A new Moniz scholar
Dr Zbigniew Kotowicz, lecturer in the history of psychiatry at Goldsmiths College, University of London, has been funded by the Wellcome trust to write a book about Egas Moniz and the origins of psychosurgery. Dr Kotowicz has a background in psychotherapy and has written books about R D Laing and a Portuguese poet.
An article by Kotowicz appeared in a recent issue of the journal Gesnerus, the Swiss journal of the history of medicine and sciences. Entitled "Gottlieb Burckhardt and Egas Moniz - two beginnings of psychosurgery", the article looks at why psychosurgery took off following the experiments of Egas Moniz in 1936 but not the earlier experiments of Swiss psychiatrist Gottlieb Burckhardt in 1888.*
According to the Summary
"This article compares the repercussions of the two attempts at psychosurgery, the first in 1888 by the Swiss psychiatrist Gottlieb Burckhardt and the second by the Portuguese neurologist Egas Moniz. Both widely publicised their procedure, yet, Burckhardt was condemned and no one ventured to repeat his operation, whereas Moniz's leucotomy was accepted and it soon entered mainstream psychiatry. The change of Zeitgeist does not explain the difference as the thinking in the time of Bruckhardt, dominated by Griesinger's 'mental illness is an illness of the brain' doctrine, would appear to be more favourable to psychosurgery than it was in the time of Moniz. Moniz reported far more favourable results, which no doubt impressed other practitioners. But most of all the adoption of psychosrugery was due to the interest in mental illness of nonpsychiatrists - neurologists and neurosurgeons -, and the arrival of the new treatment marks a change in the professional configuration of those who treat psychiatric afflictions. This article deals with the early adoption of psychosurgery. Further developments, such as the relation of psychosurgery to other treatments and the fall into disrepute of the technique, are outside the scope of this presentation."
Kotowicz points out that, in general, "the medical community tends to place the beginning of the practice of psychosurgery with Moniz, while historians of medicine are inclined to begin with Burckhardt, although there are exceptions. [here Jack Pressman - a medical historian who didn't mention Burckhardt in his book about psychosurgery - is cited as an exception.]It would seem that to the practitioners the history proper of a treatment begins not with the actual first attempt, but at the moment it is put on the medical map, when it turns into a shared practice."
Kotowicz goes on to make the interesting point that Moniz was not particularly interested in the fate of mental patients [and he probably has this in common with many of the pioneers and enthusiasts of psychosurgery and shock treatments]: "Moniz arrived at the idea of psychosurgery after two years of solitary meditation. What exactly this meditation involved is not entirely clear, but nothing suggests that it was the patients that Moniz was thinking about, as he did not work in an sylum and his knowledge of the psychiatric clinic was minimal. In fact, there is little evidence that mental illness really interested Moniz; at least this is what his long list of publications suggests....until the monograph on psychosurgery there is practically no word on psychiatry proper, we will not find in his writings a single clinical study, nor any other sign of genuine interest in the matter."
There follows a discussion of how, in the early days, neurosurgeons and neurologists tended to show more enthusiasm for psychosurgery than psychiatrists did. The author points out that Moniz received his Nobel Prize on the recommendation of a neurosurgeon, Herbert Olivecrona. He could have added that an earlier nomination did not lead to a prize when a psychiatrist, Erik Essen-Moller, wrote a more negative special report to the Nobel Committee.
In one of the concluding paragraphs Kotowicz writes: "And indeed, psychosurgery gave neuroscientfic research a tremendous push. On the one hand it was introduced as a treatment for mental illness, on the other hand it was a central plank of an extensive research programme. It must be said that psychiatrists did not profit from this research as much as neuroscientists did, and the patient population even less so."
Hopefully, in his forthcoming book, Dr Kotowicz will make good use of his background in psychology and philosophy to examine the fate of the patients in greater detail.
*Z Kotowicz, Gottlieb Burckhardt and Egas Moniz - two beginnings of Psychosurgery,
Gesnerus 62 (2005) 77-101
An article by Kotowicz appeared in a recent issue of the journal Gesnerus, the Swiss journal of the history of medicine and sciences. Entitled "Gottlieb Burckhardt and Egas Moniz - two beginnings of psychosurgery", the article looks at why psychosurgery took off following the experiments of Egas Moniz in 1936 but not the earlier experiments of Swiss psychiatrist Gottlieb Burckhardt in 1888.*
According to the Summary
"This article compares the repercussions of the two attempts at psychosurgery, the first in 1888 by the Swiss psychiatrist Gottlieb Burckhardt and the second by the Portuguese neurologist Egas Moniz. Both widely publicised their procedure, yet, Burckhardt was condemned and no one ventured to repeat his operation, whereas Moniz's leucotomy was accepted and it soon entered mainstream psychiatry. The change of Zeitgeist does not explain the difference as the thinking in the time of Bruckhardt, dominated by Griesinger's 'mental illness is an illness of the brain' doctrine, would appear to be more favourable to psychosurgery than it was in the time of Moniz. Moniz reported far more favourable results, which no doubt impressed other practitioners. But most of all the adoption of psychosrugery was due to the interest in mental illness of nonpsychiatrists - neurologists and neurosurgeons -, and the arrival of the new treatment marks a change in the professional configuration of those who treat psychiatric afflictions. This article deals with the early adoption of psychosurgery. Further developments, such as the relation of psychosurgery to other treatments and the fall into disrepute of the technique, are outside the scope of this presentation."
Kotowicz points out that, in general, "the medical community tends to place the beginning of the practice of psychosurgery with Moniz, while historians of medicine are inclined to begin with Burckhardt, although there are exceptions. [here Jack Pressman - a medical historian who didn't mention Burckhardt in his book about psychosurgery - is cited as an exception.]It would seem that to the practitioners the history proper of a treatment begins not with the actual first attempt, but at the moment it is put on the medical map, when it turns into a shared practice."
Kotowicz goes on to make the interesting point that Moniz was not particularly interested in the fate of mental patients [and he probably has this in common with many of the pioneers and enthusiasts of psychosurgery and shock treatments]: "Moniz arrived at the idea of psychosurgery after two years of solitary meditation. What exactly this meditation involved is not entirely clear, but nothing suggests that it was the patients that Moniz was thinking about, as he did not work in an sylum and his knowledge of the psychiatric clinic was minimal. In fact, there is little evidence that mental illness really interested Moniz; at least this is what his long list of publications suggests....until the monograph on psychosurgery there is practically no word on psychiatry proper, we will not find in his writings a single clinical study, nor any other sign of genuine interest in the matter."
There follows a discussion of how, in the early days, neurosurgeons and neurologists tended to show more enthusiasm for psychosurgery than psychiatrists did. The author points out that Moniz received his Nobel Prize on the recommendation of a neurosurgeon, Herbert Olivecrona. He could have added that an earlier nomination did not lead to a prize when a psychiatrist, Erik Essen-Moller, wrote a more negative special report to the Nobel Committee.
In one of the concluding paragraphs Kotowicz writes: "And indeed, psychosurgery gave neuroscientfic research a tremendous push. On the one hand it was introduced as a treatment for mental illness, on the other hand it was a central plank of an extensive research programme. It must be said that psychiatrists did not profit from this research as much as neuroscientists did, and the patient population even less so."
Hopefully, in his forthcoming book, Dr Kotowicz will make good use of his background in psychology and philosophy to examine the fate of the patients in greater detail.
*Z Kotowicz, Gottlieb Burckhardt and Egas Moniz - two beginnings of Psychosurgery,
Gesnerus 62 (2005) 77-101
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