Antiquity?
The City Council of Dundee in Scotland has created an interesting website, “Life at Liff”. The website is based on an exhibition which explored the treatment of mental illness in the city. For many years this treatment was centred on the Victorian asylum near the village of Liff just outside Dundee (hence “Life at Liff”).
Dundee, incidentally, is one of just two centres for psychosurgery in the UK. The other is at the University of Cardiff if Wales. At Ninewells Hospital in Dundee a psychosurgery team, currently consisting of psychiatrist Keith Matthews and surgeon Muftah Eljamel, have carried out more than 30 operations since 1990, all of them on people diagnosed as depressed or obsessive-compulsive.
In a section on surgery, the “Life at Liff” website tells us that:
So in the 1940s and 1950s doctors did these damaging and unethical things called leucotomies whilst nowadays they perform more advanced, and presumably ethical, psychosurgery? There is of course nothing unusual about this view. Jack el-Hai’s recent book about Walter Freeman, The Lobotomist, tells us on the first page that lobotomy disappeared a quarter of a century ago.
Certainly you won’t find recent textbooks or articles in the medical press talking about lobotomies; they talk about neurosurgery for mental disorder or anterior cingulotomies or capsulotomies and so on (which simply refers to the particular bit of the brain being operated on). But does this change in terminology reflect the disappearance of one, discredited, type of operation and its replacement by a completely different one, or is it simply an attempt by psychiatrists and surgeons to distance themselves from controversy?
Egas Moniz is generally credited with the invention of psychosurgery, although there had been attempts previously, for example by the Swiss psychiatrist Gottlieb Burckhardt, to do similar operations. Moniz (or rather the neurosurgeon Almeida Lima working under Moniz’ instructions) drilled holes in his patients’ skulls, inserted instruments into their brains, and then, either by means of injecting alcohol or cutting out some tissue, introduced a “lesion”, that is, a bit of brain was destroyed. And that, basically, remains unchanged. They may have more sophisticated tools and techniques, they may have thought up different names, but the basic principle remains the same: a lesion is made in the brain in the hope of alleviating the symptoms of mental illness.
Moniz coined the terms psychosurgery and leucotomy (cutting of the white matter) to describe his operations. He was awarded a Nobel prize for his "discovery of the therapeutic value of leucotomy in certain psychoses". In Britain both terms were adopted, leucotomy being used almost exclusively in the 1940s and 1950s and psychosurgery becoming more a popular term during the 1970s. For example the Mental Health Act 1983 talks about psychosurgery.
In the US Walter Freeman decided to call his version of the operation a lobotomy rather than a leucotomy. Others followed his example and psychosurgical operations became known as lobotomies. Freeman then went on to develop the type of operation that nowadays is associated with his name - the assembly line, no qualified surgeon required, electroshock for anaesthesia, ice-pick through the eye socket, lobotomy. It is this type of operation that most people think of when the word “lobotomy” is used and these particular operations - transorbital lobotomies - are of course no longer done.
But, while Freeman was hammering ice-picks into eye sockets, elsewhere neurosurgeons were carrying out psychosurgical operations with all the care usually accorded to neurosurgery and not an ice-pick in sight. Neurosurgeon James Poppen’s description of his “operative technic” in a 1951 volume called “Studies in lobotomy” takes up three pages (the operation itself took thirty minutes) and contains details such as:
And other neurosurgeons were busy developing new techniques. The stereotactic frame, which the American neurologist/neurosurgeon team of Spiegel and Wycis adapted from animal experiments to human use in the 1940s, enabled surgeons to find their bearings more easily and target more specific areas of the brain. The anterior cingulotomy, which is still used at Massachusetts General Hospital and at Dundee, was first described in an article published in the Lancet in 1952. The anterior capsulotomy, which is used in Sweden and Wales, was pioneered in France in the 1940s. So it is not possible to draw a clear dividing line between crude early operations and sophisticated modern ones. Nevertheless, today’s psychosurgeons try to distance themselves from their predecessors and sometimes go to bizarre lengths to do so. The psychosurgery team at Dundee University for example refer to the “indiscriminate and crude procedures of antiquity”. Antiquity? They are talking not about classical or medieval or even Victorian times but about the 1940s, 50s and 60s.
Dundee, incidentally, is one of just two centres for psychosurgery in the UK. The other is at the University of Cardiff if Wales. At Ninewells Hospital in Dundee a psychosurgery team, currently consisting of psychiatrist Keith Matthews and surgeon Muftah Eljamel, have carried out more than 30 operations since 1990, all of them on people diagnosed as depressed or obsessive-compulsive.
In a section on surgery, the “Life at Liff” website tells us that:
The pre-frontal leucotomy was introduced in Dundee by Dr Bell in 1946. The operation was carried out in Maryfield Hospital. Two years later Bell reported that the operation had been performed on 53 patients, of whom 50 had improved, 2 showed no change and 1 tragically had died.
He noted:
'The [improved] patients
include many previously restless or violent and requiring continual nursing care and supervision, who are now able to lead a relatively normal life under medical hospital conditions.'
With the discovery of new anti - psychotic drugs in the 1950s, leucotomies became unnecessary.
The operation was last performed in Dundee in 1959. Causing irreversible damage to the brain, leucotomies are now considered unethical. Psychosurgery is still carried out
as a treatment, but at a much more advanced level.
So in the 1940s and 1950s doctors did these damaging and unethical things called leucotomies whilst nowadays they perform more advanced, and presumably ethical, psychosurgery? There is of course nothing unusual about this view. Jack el-Hai’s recent book about Walter Freeman, The Lobotomist, tells us on the first page that lobotomy disappeared a quarter of a century ago.
Certainly you won’t find recent textbooks or articles in the medical press talking about lobotomies; they talk about neurosurgery for mental disorder or anterior cingulotomies or capsulotomies and so on (which simply refers to the particular bit of the brain being operated on). But does this change in terminology reflect the disappearance of one, discredited, type of operation and its replacement by a completely different one, or is it simply an attempt by psychiatrists and surgeons to distance themselves from controversy?
Egas Moniz is generally credited with the invention of psychosurgery, although there had been attempts previously, for example by the Swiss psychiatrist Gottlieb Burckhardt, to do similar operations. Moniz (or rather the neurosurgeon Almeida Lima working under Moniz’ instructions) drilled holes in his patients’ skulls, inserted instruments into their brains, and then, either by means of injecting alcohol or cutting out some tissue, introduced a “lesion”, that is, a bit of brain was destroyed. And that, basically, remains unchanged. They may have more sophisticated tools and techniques, they may have thought up different names, but the basic principle remains the same: a lesion is made in the brain in the hope of alleviating the symptoms of mental illness.
Moniz coined the terms psychosurgery and leucotomy (cutting of the white matter) to describe his operations. He was awarded a Nobel prize for his "discovery of the therapeutic value of leucotomy in certain psychoses". In Britain both terms were adopted, leucotomy being used almost exclusively in the 1940s and 1950s and psychosurgery becoming more a popular term during the 1970s. For example the Mental Health Act 1983 talks about psychosurgery.
In the US Walter Freeman decided to call his version of the operation a lobotomy rather than a leucotomy. Others followed his example and psychosurgical operations became known as lobotomies. Freeman then went on to develop the type of operation that nowadays is associated with his name - the assembly line, no qualified surgeon required, electroshock for anaesthesia, ice-pick through the eye socket, lobotomy. It is this type of operation that most people think of when the word “lobotomy” is used and these particular operations - transorbital lobotomies - are of course no longer done.
But, while Freeman was hammering ice-picks into eye sockets, elsewhere neurosurgeons were carrying out psychosurgical operations with all the care usually accorded to neurosurgery and not an ice-pick in sight. Neurosurgeon James Poppen’s description of his “operative technic” in a 1951 volume called “Studies in lobotomy” takes up three pages (the operation itself took thirty minutes) and contains details such as:
After the buttons were removed and all bone dust washed out, the dura was opened with a semicircular incision with its base toward the mid-line. The dural flaps were held up by a suture tied in the mid-line. The underlying brain was then examined and described. In a number of cases, biopsy specimens were taken for histologic and biochemical study. Having selected a representative gyrus, a block of tissue at least 1cm was resected with minimal mechanical thermal trauma.
And other neurosurgeons were busy developing new techniques. The stereotactic frame, which the American neurologist/neurosurgeon team of Spiegel and Wycis adapted from animal experiments to human use in the 1940s, enabled surgeons to find their bearings more easily and target more specific areas of the brain. The anterior cingulotomy, which is still used at Massachusetts General Hospital and at Dundee, was first described in an article published in the Lancet in 1952. The anterior capsulotomy, which is used in Sweden and Wales, was pioneered in France in the 1940s. So it is not possible to draw a clear dividing line between crude early operations and sophisticated modern ones. Nevertheless, today’s psychosurgeons try to distance themselves from their predecessors and sometimes go to bizarre lengths to do so. The psychosurgery team at Dundee University for example refer to the “indiscriminate and crude procedures of antiquity”. Antiquity? They are talking not about classical or medieval or even Victorian times but about the 1940s, 50s and 60s.
0 Comments:
Post a Comment
<< Home