This surgical practice would be unthinkable today, fortunately.
In this article we will see what it is, what its effects were, and why it is no longer performed.
What is lobotomy?
The origins of lobotomy, or at least its predecessor, are found in Portugal in the 30s by António Caetano de Abreu Freire Egas Moniz (usually simplified as António Egas Moniz), neurosurgeon and one of the disciples of the famous Spanish neurologist Santiago Ramon y Cajal . . . .
At that time the tools available to psychiatry were very limited, and that is why there were many cases in which all medical treatments to intervene in patients in the psychiatric context failed. In particular, António was concerned about patients with severe psychiatric disorders that did not even seem to improve minimally to electroconvulsive therapy (something normal, considering what this intervention consisted of at that time).
To give an answer to this kind of severe psychiatric problems (or, at least, to psychological phenomena considered at that time as a medical problem), António created a procedure called leucotomy, whose name gives us clues to what it consisted of: leuco means “white”, and “tomía”, cut.
That is,the proposal of this surgeon was to cut certain areas of white matter of the brain, composed of axons, extensions of neurons that go to other nerve cells to interact with them.
What was it for?
The goal of leukotomy was to break down the connecting areas that exist between two areas of the brain: the frontal lobe and the thalamus.
- We recommend: “Human brain: its main parts and functions”
The idea was to prevent the parts of the brain that supposedly drive mental processes linked to emotion from interfering with those areas of the brain responsible for carrying out rational thought and the ability to think and act meaningfully.
This procedure was designed by António Egaz and put into practice by his colleague Almeida Lima , since António suffered from certain malformations in his hands that did not allow him to perform the corresponding movements with the necessary precision. In any case, Egas was the one who dictated what to do and who set the objectives.
The transition from leukotomy to lobotomy
After carrying out the first twenty interventions using the leukotomy method for the first time, António Egas concluded that it was effective, since according to his observations around 70% of the patients who underwent this practice, who presented alterations such as schizophrenia , severe depression or impulse control disorders, improved or directly cured.
This response to treatment was unprecedented in the world of psychiatry, whose measures were very ineffective and when they worked normally they only did so very transiently.
The popularity of the leucotomy spread rapidly, and in fact made António so famous that in 1949 he won the Nobel Prize in Medicine.
Inspired by the work of António Egas, the American neurologist Walter Freeman decided in the mid-1930s to continue researching this kind of surgical procedure, which at that time was just beginning to be tested empirically. However, he modified the procedure somewhat, and together with neurosurgeon James Watts , who would perform the operations (Freeman was not allowed to operate directly), he created the lobotomy.
What was the difference between leucotomy and lobotomy?
The fact that Freeman gave his procedure a different name responds above all to criteria related to marketing, in order to offer his own and original service different from that of Egas.
Despite this, it is true that the techniques Freeman used were somewhat different. He first performed interventions called prefrontal lobotomy, which consisted of drilling a hole in front of each frontal lobe (that is, two holes in the forehead) in order to slide a long, pointed instrument through it and break certain areas of gray matter and white matter. in the forebrain. After assessing the first cases performed on patients, this researcher concluded that lobotomy was effective and improved approximately 60% of the people who underwent this surgical practice.
Some time later, in the 1940s, Freeman decided to develop an “improved method” and more efficient, called transorbital lobotomy, in which instead of drilling holes in the forehead, the pointed instrument was slipped between the upper eyelid and the eye, to access the brain through the eye sockets.
One of the advantages of this second method was, according to Freeman, that it was faster, did not require general anesthesia, and did not leave visible scars. However, James Watts was opposed to this type of intervention, and decided to break any professional relationship with him.
The effects on patients
As we have seen, both in the case of António Egas’ leukotomy and Walter Freeman’s lobotomy, both doctors concluded that most patients were happier and more satisfied after going through the operating room. . However, the passage of time meant that after the euphoria of the first years, the lobotomy increasingly gained a worse image .
The reason is that a coherent scientific investigation had not been carried out and that followed the evolution of the patients weeks, months or years after being lobotomized, and the experience showed that in many cases long-term adverse effects arose (which were added to those in which complications were manifested from the first moment or the death of those who were operated on directly occurred).
In fact, Rosemary Kennedy , the sister of John F. Kennedy, was permanently incapacitated after coming to Freeman, spending the rest of her life in a psychiatric hospital.
In addition, although lobotomy was initially performed only on seriously ill psychiatric patients, it became increasingly popular to treat practically any behavioral problem with this method, so that many people underwent this procedure. This caused many scandals to arise due to problems arising from injuries.
The fact that the parts of the brain that were injured were not well understood, nor were the individual differences between the functioning of the brain of the patients taken into account, added to many other negligences, led to the concept of “lobotomy” being related to the sinister medical experiments that ended with patients behaving in a manner similar to “zombies”, according to popular opinion.
Beyond the sensationalism, it is true that many patients remained in a state of affective flattening and total passivity, or even sometimes in a practically vegetative state, while in others they ended up dying from the injuries sustained or suffered from neurological disorders that were not previously known . They had.
neurosurgery today
Currently the lobotomy is not practiced, and in fact to practice it would suppose in most legal systems of the Western countries a serious illegality.
The current methods used in neurosurgery are much more sophisticatedand are based on the most rigorous scientific research, so that they are not made available to the public if they have not been proven safe and offer benefits that outweigh their risks.
References
- Cosgrove, G. Rees; Rauch, Scott L. (1995). “Psychosurgery” Neurosurg. Clin. N. Am.
- Steck, AJ (2010). Milestones in the development of neurology and psychiatry in Europe. Swiss Archives for Neurology and Psychiatry. 161(3):85-9.
- Tierney, A.J. (2000). Egas Moniz and the Origins of Psychosurgery: A Review Commemorating the 50th Anniversary of Moniz’s Nobel Prize. Journal of the History of the Neurosciences;9(1):22 – 36.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.