being made normal, or at least, being changed. The leucotomies were talked to, taken for walks, prettied with make-up and floral scarves covering their shaven heads. They were silent, docile, and their faces pale with damp skin. They were being ‘retrained’ to fit in to the everyday world, always described as ‘outside’, ‘the world outside’.

In the whirlwind of work, and the shortage of staff, and the too-slow process of retraining, the leucotomies one by one became the casualties of withdrawn attention and interest; the false spring turned once again to winter.

Read a transcript of the programme here

Forced Treatment

2006-02-08T08:24:00.000-05:00

There's an interesting story in today's New York Times about an attempt to force treatment on people judged to be mentally ill. It's in an article with the non-inflammatory title, "Killings Loom Over Debate on Treating Mentally Ill". Here's an excerpt:

Against the vivid backdrop of recent killings by mentally ill people, both sides in the national debate over whether mentally ill people who have not committed a crime can be forced into treatment are preparing for a showdown in the Legislature here.
...

Reviewing information from case managers from 1999 to 2004, the New York Office of Mental Health said people ordered into treatment under the law committed fewer crimes and were less likely to end up homeless or in psychiatric hospitals or harm themselves or others.

A little over one-third of the 10,000 cases referred to court, most of them in New York City, resulted in forced outpatient treatment, according to the report, which Gov. George E. Pataki cited in declaring Kendra's law a success.

But Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, flew to New Mexico this week to dispute the state report's findings.

Mr. Rosenthal cited a report by a legal advocacy group, New York Lawyers for the Public Interest, which asserted that blacks were five times as likely as whites to face court orders. In addition, he said, counties have unevenly applied the law, skewing the results of the study.

"New York's law is not the model it is made out to be," he said.
-------------------
In unrelated news, here is a list of murders and other crimes from the past month, also reported in the New York Times, which were committed by people who are considered sane. Perhaps we need a law to forcibly medicate sane people because they are very violent and dangerous.

Sobs and Hugs, but Not His Jailed Mother, at Abused Boy's Funeral

One Year After Chemist's Murder, a Stalled Inquiry Angers Relatives

The Tenafly Councilman and 40 Bags of Heroin

Man Appeals Conviction of Student's Murder

Michigan Couple Charged in Son's Death

Man Convicted in Two Pa. Shooting Deaths

BOROUGH PRESIDENT'S GRANDSON IS CHARGED

SUSPECT IN KILLING OF POLICE SERGEANT IS ARRESTED

Woman Gets Life in Texas Professor's Death

Ohio Doctor Indicted in Wife's Poisoning

No More Favors, Judge Tells Man Accused in Court Mayhem

Man Sentenced in 'Girls Gone Wild' Attack

Nichols May Be Tried in Atlanta Courthouse

Across the City, Gunfire and Stabbings Leave 6 Dead in 24 Hours

Murder Trial Ends, but the Mystery Doesn't

Driver Shot on Bronx Street After Police Pull Him Over

Brooklyn Jury Gets Case of Killing of Detectives

Scotland and England/Wales disagree over DBS

2006-02-07T15:04:00.000-05:00

Scotland has already legislated to include Deep Brain Stimulation with psychosurgery in section 234 of their Mental Health Act 2003. This means that it can be given to consenting patients only if a panel from the Mental Welfare Commission confirms that the patient’s consent is valid and that the operation is in the patient‘s “best interests“. (Section 234 also allows surgeons to carry out psychosurgical operations on incapable patients, as long as the patient is not objecting and the Court of Session approves the operation. However, no psychosurgery has been carried out in Scotland on non-consenting patients since the law came into force. Their previous Mental Health Act (1983) did not allow the use of psychosurgery on non-consenting patients in any circumstances, although before 1983 it was of course commonly used on patients without their consent.)

England and Wales meanwhile have done nothing. The recently published eleventh biennial report of the Mental Health Act Commission (paragraph 4.85) had this to say about DBS:

Insofar as it involves procedures that have strong similarities to techniques of Neurosurgery for Mental Disorder such as stereotactic subcaudate tractotomy (ie. The introduction under local anaesthesia and with the aid of a stereotactic frame of an object through burr holes in the skull), some mental health practitioners and lay persons have assumed that the safeguards of section 57 of the Act do or should apply to its use. However we do not take the view that DBS can fall within the description at section 57 of “a surgical operation for destroying brain tissue or the for destroying the function of brain tissue”.

The report goes on (just as the previous biennial report did) to urge the Secretary of State to legislate on DBS and to advise placing it in the ECT section, which would make it a treatment that could be given to non-consenting patients with the approval of a psychiatrist from the MHAC panel (or occasionally without). But the Secretary of State has done nothing even though experiments on patients are beginning and so DBS remains an entirely unregulated treatment which, in theory at least, can be given to patients without their consent and without involvement of the Mental Health Act Commission.

The psychosurgery team at Dundee have explained the Scottish position on DBS in their most recent biennial report to the Scottish Executive:

It is of course correct to state that some adverse effects associated with ablative procedures may be permanent. However, although less likely, similar issues can and do arise with DBS. It should not be forgotten that DBS procedures lead to the creation of lesions, although these are smaller than for ablative procedures, and, in some circumstances, may be temporary. (paragraph 81)

The report can be read here.

Psych Ward for a Creative Writer

2006-02-05T16:57:00.000-05:00

I'm going to let this story speak for itself:
---------------------------------
Family sues after creative writing assignment lands teen in psych ward By Lisa Sweetingham, Court TV

(Court TV) — Minnesota high school student David Riehm bristled at his creative writing teacher's stinging comments at the bottom of his assignment.

"David, I am offended by this piece. If this needs to be your subject matter, you're going to have to find another teacher," Ann Mershon's critique began.

The 17-year-old's satirical fable concerned a boy who awoke from a wet dream, slipped rear-end first onto a toy cone, and then had his head crushed "in a misty red explosion" under the tires of a school bus.

"I'm actually a little concerned about your obsessive focus on sex and potty language. Make a change — today!" Mershon warned.

David did not make a change. The poetry, scripts and songs he loved to write typically earned him praise from friends and family. Mershon's rebuke only roused him to rebel against her in two more essays over the course of the term.
"Bowling for Cuntcheson," a vivid dream-within-a-dream about a boy who finds a gun under a church pew and shoots his teacher, "Mrs. Cuntcheson," so frightened Mershon that she alerted the school administration.

"I felt threatened and violated by this thinly veiled fictional account of revenge against me," Mershon wrote in a statement to authorities. "I immediately had anxieties, which I have struggled with since reading the story. It scared me, it hurt me, and it also makes me very concerned for David."

David was suspended on Jan. 24, 2005. The next night, three men — a Cook County deputy sheriff, a state trooper and a social worker — showed up at Colleen Riehm's home on the Grand Portage Indian Reservation with a court order to seize her son and commit him to a psychiatric ward 150 miles away in Duluth. (David's stepfather is Native American, but David is not enrolled in any tribe.)

With no room at the juvenile facility, David was temporarily placed in the adult unit.

"He was scared to death," David's attorney told Courttv.com. "He didn't know what was going to happen from one minute to the next."

A physician later determined David was neither mentally ill nor dangerous, and more than 100 letters of support, written by classmates, faculty and parents, were presented at a court hearing, his attorney said.

David was ordered released from the hospital 72 hours after he had been taken into custody. His mother received $6,000 in medical bills.

Colleen and David Riehm filed a civil suit last month against his former teacher, the principal, and other county officials alleging numerous violations of David's constitutional rights, including freedom of speech, due process, and protection from unreasonable seizure, false imprisonment, and negligent confinement.

"Throwing a kid into a mental hospital for what he writes and not for what he does is unconscionable and unacceptable," Riehm's attorney Peter Nickitas told Courttv.com. "I would expect to see something like this in a book by George Orwell or Franz Kafka or an excerpt from the 'Gulag Archipelago,' but this happened in Minnesota in 2005."

It has also happened in Texas, Kansas, Louisiana and public schools across the nation. link

OCD-UK comments

2006-02-03T18:02:00.000-05:00

OCD-UK, the leading British charity for people who are affected by Obsessive-Compulsive Disorder, have made some interesting comments about DBS (Deep Brain Stimulation) and psychosurgery more generally.

"August 23, 2005

Deep Brain Stimulation - Our Comment

With news that research into the use of Deep Brain Stimulation (DBS) to treat OCD is to be trialled here in the UK, we felt it appropriate and important for the public interest that we comment.

OCD-UK is against any treatment that will potentially cause long term or permanent damage.

While the procedure has readily reduced symptoms associated with Parkinson’s Disease, many other more severe symptoms often appear in their place. Arguably, in the case of young sufferers, the long-term cognitive and behavioural effects cannot be known at this stage.

The risks associated with brain surgery are damage to the blood vessels (for example, causing stroke), confusional states, epilepsy and severe personality changes.

Previous work using this technique in Parkinson's disease indicates a death rate of around 1% of people, with another 2% suffering from a stroke or other serious complication. Very serious complications may occur in 1 in 30 people undergoing this operation.

It is claimed that DBS is reversible, however OCD-UK questions this due to the very nature of the operation which involves drilling two holes into the skull and inserting electrodes (which are "about the size of a piece of spaghetti").

OCD-UK wishes to make it clear to the public and medical community that the continued use of psychosurgery for the treatment of OCD should be subject to further rigorous reviews to determine if its use can be justified. We believe that there is a need for a broader debate which should consider the balance of benefits and costs (in all respects).

OCD-UK will not support this experiment when the dangers to vulnerable sufferers are so great.

We hope to publish details of past research findings later this week."

In 2003, Datamonitor published a report on "Medical Devices in CNS disorders: opportunities in developing markets" which contained the following advice for DBS manufacturers:

"Deep brain stimulation (DBS) has been shown to be truly effective in treating Parkinson’s disease (PD) but with numerous companies having drugs in development, this could potentially reduce the number of patients needing DBS. Therefore, DBS manufacturers should focus on niche sectors of the market."

NYT Reporter

2006-01-31T11:38:00.000-05:00

Today the New York Times has an article about a recently deceased (2004) journalist named Lucy Freeman who, in the 1940s and 50s, wrote a great deal about mental illness. Apparently she wrote many articles about how great lobotomy was, though she was actually a psychoanalysis devotee. From the article:

In truth, many psychiatrists were trying to convert such institutions from overcrowded, custodial facilities to state-of-the-art medical centers. Believing that mental illness stemmed from organic problems within the brain, psychiatrists had devised a series of treatments, including electroshock therapy and lobotomy.

It was these advances that Ms. Freeman relentlessly publicized as The Times's reporter on mental health. Writing scores of articles like "Action Now Urged on Mental Cases" and "State Mental Care Entering New Era," she willingly blurred the roles of reporter and advocate.

Ugh, some legacy. I wonder how many people underwent that horror of an operation because of her senseless cheerleading.

Later it says, "'By saving them,' she wrote, 'in some way I also saved myself.'".

Good Lord, who did she think she saved exactly? I bet she never even bothered to meet a lobotomy victim.

The article also includes this gem, "Moreover, recent studies have demonstrated that disorders like schizophrenia have a genetic basis and result from chemical abnormalities in the brain."

Yeah, right. How come whenever Mindfreedom confronts these "studies" head-on, they never turn out to be anywhere near as conclusive as their authors claim?

link

Another doctor who had psychosurgery

2006-01-30T13:33:00.000-05:00

Cathy Wield is not the first doctor to have undergone psychosurgery in Britain in recent years. Justine Carr-Brion wrote about her experience in the British Medical Journal in 1995.

"Problems of mental health in the medical profession seem to be a fashionable topic in the BMJ. I am another sufferer, but what worries me most is not my treatment when ill, but the discriminatory label about being a "psychiatric patient" and the effects that this has when I am dealing with non-psychiatric staff.

I have had recurrent attacks of severe depression since 1990. These have usually consisted of rapid descent to a suicidal state, though the physical and mental retardation made attempts to kill myself difficult. I had been on all the antidepressant drugs available in various combinations. My final attempt led to a cardiac arrest, but unfortunately I was in a hospital and I was resuscitated. I am afraid the staff got no praise from me. At this point I was referred for psychosurgery. (No, I did not know it still existed either.) I was on a neurology ward, the operation was performed, and I had no problems.

This, however, gave me one of my first insights as to what a "psychiatric" label meant. The sister was talking to one of the consultant neurologists during his ward round, when she started complaining about having psychiatric patients on a medical ward, and the fact that they did not have the facilities to care for us. What facilities she envisaged I do not know, as we all suffered from affective disorders and were among the quietest patients on the ward, and being a neurology ward it was overflowing with therapists of all types. Treating us as normal human beings undergoing an operation obviously never occurred to her. She obviously also thought that all psychiatric patients were deaf. I felt a strong temptation to leap up and challenge her views, but felt that this might be unwise and might reinforce her prejudices.

I had been well since the operation until the start of 1995, my last suicide attempt having been in the summer of 1993. I returned to work on 3 January to be told that I was no longer wanted."

Justine Carr-Brion goes on to describe how she was detained under the Mental Health Act, and then needed a further admission to hospital.

Read the article here.

Principle 11

2006-01-29T05:30:00.000-05:00

Cathy Wield, the British doctor who underwent psychosurgery and wrote about her experience in a recently-published book called “Life after Darkness” was detained under the Mental Health Act when she was operated on. In Britain, as long as the person consents to the operation (Scotland has provision for carrying out psychosurgery on patients who are unable to consent), this is legal but is nevertheless rare. In the fifteen year period between 1984 and 1999, out of over 300 referrals for psychosurgery in England and Wales, only two were for detained patients. At least, this is what the eighth biennial report of the Mental Health Act Commission said; figures from the Royal College of Psychiatrists suggest a somewhat higher number.

The World Health Organisation, has this to say about psychosurgery:

“Psychosurgery and other intrusive and irreversible treatments for mental illness shall never be carried out on a patient who is an involuntary patient in a mental health facility and, to the extent that domestic law permits them to be carried out, they may be carried out on any other patient only where the patient has given informed consent and an independent external body has satisfied itself that there is genuine informed consent and that the treatment best serves the health needs of the patient. Principle 11 (14) MI Principles”

From the WHO Resource Book on Mental Health, Human Rights and Legislation, 2005, page 63.

Principle 11 was included in Resolution 46/119, adopted by the General Assembly of the United Nations in 1991.

Life after Darkness

2006-01-28T17:33:00.000-05:00

A doctor who underwent psychosurgery has written a book about her experience. After being admitted to hospital several times for depression and undergoing more than 100 electroconvulsive treatments, Cathy Wield had an operation in Dundee, Scotland, and now feels she has been cured of depression. The following article is from The Daily Telegraph, 23 January 2006

'I decided to overdose, slowly'
(Filed: 23/01/2006)

"When nothing could treat her depression, Cathy Wield agreed to brain surgery
It was 1994, I was a junior doctor working in A&E. My husband, Phil, and I had swapped roles, so that I could pursue my career, and he was looking after our four children, an arrangement that we were all happy with.

I admit that my life was far from typical: there were many unusual features to it, but none that could predict the onset of the depression that was to begin that December. I cannot give an accurate picture of how it started, but it was like a mist coming down. A dark mist that clung to every part of my body and mind. I lived it and breathed it. I was off work, "sick", and the memories I have of that time are of long days spent in our bedroom doing very little.

Depression is more than a state of mind, and I felt very unwell. I was continuously tired, exhausted and lacking in energy. I wanted to sleep, but often sleep would not come. Every task was a great effort. Eating was a trial, as I had little appetite and I was constipated. I self-diagnosed, and was of the opinion that with medical assistance, it would soon be over. My GP prescribed medication and I received counselling.

That Christmas holds no memories for me, and as the New Year passed, I remained off work. The depression was gaining momentum. By February, I was desperately suicidal and was admitted to the Old Manor Hospital, Salisbury. I watched from the window as Phil drove away, tears rolling down my cheeks. I felt hopeless, guilty, ashamed and quite convinced that it was my fault.

By now, I had developed psychomotor retardation, when the processes in the brain are slowed, so, in addition to drug treatment, I was started on electro-convulsive therapy - a controversial procedure that applies a jolt of electricity to the head, to induce a seizure. It had some success, and, after six weeks, I was well enough to return home. But the improvement was short-lived, and, after as many weeks, I was re-admitted to hospital.

In the meantime, Phil was left at home with the children, knowing my sick pay would soon stop. He started to look for work, while juggling all the children's activities and wondering how he was going to cope.

A monotonous pattern was starting to emerge. Hospital admission with concomitant ECT was interspersed with periods at home. I was on several drugs, having regular psychotherapy, and, when I was at home, my community psychiatric nurse would visit twice a week.

I was not much of a mother, and Phil had effectively lost his wife. I was quiet and dispirited; nothing of my usual outgoing personality seemed to be left. However, I had not lost my intelligence - even though my thinking was slowed and delusional - and I decided that I had had enough of hospitals, and that my extreme misery was outweighing my desire to be at home with the children. Living had become a kind of hell. The only way out seemed to be suicide.

That September, once the children were back at school, I decided to overdose, slowly, on lithium, knowing that it would eventually poison and kill me. I thought this would go unnoticed. However, somehow, my psychiatric nurse got wind of it; Phil came home one day to find my GP, social worker and psychiatrist applying the Mental Health Act to detain me against my will for up to six months. The children were taken to a friend, and I was forced into the waiting ambulance; I wanted to run, but the ambulance crew dragged me back. I had become a prisoner, for my own good, for my own safety.

I arrived at the NHS psychiatric hospital, a dreary, run-down, understaffed institution. The furniture was old, and the carpet stained, but the physical surroundings were only part of the misery. Verbal aggression occurred on a daily basis, and I witnessed physical violence. Since the ward had very few private rooms, I soon found myself in a dormitory.

I craved privacy. The staff were clearly overstretched, and the nurses had little time to spend with patients. Being listened to was the only comfort I knew; it was the only painkiller for the agony of my mind, but, like any analgesic, it wears off. I required it regularly and frequently - something which could be delivered so easily in hospital, if only the nurses could find the time.

I started to inflict pain on myself: partly as a distraction from the torture of my mind, and partly as an obsessive punishment. I would get up in the night and pour boiling water over myself, and then lie in extreme pain. Two years, three years, four years - they merged into each other. By the time the fifth passed, I had been sectioned on several occasions. The doctors were doing their utmost to get me well enough to be at home, feeling it was important for the family to be together. However, despite the different combinations of drugs, I remained stuck in what, by then, was recognised as a chronic, treatment-resistant depression.

Finally, in 1999, Professor Chris Thompson, of the Mood Disorders Service at the Royal South Hants Hospital, suggested brain surgery. I felt as if I'd been struck by lightning, such was my surprise. I had never heard of an operation for depression, and I was scared. He described how, in an anterior cingulotomy, a discrete lesion could be placed, to interrupt the abnormal neural pathway that is thought to be responsible for this type of depression. I would be left with two very small scars on my scalp, a very small risk of fits and it might not work (as is the case for 33 per cent of patients) - but that was all.

Neurosurgery for mental disorders, he explained, is reserved for those patients with severe, life-threatening depression. In my case, it was predicted that I would either kill myself or die as a result of the self-harm. My most significant concern was whether it would affect my personality, but I was assured that the risks were extremely low. I was also worried that it would be done against my will, but it is never done without the patient's full consent.

By 2001, I was in a desperate way. Whatever the risks, I was living in torment and the only other option was death. I wanted this operation. Still on Section, I was transferred to the Ninewells Hospital, Dundee, for surgery - the only place in Britain where it was offered. [A similar form of psychosurgery, anterior capsulotomy, is done at the University Hospital of Wales in Cardiff - Sue K]

After the operation, I woke up with a turban on my head, and the worst headache I have ever had; I cannot recall anything else. For the first few weeks, I was not expected to do anything more than recover from the physical effects, but eight days later, the most remarkable thing happened: a light switched on in my head. It was as though the power cables had been connected, and, in an instant, my depressive symptoms lifted. It took several days before the ward staff were convinced that my experience was genuine. Phil came to visit me, and he knew immediately that he had his wife back.

I was still on Section, though, and was transferred to Southampton General Hospital. In the car, I cried at the prospect of having to stay in the hospital when I felt well; I realised, however, that to walk in with tear stains would not help my cause.
The following day, I met my psychiatrist. He was "flabbergasted" at the change he saw, and, within a short time, I was discharged from hospital. I almost danced out - such was my exhilaration and happiness.

Then came the reality of restoring my relationships with the children; I had missed seven years of their lives, they were so grown-up. I had not realised how hard it had been for my dedicated family, and Phil was exhausted. We had a turbulent year, but came through it in one piece. I returned to work in A&E, at Southampton General, which - since I had to face staff who had treated me as a patient - was a challenge.
It was then that I realised I needed to work against the stigma that mental illness brings. I hope that by publishing my diary of these years, understanding of this misunderstood illness will increase, and that conditions for patients suffering with mental illness will improve. I lost seven years to depression: seven years of being a prisoner - not just of my mind, but of a rundown healthcare system, which, according to the recent Mental Health Act Commission report, In Place of Fear, is still largely in existence."

Life After Darkness (Radcliffe Publishing) is available for £16.95, plus £1.25 p&p. To order, call Telegraph Books on 0870 428 4112

The first chapter of Cathy Wield’s book can be read here:

Nude Therapy?

2006-01-24T15:07:00.000-05:00

While perusing the news I found this odd article about a couple who ran a group home for mentally ill people. I'll let the article tell the rest of the story:

Therapist for Mentally Ill gets 30 Years

A therapist who ran a group home for the mentally ill was sentenced to 30 years in prison for enslaving its residents, forcing them to work naked and making them perform sex acts. His wife received seven years behind bars.

Arlan Kaufman, 69, and his wife, Linda, were convicted in November on charges that included health care fraud, forced labor and involuntary servitude.
...

Prosecutors contended the Kaufmans controlled the lives of their residents, including deciding who could wear clothes and forcing them to masturbate, fondle each other and shave each other's genitals — activities Arlan Kaufman videotaped.

Arlan Kaufman insisted the residents' behavior was voluntary. He testified that he videotaped them so they could see themselves more objectively later when their judgment was not clouded.

Wow. What freaks. Here are more articles I found about the case:

More about the charges

Out on bond

The Defense including the charming assertion that residents were locked in isolation rooms for "only a few days", not weeks or months as the prosecution alleged.

Interesting article about how consent was an issue - patients testify that they did consent, then talk about how they had clothes taken away as punishment and felt compelled to attend a group masturbation session called "massage group".

Finally the inevitable "How we're going to reform everything so this never happens again" article.

Downtime

2006-01-19T21:04:00.000-05:00

As you may have noticed, we have suffered some downtime as we changed over to a new host. There are some functions on the website that still need repair, but we are back online and ready for an exciting new year!

"A more paternalistic medical culture"

2005-12-17T07:01:00.001-05:00

There are now few surviving surgeons or psychiatrists from the early days of psychosurgery. But one exception is the British psychiatrist John Pippard, who is still on the Medical Register sixty-three years after he qualified as a doctor.

It was in the 1950s, as a consultant psychiatrist at Claybury Hospital in Essex, that Pippard made his name in leucotomy. In 1955 he completed a thesis on leucotomy at Cambridge University, where he had studied medicine, and during that decade published several articles on psychosurgery in medical journals. The surgeon Wylie McKissock who carried out thousands of psychosurgical operations named a particular type of cut the rostral P in his honour.

In 1962 Pippard published the results of a survey of psychosurgery in Britain, which showed that the number of operations had declined to about 500 a year (from an average of over 1100 a year in the late forties and early fifties). Interestingly, Pippard did not put that decline down entirely to the introduction of neuroleptic drugs in the way that people do nowadays. Instead, commenting on Tooth and Newton’s earlier survey of psychosurgery, he has this to say:

“The survey threw little light on the reasons for the decline in popularity of this form of treatment, but it was considered that, more than anything else, the undesirable side-effects of the operation explained it. It is also perhaps not surprising that many psychiatrists, continuing to care for the failures of leucotomy in hospital, should have become prejudiced against neuro-surgical procedures; the success of ataractic and other drugs and the increasing attention given to social influences and to occupational and recreational activities in hospital has further reduced the interest in surgery.”

Pippard’s survey found a large regional variation in the use of psychosurgery, ranging from 20 operations per million inhabitants in the North-East Metropolitan Region (which included Pippard’s own hospital and also Runwell Hospital where another psychosurgery enthusiast, Rolf Strom-Olsen, was superintendent) to 1.3 operations per million inhabitants in the neighbouring East Anglian Region. Nearly half the mental hospitals in Britain did no psychosurgery at all during 1959; at the other extreme one hospital did 45 operations. (My suspicion is that it was Runwell Hospital, but Pippard didn’t say). Pippard wrote approvingly of this hospital: “I have visited this hospital and discussed many of the patients operated upon with the consultant responsible for their treatment. It appeared to me that the cases had been carefully selected and the results of the operation seemed satisfactory in a high proportion, not only to the patients themselves but also to the relatives.” Pippard seemed to be more worried about hospitals that used little or no psychosurgery: “In general I get the impression that leucotomy is not sufficiently considered as a treatment in many cases which could, perhaps, be effectively treated only in this way”.

In later years Pippard turned his attention to a different form of treatment, ECT. He carried out surveys of ECT in the 1980s and again in the early 1990s, worked as a member of the Mental Health Act Commission panel of psychiatrists, and co-authored the chapter on ECT, the law and consent in the 1995 Royal College of Psychiatrists’ ECT handbook. There were of course other psychiatrists, for example Walter Freeman in the USA and William Sargant in Britain, who continued to use psychosurgery with as much enthusiasm as ever, even while the profession as a whole was losing interest in it.

A few years ago Pippard looked back on his psychosurgery years in an article entitled “Leucotomy: a qualified defence of ‘then’”, which appeared in the medical journal QJM (2001, volume 94, page 451).

"Leucotomy (known as lobotomy in the US) and electroconvulsive therapy (ECT) are the only physical treatments for mental illness devised in the 1930s that are still used today. Few drugs were available at this time, other than sedatives and amphetamines. The new treatments offered hope for patients with severe psychotic illness, the severely anxious, obsessional or depressed, and those exhibiting violently disturbed behaviour, all of whom were many in number…
In the more paternalistic medical culture in which leucotomy was first proposed, questions of consent were considered less seriously than they are today. Leucotomy in the form, for example, of stereotactic tractotomy and cingulectomy is still used occasionally at a few neurosurgical centres, mainly for intractable depression (especially in the elderly) and for obsessional illness. However, the Mental Health Act (1983) forbids psychosurgery without the consent of both the patient and the Mental Health Act Commission (MHAC). MHAC approval is given only after thorough assessment by three Commission members, including a psychiatrist. I performed this function over three years in the 1980s, and found it much harder, more worrying and a more controversial task than making a clinical decision 20 or 30 years ago.
Past practice may only be judged fairly when its context is understood: simply applying current ethical standards and the wisdom of hindsight not only over-denigrates the past, but underestimates the future. Consideration as to how much of our current best clinical practice will be deemed inadequate 50 years from now gives us a fairer standard by which to judge our past decisions."

Read the whole article here

It is interesting that Pippard refers to the medical culture of the 1940s and 1950s as “paternalistic”. Almost all those involved in psychosurgery have been men. (Effie Hutton at the Burden Neurological Institute was a notable exception in the early days of psychosurgery.) The majority of patients meanwhile have been women. Women out-numbered men nearly two to one in the first thousand patients treated in England and Wales; nowadays they out-number men by slightly more than two to one.

The "paternalistic" (and that, I think, is putting it politely) attitude of psychiatrists towards their patients is revealed in some of Pippard's case histories from the 1950s. Here are a few examples:

"A woman of 34, terrified in childhood by constant quarrels between her overbearing and aggressive mother and her cyclothymic father, felt herself inferior to her more favoured older sister and was a cowed, enuretic, much punished child, who early developed obsessional rituals against her fears. She was further handicapped by recurrent attacks of acute rheumatism and dyspnoeic from mitral stenosis. Her mother and sister interfered in her marriage and her husband demanded fellatio. Though partly relieved by leucotomy of the depression which had totally incapacitated her for a year she remained immature, insecure and still had obsessional ruminations and compulsions."

"An actress of 50 had never really achieved anything so satisfying in her life as playing in Maeterlinck’s Blue Bird at the age of 8. A lifetime of hypochondriasis, with frequent visits to hospitals in two continents, had given her life some meaning and provided excuses for not having done better in her career. When her mother died she became agitated and depressed and her hypochondriasis assumed tremendous proportions. With the relief of depression by open rostral leucotomy a year later she reverted to her normal level but was perhaps more difficult to live with because of an accentuation of her shrewishness and an increase in absentmindedness."

"A deaf little woman with tinnitus… lost her home in an air-raid and had to live in an uncongenial neighbourhood away from the friends of her former years, her family had grown up and left her, and her personal contacts were limited to a few cronies in the local pub; only there did she brighten up at all. There were no obvious post-operative personality deficits and her unobservant husband had not seen any change in her."

"A 42 year old housewife, a sociable person of extraverted personality, gave up her work as a milliner at 21 to care for her elderly parents… Behind a kindly front she was seething with indignation against her sister, whose illegitimate child she brought up…standard leucotomy made her bland and dull and it was not long before she was able to travel by bus for the first time in 14 years. At follow up nearly 2 years later she had grown plump and was giggly and rather fatuous, voicing her thoughts without concern for their effect on others. Her housework fully occupies all her days; she can no longer read since she cannot understand what she reads…Patient and husband call this result “a complete success”, and he rather likes the severe frontal lobe deficit syndrome."

Howard's Blog

2005-12-14T12:49:00.000-05:00

Howard Dully has started his own blog about lobotomy. Very cool!
Be sure to check it out.

http://howarddully.blogspot.com/

Antiquity?

2005-12-09T16:02:00.000-05:00

The City Council of Dundee in Scotland has created an interesting website, “Life at Liff”. The website is based on an exhibition which explored the treatment of mental illness in the city. For many years this treatment was centred on the Victorian asylum near the village of Liff just outside Dundee (hence “Life at Liff”).

Dundee, incidentally, is one of just two centres for psychosurgery in the UK. The other is at the University of Cardiff if Wales. At Ninewells Hospital in Dundee a psychosurgery team, currently consisting of psychiatrist Keith Matthews and surgeon Muftah Eljamel, have carried out more than 30 operations since 1990, all of them on people diagnosed as depressed or obsessive-compulsive.

In a section on surgery, the “Life at Liff” website tells us that:

The pre-frontal leucotomy was introduced in Dundee by Dr Bell in 1946. The operation was carried out in Maryfield Hospital. Two years later Bell reported that the operation had been performed on 53 patients, of whom 50 had improved, 2 showed no change and 1 tragically had died.
He noted:
'The [improved] patients
include many previously restless or violent and requiring continual nursing care and supervision, who are now able to lead a relatively normal life under medical hospital conditions.'
With the discovery of new anti - psychotic drugs in the 1950s, leucotomies became unnecessary.
The operation was last performed in Dundee in 1959. Causing irreversible damage to the brain, leucotomies are now considered unethical. Psychosurgery is still carried out
as a treatment, but at a much more advanced level.

So in the 1940s and 1950s doctors did these damaging and unethical things called leucotomies whilst nowadays they perform more advanced, and presumably ethical, psychosurgery? There is of course nothing unusual about this view. Jack el-Hai’s recent book about Walter Freeman, The Lobotomist, tells us on the first page that lobotomy disappeared a quarter of a century ago.

Certainly you won’t find recent textbooks or articles in the medical press talking about lobotomies; they talk about neurosurgery for mental disorder or anterior cingulotomies or capsulotomies and so on (which simply refers to the particular bit of the brain being operated on). But does this change in terminology reflect the disappearance of one, discredited, type of operation and its replacement by a completely different one, or is it simply an attempt by psychiatrists and surgeons to distance themselves from controversy?

Egas Moniz is generally credited with the invention of psychosurgery, although there had been attempts previously, for example by the Swiss psychiatrist Gottlieb Burckhardt, to do similar operations. Moniz (or rather the neurosurgeon Almeida Lima working under Moniz’ instructions) drilled holes in his patients’ skulls, inserted instruments into their brains, and then, either by means of injecting alcohol or cutting out some tissue, introduced a “lesion”, that is, a bit of brain was destroyed. And that, basically, remains unchanged. They may have more sophisticated tools and techniques, they may have thought up different names, but the basic principle remains the same: a lesion is made in the brain in the hope of alleviating the symptoms of mental illness.

Moniz coined the terms psychosurgery and leucotomy (cutting of the white matter) to describe his operations. He was awarded a Nobel prize for his "discovery of the therapeutic value of leucotomy in certain psychoses". In Britain both terms were adopted, leucotomy being used almost exclusively in the 1940s and 1950s and psychosurgery becoming more a popular term during the 1970s. For example the Mental Health Act 1983 talks about psychosurgery.

In the US Walter Freeman decided to call his version of the operation a lobotomy rather than a leucotomy. Others followed his example and psychosurgical operations became known as lobotomies. Freeman then went on to develop the type of operation that nowadays is associated with his name - the assembly line, no qualified surgeon required, electroshock for anaesthesia, ice-pick through the eye socket, lobotomy. It is this type of operation that most people think of when the word “lobotomy” is used and these particular operations - transorbital lobotomies - are of course no longer done.

But, while Freeman was hammering ice-picks into eye sockets, elsewhere neurosurgeons were carrying out psychosurgical operations with all the care usually accorded to neurosurgery and not an ice-pick in sight. Neurosurgeon James Poppen’s description of his “operative technic” in a 1951 volume called “Studies in lobotomy” takes up three pages (the operation itself took thirty minutes) and contains details such as:

After the buttons were removed and all bone dust washed out, the dura was opened with a semicircular incision with its base toward the mid-line. The dural flaps were held up by a suture tied in the mid-line. The underlying brain was then examined and described. In a number of cases, biopsy specimens were taken for histologic and biochemical study. Having selected a representative gyrus, a block of tissue at least 1cm was resected with minimal mechanical thermal trauma.

And other neurosurgeons were busy developing new techniques. The stereotactic frame, which the American neurologist/neurosurgeon team of Spiegel and Wycis adapted from animal experiments to human use in the 1940s, enabled surgeons to find their bearings more easily and target more specific areas of the brain. The anterior cingulotomy, which is still used at Massachusetts General Hospital and at Dundee, was first described in an article published in the Lancet in 1952. The anterior capsulotomy, which is used in Sweden and Wales, was pioneered in France in the 1940s. So it is not possible to draw a clear dividing line between crude early operations and sophisticated modern ones. Nevertheless, today’s psychosurgeons try to distance themselves from their predecessors and sometimes go to bizarre lengths to do so. The psychosurgery team at Dundee University for example refer to the “indiscriminate and crude procedures of antiquity”. Antiquity? They are talking not about classical or medieval or even Victorian times but about the 1940s, 50s and 60s.

Haaretz Mentions Us

2005-12-07T07:58:00.000-05:00

In a review of the book "Madhouse" about Henry Cotton the Israeli newspaper Haaretz mentions us:

"Even after Cotton's death his students continued to perform tooth extractions and tonsillectomies, until 1960. Even the inception of a treatment that was thought to be innovative at the time - lobotomy, the surgical removal of part of the brain's frontal lobe by inserting an ice pick into it, which was supposed to replace other treatments - did not lead to the end of the amputations and other surgery. (Incidentally, the developer of the lobotomy, who performed hundreds of the procedures, won the Nobel Prize for Medicine and also a great deal of support, until the real results of the treatment were revealed: The destruction of the brain tissue affected the functioning of the patient, who became a kind of zombie. Recently, several lobotomy patients' families have asked that the Nobel Prize be rescinded.) The studies that pointed to the danger and stupidity of Cotton's methods were buried in the archives of Johns Hopkins and the management of the hospital in New Jersey."

CNN story on Howard

2005-12-07T07:55:00.000-05:00

Procedure once considered legitimate medical treatment

(CNN) -- Howard Dully was 12 years old when he was told he was going to the hospital for some tests.

"I remember having big black swollen eyes one day and staying in the hospital for a few days because apparently I had an infection," recalls Dully, now 56, who lives in San Jose, California.

That's all Dully can remember of the transorbital or "ice pick" lobotomy performed on him more than 40 years ago.

Many in the medical community consider lobotomies barbaric by today's standards, but there was a time when the procedure was an accepted treatment for those suffering from severe mental illness.

Throughout the 1930s, '40s and most of the '50s, the main route of treatment for most of these patients was to keep them institutionalized in often filthy, deplorable conditions until they got better on their own. Many remained for years, even decades.

Then came the lobotomy. It was first performed in 1935 in Portugal by Dr. Egas Moniz, who later would win the Nobel Prize in physiology and medicine for the technique.

Neurologist Walter J. Freeman quickly brought the lobotomy to the United States, first performing it in 1936. A few months later the procedure made the front page of The New York Times with the headline "Surgery Used on the Soul Sick."

link

Lena Zavaroni

2005-12-04T17:18:00.000-05:00

Remember Lena Zavaroni, the Scottish child star who sang for President Ford in the White House?

At the age of eleven she had sell-out concerts at the London Palladium and appeared in concerts and TV appearances in the US, South Africa, Japan, Germany, Holland and Austria. The following year, 1976, she sang in the Royal Variety Show; in 1977 she had her own summer season in Eastbourne; in 1979 her own BBC TV series. She was said to be Scotland's richest teenager.

But underneath the success Lena was a deeply unhappy teenager who, under pressure to maintain the image of a child star, had became anorexic.

“When they tried to fit me into those costumes, they would talk about my weight. I kept wondering how they expected me to fit into these dresses. I was a plump little girl and I was also developing into a woman. I wanted to be just right for them but I had to go to all these breakfasts, dinners and lunches.” She added: “I only became fanatical about not eating when the pressure became too much. I just wanted to have a nice shape.”

Lena continued to suffer from anorexia and depression and the 1980s and 1990s saw hospital treatment, including ECT, a brief and unhappy marriage, her parents' divorce and her mother's suicide. Eventually she was living on disability benefit in a council flat. (What happened to all the money?)

In September 1999, she underwent a psychosurgical operation in the University of Wales hospital in Cardiff, one of only two centres in the UK that still perform such operations. Three weeks later, still in hospital, she died of an infection. She was thirty-five years old.

A spokesman for the hospital had this to say about the operation:

"A special surgical procedure is available as a last-resort treatment for the most severe cases of chronic clinical depression. It's not a treatment for anorexia and it's not a lobotomy.It's available only at a small number of specialist neurosurgical centres in the United Kingdom, of which the University Hospital of Wales is one. This is not an experimental or pioneering procedure - the NHS treatment has been performed successfully at the hospital for over six years.
Each operation is approved individually by the Mental Health Commission and surgery can only be performed after a rigorous examination of all the facts in each case.
This includes an interview with the patient and all the healthcare professionals involved."

Coroner Dr Lawrence Addicott recorded a verdict of death by natural causes.

Read more about Lena here

Michael Musto mentions the NPR program

2005-12-01T18:07:00.000-05:00

I'D RATHER HAVE A BOTTLE IN FRONT OF ME . . .

Barbaric Photoshopping of the brain, as it were, is spotlighted in the radio documentary My Lobotomy, whose premiere at Bellevue I gleefully went to, mainly to act all superior to the live guests who'd no doubt be screaming, slobbering, and belching the alphabet. But these survivors—who once had ice picks rammed into their heads for various un-chic reasons—were touching and well-spoken about the ramifications of their horror, though I was most attracted to the lady who said the lobotomy actually helped her resolve her schizophrenia. I hope she got two for the price of one.

link

And not forgetting the others....

2005-11-28T18:04:00.000-05:00

In the early 1970s a group of Scottish doctors experimented with brain operations, amygdalotomies, for the treatment of aggression. Their patients included two children aged under 10 and a further 5 young people aged under 20. Thirteen of their seventeen patients had epileptic seizures, but the operations were carried out in an attempt to control aggression, not seizures: "A strong history of aggression was obtained in all cases. Many of those patients in whom the prime reason for referral was that of aggression, had associated personality disorders." The doctors describe the operations:

"Wherever possible, procedures were performed without premedication under local anaesthesia. Nine patients were operated on under local anaesthesia and one was anaesthetized for the preliminary stereotactic procedure and when the probe was inserted the patient was allowed to waken up. The remaining eight patients had bilateral amygdalotomy performed under general anaesthesia because of their aggressive behaviour, and were considered too disturbed to undergo the procedure under local anaesthesia. Even those who were considered suitable for local anaesthesia often behaved violently during stimulation of the temporal lobe structures, disturbing the sterile enviroment and trying to tear the stereotactic instrument from their heads. Five of the 17 patients showed extreme restlessness and disturbed behaviour during the procedures."

From E R Hitchcock, G W Ashcroft, V M Cairns & L G Murray, Observations on the development of an assessment scheme for amydgalotomy, in L V Laitinen and K E Livingston (eds), 1973, Surgical Approaches in Psychiatry, Lancaster.

Howard Interviewed on "Talk of the Nation"

2005-11-17T16:11:00.000-05:00

Here's a link to the NPR page where the interview will be posted around 6 PM ET.

Also "A Hole in One" directed by Richard Ledes is now available on DVD at Amazon. It stars MeatLoaf Aday and Michelle Willaims of Dawson's Creek fame. It's a very interesting fictionalized account of a woman who wants a lobotomy because she thinks it will relieve her of her worries.

Howard Makes the New York Times

2005-11-16T22:56:00.000-05:00

Here's a link to a New York Times article about Howard.

Here's a link to a Daily News article about him.

Also here is a link to his NPR interview.

His show was so popular that it crashed NPR's web servers!

Howard Dully on CNN tonight

2005-11-16T12:50:00.000-05:00

A taped interview with Howard Dully is (probably) going to appear on CNN Thursday Night (tonight!) during the show that's on at 8pm eastern 5pm pacific.

He's also going be on another NPR show called Talk of the Nation on Thursday. He will be interviewed and take caller's questions.

Go Howard!

Howard's Radio Premier

2005-11-16T08:06:00.000-05:00

So on Monday night my mother and I went to Bellevue Hospital in NYC to attend the premier of Howard’s NPR program called “My Lobotomy”. It was a deeply emotional experience. Psychosurgery.org member Carol Noell was there along with Howard Dully himself. While Carol, Howard, and I have communicated for years, this was the first time we met in person. All of the Sound Portraits staff who produced the documentary were present too, including Dave Issay and Piya Kochar. Jack El Hai, author of "The Lobotomist", was there, as well as Richard Ledes who directed “A Hole in One”.

The most unexpected attendee was the doctor who had assisted Walter Freeman when he lobotomized Howard all those years ago. He was tall, thin and dressed all in black which sharply contrasted with his very white hair. I’m not sure he meant to do it, but he looked like a movie representation of a “bad guy” dressed in black like that. The truth is it took a great deal of character to face such a controversial event in his distant past. It was right that he was there.

Howard is immense at well over six feet tall. That night he was nervous – the venue was full of people who were all interested in what he had to say. It was the first time he was to speak publicly about what happened to him. His bravery is incredible.

While waiting for the program to begin my mom and I talked about my grandmother (my mom’s mom) and the terrible events that led to her commitment and lobotomization. It was good to talk to people who understood the history of the issue so deeply. Carol was amazing as she told about her memories of her mother Anna Ruth. I talked to so many people who had an interesting stake in the issue. One was a woman who worked as a psychiatric nurse and court advocate for mentally ill people. She actually talked about their civil rights which impressed me greatly. By contrast, the doctor who was Freeman’s assistant could only bring up old canards about dangerous schizophrenics who had to be forced to take medication lest they mow us all down in some fashion.

When the program began we sat with our eyes closed and listened. First we heard a voice that sounded like a 1940s radio announcer. It was the only known recording of Freeman’s voice. Then Howard's speaks in a voiceover about his story and the interviews he's about to conduct.

One person Howard interviewed was one of Freeman’s sons, a monstrous person who talked with glee about his father keeping icepicks used in surgery in the back of their cutlery drawer. There was not a bit of decency or shame in his voice. He was oblivious damage his father had done. It was revolting.

Howard spoke to Carol who talked about what her mother, who was lobotomized for headaches, was like after the surgery. It was very sad. Howard also talked to a very elderly surgeon who said he had never agreed with what Freeman was doing – it was brain surgery as an office procedure and he couldn’t stand it. The most emotional interview of all was Howard talking to his father, trying to ferret out why his father let his stepmother do this to him. Even though his father kept dodging responsibility, Howard totally forgave him and told him he loved him. He was a lesson in forgiveness that I won’t soon forget.

I can’t begin to do the program justice. There was so much more. As soon as it’s available I’ll post a link to it.

Afterward a panel made up of Howard, his wife, Jack el Hai, and the doctor who assisted Freeman was available for questions. There were lots of good ones and some interesting facts came out – for example the youngest person Freeman ever lobotomized was only four-years-old. The astonishing reason he gave was “early onset schizophrenia”. Wow.

Also it was established that there was no medical reason for Freeman to have photographed every victim/patient with the icepick in their eye socket.

Not everyone there was hostile to Freeman. Another fascinating attendee was a woman who was lobotomized and felt it had helped her. Her sister stood up and implied that Freeman wasn’t as bad as he was being made out to be. She also implied that it had been an experimental surgery and was justified. Then she did the worst thing possible – she implied that Howard had been made better by the operation, something that made all of us who know that there was nothing wrong with Howard cringe. Dave Issay took the question and stated that it’s clear from the record that there was nothing wrong with him and that the operation happened because Howard’s stepmother had manipulated the situation and Freeman was a willing accomplice. The reasons they listed for lobotomizing Howard were pathetic – “he stares into space”, “responds neither to punishment nor love”, “he won’t take a bath and likes to be dirty” and he dared to glare at his stepmother. He was 12, for goodness sake!

Howard described his life after the operation. His stepmother, disappointed that he hadn’t been made into a vegetable, kept him for five months before she had him shipped off to juvenile hall. Authorities could not keep him there because he had committed no crime, so they sent him to the only place available, Saint Agnew’s Psychiatric Hospital. After being there for 14 months, and being told daily he didn’t belong there because he was fine, the hospital closed and he went back to juvenile hall where he was forced to live until he was 20-years-old. He could have gone to a foster home but his father wouldn’t allow it. After his release he lived on disability, trying to pull his life back together.

Finally, after many years, he got tired of living on disability and decided to try to go to college. He earned an associates degree in IT. Then he started driving buses and was eventually promoted to become a bus driver trainer. It was a moving story.

After the program we all gathered to talk and too soon we were saying our goodbyes. As my mother and I headed back to Penn Station to catch the train back home she said, “All this time I thought we were the only ones.” That isolation is over for all of us, now.

God bless you Howard. You are the bravest man I know.

An abridged life

2005-11-13T08:26:00.000-05:00

This is a wonderful article about Howard Dully. I'm not sure why, but they left Psychosurgery.org out (we introduced Howard to Sound Portraits). Oh well - what can you do? I think it communicates Howard's story very well anyway.
---------------------
By Glennda Chui
Mercury News

In 1960, Howard Dully's parents took him to a San Jose hospital for what they said would be tests.

Two days later, he woke up with a headache and two black eyes, feeling like a fog had penetrated his mind.

At the age of 12, he had been given a transorbital lobotomy, in which ice-pick-like instruments were hammered through the top of the eye sockets and twirled to destroy brain tissue in an area associated with emotion.

Dully, now 56, never went back to school, never graduated. At the insistence of his stepmother, he was made a ward of the state, drifting from juvenile hall to halfway houses to Agnews State Hospital. He committed petty crimes, drank too much and lived on disability payments. He no longer felt welcome at his parents' Los Altos home.

Yet his intellect, sense of humor and emotions survived. A big, amiable man -- 6 feet 7 inches tall, with laugh lines in the corners of his eyes -- he eventually earned a two-year degree, married and became a tour bus driver in San Jose.
And five years ago he went looking for answers: Who had done this to him, and why?

The result of that quest is a radio documentary, ``My Lobotomy,'' premiering Wednesday on National Public Radio's ``All Things Considered'' program. Dully narrates the tale in his deep, gravelly voice and interviews lobotomy patients and their relatives.

``You'd probably never know what happened to me if I didn't tell you,'' Dully said in an interview. ``But I felt I was not who I was supposed to be anymore. You can't put your finger on it, but something's been taken away. Something's been altered or changed. It's very frustrating.''

In the documentary, he talks to his father for the first time about the procedure that changed his life. And he finds his medical file among the archived papers of Dr. Walter J. Freeman, the doctor who gave him the lobotomy -- years after it had been discarded as a treatment for mental illness.

``My file has everything -- a photo of me with the ice-picks in my eyes, medical bills,'' Dully says on the broadcast. ``But all I care about are the notes. I want to understand why this was done to me.''

He reads one of the entries. It's from his birthday, Nov. 30, 1960: ``Mrs. Dully came in for a talk about Howard. Things have gotten much worse and she can barely endure it. I explained to Mrs. Dully that the family should consider the possibility of changing Howard's personality by means of transorbital lobotomy. Mrs. Dully said it was up to her husband, that I would have to talk with him and make it stick.''

At the archives Dully also found a pair of leucotomes, the instruments that had been driven into his eye sockets.

The lobotomy was introduced in 1936 by a Portuguese physician, Dr. Egas Moniz. It won him the 1949 Nobel Prize in Medicine. Some 50,000 lobotomies were performed in the United States from the 1930s to the 1970s.
The original method, called prefrontal lobotomy, involved boring open the patient's skull to cut the connection between the prefrontal region -- an area concerned with emotion, learning, memory and social behavior -- and the rest of the brain. While it often relieved symptoms of severe mental illness, it also blunted emotion, leaving patients listless, apathetic and childlike.

Freeman invented an easier way, the transorbital or ``jiffy'' lobotomy, which left no obvious scars. It could be done in a few minutes as an outpatient procedure.

He traveled the country promoting the technique, performing up to 25 lobotomies per day -- some 3,400 of them in the course of his career, according to Jack El-Hai, whose biography of Freeman came out this year.

Some of Freeman's patients said they felt better after the procedure, and kept in touch with him until his death in 1972.

But others died or were severely damaged. They included Rosemary Kennedy, sister of John F. Kennedy, who was mildly impaired before the operation but had to be institutionalized afterward.

In 1954 Freeman moved from the East Coast to Los Altos, where he helped found El Camino Hospital in Mountain View. Dr. Robert Lichtenstein, 77, of Los Altos shared an office with Freeman in Sunnyvale for a few years. A neurosurgeon, he was present for half a dozen or more lobotomies, holding the instruments in position after they'd been thrust into a patient's eye sockets so Freeman could make sure they were properly placed.

In the early days, he said, when there were no effective treatments for the mentally ill, lobotomy seemed plausible.

``In the Santa Clara Valley, Agnews State Hospital was filled with thousands of psychiatric patients, and a lot of them were uncooperative and belligerent and would attack the caretakers,'' Lichtenstein said. ``So the idea of trying to render some of these people more cooperative was one of the major goals of management. Otherwise they would have to be put in a room with sometimes just a mattress on the floor, and sometimes they would destroy the mattress.''
However, by the time Freeman operated on Howard Dully, medications were available for mental illness and lobotomy had fallen out of favor.

For years, Dully told only his wife and a few close friends what had happened. He had no relationship with his stepmother, and never discussed the lobotomy with his father. But he always thought that someday he would talk to them and get some answers.

Then, in 2000, his stepmother died.

``I guess it was a jolt to me,'' he said. ``I realized I wasn't going to be able to talk to her. It was over now.''

His mother had died of cancer when he was 5, and he said he resented the fact that someone was trying to take her place.

``Oh, I hated her,'' Dully said of his stepmother. ``I didn't want any harm to come to her, physical harm. It was more a mental game. She'd tell me go to my room and I'd mutter under my breath. She always said I had a look that scared her.

``I think what happened, if you want the truth, is that when I started to get big like I am, she started to fear me.''

After she died Dully started to surf the Internet, looking for information. Eventually he was put in touch with Sound Portraits Productions, which makes radio documentaries.

``Nobody who had had a transorbital lobotomy had ever talked about it -- not that I knew of,'' said David Isay, co-producer of the radio piece. ``I was curious to know the perspective of patients.''

At first Dully did not want his name used, Isay said; later, he changed his mind.
``Having the courage to really face down his demons and ask those very, very difficult questions of the people in his life was a wonder to behold,'' Isay said.
Dully said he's thought a lot, over the years, about what life would have been like -- what he would have been like -- without the lobotomy. Yet he said he does not feel bitter.

``What good is it going to do to hate somebody?'' he said. ``I'm more about, `Let's get it out in the open and forget about it.' I can sit here and point fingers at 950 people, and it means nothing. I think we all have to live with the part we played in it ourselves.''

Ronald Senator

2005-11-13T06:12:00.000-05:00

The Pulitzer prize nominated British composer Ronald Senator underwent a leucotomy in St Andrew's hospital, Northampton, England, in 1950.

He described his experience in his 1996 book Requiem Letters:

"I might have been, throughout all these forty long years, a Sleeping Ugly imprisoned within the vegetative sleep of one of the failed leucotomies, the great majority. I would never be awakened, so I would never know I had been deprived of my forty years of life.Forty irreplaceable personal years, of loving and tasting and knowing that I loved and tasted, interwoven with forty irreplaceable years of public human history! In Oliver Sacks' Awakenings , Leonard comes to himself after forty years of unawareness caused by encaphalitis lethargica. He is shocked and sad to rcognize the lined middle-aged face which has replaced the boy's face he once knew. Poignantly he realizes he dos not know what year it is. He can never know what he might have been and done. But he has a simple gratitude for the gift of his returned awareness, for life itself...I am one of the survivors of the St. Andrew's leucotomies, School of 1950, as the other poor specters, ambling vacuously around the locked and barred hospital wards or their lawns, are not. I am grateful too. But I have also been very angry.

There is a thin line which separates everyday reality from the world of the imagination--that other reality, super- or sub-reality. It is a hairline, a line built of ghostly particles, of nanoseconds. For the heightened sensitivity, for the original and exploring, uually an outsider in society, for the poet and artist who lives by meta-phor, by meta-phrase, by marrying two realities, that line is easily crossed. For him those realities may be not merely fused, but sometimes confused. And that is madness.

...... But I am also a pygmy among many other giants who entered in and out of madness at some time: from Robert Schumann to Frederick Nietzsche, Dean Swift to Percy Shelley, Ben Johnson to Lord Byron, Cowper, Goldsmith, Blake, Melville, Coleridge, Rousseau, Pascal, Ta sso, Nijinsky, Virginia Woolf, Robert Lowell... Perhaps their brains, like my own to some degree, inherited a more complex wiring than is ordinary, and were therefore exraordinary in synthesizing unexpected connections, in experiencing a gamut of emotional extremes. Perhaps their brains, like mine, were periodically flooded with the volcanic energy of manic storms, leaving behind a flotsam of original ideas...If you imagine them all transported to St. Andrew's Hospital in 1950, the majority, no doubt, would have had their brains bored and sliced against their will, and would still perhaps be shuffling among the other human ghosts across the green lawns.

......I needed ears to listen, to understand the threat of that other world which had opened up inside myself, so that I would know it was understood...But there was hardly any attempt at communications. The nurses remained perfunctory:...their job was simply to keep their cool and leave judgements and treatments to the doctors. As for these, the demigods of the system, they made only brief and routine rounds of the wards (in some state hospitals, I hear, these could be six months apart) with impersonal formulae of few words: 'Improving, I see?' and 'Did you enjoy your breakfast?' without caring much about my answer, or anybody else's. After all, their faith now lay in so-called objective diagnoses which jam-packed all mental disturbances, in all their human compexity and variety, into some neatly labelled compartments: and in the new physical techniques, which were themselves impersonal, often speedy, and comparatively cheap. Almost a conveyor-belt process back into some social norm, without the need to delve into a person's latent conflicts--or treasures. St. Andrew's has a record from that time of one patient receiving almost one hundred insulin treatments--nor was that so unusual. From being merely prisons or places of confinement, mental hospitals had now become centers of technology where humanitarian intercourse was incidental. Humanity had to take its chance."

And Rest in Peace Mr Denson

2005-11-12T15:07:00.000-05:00

Last July Christine posted a story about Ronald Shaw, an elderly man who had disappeared from his home in Ellesmere Port, England, last year. When his body was eventually found he was identified by the holes that had been drilled in his skull when he had a leucotomy over fifty years ago.

An eerily similar story appeared in another British local paper a few years ago, this time about Mr Denson from Sussex.

"Relatives of a man whose remains were found in woodland 14 years after he vanished are hoping to have them buried next to his parents. Bones, false teeth and clothing belonging to schizophrenic Walter Denson, 71, were found by police in Hellingly Woods, near Hailsham. It followed the discovery of Mr Denson's skull by mother-of-two Karen Perez, of Warwick Close, Hailsham, during an outing with her partner and one of her daughters. Mr Denson, of De Roos Road, Eastbourne, vanished in August 1988. Mr Denson's aunt, his last surviving relative who lives in Herfordshire, hopes to have his remains buried beside his parents in Hollington, St Leonards. A police search team found the bones, clothing a full set of false teeth belonging to Mr Denson on Friday morning. His death is not being treated as suspicious. Forensic tests showed the skull had two holes drilled into it, consistent with a leucotomy operation Mr Denson had in 1952. Detective Inspector David Oakley, of East Downs CID, said: "We are now confident that the remains are that of Mr Denson but it will be for the coroner to make the final decision at a later inquest." Karen Perez is to be congratulated for finding the vital piece of evidence that local people, police and the Army were unable to find in 1988. Though it is speculation until the coroner's verdict, I am confident that we will finally be able to put Mr Denson's case to rest".

From This is Brighton and Hove, April 23 2002.

People Magazine for November 14th, 2005

2005-11-04T13:41:00.000-05:00

The November 14th issue of People Magazine (Ellen Degeneres is on the cover) became available today. On page 85 is the story of Psychosurgery.org member Howard Dully who was lobotomized at age 12 by Walter Freeman himself. Howard is incredibly brave and the story is really well done. So far the story is not on their website, but I will link to it if it becomes available.

Thank goodness that people like Howard are brave enough to come forward and tell their story. We will not allow history to be re-written by people who were not there and don't understand what happened.

Joanna David's mother

2005-11-01T16:55:00.000-05:00

Joanna David, the British TV actress and mother of Emilia Fox, spoke about her mother's leucotomy in an interview with the Independent newspaper a few years ago.

Joanna's early years were spent in relative comfort in Hale, near Manchester. But when she was eleven her father went bankrupt, moved the family to London and then left them. Joanna's mother brought up the three children on her own in the East End of London, finally having a breakdown when they were grown up. She was treated with a leucotomy:

Did the leucotomy work? "Yes, because it took away the obsessional thing, but didn't change her sweetness of nature. They had said that she could end up vegetable-like, but she didn't. It made her docile, and she just sat in a chair smoking fags all day, whereas before she had been very highly charged. She'd been under such strain, you see, getting us all educated. As soon as we were all on our feet, when I was about 19, she suddenly keeled over and had this ghastly breakdown."

The operation was carried out in the late 1960s by which time only a few hundred operations a year were being done in the UK.

The interview with Joanna David can be read here

Walter Freeman's Handiwork

2005-11-01T12:51:00.000-05:00

Though I never dreamed it possible, Walter Freeman actually has apologists. It's pretty stunning. This is something they should see. It is a photograph of our friend Howard Dully being lobotomized. He is 12-years-old in this image taken in 1961. The hand belongs to Walter Freeman's assistant. Freeman took the photograph. In fact, though there was no medical reason to do so, Freeman took photos of every single person he ever lobotomized with the icepick in their eye socket. I believe the reason he did it was because, like a serial killer, he wanted to keep a momento of his conquest. I suspect that Freeman looked at them with great satisfaction, enjoyment, and pleasure. Why else would he have kept taking them for so many years?

This photograph is the property of Howard Dully, rendered here with permission. It is NOT to be reproduced elsewhere without written permission from Howard Dully who can be contacted via christine@psychosurgery.org.

NPR's "All Things Considered"

2005-10-31T14:33:00.000-05:00

As many of you know, Soundportraits has been working on a documentary for the NPR program "All Things Considered". It is called "My Lobotomy" and features two members of Psychosurgery.org. The program is going to air on November 16th. I'll give you more details as we get closer to the date. It promises to be an deeply emotional event.

Fifty years of psychopharmacology

2005-10-29T15:14:00.000-04:00

Heather Ashton, Emeritus Professor of Clinical Psychopharmacology at Newcastle University, England, and long-time researcher into benzodiazepine dependency, recently gave a lecture looking back on 50 years of psychopharmacology. In the lecture Ashton takes a critical look at the pharmaceutical industry and wonders if, half a century on, we are any nearer understanding the causes of mental illness or finding a cure.

"It happens that I am old enough to have witnessed the start of the Era of Psychopharmacology - of drugs that affect the mind. Around the 1950s a whole host of such psychotropic drugs - all discovered by chance - entered the medical scene. These included the major tranquillisers such as chlorpromazine (Largactil), since developed into a range of antipsychotic drugs; it included the first antidepressants, the tricyclics and monoamine oxidase inhibitors, now joined by the SSRIs such as Prozac; and it included the so-called minor tranquillisers, the benzodiazepines Valium and Librium, now including a number of Z-drug hypnotics such as zopiclone and others.

These early discoveries were very exciting at the time, as they seemed to promise a cure for all psychiatric diseases. Schizophrenics taking antipsychotics could be, and were, let out of hospital to live in the community. Patients with depression could, allegedly, be freed from suicidal thoughts and from the perceived threat of electroconvulsive therapy (ECT). And the minor or major anxieties of life could be universally replaced with tranquillity and peaceful sleep induced by benzodiazepines. One eminent neurologist, Sir Henry Miller, even wrote that from now on all mental illness could be cured by a handful of pills and there would be no need for psychiatrists. He also memorably said that medical practice would now be so easy that it could safely be left entirely to women doctors!

At the same time it was believed, by a sort of backwards logic, that the cause of mental illness would be revealed by these drugs. Antipsychotics were found to block brain receptors for the neurotransmitter dopamine; therefore schizophrenia must be due to an excess of dopamine. Antidepressants were shown to increase the activity of the neurotransmitter serotonin; therefore depression must be due to a lack of serotonin. Benzodiazepines increased the activity of the neurotransmitter GABA, so anxiety must be due to lack of GABA.

Of course these naïve and simple hopes turned out to be in vain. 50 years later we still do not know the cause of schizophrenia or depression or even how the drugs work. The prognosis of these illnesses has changed little. And anxiety and insomnia are as common as ever. It has become clear that the drugs do not cure anything; they do, often usefully it must be said, control some symptoms but have little effect on the underlying processes. And, as everyone here knows, the drugs carry their own disadvantages. But these same drugs have made millions for drug companies."

Read the lecture here

The 13th Earl of Galloway

2005-10-28T17:29:00.000-04:00

AN UNLIKELY COUNTESS: Lily Budge and the 13th Earl of Galloway BY Louise Carpenter (HarperCollins, £18.99)
REVIEWED BY GEORGE ROSIE

"As everyone said at the time – 1975 – Lily and Randolph made an odd couple. He was 47, she was 59. She was the daughter of a Borders chauffeur, he was son and heir to the 12th Earl of Galloway, the southern branch of the great Stewart dynasty. She’d been married twice before, both times to working-class men and had four children. He was mentally fragile, to say the least, having in his time been extensively drugged, electro-shocked and lobotomised. In their different ways they were both damaged goods. The fact that their union met with bitter hostility from Randolph’s aristocratic family didn’t help. Randolph Stewart and Lily Miller didn’t have much going for them.
That their marriage lasted (after a fashion) from 1975 until her death in 1999 says a lot for the forbearance, guile, compassion, ambition and tenacity of Lily Miller. No matter what the Stewart family or Scotland’s toffs threw at her, the small-town girl from Duns held on to her husband – and to her title of Countess of Galloway. Lily Miller’s wayward, touching life is told by Louise Carpenter in this pain stakingly researched and very readable first book. Nobody could accuse Lily of being “important” but her tale sheds light into some very musty corners of upper-crust Scotland." Read more

The Earl was diagnosed as schizophrenic when young and underwent a psychosurgical operation at St Mary's Hospital in London in 1952. He was, in his own words, "never the same again" and spent the next fifteen years in a mental hospital in Scotland. Now aged 77 he lives in sheltered housing in Scotland, his father having disinherited him of the family estate after his marriage.

Another article about the Earl and Countess appeared in the Scotsman on Sunday last year:

"BORN on October 14, 1928, Randolph was a physically perfect baby. His mother, Philippa Wendell, was an American beauty who had brought wealth and glamour to the cash-strapped Stewart dynasty. Randolph’s childhood was privileged, but emotionally lacking - he once told Lily that the only time he got a cuddle was from a kindly laundry maid. A slight, sickly child, he grew increasingly odd and eccentric, throwing tantrums, fussing about and repeatedly breaking wind. His parents consoled themselves with the thought that he would grow out of it. He did not.

These were anguished times for Randolph and his family, since he periodically lost control and became violent (episodes that would be repeated years later, when he was charged in Edinburgh Sheriff Court in 1979 for attacking a woman - a stranger - in an Edinburgh street, while the following year he even tried to strangle Lily).

After being sent away to prep school and then Harrow, where he was so miserable he refused to eat, Randolph was diagnosed as schizophrenic and subjected to insulin coma therapy, a procedure now regarded as a highly dangerous quack remedy. In Randolph’s case it was a spectacular failure, although it was nothing to the butchery that followed.

In 1952, when he was 23, Randolph’s parents told him to pack a trunk for a stay down south. He assumed he was going on holiday to the seaside. In fact, he was taken to St Mary’s Hospital in London, where he was lobotomised - a hole was drilled in the top of his skull and the frontal lobe severed - in an attempt to control his behaviour. He spent the next 15 years in the mental wing of the Crichton Royal Infirmary, in Dumfries. The lobotomy changed him forever; "I was never the same again," Randolph told Carpenter."

A new Moniz scholar

2005-10-25T09:30:00.000-04:00

Dr Zbigniew Kotowicz, lecturer in the history of psychiatry at Goldsmiths College, University of London, has been funded by the Wellcome trust to write a book about Egas Moniz and the origins of psychosurgery. Dr Kotowicz has a background in psychotherapy and has written books about R D Laing and a Portuguese poet.

An article by Kotowicz appeared in a recent issue of the journal Gesnerus, the Swiss journal of the history of medicine and sciences. Entitled "Gottlieb Burckhardt and Egas Moniz - two beginnings of psychosurgery", the article looks at why psychosurgery took off following the experiments of Egas Moniz in 1936 but not the earlier experiments of Swiss psychiatrist Gottlieb Burckhardt in 1888.*

According to the Summary

"This article compares the repercussions of the two attempts at psychosurgery, the first in 1888 by the Swiss psychiatrist Gottlieb Burckhardt and the second by the Portuguese neurologist Egas Moniz. Both widely publicised their procedure, yet, Burckhardt was condemned and no one ventured to repeat his operation, whereas Moniz's leucotomy was accepted and it soon entered mainstream psychiatry. The change of Zeitgeist does not explain the difference as the thinking in the time of Bruckhardt, dominated by Griesinger's 'mental illness is an illness of the brain' doctrine, would appear to be more favourable to psychosurgery than it was in the time of Moniz. Moniz reported far more favourable results, which no doubt impressed other practitioners. But most of all the adoption of psychosrugery was due to the interest in mental illness of nonpsychiatrists - neurologists and neurosurgeons -, and the arrival of the new treatment marks a change in the professional configuration of those who treat psychiatric afflictions. This article deals with the early adoption of psychosurgery. Further developments, such as the relation of psychosurgery to other treatments and the fall into disrepute of the technique, are outside the scope of this presentation."

Kotowicz points out that, in general, "the medical community tends to place the beginning of the practice of psychosurgery with Moniz, while historians of medicine are inclined to begin with Burckhardt, although there are exceptions. [here Jack Pressman - a medical historian who didn't mention Burckhardt in his book about psychosurgery - is cited as an exception.]It would seem that to the practitioners the history proper of a treatment begins not with the actual first attempt, but at the moment it is put on the medical map, when it turns into a shared practice."

Kotowicz goes on to make the interesting point that Moniz was not particularly interested in the fate of mental patients [and he probably has this in common with many of the pioneers and enthusiasts of psychosurgery and shock treatments]: "Moniz arrived at the idea of psychosurgery after two years of solitary meditation. What exactly this meditation involved is not entirely clear, but nothing suggests that it was the patients that Moniz was thinking about, as he did not work in an sylum and his knowledge of the psychiatric clinic was minimal. In fact, there is little evidence that mental illness really interested Moniz; at least this is what his long list of publications suggests....until the monograph on psychosurgery there is practically no word on psychiatry proper, we will not find in his writings a single clinical study, nor any other sign of genuine interest in the matter."

There follows a discussion of how, in the early days, neurosurgeons and neurologists tended to show more enthusiasm for psychosurgery than psychiatrists did. The author points out that Moniz received his Nobel Prize on the recommendation of a neurosurgeon, Herbert Olivecrona. He could have added that an earlier nomination did not lead to a prize when a psychiatrist, Erik Essen-Moller, wrote a more negative special report to the Nobel Committee.

In one of the concluding paragraphs Kotowicz writes: "And indeed, psychosurgery gave neuroscientfic research a tremendous push. On the one hand it was introduced as a treatment for mental illness, on the other hand it was a central plank of an extensive research programme. It must be said that psychiatrists did not profit from this research as much as neuroscientists did, and the patient population even less so."

Hopefully, in his forthcoming book, Dr Kotowicz will make good use of his background in psychology and philosophy to examine the fate of the patients in greater detail.

*Z Kotowicz, Gottlieb Burckhardt and Egas Moniz - two beginnings of Psychosurgery,
Gesnerus 62 (2005) 77-101

Helen Mayberg goes to London

2005-10-19T08:17:00.000-04:00

Professor Helen Mayberg of Emory University, Atlanta, is famed for her experiments with DBS (deep brain stimulation) on depressed people. Recently, Professor Mayberg visited London and spoke at the Science Media Centre of the Royal Insitution ("where science meets the headlines"):

"This is a very new way to think about the nature of depression.

We are not just exciting the brain, we are using electricity to retune and remodulate.

We can interrupt or switch off an abnormally functioning circuit."

She said that although DBS was still in its infancy as a treatment for depression, it was very promising.

"The effects were immediate. One patient told me she felt suddenly relieved.

These are the sickest of the sick. They are not just having a bad day."

More...

"The sickest of the sick" - I am always suspicious of psychiatrists who talk about people in such terms, or use slightly more polite and technical terms such as "intractable" "refractory" or "treatment resistant". Is this going to be another ECT: "safe and effective", but, just in case they are wrong, there is nothing to worry about because it is only used as a "last resort"? Of course, there is no restriction on the use of ECT in the sense of only using it after other treatments have been tried. In fact, the British guidelines on its use recommend that on occasion ECT may be used as a first-line treatment, more usually as a second-line treatment. So too do all the other guidelines I have seen (American, Canadian, French, Dutch for example). Psychiatrists use the stigmatising term "last resort" to marginalise ECT patients and shift responsibility for treatment from themselves to the patients.

And just how do you decide who is the "sickest of the sick" in the absence of any biological tests for mental illness?

Professor Mayberg claims that one per cent of the population might benefit from being treated with DBS for depression. In Britain that would be over half a million people with electrodes in their brain. Newspaper headlines are talking about "the sunshine implant". But would the world be a better place?

A more cautious look at DBS is taken by American neurologist Joseph H Friedman in an article he wrote last year about the comeback of psychosurgery in the form of DBS:

"...the lobotomy procedure represents a terrible, dark stain on the history of modern medicine which those of us involved in brain medicine must never forget. This "cure" for schizophrenia demonstrates what may happen when a converted few lose objectivity and a host of willing believers subvert their disbelief in the hopes that their own eyes deceived them."

Read the article here...

He lost his mind

2005-10-17T10:09:00.000-04:00

Salon has an article about memory and ECT in today's issue. You'll need to watch an ad if you want to read the piece.
------------------
... This winning streak came to an end in 1998, when Cott's mother died. Her death set off a bout of depression from which Cott was unable to recover. "I had been truly seriously depressed a number of times in my life, but never to the extent of being 'clinically' depressed," Cott says. "I just didn't care anymore."

That's when the electroconvulsive therapy began. Cott was given 36 treatments over the course of the next two years. When he emerged from them, he could remember nothing from the years 1985 to 2000. Fifteen years of his life -- friends he had known, places he had lived, books he had written -- had been completely wiped out.
...

In your book you quote Steven Rose describing ECT as "analogous to trying to mend a faulty radio by kicking it.

Yes, and I was the radio.

How exactly does ECT work?

They send an electrical current of about 200 volts for a fraction of a second through the frontal lobes of the brain, by means of electrodes connected to a machine that resembles a stereo receiver. But I don't remember that. I only remember receiving the anesthesia. I remember the feeling of falling off into unconsciousness, which was a beautiful feeling. But that's all.

You must have agreed to go along with it at some point.

Well, I was in a pretty distraught state, emotionally, and I think I had been talked into it by the doctors. They said I was in a really bad state and that I really needed to do this, and that there would be no serious side effects. I'd lose some memory but the memory would come back. This is what they tell patients. And when you're in a really disruptive state, like I was, it's very hard to be objective. I certainly hadn't thought about ECT treatments before. I didn't know they still gave them.

The last of the treatments happened seven years ago. Have you forgiven the doctors and moved on, or do you still feel angry?

I was angry, to begin with, that the doctors didn't really tell the truth about the possible damage that can occur, both cognitively and in memory loss. And I still feel angry about that. I believe that ECT does damage the brain. There's dispute about this, but there's increasing evidence to show that this is certainly a possibility. And there are many other people, not just myself, who suffer this kind of damage. I'm not prone to anger, but I do feel angry for the sake of other people. I really feel that ECT shouldn't be used at all except as a last resort, in the very final moments of emotional desperation, or mania, or catatonia.
...

Jose Delgado resurfaces

2005-10-16T05:06:00.000-04:00

Jose Delgado, Direstor of Neuropsychiatry at Yale University Medical School in the 1960s and 70s, and later Professor of Neurobiology in Madrid, Spain, has resurfaced in this month's Scientific American where an article by John Horgan takes a largely uncritical look at his work implanting electrodes into animals and people. Read it here

A more critical interview with Jose Delgado can be found in an article by Swedish writers and artists Magnus Bartas and Fredrik Ekman in a 2001 issue of Cabinet Magazine.

"He looks at the clock and says that we only have five minutes left. But we do not want to abandon our questions about the patients. What happened to them? How long were the implants in their brains? Delgado now becomes somewhat vague. He says that it was other researchers that left the implants in for a long time, not him or Dr. Heath, and he does not recall which patients it was. The electrodes were taken out of his own patients after a couple of days and did not cause any injuries. "We killed maybe a few hundred neurons when we inserted the electrodes. But the brain has millions of neurons." More

Operation for stealing £66 12s*

2005-10-15T17:14:00.000-04:00

From the Guardian of 2 April 1968

Court agrees to Brain Operation for Gambler

Warrington [UK] magistrates yesterday made an order under the Mental Health Act of 1959 so that a 21 year old man can undergo a brain operation in an attempt to cure him of compulsive gambling.

Eric Wills, an ice-cream salesman, of Wellfield Street, Warrington, had to consent to the operation, and was remanded in custody until he is admitted to hospital. He had been remanded for a medical report after admitting obtaining £40 by false pretences and stealing £26 12s from a gas meter.

Dr Harry Fleming, senoir consultant psychiatrist at Winwick Hospital, told the court: "this man has been examined by a neurosurgeon. If you agree, he will enter Winwick Hospital next Sunday and have an operation in a week's time".

* Less than 1500 dollars in today's money

Tell me that it's chemical again

2005-10-10T08:41:00.000-04:00

Wounds no one was able to see

BY INDRANI SEN
STAFF WRITER

Photographed carrying a terrified, half-naked Iraqi child to safety in March of 2003, Army Spc. Joseph Dwyer, of Mount Sinai, was on front pages across the country, a potent symbol of American heroism.

Friday morning, Dwyer, 29, was arrested in El Paso, Texas, after a three-hour standoff in which he fired a 9-millimeter handgun in his apartment.
...
Family members say they saw Dwyer changed from the cheerful kid who loved to fish and played golf for Mount Sinai High School. The first sign was the 50 pounds he put on in six weeks after he returned from Iraq, more than making up for the 30 pounds he lost during his deployment. Then there was the car accident in El Paso, caused by Dwyer swerving to avoid what he thought was a roadside bomb detonating device. Friends told the El Paso Times that Dwyer had been having nightmares and had been abusing alcohol and sniffing inhalants.

Friday's incident was the most alarming, said his father, Patrick Dwyer of North Carolina.

"When he was in the apartment, he was calling for air strikes," Patrick Dwyer said. "He put a mirror out the window to see what was going on. He was being very defensive. Totally not connected to reality. And that's not like him."

more

Lawyers with a conscience?

2005-10-07T05:50:00.000-04:00

As far as I know, in spite of all the people who have been left dead or damaged by psychosurgery in Britain, only one person has ever received compensation. There may of course be others that I have not heard about. A short piece about the case appeared in the Times, 14 May 1981.

"NHS Lawyers to be disciplined"

Two senior health authority lawyers are to be disciplined because of a case in which a female patient won a £95,000 compensation claim against the South West Thames Regional Health Authority in January when it failed to defend an action in the High Court.

Mrs Eileen Davey, aged 56, now living in Lincolnshire, was said to have dwindled to a wreck after two leucotomies - operations to remove frontal brain lobe tissue.

The judge said the authority solicitors' handling of the claim was a shambles. A range of disciplinary measures, including dismissal, faces the two lawyers who have not been named.

The authority said last night that the case had been mishandled and as a result a significant loss of public funds had occurred. Apart from the damages, the authority had to pay a five-figure sum in costs."

Nervous Much?

2005-09-29T11:26:00.000-04:00

Medicine prize launches Nobel season next week

STOCKHOLM (Reuters) - The Nobel prize for medicine, called by past winners both an honor and a distraction from research, heralds the start next week of the century-old season of awards founded in the will of the inventor of dynamite.

The winner of the 10 million Swedish crowns ($1.3 million) is to be announced on Monday, October 3 at 0930 GMT.

...

AVOIDING CONTROVERSY

The prize-giving Nobel Assembly at Stockholm's Karolinska Institute of medical research has tended to avoid controversy in its awards -- a rare exception being the case of Portuguese scientist Egas Moniz, the inventor of the lobotomy.

U.S. relatives of patients who had treatment, which sought to calm mentally ill patients by severing nerve fibres in the brain, have demanded the prize be withdrawn. They say it led to injury or death for their kin.
...

And in Brazil

2005-09-28T05:53:00.000-04:00

When Egas Moniz was awarded the Nobel Prize in 1949 two of his nominators were from Brazil. But within a few years Brazil had stopped performing psychosurgical operations because they were considered to contravene the Nuremberg Code of medical ethics, according to this article from a Brazilian Journal:

MASIERO, A. L.: ‘Lobotomy and leucotomy in Brazilian mental hospitals’. História, Ciências, Saúde — Manguinhos, vol. 10(2): 549-72, May-Aug. 2003.

"Lobotomy and leucotomy were used in Brazilian mental institutions from 1936 to 1956. Also called psycho-surgeries, they were operations that separated the right and left frontal lobes and pre-frontal lobes from the rest of the brains, aiming at modifying behavior or curing mental diseases. The technique, created by the Portuguese neurologist Egas Moniz in 1935 and developed by Walter Freeman from the United States, arrived in Brazil through the hands of Aloysio Mattos Pimenta, neurologist from Hospital Psiquiátrico Juquery in São Paulo. Soon, many doctors followed suit. These procedures were used on more than a thousand in-patients aiming at not only healing results, but also the technical improvement of the surgical technique, since preliminary experiments with animals were quite rare at the time. In Brazil, the technique was used until 1956, when it was considered as going against the 1947 Nuremberg Code, whose objective was to detain and regulate the medical experiments with human beings made during the Second World War."

Meanwhile in Umea

2005-09-22T18:58:00.000-04:00

On the 10th of December 1949 Nobel prizewinners and dignatories sat down for the Nobel Banquet at the Swedish Academy in Stockholm (Egas Moniz was not present as ill-health had prevented him travelling from Portugal). They listened to a speech by Carl Skottsberg, President of the Royal Academy of Sciences, in which he expressed gratitude and admiration for Egas Moniz and said: "Today his method is practised everywhere with very good results".

Two hundred and fifty miles north in the town of Umea, 35 patients at the local mental hospital, Umedalens Hospital, had already died as a result of lobotomy. Doctors there started operating in 1947 and by the end of 1949 had carried out 279 operations, with a 12.5 per cent mortality rate.* Umedalens Hospital would go on to do more lobotomies than any other hospital in Sweden. Children as young as four were operated on. One seven year old died following a lobotomy.

* These figures come from an article by Kenneth Ogren and others, which was published in the Swedish medical journal Lakartidningen in 2000.

Strange but True

2005-09-22T15:01:00.000-04:00

Woman awarded $100,000 for CIA-funded electroshock
Thu, 10 Jun 2004

MONTREAL - A Montreal woman who underwent intense electroshock treatment in a program funded by the CIA 50 years ago has been awarded $100,000.

Gail Kastner was given massive electroshock therapy to treat depression in 1953 at the Allan Memorial Institute in Montreal. She was told on Wednesday of the compensation award.

She was left out of a federal compensation package in 1994 because her treatment was deemed to have been less intense than that of other victims of the experiments. Her treatment was also found to have had fewer long-term effects.

A Federal Court judge reversed that ruling, and awarded her the same amount Ottawa gave to 77 others as compensation for their treatment.

There were 253 claims rejected.

Dr. Ewan Cameron, who was director of the Allan Memorial Institute, conducted experiments using electroshock and drug-induced sleep. The research was funded from 1950 to 1965 by the CIA and by the Canadian government.

link

So There ... Until We Comment Again

2005-09-19T14:09:00.000-04:00

This little blurb appeared in Clinical Neurology News:

Neurologist's Nobel Intact

The Nobel Foundation is rejecting efforts by a group of physicians and family members of lobotomy patients to revoke the 1949 Nobel Prize in Medicine awarded to late neurologist Egas Moniz, the developer of the procedure. “The Nobel Committee has never taken responsibility for the fact that they awarded a prize for an operation that was a total failure and without any scientific merit,” said a statement on the Web site http://www.psychosurgery.org/, which is involved in the campaign to revoke the prize. “In the United States alone, lobotomy, leucotomy, and related operations resulted in at least 50,000 surgical casualties. Through the [Nobel] Committee's actions, they endorsed this brutal operation and provided justification for thousands of more operations.” The psychosurgery organization was founded by Christine Johnson, a medical librarian whose grandmother was lobotomized in 1954 and was in and out of institutions for the rest of her life. But Michael Sohlman, executive director of the Nobel Foundation, is having none of it. “There's no possibility to revoke it. It's a nonstarter,” he said in an interview. Asked to elaborate further in an e-mail, he wrote, “We divide mankind into two groups—one which has been awarded the Nobel Prize, and the other which has not. We only inform about the former group.” He added that “no further statements on this subject have been or, for that matter, will be made by the Nobel Foundation.”

Reuters Portugal Part II

2005-09-15T09:09:00.000-04:00

Here is a longer version of the Reuters Portugal article that ran in today's San Diego Union-Tribune:

Patients' kin want lobotomy Nobel withdrawn

AVANCA, Portugal – An unsettling rumor is doing the rounds in the dusty Portuguese town of Avanca.

Egas Moniz, the inventor of the lobotomy and Avanca's most famous son, could be stripped of his Nobel prize because of a battle being waged overseas, residents hear.

"A bunch of American scientists, I'm not sure if they're American or British, they're going to take away his Nobel prize," grumbled 71-year-old Armando Hilario, speaking with two other friends, across the street from Moniz's cemetery plot.

"You know. That prize he won for the brain illness."

Fifty years after Moniz's death in 1955, relatives of lobotomy patients in the United States have launched a campaign which they say is meant to shame the Nobel Foundation into breaking precedent by withdrawing the scientist's 1949 award.

They argue that the Nobel prize legitimized the procedure, which sought to calm mentally ill patients by severing nerve fibers between the frontal lobes and the main part of the brain. Moniz called the process a prefrontal leucotomy.

It was later modified and popularized in the United States with the so-called "ice-pick" procedure: using a hammer to tap a metal pick up through the eye socket and into the brain.

Bioethics Blog

2005-09-14T08:29:00.000-04:00

I found this very interesting blog for the American Journal of Bioethics.

An entry that caught my eye was this one that mentions a survey that found most American medical students think it's okay to take gifts from drug companies and many of them do so. We're talking about people who have not even become physicians yet who are already being influenced by the giant conglomerate. Unbelievable!

Another entry talked about the use of euthanasia in New Orleans during the flood (though some question the veracity of the story). Euthanasia is illegal in Louisiana and is the focus of heated debate in the United States. Considering that two nursing home operators were charged with murder for not evacuating their residents in time, I don't see how those euthanasia physicians can go without being charged with murder as well. The nursing home people didn't even intentionally kill their patients while these physicians allegedly did. This could turn into something very big if it turns out to be true.

Reuters Portugal Story

2005-09-08T23:14:00.000-04:00

Here's a story out of Reuters in Portugal:
--------------------------
Bid to strip lobotomy pioneer of Nobel
REUTERS in Avanca
An unsettling rumour is doing the rounds in the dusty town of Avanca.

Egas Moniz, inventor of the lobotomy and Avanca's most famous son, could be stripped of his Nobel prize because of a battle being waged overseas, residents hear.

"A bunch of American scientists, they're going to take away his Nobel prize," grumbled 71-year-old Armando Hilario, speaking with two friends, across the street from Moniz's cemetery plot.

Fifty years after Moniz's death in 1955, relatives of lobotomy patients in the United States have launched a campaign which they say is meant to shame the Nobel Foundation into breaking precedent by withdrawing the scientist's 1949 award.

They argue that the Nobel prize legitimised the procedure, which sought to calm mentally ill patients by severing nerve fibres between the frontal lobes and the main part of the brain. Moniz called the process a prefrontal leucotomy.

He performed his first prefrontal leucotomies on people in the mid-1930s in Lisbon. At the time, this was considered a major medical breakthrough.

It was modified and popularised in the US with the so-called "ice-pick" procedure: using a hammer to tap a metal pick up through the eye socket and into the brain.

more

Kerouac and my Grandmother

2005-09-08T11:08:00.000-04:00

What did Jack Kerouac and my grandmother have in common? They were both diagnosed with dementia praecox (an early name for schizophrenia).

According to The Smoking Gun:

'Kerouac ... complained that the harsh appraisal, which was later softened, came after he complained of headaches and asked for aspirin. Instead, "they diagnosed me Dementia Praecox," he said.'

My grandmother also wanted to be a writer. What might she have given the world if her brain had been spared by the lobotomists?

Want a good laugh? Read Kerouac's medical history.