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Biology 202
2000 First Web Report
On Serendip
In 1847 an Irish workman, Phineas Cage, shed new light on
the field of
neuroscience in a rock blasting accident which sent an iron rod through the
frontal region of his brain. Miraculously enough, he survived the incident,
but even more astonishing to the science community at the time
were the marked
changes in Cage’s personality after the rode punctured his
brain. Where
before Cage was characterized by his mild mannered nature, he had now become
aggressive, rude and "indulging in the grossest profanity,
which was not
previously his custom, manifesting but little deference for his
fellows, impatient
of restraint or advice when it conflicts with his desires"
(1)
according to the Boston physician Harlow in 1868. However, Cage sustained no
impairment with regards to his intelligence or memory (1). This incident provoked
scientists to ask the question, "can alteration of the brain structure
lead to differences in personality?" and if so, then
"are there specialized
regions of the brain responsible for the function of different
elements of our
personal character?" Thus, completely by chance, the
foundational discoveries
for the development of frontal lobotomy were laid.
Beginning in the late 1800’s, experimental surgeries involving
various incisions slicing or destroying parts of the frontal
cortex were performed
on a variety of subjects in an effort to produce a calming effect
in their behavior.
In 1935, Dr. John Fulton presented the results of his research on a pair of
chimpanzees at a conference for neurology. Fulton had
"removed completely
the frontal lobes" (4) of the chimps and observed that
after the surgery they appeared significantly calmer than before
the operation
as he was unable to "generate experimental forms of neurosis
in the animals"(1).
Attending this conference were two neuro-scientists, Egas Moniz
and Walter Freeman,
both of whom would become major figures in the practice of
lobotomy. Egas Moniz
was particularly fascinated by the idea of the behavioral changes
in Fulton’s
chimps and posed the shocking question, "If the frontal lobe
removal prevents
the development of experimental neurosis in animals and eliminates
frustrational
behavior, why would it not be possible to relieve anxiety states
in man by surgical
means?" (1). Although many in attendance were appalled
at Moniz’ suggestion, Freeman was inspired by the possibilities opened
by the suggestion of what would come to be termed psychosurgery.
Soon after the conference, Moniz and the Freeman began exploring the
possibilities of lobectomy (the cutting of the frontal lobes of
the brain) as
a method of eliminating certain mental illnesses. For example, in
diseases such
as obsessive compulsive disorder, it was thought that the symptoms were the
result of hyper-metabolic activity in the frontal
cortex–repeated patterns
of brain function which were able to dominate over other patterns
(7).
Moniz and Freeman thought that by cutting the nerve fiber
connections between
the frontal cortex and thalamus which conducts sensory information
in the brain,
these repetitive patterns would be eliminated (4). Thus, in
1936, Moniz published his written research on his first human
frontal lobotomy
and shortly after, Walter Freeman performed the first lobotomy in the United
States (2).
While Moniz can be attributed with the first implementations of human
lobotomy (or lobectomy as he termed it), it was Freeman, with the assistance
of neurosurgeon James Watts who was able to steer the procedure
into the mainstream
of psychological medicine. They started with Moniz’s original method,
which he called the "pre-frontal lobotomy" which
involved the insertion
of a wire knife (leukotome) into many holes in the brain and then,
with a few
swinging motions, massacring the brain matter and presumably alleviating the
psychotic symptoms in the patient (4). They
revised this procedure,
calling it the "Freeman-Watts Standard Procedure" (4).
However, frustrated with the messiness and inconvenience of the
surgery, Freeman
came upon an idea which would simplify the surgery and make it administrable
by less specialized medical professionals. In 1945, inspired by
similar practices
in Italy at the time, Freeman introduced the idea of the
"ice-pick"
or transorbital lobotomy (2). The procedure
involved the insertion
of an actual ice pick into the brain via the eye socket. Freeman
describes his
new technique in a letter to his son: "This consists of
knocking them out
with a shock and while they are under the "anesthetic"
thrusting an
ice pick up between the eyeball and the eyelid through the roof of the orbit
actually into the frontal lobe of the brain and making the lateral
cut by swinging
the thing from side to side." (5). Due to the extreme
brutality of this procedure, James Watts broke his partnership with Freeman.
Indeed, many notable surgeons were reputed to have fainted while
watching Freeman
perform his surgery and many others refused to do lobotomies (1).
However, with the avidity of Freeman and cooperation of other
surgeons around
18,000 lobotomies were performed in the US between 1939 and 1951. It was not
until the 50’s that opposition to lobotomy became especially vocal and
finally with the introduction of anti-psychotic medications such
as Thorazine
doctors became less and less reliant on lobotomy to treat patients
(4). Freeman
performed his last lobotomy in 1967 which resulted in fatality
when he nicked
a blood vessel and the patient bled to death.
The practice of lobotomy has special significance, not only
has a dark
epoch in the history of neuroscience, but in the understanding of
how a scientist
can most effectively approach the brain. One of the major failures
of the proponents
of lobotomy was that they did not seem to acknowledge the extreme
specificity
of brain structure. A lobotomy–the insertion wiggling around
of a rather
large instrument in the frontal cortex and-- is a highly
unspecific procedure.
It attacks the problem at too high a level of boxes. This can
account for the
extreme diversity of outcomes of the surgery. There were many
recorded fatalities
and many patients were crippled for the rest of their lives when
it was expected
that they would become simply more docile and calm. Rosemary
Kennedy, the mildly
retarded daughter of Joseph and Rose Kennedy, received a lobotomy
at the request
of her father which left her permanently disabled and completely dependent.
The same was true for Rose Williams, sister of playwright
Tennessee Williams (7)
. It can be argued that every lobotomy performed resulted in
catastrophe, since
each one deprived the patient of his/her personality–the
surgery had the
effect of making its recipients passive zombies, in essence. A
report from Freeman’s
first surgery on a 63 year old woman describes her as changing her
mind about
the operation when she found out that her hair would have to be shaved off.
In an effort to placate her, the doctors assured her (falsely)
that they would
save her hair for her after the lobotomy. Consenting, the surgery
was done and
when she woke up, Freeman notes that, "she no longer
cared" (1)
. Such was the effect of lobotomy in all of its stages of
development–massacre
of the brain resulting in massacring of the personality.
2)"Lobotomy's Back", An article by F. Vertosick, Jr. as published in Discover Magazine, Oct. 1997.
3)History of Lobotomy, A very brief overview of this history of the procedure, put out by PBS.
4)Excerpt from The History of Psychosurgery, by R.M.E. Sabbatini, PhD.
5)Great and Desperate Cures, by Elliot Valenstein. New York:Basic Books, 1986.
6)OCD and the Brain, Andrew Hollander's web paper on Obsessive Compulsive Disorder.
7)Lobotomy's Hall of Fame, Sabbatini's notes on famous recipients of lobotomy.
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