Why did Moniz get the prize?
The award of the 1949 Nobel prize for Medicine or Physiology to Egaz Moniz for psychosurgery is perhaps the Nobel Committee's most famous mistake. How did it happen? Fifty years later, in 1999, the archives were opened and medical historian Carl-Magnus Stolt was able to look at the documents and write his conclusions in "Moniz, lobotomy, and the 1949 Nobel Prize" in a volume edited by Elisabeth Crawford, "Historical Studies in the Nobel Archives: the prizes in science and medicine", Uppsala Studies in the History of Science, 31, published by the Universal Academy Press, Tokyo, in 2002.
Stolt describes how the Portuguese neurosurgeon and politician had been nominated on four previous occasions. In 1928, 1933, and 1937 colleagues in Lisbon put his name forward for his radiological work. In 1943 it was Walter Freeman who nominated Moniz, this time for psychosurgery. The Nobel Committee asked a professor of psychiatry, Erik Essen-Moller, to write a special report. The report was critical of both Moniz' theories and his practice, in particular of the way Moniz first 20 patients included people who hadn't been ill for very long and were only followed up for a matter of weeks after surgery. Stolt goes on to say how Essen-Moller also looked at the literature on psychosurgery in other countries and remarked on the mortality rate of 3.5 per cent, the irreversible side effects, including increased aggression and "a surgically induced childhood", and on the lack of a comparison between psychosurgery and other treatments such as insulin treatment or electroconvulsive treatment. Stolt quotes Essen-Moller's conclusion: "the procedure is and will remain a mutilating operation. The question is, whether the positive effects will outweigh the negative. That seems to be the implication drawn from the literature in this case, where one needs to bear in mind that the negative side has yet to be heard."
Stolt describes how Moniz was nominated again in 1949, this time by five colleagues in Lisbon, two doctors in Brazil and one in Copenhagen. The Nobel Committee asked neurosurgeon Herbert Olivecrona to write a special report. Olivecrona's report was more enthusiastic than Essen-Moller's; he referred to the death rate of one to two per cent (which seems surprisingly low - it was certainly much higher than that in Britain in the 1940s) as "not worth mentioning" and said the side-effects were of "subordinate importance". His conclusion was that the operation was "a great therapeutic step forward". The prize was awarded to Moniz.
Stolt concludes his chapter:
"The debate surrounding the era of lobotomy continues in Sweden and elsewhere. When a Swedish medical journal discussed lobotomy in 1997, a comparison between lobotomy and forced sterilisation was made in several articles. The psychiatrist Christina Doctare wrote, "I think about how many people had to die, and all the victims of lobotomy who survived, who continue the rest of their lives as zombies, without the ability to care about anything". Doctare tells of the well-known artist Sigrid Hjerten: "when the trumpets sounded in the concert hall in 1949 for the medical prize for lobotomy, Sigrid Hjerten had been dead a year. She died on the operating table in 1948 whilst undergoing lobotomy".....
Finally, to sum up: the medico-historical analysis of lobotomy is an intensely complex interdisciplinary ethical and philosophical subject."
The Nobel Foundation has chosen to defend the 1949 decision by publishing an essay by Swedish psychiatrist Bengt Jansson (http://nobelprize.org/medicine/articles/moniz/) which unfortunately does not do justice to what Stolt calls "an intensely complex interdisciplinary ethical and philosophical subject". They refer to Jansson as a "knowledgeable expert" and as "someone who lived and worked during the time when this controversial therapy was introduced and practiced" (http://www.psychosurgery.org/index_files/Page2782.htm). Like anyone else his age (Jansson was born in 1932) he was alive when psychosurgery was introduced. When he started out in psychiatry, psychosurgery was still being used although not nearly as much as it was in the 1940s. Did he have any personal experience of psychosurgery in those days, or more recently? I don't know. There is no mention of personal experience in his essay and I have never come across his name before in the history of psychosurgery, although I am not too familiar with the Swedish literature. More importantly, the fact that most of the article is taken from an article by Victor Swayze which appeared in the American Journal of Psychiatry in 1995 suggests that Jansson is neither very knowledgeable or even very interested in psychosurgery. In fact Jansson's own contribution is limited to a few opening and closing paragraphs, in which he says: "However, I see no reason for indignation at what was done in the 1940s as at that time there were no other alternatives!" (Of course there were alternatives. Essen-Moller referred to them in his 1944 report to the Nobel Committee.) and "Actually, I think there is no doubt that Moniz deserved the Nobel Prize". There remains plenty of doubt, just as there was in 1940s when Essen-Moller and Olivecrona were able to produce such different reports. And the Nobel Foundation's failure to find a genuinely knowledgable expert who is prepared to defend the 1949 decision only adds to the doubt.
Stolt describes how the Portuguese neurosurgeon and politician had been nominated on four previous occasions. In 1928, 1933, and 1937 colleagues in Lisbon put his name forward for his radiological work. In 1943 it was Walter Freeman who nominated Moniz, this time for psychosurgery. The Nobel Committee asked a professor of psychiatry, Erik Essen-Moller, to write a special report. The report was critical of both Moniz' theories and his practice, in particular of the way Moniz first 20 patients included people who hadn't been ill for very long and were only followed up for a matter of weeks after surgery. Stolt goes on to say how Essen-Moller also looked at the literature on psychosurgery in other countries and remarked on the mortality rate of 3.5 per cent, the irreversible side effects, including increased aggression and "a surgically induced childhood", and on the lack of a comparison between psychosurgery and other treatments such as insulin treatment or electroconvulsive treatment. Stolt quotes Essen-Moller's conclusion: "the procedure is and will remain a mutilating operation. The question is, whether the positive effects will outweigh the negative. That seems to be the implication drawn from the literature in this case, where one needs to bear in mind that the negative side has yet to be heard."
Stolt describes how Moniz was nominated again in 1949, this time by five colleagues in Lisbon, two doctors in Brazil and one in Copenhagen. The Nobel Committee asked neurosurgeon Herbert Olivecrona to write a special report. Olivecrona's report was more enthusiastic than Essen-Moller's; he referred to the death rate of one to two per cent (which seems surprisingly low - it was certainly much higher than that in Britain in the 1940s) as "not worth mentioning" and said the side-effects were of "subordinate importance". His conclusion was that the operation was "a great therapeutic step forward". The prize was awarded to Moniz.
Stolt concludes his chapter:
"The debate surrounding the era of lobotomy continues in Sweden and elsewhere. When a Swedish medical journal discussed lobotomy in 1997, a comparison between lobotomy and forced sterilisation was made in several articles. The psychiatrist Christina Doctare wrote, "I think about how many people had to die, and all the victims of lobotomy who survived, who continue the rest of their lives as zombies, without the ability to care about anything". Doctare tells of the well-known artist Sigrid Hjerten: "when the trumpets sounded in the concert hall in 1949 for the medical prize for lobotomy, Sigrid Hjerten had been dead a year. She died on the operating table in 1948 whilst undergoing lobotomy".....
Finally, to sum up: the medico-historical analysis of lobotomy is an intensely complex interdisciplinary ethical and philosophical subject."
The Nobel Foundation has chosen to defend the 1949 decision by publishing an essay by Swedish psychiatrist Bengt Jansson (http://nobelprize.org/medicine/articles/moniz/) which unfortunately does not do justice to what Stolt calls "an intensely complex interdisciplinary ethical and philosophical subject". They refer to Jansson as a "knowledgeable expert" and as "someone who lived and worked during the time when this controversial therapy was introduced and practiced" (http://www.psychosurgery.org/index_files/Page2782.htm). Like anyone else his age (Jansson was born in 1932) he was alive when psychosurgery was introduced. When he started out in psychiatry, psychosurgery was still being used although not nearly as much as it was in the 1940s. Did he have any personal experience of psychosurgery in those days, or more recently? I don't know. There is no mention of personal experience in his essay and I have never come across his name before in the history of psychosurgery, although I am not too familiar with the Swedish literature. More importantly, the fact that most of the article is taken from an article by Victor Swayze which appeared in the American Journal of Psychiatry in 1995 suggests that Jansson is neither very knowledgeable or even very interested in psychosurgery. In fact Jansson's own contribution is limited to a few opening and closing paragraphs, in which he says: "However, I see no reason for indignation at what was done in the 1940s as at that time there were no other alternatives!" (Of course there were alternatives. Essen-Moller referred to them in his 1944 report to the Nobel Committee.) and "Actually, I think there is no doubt that Moniz deserved the Nobel Prize". There remains plenty of doubt, just as there was in 1940s when Essen-Moller and Olivecrona were able to produce such different reports. And the Nobel Foundation's failure to find a genuinely knowledgable expert who is prepared to defend the 1949 decision only adds to the doubt.
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