Despite all the advances we have made in medicine over the years, there remains considerable ambiguity with regards to the pathomechanics involving diseases of the brain. To make matters worse, the limited regenerative ability of the central nervous system, particularly in adults, hinders recovery and often restricts treatment to simply managing symptoms.
Considering this, it is hard to imagine how patients with psychiatric problems were managed many years ago. Indeed, before the advent of anti-psychotics and mood stabilizers, patients were treated with relatively dangerous treatment methods including insulin comas and electric shock therapy.
In an attempt to find an alternative and longer lasting treatment, a Portuguese physician by the name of Egas Moniz and his colleague Almeida Lima developed a procedure called leukotomy (aka lobotomy). The procedure permanently damaged part of the frontal brain (closer to the forehead) in an attempt to treat a wide range of behavioral problems including depression. The underlying logic was that neurons were improperly wired and fixed in such patients and therefore removing these connections will alleviate pathology. Another physician by the name of Walter Freeman along with his colleague James Watts brought this psycho-surgery over to the U.S. from Europe and simplified the procedure by jamming an ice pick through the eye to reach the brain.
When we reflect upon this therapeutic method it is evident that some merit for such a radical approach existed, as the other treatment options at the time were dangerous and benefits after these lobotomies had been documented. However, many severe side effects occurred as well. Perhaps one of the most famous cases has been that of Rosemary Kennedy who received a lobotomy (performed by Freeman and Watts) to control her "mood swings" and subsequently became incapacitated.
One can only expect that such invasive measures may stir controversy, especially when they can lead to debilitating side effects. It appears however that much of the controversy of lobotomies did not arise from what appeared to be a barbaric procedure to calm the moody, psychotic or ill-behaved but rather the "over willingness" of many physicians to perform this procedure without reservations.
Fortunately, the advent of anti-psychotics including chlorpromazine in 1950 resulted in a significant reduction of these surgeries. Medications were superior because they were more effective, but also because of their obvious none-invasive nature. Today, the procedure remains in use in a modified form; however for a very small number of indications.
- From prefrontal leukotomy to deep brain stimulation: the historical transformation of psychosurgery and the emergence of neuroethics (Journal of Neurosurgery, July 2008)