At the end of this month, the Douglas Institute will be hosting its third annual Mini-Psych School. I won’t be giving a presentation this year but I have the honour of hosting.
The previous years focussed on providing an overview of mental illnesses. As a change of pace this time, we decided to explore some interesting areas in the field of psychiatry such as “Does mental illness really exist?” and, “Has the use of medication in psychiatry gone too far?”
The first lecture will be given by our chief of psychiatry, Dr. Mimi Israel. She will explore the origins of stigmatization in mental illness and discuss the history of psychiatry. It should be a great kick-off to the series.
I had originally hoped to write about a personal milestone in last week’s column but that will have to wait until the next one (stay tuned). Instead, I decided to explore a theme from the Mini-Psych School and review a sad yet important chapter in the history of psychiatry. It is the story of the lobotomy.
The history of the lobotomy is a tragic example of what happens when lack of knowledge, self-serving motives, and paternalistic attitudes that disregard the rights of the mentally ill, converge.
The lack of knowledge was obvious. The gray blob that is brain tissue belies the incredible complexity of the organ. To assume you can simply slice through it without serious repercussions is a testament to one’s incredible ignorance. Too often we defer to “experts” without critical scrutiny.
When mental illness, or any other medical problem for that matter, has no cure and ruins lives, it is easy to fall prey to people, (and their “treatments”) that promise relief. Unfortunately, there is never a shortage of such people. Walter Freeman became rich and famous from the procedure long before he became infamous. But he was not the only one with self-serving interests. Families as well as psychiatric hospitals also bought into the promise because it made their lives easier. This attitude even resulted in some children receiving lobotomies because of rebellious behaviour.
Paternalistic attitudes were part of the zeitgeist of that era (although not necessarily completely gone today). The mentally ill are poor spokespeople for their diseases. That is why it was easy to disregard them and do what we thought was best for them. What they wanted was irrelevant since they were considered too ill to think for themselves.
The saddest well-known case of lobotomy was that of Rosemary Kennedy, the American President’s sister. She had an estimated IQ of 90 and could keep elaborate written diaries. When she started exhibiting mood swings, her father decided to have her lobotomized. During the procedure she was asked to recite songs or count backwards while the surgeons cut brain tissue. When her speech became incoherent, they stopped. The procedure left her incontinent and unable to speak for the rest of her life. She spent the remaining sixty-four years of her life in institutions.
In the film One Flew Over the Cuckoo’s Nest, Jack Nicholson’s character undergoes a lobotomy. A scene from the movie accompanied the text below in October 7th edition of Métro (Montréal).
And the Nobel goes to…Egas Moniz!
(Source: Journal Métro, Apprendre des erreurs du passé, October 7, 2008)In 1949, the Nobel Prize in physiology and medicine was awarded to Antonio Egas Moniz. Moniz was credited with perfecting the prefrontal leucotomy – a procedure that came to be known in psychiatry as a lobotomy. Moniz would drill holes into the prefrontal cortex of some mentally ill patients and destroy targeted brain tissue by injecting alcohol into the openings.
Walter Freeman followed up on Moniz’s work by developing a simpler and cheaper technique that did not require anesthesia or operating rooms. It involved sticking a long ice pick under the eyelid, hammering it into the brain through the eye socket and sweeping it back and forth like a windshield wiper. Lobotomies became so popular that tens of thousands of people underwent the procedure.
In order to understand the popularity of the lobotomy, one must first understand that psychotic illnesses, like schizophrenia, were untreatable in the Freeman and Moniz days. Some patients benefited from electroconvulsive therapy – or shock – but the effect usually wore off. Medications were not yet developed. Most patients were trapped in a world of demons, paranoia, and confusion. Many were so agitated or aggressive they had to be restrained with straight jackets or strapped onto their beds.
The lobotomy transformed aggressive and difficult patients into docile and manageable ones. The tide did not turn against the procedure until it became evident that it did not produce any cure. Worse still, many became vegetables from the brain damage. It turned out that lobotomy was little more than another form of restraint, a permanent one at that.
It is tempting to blame Moniz, Freeman and their colleagues for this sad chapter in the treatment of the mentally ill but nothing happens in a vacuum. Their success at the time was helped by the general lack of critical thinking when it came to psychiatric treatments. Since patients with serious conditions often could not speak for themselves, it was easy to see them as less than human. The focus thus shifted to the needs of others around them, such as making it easier to manage a psychotic person’s behaviour. The question of how the procedure impacted the patient’s own wellbeing, became secondary.
I tell this story because an understanding of past mistakes helps us improve scientific knowledge and develop effective treatments. More importantly, this understanding also helps us improve our attitudes toward the mentally ill and underscores the importance of respecting their rights.
Tagged as Egas Moniz, lobotomy, mental illness, Walter Freeman.
Posted in Mental health.
Posted on 13 Oct 2008
