Good intentions with tragic consequences
So where did lobotomy come from and why did it become popular so quickly? The answer lies in historical facts and coincidences, the human qualities of individual doctors, the degree of defenselessness of patients in psychiatric clinics, and even the nuances of politics and economics in some countries.
The discoverer of lobotomy as a treatment method in psychiatry is considered to be the Portuguese Egas Moniz, who became the first who decided to use the technique on humans. Previous studies were limited to lobotomies in chimpanzees, but Egash went further, which he himself did not regret at all, which cannot be said about the relatives of his patients.
The development of brain lobotomy dates back to 1935, when Moniz suggested that uncoupling the neural pathways of the frontal lobe of the brain could be effective in a number of psychiatric diseases. Without conducting enough research and without weighing the risks, the psychiatrist decided to intervene the following year. Since gout prevented him from carrying it out on his own, he entrusted the experiment, which he personally supervised, to neurosurgeon Almeida Lima.
During the operation, the white matter pathways of the frontal lobes were separated, connecting these sections with other brain structures, but the lobes themselves were not destroyed, hence the name “leucotomy”. The manipulation was announced as a life-saving radical method for hopeless patients.
The operation, which was proposed by E. Moniz, was carried out as follows: using a special conductor, a metal loop was inserted into the substance of the brain, which was to be rotated to destroy the nervous tissue. There was no talk of any more or less adequate anesthesia.
Under the leadership of Moniz, about a hundred lobotomies were performed, and history is silent about the peculiarities of patient selection, determination of indications, and methods of previous treatment. When assessing the postoperative condition of patients, Moniz was quite subjective, and the observation itself was limited to a few days, after which the patients dropped out of the doctor’s field of vision and no one was particularly worried about their fate.
Having identified lobotomy as an effective method of treatment, Moniz immediately began to promote it among his colleagues, reporting meager observational results, limited to two dozen people operated on, but presented as reliable evidence of the effectiveness of the new technique. What motivated the doctor and why such a rush is not entirely clear. Maybe it was really a delusion with good intentions, or perhaps it was a desire to become famous and go down in history. One way or another, the name Moniz is known in narrow circles and has gone down in history.
According to data published by Moniz, seven out of 20 operated patients recovered, the same number showed improvement, and six remained without positive dynamics. The adverse consequences that inevitably awaited all patients were kept silent. Actually, the psychiatrist himself did not try to find out about them, releasing the patients on all four sides a few days after the operation.
Today, such a small observation seems somewhat unreal, unable to provide at least some basis for conclusions, but even in the last century, scientists sharply criticized the data of E. Moniz. However, the latter published many publications and even books dedicated to leucotomy.
examples of “before and after” “successfully” performed lobotomies
The further history of brain lobotomy unfolded tragically quickly, the operation became extremely popular, and the number of victims from it is estimated in tens of thousands in America alone.
Opponents of the method pointed out that the consequences of the operation are similar to those that occur with traumatic brain injury, focusing special attention on personality degradation. Calling for the abandonment of lobotomy, they explained that irreparable damage to any organ cannot make it healthier, especially when it comes to such a complex and little-studied structure as the human brain. In addition to the risk of neurological and mental disorders, lobotomy was considered dangerous due to the likelihood of meningitis and brain abscess.
The efforts of lobotomy opponents were in vain: the operation was adopted as an experimental treatment method by specialists not only from the USA and South America, but also by psychiatrists in Italy and other European countries. By the way, the indications for it were never formulated, and the experiment was literally put on hold, and not a single practicing doctor bore responsibility for its result.
In 1949, Egas Moniz was awarded the Nobel Prize for the development of lobotomy as a therapeutic measure for psychiatric pathology. Somewhat later, the relatives of those patients who were subjected to barbaric treatment asked to reverse this decision, but all their requests were rejected.
The peak use of lobotomy occurred in the early forties of the twentieth century, when it became very popular in the United States. One of the reasons is quite banal: the high costs of maintaining patients and staff in psychiatric departments, which became overcrowded against the backdrop of World War II with former soldiers who experienced extreme stress and could not cope with it on their own. Such patients often turned out to be aggressive or too agitated, it was quite difficult to control them, there were no special medications, and the clinics were forced to maintain a large staff of orderlies and nurses.
Lobotomy was a cheap and relatively simple way to deal with aggressive and uncontrollable patients, so the authorities even organized special training programs for surgeons. It is estimated that using the operation would reduce costs by $1 million daily. In addition, there were no effective methods of conservative treatment for mental illness at that time, so lobotomy quickly gained popularity.
How did the idea of doing a lobotomy come about?
Wilhelm Roentgen discovered X-rays for studying the skull and other bones. The brain remained shrouded in mystery. Moniz undertook to shed light on the study of this important organ of the nervous system.
In 1927, he began using iodine preparations, thorium dioxide, to inject a contrast agent into the blood vessels of the brain. Thus, it became clear how they are located throughout the volume as the liquid spreads.
He also developed intraoperative access to the carotid artery through the temporal part of the skull. To this day, in surgery this method is named after him.
In 1935, the doctor went to the Second International Congress of Neurology in the capital of England. Two scientists from America spoke there and opened the first laboratory for the study of monkeys . They presented the results of observations of animals that had their prefrontal cortex removed. As a result, the monkeys' anxiety decreased, but at the same time their cognitive abilities.
This is what prompted Monisha to apply this technique to people. Directly to patients with severe levels of mental impairment.
He tried to be humane, so he decided not to remove the entire frontal lobe. But only the white matter that connects the front part of the brain with the neighboring one.
Dr. Freeman and the ice pick
Meanwhile, the war ended, and there were fewer and fewer former military personnel admitted to psychiatry. It would seem that there was no longer such a need for a lobotomy. However, not only were operations not suspended. According to some reports, their popularity only began to grow, and surgeons could already demonstrate new instruments and methods of destroying nervous tissue, without being embarrassed at all if the patient was a child.
In many ways, the widespread use of lobotomy after 1945 was due to the American psychiatrist Walter Freeman, who proposed the so-called transorbital lobotomy. Its difference from previously used techniques is in the approach through the orbit. Freeman actively promoted leucotomy and performed more than one thousand such operations himself.
By the way, not only the lobotomy looks barbaric, but also the methods of pain relief. In a number of cases they were absent altogether, and the same Freeman, during the first operation he performed, provided analgesia to the poor fellow with electroconvulsive effects. After strong electrical discharges, the patient loses consciousness for a short time, but this is enough to perform a lobotomy.
Freeman's technique consisted of inserting a sharp instrument resembling an ice pick into the eye socket and then into the brain. Using a hammer and such a knife, Freeman got through the puncture of the bone directly to the brain, in which he cut the nerve fibers. According to the doctor, such treatment was supposed to relieve a patient suffering from mental illness from aggression, strong emotionality and uncontrollability.
There is information according to which it was the ice pick that became the tool that seemed most suitable for transorbital lobotomy. According to Freeman's relatives, during one of the operations, which, by the way, was not always carried out not only in the operating room, but also in the clinic in general, a surgical instrument broke. The action took place at home, and the surgeon had an ice knife at hand, which he hastened to point at the patient’s brain. The knife seemed convenient, and thus Freeman, having slightly modified it and provided it with divisions indicating length, became the inventor of the leukotome and orbitoclast.
Freeman lobotomy technique
Let us remember that the operation was done blindly, that is, neither before nor after, no one conducted any studies of the brain, and in those years they did not know about MRI at all. The surgeon or psychiatrist would destroy those areas of the brain that were in the path of the cutting instrument, without worrying one bit about the extent of the damage that could be done.
In fairness, it should be noted that the first results of lobotomies were indeed positive, because aggressive patients almost immediately became calm and even indifferent to what was happening. However, this does not justify the operation itself, since it was performed in completely different ways for patients with different diagnoses.
In addition, there was no clear system for analyzing the results, and the factor of controllability of the operated patient after the intervention acted as a criterion for cure. The “calmed down” mentally ill people left the clinic and no one was interested in their further well-being and fate.
What is a lobotomy: general concepts
By and large, no treatment was carried out as such; patients were “closed” in mental hospitals, from where it was almost impossible to return to a full life. Therefore, doctors struggled to develop an effective way to treat these people. And so Egas Moniz proposed to disrupt one of the frontal parts of the human brain, since it is the frontal parts that are responsible for the mental adequacy of people’s behavior.
Some time after the congress of doctors in 1936, under the leadership of Egas, surgeon Almeida Lima performed a human lobotomy, the first in the world. Two holes were drilled into the skull of a woman who suffered from paranoia, through which alcohol was injected, which destroyed part of the brain in the frontal region. The operation was called leucotomy (translated from Greek λευκός - white, since the substance of the brain of the head is white when cut, and τομή - cut). That is, nothing was removed from the cranial cavity. The patient's condition improved and, inspired by the success, doctors began to introduce this method of treatment.
Subsequently, Egas Moniz improved this operation. A special surgical instrument was developed - a leukotome , which cut brain tissue with a wire loop. Of the 20 people who were subjected to lobotomy, 7 began to feel better, another 7 had an insignificant result, and 6 had no effect at all. The less than positive results did not stop Egash from continuing to use this method of treatment, and in 1949 he was even awarded the Nobel Prize for his contribution to the treatment of complex mental disorders.
Moniz's idea was very quickly and actively picked up in the USA. Neurosurgeon James Watts and psychiatrist and neurologist Walter Freeman began performing lobotomies, which also required drilling holes in the skull and, accordingly, was not available to most psychiatric clinics (since this required a special doctor, a neurosurgeon). Freeman set himself the task of simplifying lobotomy so much that every psychiatrist could perform this operation independently. And after some time, he proposed an operation called transorbital lobotomy.
but on the other hand
Almost a decade after the start of the experimental use of lobotomies, more scrupulous studies of its feasibility and even danger began. Thus, it turned out that mortality after surgery reaches 6%, and side effects include convulsive syndrome in a third of patients, obesity, impaired motor function up to paralysis, dysfunction of the pelvic organs, speech, and much more.
But the influence of lobotomy on a person’s personality, intelligence and behavior was much more disastrous. In almost all those operated on, the intelligence decreased to the level of infancy, control over behavior and actions was lost, emotional lability, indifference, lack of initiative and the ability to take purposeful, meaningful actions were observed. I lost self-criticism about the world around me, the ability to make plans, work and live more or less fully in society.
By the way, Freeman himself did not regard such changes in personality, which practically ceased to exist, as a negative result of treatment. According to his observations, a quarter of those operated on regressed intellectually to the level of a domestic animal, but became manageable and quiet.
Longer observations have shown that 10-15 years after a lobotomy, the connection between the frontal lobes and other brain structures is partially restored, returning hallucinations, delusional disorders, and aggression to mentally ill people, but not intelligence. Repeated operations further aggravated the intellectual and personality changes.
How it all began
In 1874, Antonio Caetano de Abreu Freire . He was interested in politics, after which he switched to medicine. There is an opinion that he wanted to achieve fame, and in this area it is much easier to become famous.
It is unlikely that Freire’s surname can be easily found in reference books and other documents, since during his student years he opposed the monarchy of his native country, so he had to hide and take the pseudonym of Egas Moniz, a figure of the 12th century.
He graduated from the University of Coimbra and received a degree for his work on diphtheria in 1899. At the same time, he fell ill with gout. In 1902 he wrote a treatise on the pathophysiology of sex, and then left medicine and became a government official for 14 years.
In 1917, he returned to science and published a voluminous monograph, “Military Neurology.” Observed soldiers in World War I who had wounds to the head. Even then he was interested in the effect of brain injury on human behavior and psyche.
In the same year, Moniza became such an influential figure in politics that he was tasked with signing the Treaty of Versailles on behalf of Portugal, after which he became Ambassador of Spain. Later - Minister of Foreign Affairs.
Some Terrifying Facts About Lobotomy
The scale of the ongoing lobotomy campaign is impressive: by the middle of the last century, up to 5,000 of them were performed annually in America alone. In total, during the period from the first experiment, about fifty thousand American patients were treated, and not only severe schizophrenia, but also neuroses, anxiety disorders, and depression could be the reason for the operation.
Other truly strange circumstances for surgical treatment include the conditions of the operation - in Dr. Freeman's special van, in the ward, and even at home. Without observing asepsis and antisepsis, using unsterile instruments, in the presence of a large number of observers.
Lobotomies were widely practiced by psychiatrists who had a vague understanding of surgery, the peculiarities of brain operations and its anatomy. Dr. Freeman himself did not have a surgical education, but managed to perform approximately 3.5 thousand lobotomies.
There is also an abuse of lobotomy under plausible pretexts: it began to be performed on poorly controlled and hyperactive children, grumpy wives, and emotionally unstable young women. By the way, there were much more women among those operated on than men.
Since the second half of the twentieth century, it was no longer possible to hide the most serious negative consequences of lobotomy. The operation was finally recognized as dangerous and was banned at the legislative level. Tens and thousands of victims of the inhumane treatment method, broken lives, as well as relatives who actually lost loved ones during their lifetime - confirmation of not a therapeutic, but a crippling result of the effect on the brain.
When was the lobotomy operation cancelled?
Not all neurosurgeons supported this method of treatment. Very often thoughts were expressed about the increased traumatic nature of these procedures and the inappropriateness of this method of treatment. Relatives of patients to whom the operated patients were returned in a state of “vegetables” began to write complaints and petitions so that this inhumane method of treatment would be banned.
The only thing on which most doctors agreed was that lobotomy could only be used in situations where none of the treatment methods existing at that time (including electric shock, insulin therapy) showed any positive effect, and the person was very aggressive and could cause harm to others or yourself.
But at the same time, lobotomy gradually began to gain momentum and was performed even in the most banal situations . For example, one child was lobotomized at the age of 12 due to his bad behavior and disobedience. And this is not just one example. The abuse of such a surgical method of therapy as lobotomy, unfortunately, has been noted more than once.
The decline of lobotomy dates back to the 1950s. In the Soviet Union, after studying the effectiveness of lobotomy treatment on 400 patients in 1950, the Ministry of Health issued a decree officially banning this method of treatment. In some countries, such as Norway, America, France, England, India, Belgium, Spain, Finland and some others, lobotomy was performed until the 80s of the 20th century. There is no exact date for the ban on these terrible operations.
After investigating some cases of lobotomy, in 1977 the National Committee for the Protection of Human Subjects from Behavioral and Biomedical Research concluded that only in some situations this operation is justified, and, by and large, it is absolutely ineffective . And over time, this treatment fell into oblivion. An important role in this was played by the fact that in 1950 the antipsychotic Chlorpromazine (Aminazine) was created for the first time in the world. When it began to be used in psychiatric practice, it became a major breakthrough in treatment. And after this, there was no longer a need for a lobotomy, since it was now possible to reduce the phenomena of psychosis with the help of ordinary injections.
Soviet scientists are against it?
In the USSR, psychiatrists and neurosurgeons approached the issue of lobotomy quite carefully, without rushing to massively destroy the brains of Soviet people with a knife. The first to doubt the appropriateness of the method was the outstanding surgeon N. N. Burdenko, who instructed his doctoral student Yu. B. Rozinsky to carefully analyze the essence and prospects of lobotomy for severe psychiatric pathology.
However, there were also like-minded people in the Soviet Union of Freeman and Moniz, in particular, Professor A. S. Shmaryan, who actively promoted prefrontal lobotomy and even found a supporter of the method among neurosurgeons - not just someone, but an outstanding neurosurgeon scientist, the future director of the Institute of Neurosurgery.
Professor Egorov, who performed lobotomies “at the suggestion” of Shmaryan, approached the issue of surgical technique more carefully, using his own modification - osteoplastic trepanation for good revision and orientation at the site of destruction of brain tissue. The “Soviet” version of leucotomy was much more gentle, since it involved only unilateral intersection of the nerve tracts while preserving the integrity of the ventricular system, pyramidal tracts and basal ganglia.
Patients who were sent for a lobotomy were selected extremely strictly. The operation was considered advisable only when none of the known conservative methods with long-term use gave positive dynamics, including insulin comas and electric shock.
Before the operation, the patients were carefully examined by therapists, neurologists, and psychiatrists. After the lobotomy, the observation continued, and the doctors clearly recorded absolutely all changes in the psyche, social adaptation, and behavior of those operated on. Both positive and negative consequences, including death, were objectively analyzed. Thus, Russian doctors were able to formulate the reasons and obstacles to prefrontal lobotomy.
By 1948, based on the accumulated observational data of patients after lobotomies, the operation was recognized in principle as permissible, but only if carried out by a highly qualified neurosurgeon, in a hospital, in case of irreversible brain damage and the ineffectiveness of all possible treatment methods.
In parallel, neurophysiology begins to develop, new approaches to neurosurgical techniques for lobotomy are substantiated, and new instruments and approaches appear. The results seemed satisfactory: more than half of the patients with paranoid schizophrenia experienced improvement, and a fifth experienced restoration of normal mental status, ability to work, and intelligence.
However, it was not possible to avoid consequences in the form of “frontal” and intellectual disorders even with the most gentle approaches. The debate between opponents and supporters of psychosurgery did not subside. And if in 1949 lobotomy was considered a relatively safe and even effective intervention, then a year later, in 1950, it was banned at the government level.
The ban on lobotomy in the USSR was dictated more by scientific ideas and the results of clinical trials than by political reasons. Severe psychoneurological changes in the postoperative period did not allow lobotomy to be included in the list of officially approved operations.
Lobotomy was banned thanks to the efforts of Professor Gilyarovsky, who repeatedly raised discussions of this problem among scientists. The checks he initiated showed that the intervention was carried out not only by surgeons, but also by psychiatrists, and all patients were left with organic disorders of brain activity expressed to varying degrees.
The history of lobotomies in Russia was marked by a devastating article by Gilyarovsky in the journal “Medical Worker”, where both the treatment method itself and its justification by American psychiatrists were criticized, and then by a publication in Pravda, in which lobotomy was called a pseudoscientific method of bourgeois medicine, which has no place among Soviet doctors raised in the spirit of humanism. On December 9, 1950, lobotomy was officially banned in the USSR.
Fortunately, today lobotomy is a horrifying past, one of the unsightly examples of a scientific search that turned into a tragedy for many thousands of patients and their families. I would like to believe that modern medicine will not come up with a new treatment method that will become such a large-scale experiment on people, conducted with the support of the governments of fully developed countries.
Consequences after a lobotomy
We can safely say that there have been very rare cases when a lobotomy treated a mental illness, without causing harm to a person’s health. Most often, many of the results of a lobotomy were quite disastrous . What complications appeared after performing a lobotomy? Let's consider:
- epileptic seizures;
- infectious complications (encephalitis, meningitis);
- muscle weakness in the limbs (paralysis and paresis);
- violations of control over the work of the pelvic organs (defecation and urination);
- speech disorders;
- loss of sensation;
- death (up to 6% of total cases);
- rapid increase in human weight;
- emotional dullness, a significant decrease in intelligence (patients after surgery were called “vegetables” and compared to domestic animals).
As you can see, not all the time the elimination of mental disorders using a lobotomy could be compared with other “effects” of these operations. And, by and large, lobotomy did not always cure psychiatric diseases. Taking into account statistics, for one third of the people operated on, the operation was useless , for another third it was accompanied by significant complications, and only another third of patients received a certain therapeutic result.
