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PsychosurgeryLobotomy (Greek: λοβός – lobos: "lobe (of brain)"; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy (from the Greek λευκός – leukos: "clear/white" and tome). It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain. While the procedure, initially termed a leucotomy, has been controversial since its inception in 1935, it was a mainstream procedure for more than two decades, prescribed for psychiatric (and occasionally other) conditions—this despite general recognition of frequent and serious side-effects.
Half of the Nobel Prize for Physiology or Medicine of 1949 was awarded to António Egas Moniz for the "discovery of the therapeutic value of leucotomy in certain psychoses".[2] The heyday of its usage was from the early 1940s until the mid-1950s when modern neuroleptic (antipsychotic) medications were introduced. By 1951, almost 20,000 lobotomies had been performed in the United States. The decline of the procedure was gradual rather than precipitous. In Ottawa's psychiatric hospitals, for instance, the 153 lobotomies performed in 1953 were reduced to 58 by 1961, after the arrival in Canada of the antipsychotic drug chlorpromazine in 1954.[3][4] This method is an extreme method to calm insane people or people with swinging mood, not stable. It is used when all the other methods have failed. However, like any other psychosurgical procedures, it has some undesirable effects but can be control by medicine.[5]
The lobotomy was one of a series of radical and invasive physical therapies developed in Europe in the first half of the 20th century. These psychiatric innovations signaled a break with a culture relegating psychiatric patients to asylums, which had prevailed because most serious forms of mental illness were treated only unsatisfactorily by extreme measure, or as unamenable to treatment.[6][7][8] These new early twentieth century physical therapies included malarial therapy for general paresis of the insane (1917),[9] barbiturate-induced deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938).[10][11]
The development of the leucotomy procedure by Moniz in 1936, took place at a time when all of the above therapeutic interventions were extreme and experimental forms of therapy and most posed serious risks to the health of the patients who underwent them. Leucotomy was seen by many psychiatrists as no more severe than therapies such as insulin or cardiazol shock;[12] these apparently successful procedures conceived for the treatment of patients suffering severe mental illnesses helped to create the intellectual climate and medical and social warrants that allowed a surgical procedure as radical and irreversible as leucotomy to appear as a viable and even necessary proposition. Moreover, Joel Braslow argues that from malarial therapy onward to lobotomy, physical psychiatric therapies "spiral closer and closer to the interior of the brain" with this organ increasingly taking "centre stage as a source of disease and site of cure."[13] For Roy Porter, these often violent and invasive psychiatric interventions are indicative of both the well-intentioned desire of psychiatrists to find some medical means of alleviating the suffering of the thousands of patients in psychiatric hospitals in the twentieth century and also the relative lack of social power of those same patients to resist the increasingly radical and even reckless interventions of asylum doctors.[14]
It is commonly accepted that the first systematic attempt at human psychosurgery was conducted by the Swiss psychiatrist Gottlieb Burckhardt in late 1880s.[15] Burckhardt operated on the brains of six patients (one of whom died a few days after the operation) at Préfargier Asylum, cutting out a piece of cerebral cortex. He presented the results at the Berlin Medical Congress and published a report, but the response was hostile and he did no further operations.[16] Early in the 20th century Russian neurologist Vladimir Bekhterev and Estonian neurosurgeon Ludvig Puusepp operated on three patients with mental illness, with discouraging results.[16]
The development of the leucotomy procedure was the work of the Portuguese physician and neurologist António Egas Moniz, who was highly acclaimed for his work on cerebral angiography (radiographical visual of the blood vessels in the brain) in 1927.[17][18] Despite having no clinical psychiatric experience and, indeed, little interest in psychiatry, in 1935 at the Hospital Santa Marta in Lisbon, he devised the surgery called prefrontal leucotomy which was carried out under his direction by the neurosurgeon Pedro Almeida Lima. He was also responsible for coining the term psychosurgery.[19] The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later changed technique, using a surgical instrument called a leucotome that cut brain tissue by rotating a retractable wire loop (a quite different cutting instrument also used for lobotomies shares the same name).[clarification needed][20] Between November 1935 and February 1936 Moniz and Lima operated on twenty patients, publishing their findings in the same year.[21] Their own assessment was that 35% of the patients improved greatly, 35% improved moderately and that in the remaining 30% there was no change. The patients were aged between 27 and 62 years of age, 12 were female and eight were male. Nine of the patients were diagnosed as suffering from depression, six from schizophrenia, two from panic disorder, and one each from mania, catatonia and manic-depression with the most prominent symptoms being anxiety and agitation. The duration of the illness prior to the procedure varied from as little as four weeks to as much as 22 years, although all but four had been ill for at least one year. The post-operative follow-up assessment took place anywhere from one to ten weeks following surgery. The observed complications were less severe than in Burckhardt's sample as there were no deaths or epileptic convulsions and the most cited complication was fever.[22]
The theoretical underpinnings of Moniz's avant garde psychosurgery were largely commensurate with the nineteenth century ones that formed the basis of Burckhardt's theories before him. Although in his later writings he referenced both the neuron theory of Ramón y Cajal and the conditioned reflex of Ivan Pavlov, in essence he simply interpreted this new neurological research in terms of the old psychological theory of associationism.[23] He differed significantly from Burckhardt in that he did not think there was any physical anatomical pathology in the brains of the mentally ill, but rather that their neural pathways were caught in fixed and destructive circuits[24] As he wrote in 1936:
[The] mental troubles must have [...] a relation with the formation of cellulo-connective groupings, which become more or less fixed. The cellular bodies may remain altogether normal, their cylinders will not have any anatomical alterations; but their multiple liaisons, very variable in normal people, may have arrangements more or less fixed, which will have a relation with persistent ideas and deliria in certain morbid psychic states.[25]
Later, Burckhardt was condemned for his methodology while Moniz's more favorable results earned him acceptance within the psychology community.[26]
Brain animation: left
frontal lobe highlighted in red. Moniz targeted the frontal lobes in the leucotomy procedure which he first conceived in 1933.
The removal of these aberrant and fixed pathological brain circuits, therefore, might lead to some improvement in mental symptoms. Moniz believed that the brain would functionally adapt to such injury.[27] A significant advantage of this approach was that, unlike the position adopted by Burckhardt, it was unfalsifiable according to the knowledge and technology of the time as the absence of a known correlation between physical brain pathology and mental illness could not disprove his thesis.[28]
Traditionally, the question of why Moniz targeted the frontal lobes in particular has been answered by reference to a presentation by John Fulton and Carlyle Jacobsen at the Second International Congress of Neurology held in London in 1935. Fulton and Carlyle presented two chimpanzees who had undergone frontal lobectomies. The operation had had a pacifying effect on the two primates, who had previously suffered from behavioral disorders. It has been alleged that this provided the impetus and inspiration for Moniz to try the same technique on psychiatric patients.[29][30] However, as Berrios points out, this conflicts with the fact that Moniz had told his colleague Lima in confidence as early as 1933 of his psychosurgical idea. Nor did he mention Fulton's and Carlyle's presentation as an influence when writing about the procedure in 1936.[31] Indeed, as Kotowicz notes, his attention was drawn more to the case presented by Richard Brickner, at the same conference, of a patient who had had his frontal lobes ablated and, while experiencing a flattening of affect, had suffered no apparent decrease in intellect. Brickner had published on this case in 1932.[32]
Moniz was given the Nobel Prize for medicine in 1949 for this work.[33][34]
Site of borehole for the standard pre-frontal lobotomy/leucotomy operation as developed by Freeman and Watts
The American neurologist and psychiatrist Walter Freeman, who had also attended the London Congress of Neurology in 1935, was intrigued by Moniz's work, and with the help of his close friend, neurosurgeon James W. Watts, he performed the first prefrontal leucotomy in the United States in 1936 at the hospital of George Washington University in Washington.[35] Freeman and Watts gradually refined the surgical technique and created the Freeman-Watts procedure (the "precision method", the standard prefrontal lobotomy).
The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed this surgery would be unavailable to those he saw as needing it most: patients in state mental hospitals that had no operating rooms, surgeons, or anesthesia and limited budgets. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in mental asylums, which housed roughly 600,000 American inpatients at the time.
Inspired by the work of Italian psychiatrist Amarro Fiamberti, Freeman at some point conceived of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an icepick[36] from his own kitchen and began testing the idea on grapefruit[37] and cadavers. This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose, around fifteen degrees toward the interhemispherical fissure. The orbitoclast was malleted five centimetres into the frontal lobes, and then pivoted forty degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimetres into the brain, before being pivoted around twenty-eight degrees each side, to cut outwards and again inwards. (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of the interhemispherical fissure; the "Deep frontal cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.
Freeman performed the first transorbital lobotomy on a live patient in 1946. Its simplicity suggested the possibility of carrying it out in mental hospitals lacking the surgical facilities required for the earlier, more complex procedure (Freeman suggesting that, where conventional anesthesia was unavailable, electroconvulsive therapy be used to render the patient unconscious).[38] In 1947, the Freeman and Watts partnership ended, as the latter was disgusted by Freeman's modification of the lobotomy from a surgical operation into a simple "office" procedure. Between 1940 and 1944, 684 lobotomies were performed in the United States. However, because of the fervent promotion of the technique by Freeman and Watts, those numbers increased sharply towards the end of the decade. In 1949, the peak year for lobotomies in the US, 5,074 procedures were undertaken, and by 1951 over 18,608 individuals had been lobotomised in the US.[39]
In the United States approximately 40,000 people were lobotomized. In Great Britain 17,000 lobotomies were performed, and the three Nordic countries of Finland, Norway and Sweden had a combined figure of approximately 9,300 lobotomies.[40] Scandinavian hospitals lobotomized 2.5 times as many people per capita as hospitals in the US.[41] Sweden lobotomized at least 4,500 people between 1944 and 1966, mainly women. This figure includes young children.[42] In Norway there were 2,500 known lobotomies.[43] In Denmark there were 4,500 known lobotomies, mainly young women, as well as mentally retarded children.[44]
By the late 1970s the practice of lobotomy had generally ceased, but some countries continued to use other forms of psychosurgery. In 2001 there were, for example, 70 operations in Belgium, about 15 in the UK and about 15 a year at Massachusetts General Hospital in Boston, while France had carried out operations on about 5 patients a year in the early 1980s.[45]
According to the Psychiatric Dictionary[46] published in 1970:
Prefrontal lobotomy is of value in the following disorders, listed in a descending scale of good results: affective disorders, obsessive-compulsive states, chronic anxiety states and other non-schizophrenic conditions, paranoid schizophrenia, undetermined or mixed type of schizophrenia, catatonic schizophrenia, and hebephrenic and simple schizophrenia. Good results are obtained in about 98 percent of cases, fair results in some 35 percent and poor results in 25 percent are thereabouts. The mortality rate probably does not exceed 3 percent. Greatest improvement is seen in patients whose premorbid personalities were 'normal', cyclothymic, or obsessive compulsive; in patients with superior intelligence and good education; in psychoses with sudden onset and a clinical picture of affective symptoms of depression or anxiety, and with behaviouristic changes such as refusal of food, overactivity, and delusional ideas of a paranoid nature.[47]
Prefrontal lobotomy has also been used successfully to control pain secondary to organic lesions. In this case, the tendency has been to employ unilateral lobotomy, because of the evidence that a lobotomy extensive enough to reduce psychotic symptoms is not required to control pain.[47]
According to the same source, prefrontal lobotomy reduces:
anxiety feelings and introspective activities; and feelings of inadequacy and self-consciousness are thereby lessened. Lobotomy reduces the emotional tension associated with hallucinations and does away with the catatonic state. Because nearly all psychosurgical procedures have undesirable side effects, they are ordinarily resorted to only after all other methods have failed. The less disorganized the personality of the patient, the more obvious are post-operative side effects. ...[47]
Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incontinence.[48]
As early as 1944 an author in the Journal of Nervous and Mental Disease remarked: "The history of prefrontal lobotomy has been brief and stormy. Its course has been dotted with both violent opposition and with slavish, unquestioning acceptance." Beginning in 1947 Swedish psychiatrist Snorre Wohlfahrt evaluated early trials, reporting that it is "distinctly hazardous to leucotomize schizophrenics" and lobotomy to be "still too imperfect to enable us, with its aid, to venture on a general offensive against chronic cases of mental disorder" and stating that "Psychosurgery has as yet failed to discover its precise indications and contraindications and the methods must unfortunately still be regarded as rather crude and hazardous in many respects."[42] In 1948 Norbert Wiener, the author of Cybernetics: Or the Control and Communication in the Animal and the Machine, said: "[P]refrontal lobotomy... has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier."[49]
Concerns about lobotomy steadily grew. The USSR officially banned the procedure in 1950.[50] Doctors in the Soviet Union concluded that the procedure was "contrary to the principles of humanity" and that it turned "an insane person into an idiot."[51] By the 1970s, numerous countries had banned the procedure as had several US states.[52] Other forms of psychosurgery continued to be legally practiced in controlled and regulated US centers and in Finland, Sweden, the UK, Spain, India, Belgium and the Netherlands.
In 1977 the US Congress created the National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery—including lobotomy techniques—were used to control minorities and restrain individual rights. It also investigated the after-effects of surgery. The committee concluded that some extremely limited and properly performed psychosurgery could have positive effects.
There have been calls for the Nobel Foundation to rescind the prize it awarded to Moniz for developing the lobotomy, a decision that has been called an astounding error of judgment at the time and one that psychiatry might still need to learn from, but the Foundation declined to take action and has continued to host an article defending the results of the procedure.[53][54]
- Rosemary Kennedy, sister of President John F. Kennedy, underwent a lobotomy in 1941 at age 23 which left her permanently incapacitated.[55]
- Howard Dully wrote a memoir of his late-life discovery that he had been lobotomized in 1960 at age 12.[56]
- New Zealand author and poet Janet Frame received a literary award in 1951 the day before a scheduled lobotomy was to take place, and it was never performed.[57]
- French Canadian singer Alys Robi underwent a lobotomy and later resumed singing professionally.
- Swedish modernist painter Sigrid Hjertén died following a lobotomy in 1948.
- American Playwright Tennessee Williams's older sister Rose received a lobotomy which left her incapacitated for life; the episode is said to have inspired characters and motifs in certain of his works.[58]
It is often said that when an iron rod was accidentally driven through the head of Phineas Gage in 1848, this constituted an "accidental lobotomy", or that this event somehow inspired the development of surgical lobotomy a century later. According to the only book-length study of Gage, careful inquiry turns up no such link.[59][60]
Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it. The 1946 novel All the King's Men by Robert Penn Warren described a lobotomy, saying it "would have made a Comanche brave look like a tyro [novice] with a scalping knife." The surgeon is portrayed as a repressed man who couldn't change others with love but instead resorted to "high-grade carpentry work."[61] In Tennessee Williams's 1958 play, Suddenly, Last Summer, the protagonist is threatened with a lobotomy to stop her from telling the truth about her cousin Sebastian.[62] The surgeon says, "I can't guarantee that a lobotomy would stop her babbling." Her aunt responds, "That may be, maybe not, but after the operation who would believe her, Doctor?"[63]
A damning portrayal of the procedure is found in Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest and its 1975 movie adaptation. Several patients in the mental ward receive lobotomies to discipline or calm them. The operation is described as brutal and abusive, a "frontal-lobe castration". The book's narrator, Chief Bromden, is shocked: "There's nothin' in the face. Just like one of those store dummies." One patient's surgery changes him from an acute to a chronic mental condition. "You can see by his eyes how they burned him out over there; his eyes are all smoked up and gray and deserted inside."[61]
Other sources include Sylvia Plath's 1963 novel The Bell Jar, in which the protagonist, Esther, reacts with horror to the "perpetual marble calm" of a lobotomized young woman named Valerie.[61] Elliott Baker's 1964 novel and 1966 film version, A Fine Madness, portrays the dehumanizing lobotomy of a womanizing, quarrelsome poet who in the end is just as aggressive as ever. The surgeon is depicted as an inhumane crackpot.[64] In the 1968 film Planet of the Apes, time travelling astronaut Landon (Robert Gunner) is subjected to a lobotomy by Dr. Zaius (Maurice Evans) and rendered catatonic in an effort to shield the truth from the Ape race by covering up the fact that man was once an intelligent being capable of speech. The 1982 biopic Frances includes a disturbing scene showing actress Frances Farmer undergoing transorbital lobotomy. The claim[65] that a lobotomy was performed on Farmer (and that Freeman performed it) has been criticized as having little or no evidence supporting it.[66][67] In Unruhe, an episode in the fourth season of The X-Files, a kidnap victim is discovered wandering aimlessly along a road, staring blankly ahead and not responding to any of her surroundings. She is hospitalized and a PET scan reveals that a transorbital lobotomy, done incorrectly, has been performed on her. It is performed on another woman and Scully herself narrowly escapes the procedure. In the 2011 movie Sucker Punch, Babydoll's impending lobotomy is what drives her to try to escape from the Institute. An ice-pick type leucotome forms part of the detail around the "S" of the film's title, counterpoised by the final upright of the "H" being a Samurai sword. In The Simpsons 2F03, Treehouse of Horror V, Moe is subjected to a full frontal lobotomy after undergoing 'Re-neducation' leaving him drooling and somewhat incapacitated. He keeps the removed piece of brain in a jar. Lobotomization is a plot element in the 2001 film, From Hell with Johnny Depp and Heather Graham.
- ^ Walter Freeman had originally used ice picks for his modified form of the leucotomy operation that he termed transorbital lobotomy. However, because the ice picks would occasionally break inside the patient's head and have to be retrieved, he had the very durable orbitoclast specially commissioned in 1948. Acharya, Hernish J. (2004). The Rise and Fall of Frontal Leucotomy. In Whitelaw, W.A. The Proceedings of the 13th Annual History of Medicine Days. Calgary: p. 40.
- ^ "The Nobel Prize in Physiology or Medicine 1949 Walter Hess, Egas Moniz". Nobelprize.org. http://nobelprize.org/nobel_prizes/medicine/laureates/1949/index.html. Retrieved 6 July 2010. (Walter Rudolf Hess was awarded a share of the prize for his work on the function of the midbrain and was not involved with leucotomy.)
- ^ Braslow, Joel. T. (1997). Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century. University of California Press: pp. 126–127
- ^ Shorter, Edward (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley: pp. 390–391, n. 161.
- ^ "lobotomy". http://www.britannica.com/EBchecked/topic/345502/lobotomy. Retrieved 2 June 2012.
- ^ Swayze, VW; N (1995). "Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935–1954): a historical overview". American Journal of Psychiatry 152 (4): 505–515. PMID 7900928. http://ajp.psychiatryonline.org/cgi/content/abstract/152/4/505.
- ^ Ugo Cerletti, for instance, described psychiatry during the interwar period as a "funereal science". Quoted in Shorter, Edward (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley: p. 218. See also: Hoenig, J. (1995). Schizophrenia. In Berrios, German and Porter, Roy (Eds.), A History of Clinical Psychiatry. Athlone: p. 337
- ^ Meduna L.J. (1985). "Autobiography of L.J. Meduna". Convulsive Therapy 1 (1): 53.
- ^ Brown, Edward M. (2000). Why Wagner-Jauregg won the Nobel Prize for discovering malaria therapy for General Paresis of the Insane. History of Psychiatry. 11 (4): pp. 371–382;
- ^ Shorter, Edward (1997). A History of Psychiatry. Wiley: pp. 190–225.
- ^ Jansson, Bengt (29 October 1998). "Controversial Psychosurgery Resulted in a Nobel Prize". Nobelprize.org. http://nobelprize.org/nobel_prizes/medicine/laureates/1949/moniz-article.html. Retrieved 6 July 2010.
- ^ For instance, G.W.T.H. Fleming, editor of the Journal of Mental Science, which would later become the British Journal of Psychiatry, and Medical Superintendent of a private psychiatric institution in Gloucester, remarked: 'At first sight the operation [leucotomy] would appear to be a revolutionary proceeding; and so it is in some ways. It is, however, no more drastic than the convulsion or insulin treatments in which the patient is near enough the line which separates life and death'. Fleming, G.W.T.H. (1942). Some preliminary remarks on prefrontal leucotomy. Journal of Mental Science. 88 (371): 282.
- ^ Braslow, Joel (1997). Mental Ills and Bodily Cures. University of California Press: p. 3.
- ^ Porter, Roy (1999). The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. Fontana Press: p. 520.
- ^ Gross, Dominik; Gereon Schäfer (2011). "Egas Moniz (1874–1955) and the "invention" of modern psychosurgery: a historical and ethical reanalysis under special consideration of Portuguese original sources". Neurosurgical Focus 30 (2): 8. Heller, A. C; A. P Amar, C. Y Liu, M. L.J Apuzzo (2006). "Surgery of the mind and mood: A mosaic of issues in time and evolution". Neurosurgery 59 (4): 727. Joanette, Yves; Brigitte Stemmer, Gil Assal, Harry Whitaker (1993). "From theory to practice: the unconventional contribution of Gottlieb Burckhardt to psychosurgery". Brain and Language 45 (4): 572, 575. DOI:10.1006/brln.1993.1061. PMID 8118674. Kotowicz, Z. (2008-12). "Psychosurgery in Italy, 1936-39". History of Psychiatry 19 (4): 486. DOI:10.1177/0957154X07087345. ISSN 0957-154X. Manjila, S.; S. Rengachary, A. R Xavier, B. Parker, M. Guthikonda (2008). "Modern psychosurgery before Egas Moniz: a tribute to Gottlieb Burckhardt". Journal of Neurosurgery: Pediatrics 25 (1): 1. Noll, Richard (2007-01). The encyclopedia of schizophrenia and other psychotic disorders. Infobase Publishing. p. 326. ISBN 978-0-8160-6405-2. http://books.google.ie/books?id=jzoJxps189IC&pg=PA326. Reevy, Gretchen; Yvette Malamud Ozer, Yuri Ito (2010-09). Encyclopedia of Emotion. ABC-CLIO. p. 485. ISBN 978-0-313-34576-0. http://books.google.ie/books?id=tnPkFDU8orEC&pg=PA485. Steck, A.J. (2010). "Milestones in the development of neurology and psychiatry in Europe". Schweizer Archiv fur Neurologie und Psychiatrie 161 (3): 85–9. http://www.embase.com.eproxy.ucd.ie/search/results?subaction=viewrecord&rid=2&page=1&L358651728. Retrieved 2011-08-12. Stone, James L. (2001-01). "Dr. Gottlieb Burckhardt the Pioneer of Psychosurgery". Journal of the History of the Neurosciences 10 (1): 79–92. DOI:10.1076/jhin.10.1.79.5634. ISSN 0964-704X. PMID 11446267. http://www.informaworld.com/openurl?genre=article&doi=10.1076/jhin.10.1.79.5634&magic=crossref%7CD404A21C5BB053405B1A640AFFD44AE3. Retrieved 2011-08-12. Suchy, Yana (2011-01-20). Clinical Neuropsychology of Emotion. Guilford Press. p. 37. ISBN 978-1-60918-072-0. http://books.google.ie/books?id=Zy5tzjiUV9oC&pg=PA37. Mareke, Arends; Fangerau, Heiner (2010). "Deep brain stimulation in psychiatric disorders". In Fangerau, Heiner; Jörg, Fegert; Mareke, Arends. Implanted Minds: The Neuroethics of Intracerebral Stem Cell Transplantation and Deep Brain Stimulation. Verlag. p. 138. ISBN 978-3-8376-1433-6. http://books.google.ie/books?id=pzI0Kj21KIcC&pg=PA138. Ford, Paul J.; Henderson, Jaimie M. (2006). "Functional neurosurgical intervention: neuroethics in the operating rooms". In Illes, Judy. Neuroethics: defining the issues in theory, practice, and policy. Oxford University Press. p. 219. ISBN 978-0-19-856721-9. http://books.google.ie/books?id=m7USFu5Z0lQC&pg=PA219. Green, Alexander; Astradsson, A.; Stacey, R.J.; Aziz, T.Z. (2010). "Functional and epilepsy neurosurgery". In Johnson, Reuben; Green, Alexander. Landmark Papers in Neurosurgery. Oxford University Press. p. 208. ISBN 978-0-19-959125-1. http://books.google.ie/books?id=dp58uHAFr-kC&pg=PA208. Sakas, Damianos E.; Panourias, L.G.; Singounas, E.; Simpson, B.A. (2007). "Neurosurgery for psychiatric disorders: from the excision of brain tissue to the chronic electrical stimulation of neural networks". In Sakas, Damianos E.; Simpson, B.A.. Operative Neuromodulation. Functional Neuroprosthetic Surgery: An Introduction. Springer. pp. 366. ISBN 978-3-211-33078-4. http://books.google.ie/books?id=pWOx5aU6v3YC&pg=PA366. Whitaker, H.A.; Stemmer, B.; Joanette, Y. (1996). "A psychosurgical chapter in the history of cerebral localization: the six cases of Gottlieb Burkhardt". In Code, Christopher; Wallesch, C.-W.; Joanette, Y.; Roch, A.. Classic Cases in Neuropsychology. Hove: Psychology Press. pp. 276. ISBN 978-0-86377-395-2. http://books.google.ie/books?id=59pMz9m83yQC&pg=PA276. However, Kotowicz notes a difference, irregularly observed, among medical historians and medical practitioners in their location of the origin of psychosurgery. The latter group, he contends, tend to favour beginning the narrative with Burckhardt while the former group favour starting with Moniz. Kotowicz, Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz–Two Beginnings of Psychosurgery". Gesnerus 62 (1–2): 78–9. In the context of early psychosurgery, Berrios unusually also refers to the operations performed in 1889 by a surgeon (Harrison Cripps) at the behest of the British psychiatrist Thomas Claye Shaw in which fluid was drawn from the brain of a patient diagnosed with General Paralysis of the Insane. While the purpose of the operation was aimed towards the alleviation of mental symptoms attendant on the condition the procedure did not aim to interfere directly with brain tissue and therefore it has been excluded from most conventional accounts of psychosurgery. Berrios, German E. (1991). "Psychosurgery in Britain and elsewhere: a conceptual history". In Berrios, German E.; Freeman, Hugh. 150 Years of British psychiatry, 1841–1991. Gaskell. pp. 181–5. ISBN 978-0-902241-36-7.
- ^ a b Kotowicz, Z. (2005). "Gottlieb Burckhardt and Egas Moniz - two beginnings of psychosurgery". Gesnerus 62 (1–2): 77–101. PMID 16201322.
- ^ Doby, T (1992) Cerebral Angiography and Egas Moniz. American Journal of Roentgenology. 359 (2): p. 2. Indeed, prior to his exploration of psychosurgery, he had twice been nominated for, and twice failed to win, a Nobel Prize for this work. Edward Shorter, perhaps unfairly, attributes his development of the leucotomy procedure to his desire to finally capture that noble accolade.
- ^ Shorter, Edward (1997). A History of Psychiatry. Wiley: p. 226.
- ^ Kotowicz, Zbigniew (2005). Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery. Gesnerus. 62 (1/2): pp. 83, 80, 78.
- ^ Jansson, Bengt (1998-10-29). "Controversial Psychosurgery Resulted in a Nobel Prize". Nobelprize.org. Nobel Web AB. http://nobelprize.org/nobel_prizes/medicine/laureates/1949/moniz-article.html. Retrieved 2008-03-30. . For an account by Moniz of the procedure see: Moniz, Egas (1937). Prefrontal Leucotomy in the Treatment of Mental Disorders. Reproduced in American Psychiatric Association, Sesquicentennial Anniversary 1844–1944. American Psychiatric Publishing: p. 237.
- ^ Kotowicz, Zbigniew (2005)Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery. Gesnerus. 62 (1/2): p. 81.
- ^ Berrios G.E. (1997). "The Origins of Psychosurgery: Shaw, Burckhardt and Moniz". History of Psychiatry 8 (1): 74–76.
- ^ Berrios, G.E. (1997). The Origins of Psychosurgery: Shaw, Burckhardt and Moniz. History of Psychiatry. 8 (1): pp. 72.
- ^ Kotowicz, Zbigniew (2005). Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery. Gesnerus. 62 (1/2): p. 88. Moniz wrote in 1948: 'sufferers from melancholia, for instance, are distressed by fixed and obsessive ideas ... and live in a permanent state of anxiety caused by a fixed idea which predominates over all their lives ... in contrast to automatic actions, these morbid ideas are deeply rooted in the synaptic complex which regulates the functioning of consciousness, stimulating it and keeping it in constant activity ... all these considerations led me to the following conclusion: it is necessary to alter these synaptic adjustments and change the paths chosen by the impulses in their constant passage so as to modify the corresponding ideas and force thoughts along different paths...' Quoted in: Berrios, G.E. (1997). The Origins of Psychosurgery: Shaw, Burckhardt and Moniz. History of Psychiatry. 8 (1): p. 74.
- ^ Kotowicz Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery" (PDF). Gesnerus 62 (1/2): 88. http://www.gesnerus.ch/fileadmin/media/pdf/2005_1-2/077-101_Kotowicz.pdf.
- ^ Kotowicz Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery" (PDF). Gesnerus 62 (1/2): 84. http://www.gesnerus.ch/fileadmin/media/pdf/2005_1-2/077-101_Kotowicz.pdf.
- ^ Berrios G.E. (1997). "The Origins of Psychosurgery: Shaw, Burckhardt and Moniz". History of Psychiatry 8 (1): 74.
- ^ Kotowicz Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery" (PDF). Gesnerus 62 (1/2): 89. http://www.gesnerus.ch/fileadmin/media/pdf/2005_1-2/077-101_Kotowicz.pdf.
- ^ See, for instance, Shorter's account: Shorter, Edward (1997). A History of Psychiatry. Wiley: p. 226. This conference also held "a remarkable symposium...on the functions of the frontal lobes".
- ^ Freeman Walter, Watts James W (1944). "Psychosurgery: An Evaluation of Two Hundred Cases over Seven Years". Journal of Mental Science 90 (379): 532.
- ^ Berrios G.E. (1997). "The Origins of Psychosurgery: Shaw, Burckhardt and Moniz". History of Psychiatry 8 (1): 72–73.
- ^ Kotowicz Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery" (PDF). Gesnerus 62 (1/2): 84. http://www.gesnerus.ch/fileadmin/media/pdf/2005_1-2/077-101_Kotowicz.pdf.
- ^ "The Nobel Prize in Physiology or Medicine 1949". Nobelprize.org. Nobel Web AB. http://nobelprize.org/nobel_prizes/medicine/laureates/1949/. Retrieved 2008-03-30. He shared the prize with the Swiss physiologist Walter Hess.
- ^ Kotowicz, Zbigniew (2005).Gottlieb Burckhardt and Egas Moniz - Two Beginnings of Psychosugery. Gesnerus. 62 (1/2): p. 78 n. 2.
- ^ Shorter, Edward (1997). A History of Psychiatry.Wiley: p. 227.
- ^ Frank Freeman, Walter Freeman's son, stated in an interview with Howard Dully that: "He had several ice-picks that just cluttered the back of the kitchen drawer. The first ice-pick came right out of our drawer. A humble ice-pick to go right into the frontal lobes. It was, from a cosmetic standpoint, diabolical. Just observing this thing was horrible, gruesome." When Dully asked Frank Freeman, then a 79-year-old security guard, whether he was proud of his father, he replied: "Oh yes, yes, yeah. He was terrific. He was really quite a remarkable pioneer lobotomist. I wish he could have gotten further." Walter Freeman's son Frank tells Howard Dully about the origins of the transorbital lobotomy developed by Doctor Freeman. Extract from radio documentary: Dully, Howard. (2005). 'My Lobotomy': Howard Dully's Journey. All Things Considered. NPR. Accessed 28th November, 2009.
- ^ Rodney Dully, whose son Howard Dully had had a transorbital lobotomy performed on him by Walter Freeman when he was twelve years old , stated in a interview with his son that: "I only met him [Freeman] I think the one time. He described how accurate it [transorbital lobotomy] was and that he had practised the cutting on, literally, a carload of grapefruit, getting the right move and the right turn. That's what he told me." In 2004, for the first time since the operation, Rodney Dully, Howard Dully's father, agreed to discuss the lobotomy with his son. Extract from radio documentary: Dully, Howard. (2005). 'My Lobotomy': Howard Dully's Journey. All Things Considered. NPR. Accessed 28th November, 2009.
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- Shutter Island (2010)
