Abuses are not in the Past

Report Criticizes Calif. Mental Hospital

SAN FRANCISCO - Patients at a state mental hospital overdosed on illegal drugs, were improperly restrained for hours on end and were forced to spend 12 hours in soiled diapers, according to a scathing report issued by the U.S. Justice Department.

The report said the problems were among "widespread and systematic deficiencies" at Napa State Hospital, including suicide and inadequate medical care. Some patients were bathed only every two to four weeks, the report said.
...
The Justice Department investigation began in January 2004. The California Department of Mental Health has refused to cooperate, repeatedly preventing access to the facility, said the letter from Bradley J. Schlozman, acting assistant attorney general. A Justice Department spokesman did not immediately return a call seeking comment.
...
Restraints and seclusion also are overused at Napa, according to the Justice Department. The report cited one patient who was restrained for 369 consecutive hours.

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Josef Hassid

Between January 1947 and June 1952, 180 people died as a result of leucotomies in England and Wales. W S Maclay, the President of the Section of Psychiatry of the Royal Society of Medicine, said: "the total is considerable when one thinks in terms of individuals and not of statistics and percentages".

One of those individuals was Josef Hassid, the Polish violinist, who died after a leucotomy in Long Grove Hospital, Epsom, England. He was 26 years old.

Hassid had come to London with his father in 1938 and was prevented from returning to Poland by the outbreak of World War II. In London he gave recitals and concert performances and made recordings for HMV. But in 1941 he had a nervous breakdown and was admitted to St Andrew's Hospital, Northampton, where he was given insulin coma therapy and electroconvulsive therapy. After a short period out of hospital he was detained in Long Grove Hospital which had a wing for Polish civilians, and remained there until his death.

Psychosurgery without consent

Since 30 September 1983, when our current Mental Health legislation came into force, it has been illegal for surgeons in England and Wales to perform psychosurgery on people who have not given their consent. But now the government in London wants to change the law and allow surgeons, with court approval, to operate on people who are incapable of consenting. Why do they think there is a need for change?

Under the 1983 Act psychosurgery can only be carried out with the permission of the Mental Health Act Commission (MHAC) who send three people, including a doctor, to verify that the operation is necessary and that the patient’s consent is valid. (Apart from anything else, it means that we at least have accurate statistics on the use of psychosurgery. Between 1984 and 1999 265 operations were carried out in England and Wales.) In about one in five cases the MHAC refuses to give permission for the operation to go ahead, usually because they decide the patient is not capable of consent.

Most operations in the 1980s and early 1990s were carried out at the Brook Hospital in London. (In 1994 the Brook psychosurgery unit moved to the Maudsley/Kings College Hospital) The psychosurgery team at the Brook Hospital was led by psychiatrist Paul Bridges, who was a forceful critic of the legislation from the moment it was introduced, arguing that MHAC involvement interfered with the doctor/patient relationship and that incapable patients should not be denied psychosurgery. In 2001 Bridges was struck off the medical register following a conviction for indecent assault of a 15 and a 16 year old.

The Government is now planning to introduce new mental health legislation and included in their draft bill is the proposal to allow psychosurgery, with court approval, on incapable patients. A recent parliamentary scrutiny committee recommended that the law should remain the same - no psychosurgery without consent - but the government is nevertheless determined to go ahead and change the law. None of the major organisations (with the exception of the MHAC) who gave evidence to the scrutiny committee wanted this change. The Royal College of Psychiatrists, the Mental Health Alliance, the Church of England all, for example, expressly opposed the proposed change in their evidence to the scrutiny committee.
So why is the government so determined to change the law? When I asked them I received this reply from the Department of Health:
“The reason we have gone for the scope to enable people without capacity to have psychosurgery is because the current prohibition has created problems in some rare cases where the patient does not object to the treatment but the treatment cannot be given because the patient is not competent to consent.
For example, the Department was asked for advice on a case concerning a severely learning disabled woman. The care team had tried all other avenues over a long period since she was a child but her condition had worsened and she was in increasing distress. The consultant considered psychosurgery the only way to relieve her distress and bring about an improvement in her condition but, as she was incapable of giving consent, it could not be carried out.”

And who was “the consultant” they were listening to? When I asked the Department of Health, they told me they didn’t know:
“One specific psychosurgery file was destroyed in April 2004, in accordance with the Department's agreed destruction schedules, and it is possible that this may have contained the information you are seeking.”

Until someone can tell me otherwise, I shall believe they have been listening to Bridges (perhaps indirectly via the MHAC), as he seems to be the only psychiatrist who has been campaigning for this change in the law. But should they be listening to a psychiatrist who, in the words of the chairman of the General Medical Council hearing had “brought the profession into disrepute and undermined public trust”?

While the government is planning to make it possible to operate on people who cannot consent, doctors in England appear to have quietly given up psychosurgery. There have been no operations carried out in England since 1999, although a few operations continue to be done in Wales. Scotland also has a centre for psychosurgery but they have their own legislation.

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.

Words of Wisdom

"Historical records fail to explain some astounding errors of judgment. Witness the 1949 prize in physiology or medicine, shared by neuroscientist Antonio Egas Moniz for his development in 1935 of the prefrontal lobotomy. The jury failed to appreciate how widely discredited the procedure had become by the time it tapped Moniz. It was a terrible mistake that caused permanent damage to thousands of patients," says 1981 physiology or medicine laureate Torsten Wiesel of Rockefeller University in New York City."

http://tinyurl.com/bqdfr

Read an excellent article about this here

Let the promiscous suffer!

Sue K. sent this to me:
--------------------------------
This comes from a book called "Surgery of the Mind" by Eric A Turner published in 1982, Carmen Press, Birmingham.

Turner was a neurosurgeon who carried out psychosurgical operations in Birmingham and the book is about the 342 people he operated on in the 1960s and 1970s, but that included some people who were operated on for epilepsy not psychiatric symptoms.

"A decline in moral standards was not a significant feature in post-operative cases. Where promiscuity, or prostitution or moral delinquincy was known before illness, the case would not be considered for frontal operations, and the psychiatrists were seldom caught out on this score. Certain inoffensive attitudes that did not impinge on any serious moral principles were not a bar. A number of women patients were, or became, barmaids." p 64

"There had been stories of women taking to prostitution after lobotomy, so sexual laxity was considered a contra-indication to surgery. These decisions were taken in an epoch when sexual moral standards were narrower than they are today, so the decision appeared at that time easier than it would be now. Promiscuity was sufficient to preclude operation, in the belief it would be unacceptably vigorous afterwards." p 71

10 percent were helped

I see the headline that the U.S. media has now seized is that lobotomy "helped 10% of all patients". Of course I don't agree that even 10% were helped, but let's humor them for a moment. If that number is to be believed then conversely 90% of all of the lobotomies were a failure.

I wonder how many would have consented if they knew that lobotomy had an estimated 90% failure rate?

One woman's experience of psychosurgery

In 1976 Yorkshire TV in the UK showed a documentary called "A Matter of Life: it's a little frightening" which followed Margaret Chapman as she underwent psychosurgery as a treatment for violence.

Margaret Chapman featured more recently in Susan Brin Hyatt's chapter "Poverty and the medicalisation of motherhood" in a book called "Sex, gender and health", edited by Tessa M Pollard and Susan Brin Hyatt, published by Cambridge University Press in 1999. What follows is from this book (pages 97 -112):

"Male voice of a psychiatrist: You've had this anger your entire life and you tend to have little control over it...
Another male voice, the film's narrator, explains: A psychiatrist's office in Yorkshire....
A working-class woman speaks: I was in the club one night and something started in me and I just picked up a glass and I just stuck it in this woman's face, you know.... and I didn't realize afterwards that I'd done it, you know...
Psychiatrist: And, you've attacked people and scratched their faces, haven't you?
Woman: Yes
Psychiatrist: ...rained blows on them
Woman: Yes
Psychiatrist: Has your bad temper and you inability to control it, has this got you in trouble with the police or in the courts at all?
Woman: Yes, I have had five convictions for assault.
Psychiatrist: You have - well, it seems to me that since you've been on tablets and pills for years and you've never really got this major problem in you life under control, it is quite reasonable, VERY reasonable at this stage, to consider an operation designed to tone down very considerably indeed your aggressive impulses, to eliminate your bad temper.
Woman: Will this help me?
Psychiatrist: Yes, I think it will
Woman: It's just a bit frightening, isn't it?
Psychiatrist: Well, I suppose all operations are a bit frightening - some people are more nervous than others.

....The woman who was subjected to this operation in 1976 is named Margaret Chapman. She still lives on a council estate [public sector housing] located on the outskirts of the northern city of Bradford. By the time I first met her in 1991, she had become a well-known local activist and was at the forefront of a number of campaigns her community had courageously waged....The first time I ever spoke to her she recounted to me the startling story of her brain surgery.....

Margaret Chapman's medical history prior to the time of her surgery offers an instructive glimpse into the consequences of the over-medication that is typical of many women in her situation. In her published autobiography, No Option but to Fight, Margaret describes how she first began using prescription drugs, in this case, amphetamines. Trapped in a violent marriage, saddled with three small children and pregnant with her fourth by the age of 25, she consulted her doctor: "I told him that I was feeling worn out and that my mind was willing to do things but my body wouldn't shift. He wrote me a prescription and I went round to the chemist to collect my 'cure'. Until then I had never taken a tablet in my life."...

Throughout her history of treatment for various ailments including addiction to prescription drugs (which was largely an outcome of the medical treatment she had received), alcoholism and depression, Margaret was periodically judged to be an 'unfit mother' and her children were regularly taken into custody by the state. In fact, according to her own autobiography Margaret, having become overwhelmed by the demands of her now five teenaged children and with no support system made up of other adults (she had been raised in an orphanage and had no mother or female kin living nearby), asked to be admitted into hospital for treatment for her depression. Her children were again taken into care. It was at that point, when she was at her most vulnerable andf earful about the future of her relationship with her children, that she was persuaded to consent to surgery....

What the actual effect of the operation was, I was never able to ascertain. Margaret frequently complained that it left her with severe headaches, an inability to concentrate well, and a slackness of her jaw. Her supposed propensity for violence seemed to dissipate many years later, after her children were grown and she had become involved in grassroots campaigns aimed at bettering conditions in her community. Margaret, herself, attributed her relative calm as she grew older to her having learned ot channel her furstrations through political activism rather than as any consequence of the surgery. Indeed, the film, itself, ends ambiguously with Margaret reporting to the doctor on screen that even after the operation, she still felt compelled toward violence."

Lobotomy impact lingers

This is from today's Newsday:

Lobotomy impact lingersGranddaughter of LI woman who had the procedure in the 1950s is pressing the Nobel committee to rescind its prize to the inventor

BY JAMIE TALAN

When Christine Johnson was a little girl and learned her grandmother was "crazy" and that a lobotomy had left her "childlike," she pulled out her Barbies so Grandma Beulah could play."No, dear, I'm too old for that," her grandmother said.

Now, more than two decades later, Johnson, 32, has pored over hundreds of pages of her grandmother's medical and psychiatric files from her time as a patient at Pilgrim State Psychiatric Center in Brentwood from 1952 to 1972.

She has attempted to understand why doctors performed the procedure, which involved drilling holes into her brain and swiping at the frontal lobes. It was thought to be a cure for psychosis.

Johnson, of Levittown, also is challenging the 1949 Nobel Prize awarded to Portuguese Dr. Egas Moniz, who invented the lobotomy procedure. Moniz died in 1955, and soon after, the procedure began to be discredited.

continued

WVTS - Jerry Waters

Tomorrow at 11:00 AM Eastern Time Jack El Hai and I will be on the Jerry Waters show on the West Virginia radio station WVTS.

New England Journal of Medicine

Hey, we're mentioned in the New England Journal of Medicine. You'll need a subscription to see the full-text article.

Last-Ditch Medical Therapy — Revisiting Lobotomy

Desperate times call for desperate measures. So thought Walter J. Freeman, a neurologist who became the United States's staunchest advocate of the lobotomy between the 1930s and the 1970s. A new book, The Lobotomist, by journalist Jack El-Hai,1 chronicles Freeman's advocacy of a procedure that was viewed by many, and continues to be viewed, as barbaric. In exploring the ways in which lobotomy became part of common medical practice, El-Hai raises questions not only about how we should judge the procedure in retrospect, but also about what lobotomy teaches us about last-ditch medical interventions.

Struggle for Justice

Psychosurgery.org is deeply gratified by the overwhelming positive response to the Associated Press article. If you are as shocked as we are by the Nobel Foundation's snarky attitude, and as upset by the way they are dodging responsibility in this matter, please write them at comments@nobel.se and tell them that the only decent thing to do is REVOKE Egas Moniz's Nobel Prize.

To any Nobel Laureates that are reading this - please contact Christine at christine@psychosurgery.org and tell us what you think of this situation. We think that the Nobel Prize for lobotomy sullies all of the other Prizes. You should not have to be associated with a human rights violation like psychosurgery. We hope that you will support us in our struggle for justice. We need your help.

Thank you to all the kind people out there ...

Rest in Peace Mr. Shaw

I'm posting this because the man in the story was a lobotomy victim:

A HUMAN skeleton found in the field in Holywell had to be identified by scars on the bones on the remains.

Mystery will forever surround the death of Ronald Shaw, 71, who disappeared from his home in Ellesmere Port on July 28 last year.

Mr Shaw (pictured), an ex-serviceman, was a diagnosed schizophrenic and was commonly known as a wanderer.

...

Mr Raymond Shaw described his brother as very fastidious and had a particular peculiarity in that he would keep a running diary of his daily events. A vital piece of evidence in identifying the body was the scarring on the skull from a lucotomy (lobotomy) operation Mr Shaw had undergone as a child.

read the rest

I Can't Help but Smile

Thank you Tom Cruise - I have thoroughly enjoyed watching all the hoopla surrounding your stand against psychiatry. People are talking. They are thinking. It's very exciting.

I take back saying that I wish you'd be quiet about it. I hope you never shut up about it.

Salon went all twitchy in today's edition. It is quite a hatchet job that is heavy on invective (the scientology anti-drug program is described as having "infiltrated" the area schools) and short on actual discussion. For example, they claim that scientology has opportunistically jumped on the anti-Ritalin bandwagon, but they don't address the fact that many people who would never dream of joining an alternate religion legitimately feel that Ritalin is seriously over prescribed. In other words, you don't have to be a scientologist to be deeply suspicious of psychiatry.

Brooke Shields came out with a response in the New York Times today too. She wrote:

In a strange way, it was comforting to me when my obstetrician told me that my feelings of extreme despair and my suicidal thoughts were directly tied to a biochemical shift in my body.

Brooke - the cause of post partum depression and psychosis has not been proved no matter what your shrink told you. Under the heading "Causes, incidence, and risk factors" of postpartum depression the National Library of Medicine lists the following:

You have a higher chance of post-partum depression if:

• You had mood or anxiety disorders prior to pregnancy, including depression with a previous pregnancy
• You have a close family member who has had depression or anxiety
• Anything particularly stressful happened to you during the pregnancy, including illness, death or illness of a loved one, a difficult or emergency delivery, premature delivery, or illness or abnormality in the baby
• You are in your teens or over age 30
• The pregnancy is unwanted or unplanned
• You currently abuse alcohol, take illegal substances, or smoke -- these are also serious medical health risks for the baby

Nary a word about serotonin. In fact, most of the listings are emotional factors. Interesting.