Pre-Teenage Lobotomy

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The LA Times today offers a decent, but probably too short, account (reg. req.) of the rise and fall of the lobotomy, in the context of one 55-year-old survivor who was forced into one by his parents at age 12. The key to why psychiatric professionals loved destroying people's prefrontal cortexes (often with ice picks shoved through eye sockets–less messy that way) can be found in this excerpt from the story:

"We as a profession had one generation of humility after the era of lobotomy, but it's gone," said Jeffrey Schwartz, a research psychiatrist at UCLA. "We're now back to a point where the elite of our society believe that the most sophisticated way to treat mental illness is with drugs, magnetic fields, a knife or radiation beam. It's especially important that we hear the rest of the lobotomy story from people who were there."

To fathom why lobotomy was once widely accepted, an understanding of the state of mental healthcare half a century ago is required. Overwhelmed by sheer numbers, many mental institutions in the U.S. were chaotic warehouses. ….

Some top psychiatrists and neurosurgeons began performing lobotomies in the late 1930s and found that their patients emerged calmer and easier to manage. Many were able to return home. Soon, news accounts reported that doctors had devised a "surgical cure" for mental illness. By the mid-1940s, lobotomy was viewed as the most advanced treatment psychiatry could offer for severe mental illness. In 1949, [lobotomy inventor Egas] Moniz was awarded the Nobel Prize in medicine.

"In the context of that time, control of behavior became paramount, and any treatment that achieved that control was seen as therapeutic," said Joel Braslow, a UCLA psychiatrist who has written a history of the era, "Mental Ills and Bodily Cures."

"The illness was being defined by the physician, and the outcome ? whether it succeeded or failed ? was also defined by the physician."

A book review I did for Reason in our May 2002 issue on Robert Whitaker's Mad in America, a history of psychiatric abuses in America covering lobotomies and various horrors that both preceded and followed them, can be found here. A Web site dedicated to stories of victims of psychosurgery is here.

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  1. But… if the market demands lobotomies, even if the demand is based on faulty information, is it wrong for doctors to perform them?

    They’re just serving the market.

  2. Otto:
    Lobotomy. Isn’t that for loonies?

    J. Frank Parnell:
    Not at all. A friend of mine had one. Designer of the neutron bomb. Ever hear of the neutron bomb? Destroys people. Leaves buildings standing. And it fits in a suit case. It’s so small no one knows it’s there until BLAMMO!! Eyes melt skin explodes everybody dead! It’s so immoral working on the thing can drive you mad. That’s what happened to this friend of mine. So he had a lobotomy. Now he’s well again.

    Otto:
    What kind of car does your friend drive?

    J. Frank Parnell:
    Chevy Malibu.

  3. Jon H.,
    I’m not a Libertarian/libertarian/anarcho-capitalist, nor do I even play one on TV, however. I think that the differnce here is in WHO is ordering the lobotomies. If I am manic-depressive/bipolar/schizophrenic and I want a lobotomy (ignoring the fact that I may be crazy so can I ask for a treatment, not being of “sound mind”?) that wuold be one thing.

    If, however, I am PRESCRIBING one for YOU or authorizing that one be PERFORMED on YOU that’s a different thing. I am affecting YOU, not me.

    So many of these treatments were done TO people, not asked for BY the patient. And that is a fundamental difference. Acting as your guardian I destroy your prefrontal lobe is different than destroying my own.

  4. I would rather have a bottle in front of me than a frontal lobotomy.

  5. I guess it begs the question. How different is it to pacify deranged people by “treatment” with Haldol.

    Incidentally, life isn’t completely unfair. I believe Moniz was the one that was killed in his office by one of his patients.

  6. This begs the question of whether pacifying patients with Haldol is that much different. Less permanent though it is.

    Incidentally, wasn’t Moniz the one that was killed in his office by one of his patients?

  7. I guess it begs the question. How different is it to pacify deranged people by “treatment” with Haldol.

    The difference is that you can stop giving someone Haldol. You can’t un-mutilate their prefrontal cortex.

  8. Except Pavel, Haldol does NOT equal lobotomy… Don’t like the effects of a lobotomy, TOUGH! Don’t like the effects of Haldol, stop taking it. There IS a difference.

    We may not understand fully how Haldol and other drugs work, and their effect may be spotty, BUT by-and-large there is some overall positive effect, unless you have credible SCIENITIFIC studies proving otherwise and the effects can be reversed.

    Overall, Haldol better than lobotomy is a justifiable conclusion.

    I have found this board’s contributor’s rather against psychology/psychiatry. I guess, I mean to say that if the practioners of the natural philosophy of psychology overstate their conclusions and diagnosises, then also does this board over-denigrate their contributions.

    Psychology/psychiatry is at the same stage, I’d say, as Medicine was prior to the Germ Theory of Disease. Physicians were not sure of what CAUSED disease, and their methods were not always effective, BUT that did not make them totally worthless. Oft’ times a physician was a better bet than NO physician.

    So, I’d say what is lacking in this board is a sense of proportion in regards to the claims of Psychology and the claims of its detractors. Neither is a accurate as they would like you to think.

  9. Joe L writes: “If, however, I am PRESCRIBING one for YOU or authorizing that one be PERFORMED on YOU that’s a different thing. I am affecting YOU, not me.”

    But in either case, the physician is just responding to market demand, that some person’s condition be ‘fixed’.

  10. The difference is that you can stop giving someone Haldol. You can’t un-mutilate their prefrontal cortex.

    Kindly note my addition in my second not-quite-double post.

    Of course it’s not the same when it comes to reversibility, and this is a big difference. But reversibilty shouldn’t be all that matters when it comes to “treating” the mentally ill. My point is that when it comes to the state of being lobotomized vs. being on Haldol…I’m not sure there’s much of a difference.

  11. Well Pavel, I’m not sure that your conclusion is justified. Haldol SEEMS to help some patients. I think you’re argument is that it is just a placebo and that’s not medically justifiable statement.

    And Jon H. shooting criminals out of hand can solve crime problems, but I would blame police for providing that service, even if the “market” demanded it…

  12. tomhynes
    I with you bud , this is giving me a headache.

  13. The lobotomy era was also one of involuntary commitment to mental institutions. Many a rich old eccentric uncle wound up in the “loony bin” on the signature of their greedy son nephew.

    Now you can’t get someone committed unless they’ve drawn blood. Then we send them to prison.

    Mental illness is heart wrenching, expensive, stigmatizing and lethal. It is also chronic, requiring many different types of treatments over the years and insurance companies hate it, seemingly enjoying the extra pain they can apply. Heart disease, on the other hand, shares the same chronic description but is accepted as a “health” condition rather than a “mental health” condition.

    No answers. Only questions.

  14. What Gadfly said…

  15. Gadfly: One difference is that there are clear physical tests, such as EKG’s, for heart disease. “Mental illness” has no comparable test.

  16. Well Pavel, I’m not sure that your conclusion is justified. Haldol SEEMS to help some patients. I think you’re argument is that it is just a placebo and that’s not medically justifiable statement.

    Hmm. Placebo would mean people it’s a sugar pill the effects of which are based on faith. I’m saying quite the opposite. Chemical lobotomy is far from a placebo.

    While it is a far better thing to reversibly turn people into zombies than brain damage them…it’s still a matter of social control and not “treatment” in the vast majority of instances.
    I don’t know of anyone that voluntarily takes Haldol to reduce the symptoms of some condition. Having worked in psych hospitals I do know how it is used there…and widely.

    And having *cough* taken some recreationally…well…lobotomy in a pill is a pretty fair description.

  17. I believe haldol and a number of other psychotropic drugs are available for non-hospitalized patients. It isn’t simply for control.. unless you define control in that sense that they person is not acting crazy and they had a right to act crazy.

    I think this gets back to my earlier point that psychiatry comes under undo attack, hereabouts. It certainly is NOT an exact science, or even a science at all (in a Kuhnian Sense) but that does not mean it’s works and efforts are valueless. And I think you and others here are trying to go that route, or close enough as to make little or no difference.

  18. Joe L.,

    I’m bi-polar. Trust me, I denigrate the field for a reason.

    garym,

    “One difference is that there are clear physical tests, such as EKG’s, for heart disease. ‘Mental illness’ has no comparable test.”

    When they have in a room, wearing a straight-jacket and you are screaming your guts about wanting to go scuba diving, you don’t need a “test.” Further there are tests by inference; such as – I take lithium, mood swings even out, no more straight-jackets.

  19. Gary Gunnels, you can complain all you want. I once had a friend who was a PhD in Psychology and he was vicious about his profession. I simply get the impression from the articles posted here, that many seem to equate Voodoo and Psychiatry and that isn’t quite fair, either.

  20. Joe L.,

    I used the term denigrate, not complain. 1% of shrinks are useful; the rest of them have corncobs up their asses.

  21. Jon H-
    By your logic, it could be said that slave traders are only responding to market demand, too.

  22. First to Mr Nice Guy, nice way to work in the Repo Man reference .

    Secondly: Most people know very little about the actual practice of psychiatry. In all reality the suggestion that it is in its infancy, as in pre-Germ Theory of Disease for traditional medicine, is quite apt. But more importantly is the lack of imperical evidence required prior to initiating a treatment regime. For instance, the beleif that you can “just stop” taking many of these drugs. To put my objection plainly, things that alter your personality, alter your personality. Or to be even simpler, you really may not be able to go home again after visiting the pharma solution. In most traditional models of knowledge, it is not enough to say “look ma, it works” like highschool algebra, you have to show your work, and that simply has not been done with most of these regimes. I actually am pretty happy with the way things have been going in that industry, but it still remains, that one of the quickest ways to get diagnosed, is to disagree with an authority figure. Then after twenty years of “solving” that problem, many wonder.

    Should Lincoln have been on anti-depressants? I fall into the negative camp on this issue. Should a suicidal thought cross my mind, I jwould rather live with that risk than than a re-organization of my basic personality traits to suit societies needs. Guess I definitely would have been a candidate for the full frontal treatment.

    Ho Hum

  23. We do things to make it possible to deal with problems. Very few families have the resources to provide the guardianship that some crazy people need. A padded cell or a snake pit or a lobotomy sounds cruel, but look at the streets of Frisco and see what crazy people do to themselves when they are let loose. Don’t condemn people for a poor choice when they have no good choices.

  24. Reason dudes: spell-check! “psychatric”? “preceeded”? And elsewhere on H&R today: “meance”, “Queda”. (OK, so Spell wouldn’t help with that last one.)

  25. Should a suicidal thought cross my mind, I jwould rather live with that risk than than a re-organization of my basic personality traits to suit societies needs.

    If you had a life-threatening infection, would you refuse antibiotics on the grounds that you won’t “re-organize your body to suit society’s needs”? Who cares whether or not society wants you to not be suicidally depressed? Don’t YOU want to not be suicidally depressed, regardless of society’s wishes?

  26. I’m continually amazed at the tendency of people to think both that:

    a) it’s of course perfectly reasonable for the heart, liver, skin, eyes, stomach, bones, circulatory system, etc. to be broken, or wired wrong, and require some external treatment

    and

    b) it’s all just silly handwaving to think that the most complex piece of machinery in the universe that we know of, the human brain, may be vulnerable to a glitch or two itself.

    Of course there are abuses in psychiatry and psychology, just as there are in any field. And the fact that the subject of inquiry for those fields is so hard to physically “get one’s hands on” opens up extra opportunities for fraud, fakery, and excuse making. But people who do not look beyond this are letting the perfect be the enemy of the good.

    The state of mental health care in the world today as compared to the late 1800s is *hugely* advanced. If you get the willies reading about psychosurgery, try leafing through some accounts of life in an institution in the 19th century.

    The smug anti-psychiatry tone here in some quarters at Reason is disconcertingly similar to that of your typical Scientologist. There are of course significant philosophical and legal issues that come into play when treating and identifying mental illness, but that is an entirely different issue than the question of “is it real”. If you have troubles believing it’s real, then you just need to admit that you’re a dualist and that you simply don’t agree that everything you think, feel, are, and remember is simply chemical and electrical blips in the 3 pound bag of grey much in your skull.

    Don’t compare things to how they should be in an ideal world. Compare them to how they would otherwise be in the actual world.

  27. Dan,

    In some instances, suicide is the perferable option.

    Skepticos,

    I have a friend who was forced to undergo electro-shock therapy while he was in highschool (this was in the 1960s). This “therapy” was recommended as a “cure” for his “anti-social” behavior as editor of school newspaper. This behavior included advocating integration of his high-school and expressing homosexual inclinations.

    ______________________________

    “Medicine had tended, since the eighteenth century, to recount its own history as if the patient’s bedside had always been a place of constant, stable experience, in contrast to theories and systems, which had been in perpetual change and masked beneath their speculation the purity of clinical evidence. The theoretical, it was thought, was the element of perpetual change, the starting point of all the historical variations in medical knowlege, the locus of conflicts and disappearances; it was in this theoretical element that medical knowledge marked its fragile relativity. The clinic, on the other hand, was thought to be the element of its positive accumulation: it was this constant gaze upon the patient, this age-old, yet ever renewed attention that enabled medicine not to disappear entirely with each new speculation, but to preserve itself, to assume little / by little the figure of a truth that is definitve, if not completed, in short, to develop, below the level of the noisy episodes of its history, in a continuous historicity. In the non-variable of the clinic, medicine, it was thought,had bound truth and time together.”

    Michel Foucault, The Birth of the Clinic, p. 54-55

  28. Good grief, having just read the ‘book review’ by Mr. Doherty, I see that it was indeed no accident that the hysterical rants of Scientologists came to my mind.

    What a complete and utterly ignorant piece.

  29. Illnesses of the brain can be particularly subtle and hard to diagnose, to be sure. But “mental illness” is an ambiguous term which sometimes refers to physical malfunction of the brain and sometimes to dubious thinking (a blurring of the distinction between “hardware” and “software” failure, if you like those terms). When people use reluctance to be incarcerated as a demonstration of “illness,” I have every reason to believe their notions of health and illness have more to do with voodoo than with physiology. If people would talk about “brain illness” or “neurological illness,” then I’d be more sure of what they were talking about.

    “Admitting” that thought is not simply electricity and chemistry is a strange way to put it. The existence of consciousness as a distinct phenomenon in kind is a directly perceived fact.

  30. darn it, didn’t mean to hit post yet.

    ahem.

    What, pray tell, will be the “new and modern” version of what schizophrenia is caused by other than an improper system of neurotransmitters presumably caused by some organic problem with the tissues of the brain?

    Ghosts? the Devil? Evil baby Jesus?

    Perhaps we should return to the days of trephining so we can let those nasty buggers loose!

  31. “Admitting” that thought is not simply electricity and chemistry is a strange way to put it. The existence of consciousness as a distinct phenomenon in kind is a directly perceived fact.”

    Come again? What exactly would that be? Certainly not anything from mainstream science.
    As I said, we’ve got a bunch of closet dualists here.

    As to the rest of what you wrote, playing semantics with what the term ‘mental illness’ means doesn’t get us anywhere. As I said, the philosophical and legal issues around what counts as a mental illness, and what we then do about it even if we count it, are completely separate issues from the central point.

  32. I don’t think anybody here is saying that those with mental illness should be denied treatment, I think they’re saying that those perceived to be mentally ill should not be FORCED into treatment. Kind of like the way I’m seriously opposed to rape, but think that consensual sex is just fine.

  33. Gary Gunnels:

    If you put a person in a strait-jacket and lock him up, and he screams that he wants to be somewhere else, how does that prove that he’s “mentally ill”?

    Sounds like Catch 22 in reverse; if you don’t want to be “treated” for your “illness,” that proves you’re crazy.

  34. … and if she floats, she’s a witch, so we kill her.

    I’ve never understood how people can miss the “duh-huh” observation that while denial may be a symptom of people with a condition, it’s also a symptom of those without it. No matter what somebody accuses you of, if you deny it, that’s treated as further evidence that the accusation is true.

    “Only the Messiah would deny his true nature.” “Okay, I’m the Messiah.” “It’s the Messiah!”

    Anyway…

  35. garym,

    Its what gets you into the straight-jacket in the first place that is the real issue. As a person who has suffered with bi-polar disease most of his life I would say that the main benefit of having had contact with the field of psychology is this: it gives one an incentive to avoid that field entirely. Its at best a negative experience that is a kin to being burnt by the stove as a child.

    Accordingly one seeks out limited avenues of involvement with that arena; doing enough to stay sane, while at the same time remaining wary of the agendas of those who profess a desire to “help” you. That help generally comes in the form of emasculation and attempts to rob people of their personalities, independence, etc. The field of psychology as a whole is deeply opposed to individual liberty.

  36. GABBA GABBA HEY!

  37. Now I guess I’ll have to tell ‘um that I got no cerebellum.

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