NPR's "All Things Considered"

As many of you know, Soundportraits has been working on a documentary for the NPR program "All Things Considered". It is called "My Lobotomy" and features two members of Psychosurgery.org. The program is going to air on November 16th. I'll give you more details as we get closer to the date. It promises to be an deeply emotional event.

Fifty years of psychopharmacology

Heather Ashton, Emeritus Professor of Clinical Psychopharmacology at Newcastle University, England, and long-time researcher into benzodiazepine dependency, recently gave a lecture looking back on 50 years of psychopharmacology. In the lecture Ashton takes a critical look at the pharmaceutical industry and wonders if, half a century on, we are any nearer understanding the causes of mental illness or finding a cure.

"It happens that I am old enough to have witnessed the start of the Era of Psychopharmacology - of drugs that affect the mind. Around the 1950s a whole host of such psychotropic drugs - all discovered by chance - entered the medical scene. These included the major tranquillisers such as chlorpromazine (Largactil), since developed into a range of antipsychotic drugs; it included the first antidepressants, the tricyclics and monoamine oxidase inhibitors, now joined by the SSRIs such as Prozac; and it included the so-called minor tranquillisers, the benzodiazepines Valium and Librium, now including a number of Z-drug hypnotics such as zopiclone and others.

These early discoveries were very exciting at the time, as they seemed to promise a cure for all psychiatric diseases. Schizophrenics taking antipsychotics could be, and were, let out of hospital to live in the community. Patients with depression could, allegedly, be freed from suicidal thoughts and from the perceived threat of electroconvulsive therapy (ECT). And the minor or major anxieties of life could be universally replaced with tranquillity and peaceful sleep induced by benzodiazepines. One eminent neurologist, Sir Henry Miller, even wrote that from now on all mental illness could be cured by a handful of pills and there would be no need for psychiatrists. He also memorably said that medical practice would now be so easy that it could safely be left entirely to women doctors!

At the same time it was believed, by a sort of backwards logic, that the cause of mental illness would be revealed by these drugs. Antipsychotics were found to block brain receptors for the neurotransmitter dopamine; therefore schizophrenia must be due to an excess of dopamine. Antidepressants were shown to increase the activity of the neurotransmitter serotonin; therefore depression must be due to a lack of serotonin. Benzodiazepines increased the activity of the neurotransmitter GABA, so anxiety must be due to lack of GABA.

Of course these naïve and simple hopes turned out to be in vain. 50 years later we still do not know the cause of schizophrenia or depression or even how the drugs work. The prognosis of these illnesses has changed little. And anxiety and insomnia are as common as ever. It has become clear that the drugs do not cure anything; they do, often usefully it must be said, control some symptoms but have little effect on the underlying processes. And, as everyone here knows, the drugs carry their own disadvantages. But these same drugs have made millions for drug companies."

Read the lecture here

The 13th Earl of Galloway

AN UNLIKELY COUNTESS: Lily Budge and the 13th Earl of Galloway BY Louise Carpenter (HarperCollins, £18.99)
REVIEWED BY GEORGE ROSIE



"As everyone said at the time – 1975 – Lily and Randolph made an odd couple. He was 47, she was 59. She was the daughter of a Borders chauffeur, he was son and heir to the 12th Earl of Galloway, the southern branch of the great Stewart dynasty. She’d been married twice before, both times to working-class men and had four children. He was mentally fragile, to say the least, having in his time been extensively drugged, electro-shocked and lobotomised. In their different ways they were both damaged goods. The fact that their union met with bitter hostility from Randolph’s aristocratic family didn’t help. Randolph Stewart and Lily Miller didn’t have much going for them.
That their marriage lasted (after a fashion) from 1975 until her death in 1999 says a lot for the forbearance, guile, compassion, ambition and tenacity of Lily Miller. No matter what the Stewart family or Scotland’s toffs threw at her, the small-town girl from Duns held on to her husband – and to her title of Countess of Galloway. Lily Miller’s wayward, touching life is told by Louise Carpenter in this pain stakingly researched and very readable first book. Nobody could accuse Lily of being “important” but her tale sheds light into some very musty corners of upper-crust Scotland." Read more

The Earl was diagnosed as schizophrenic when young and underwent a psychosurgical operation at St Mary's Hospital in London in 1952. He was, in his own words, "never the same again" and spent the next fifteen years in a mental hospital in Scotland. Now aged 77 he lives in sheltered housing in Scotland, his father having disinherited him of the family estate after his marriage.

Another article about the Earl and Countess appeared in the Scotsman on Sunday last year:

"BORN on October 14, 1928, Randolph was a physically perfect baby. His mother, Philippa Wendell, was an American beauty who had brought wealth and glamour to the cash-strapped Stewart dynasty. Randolph’s childhood was privileged, but emotionally lacking - he once told Lily that the only time he got a cuddle was from a kindly laundry maid. A slight, sickly child, he grew increasingly odd and eccentric, throwing tantrums, fussing about and repeatedly breaking wind. His parents consoled themselves with the thought that he would grow out of it. He did not.

These were anguished times for Randolph and his family, since he periodically lost control and became violent (episodes that would be repeated years later, when he was charged in Edinburgh Sheriff Court in 1979 for attacking a woman - a stranger - in an Edinburgh street, while the following year he even tried to strangle Lily).

After being sent away to prep school and then Harrow, where he was so miserable he refused to eat, Randolph was diagnosed as schizophrenic and subjected to insulin coma therapy, a procedure now regarded as a highly dangerous quack remedy. In Randolph’s case it was a spectacular failure, although it was nothing to the butchery that followed.

In 1952, when he was 23, Randolph’s parents told him to pack a trunk for a stay down south. He assumed he was going on holiday to the seaside. In fact, he was taken to St Mary’s Hospital in London, where he was lobotomised - a hole was drilled in the top of his skull and the frontal lobe severed - in an attempt to control his behaviour. He spent the next 15 years in the mental wing of the Crichton Royal Infirmary, in Dumfries. The lobotomy changed him forever; "I was never the same again," Randolph told Carpenter."

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

Helen Mayberg goes to London

Professor Helen Mayberg of Emory University, Atlanta, is famed for her experiments with DBS (deep brain stimulation) on depressed people. Recently, Professor Mayberg visited London and spoke at the Science Media Centre of the Royal Insitution ("where science meets the headlines"):

"This is a very new way to think about the nature of depression.

We are not just exciting the brain, we are using electricity to retune and remodulate.

We can interrupt or switch off an abnormally functioning circuit."

She said that although DBS was still in its infancy as a treatment for depression, it was very promising.

"The effects were immediate. One patient told me she felt suddenly relieved.

These are the sickest of the sick. They are not just having a bad day."

More...


"The sickest of the sick" - I am always suspicious of psychiatrists who talk about people in such terms, or use slightly more polite and technical terms such as "intractable" "refractory" or "treatment resistant". Is this going to be another ECT: "safe and effective", but, just in case they are wrong, there is nothing to worry about because it is only used as a "last resort"? Of course, there is no restriction on the use of ECT in the sense of only using it after other treatments have been tried. In fact, the British guidelines on its use recommend that on occasion ECT may be used as a first-line treatment, more usually as a second-line treatment. So too do all the other guidelines I have seen (American, Canadian, French, Dutch for example). Psychiatrists use the stigmatising term "last resort" to marginalise ECT patients and shift responsibility for treatment from themselves to the patients.

And just how do you decide who is the "sickest of the sick" in the absence of any biological tests for mental illness?

Professor Mayberg claims that one per cent of the population might benefit from being treated with DBS for depression. In Britain that would be over half a million people with electrodes in their brain. Newspaper headlines are talking about "the sunshine implant". But would the world be a better place?

A more cautious look at DBS is taken by American neurologist Joseph H Friedman in an article he wrote last year about the comeback of psychosurgery in the form of DBS:

"...the lobotomy procedure represents a terrible, dark stain on the history of modern medicine which those of us involved in brain medicine must never forget. This "cure" for schizophrenia demonstrates what may happen when a converted few lose objectivity and a host of willing believers subvert their disbelief in the hopes that their own eyes deceived them."

Read the article here...

He lost his mind

Salon has an article about memory and ECT in today's issue. You'll need to watch an ad if you want to read the piece.
------------------
... This winning streak came to an end in 1998, when Cott's mother died. Her death set off a bout of depression from which Cott was unable to recover. "I had been truly seriously depressed a number of times in my life, but never to the extent of being 'clinically' depressed," Cott says. "I just didn't care anymore."

That's when the electroconvulsive therapy began. Cott was given 36 treatments over the course of the next two years. When he emerged from them, he could remember nothing from the years 1985 to 2000. Fifteen years of his life -- friends he had known, places he had lived, books he had written -- had been completely wiped out.
...

In your book you quote Steven Rose describing ECT as "analogous to trying to mend a faulty radio by kicking it.

Yes, and I was the radio.

How exactly does ECT work?

They send an electrical current of about 200 volts for a fraction of a second through the frontal lobes of the brain, by means of electrodes connected to a machine that resembles a stereo receiver. But I don't remember that. I only remember receiving the anesthesia. I remember the feeling of falling off into unconsciousness, which was a beautiful feeling. But that's all.

You must have agreed to go along with it at some point.

Well, I was in a pretty distraught state, emotionally, and I think I had been talked into it by the doctors. They said I was in a really bad state and that I really needed to do this, and that there would be no serious side effects. I'd lose some memory but the memory would come back. This is what they tell patients. And when you're in a really disruptive state, like I was, it's very hard to be objective. I certainly hadn't thought about ECT treatments before. I didn't know they still gave them.

The last of the treatments happened seven years ago. Have you forgiven the doctors and moved on, or do you still feel angry?

I was angry, to begin with, that the doctors didn't really tell the truth about the possible damage that can occur, both cognitively and in memory loss. And I still feel angry about that. I believe that ECT does damage the brain. There's dispute about this, but there's increasing evidence to show that this is certainly a possibility. And there are many other people, not just myself, who suffer this kind of damage. I'm not prone to anger, but I do feel angry for the sake of other people. I really feel that ECT shouldn't be used at all except as a last resort, in the very final moments of emotional desperation, or mania, or catatonia.
...

Jose Delgado resurfaces

Jose Delgado, Direstor of Neuropsychiatry at Yale University Medical School in the 1960s and 70s, and later Professor of Neurobiology in Madrid, Spain, has resurfaced in this month's Scientific American where an article by John Horgan takes a largely uncritical look at his work implanting electrodes into animals and people. Read it here

A more critical interview with Jose Delgado can be found in an article by Swedish writers and artists Magnus Bartas and Fredrik Ekman in a 2001 issue of Cabinet Magazine.

"He looks at the clock and says that we only have five minutes left. But we do not want to abandon our questions about the patients. What happened to them? How long were the implants in their brains? Delgado now becomes somewhat vague. He says that it was other researchers that left the implants in for a long time, not him or Dr. Heath, and he does not recall which patients it was. The electrodes were taken out of his own patients after a couple of days and did not cause any injuries. "We killed maybe a few hundred neurons when we inserted the electrodes. But the brain has millions of neurons." More

Operation for stealing £66 12s*

From the Guardian of 2 April 1968

Court agrees to Brain Operation for Gambler

Warrington [UK] magistrates yesterday made an order under the Mental Health Act of 1959 so that a 21 year old man can undergo a brain operation in an attempt to cure him of compulsive gambling.

Eric Wills, an ice-cream salesman, of Wellfield Street, Warrington, had to consent to the operation, and was remanded in custody until he is admitted to hospital. He had been remanded for a medical report after admitting obtaining £40 by false pretences and stealing £26 12s from a gas meter.

Dr Harry Fleming, senoir consultant psychiatrist at Winwick Hospital, told the court: "this man has been examined by a neurosurgeon. If you agree, he will enter Winwick Hospital next Sunday and have an operation in a week's time".

* Less than 1500 dollars in today's money

Tell me that it's chemical again

Wounds no one was able to see

BY INDRANI SEN
STAFF WRITER

Photographed carrying a terrified, half-naked Iraqi child to safety in March of 2003, Army Spc. Joseph Dwyer, of Mount Sinai, was on front pages across the country, a potent symbol of American heroism.

Friday morning, Dwyer, 29, was arrested in El Paso, Texas, after a three-hour standoff in which he fired a 9-millimeter handgun in his apartment.
...
Family members say they saw Dwyer changed from the cheerful kid who loved to fish and played golf for Mount Sinai High School. The first sign was the 50 pounds he put on in six weeks after he returned from Iraq, more than making up for the 30 pounds he lost during his deployment. Then there was the car accident in El Paso, caused by Dwyer swerving to avoid what he thought was a roadside bomb detonating device. Friends told the El Paso Times that Dwyer had been having nightmares and had been abusing alcohol and sniffing inhalants.

Friday's incident was the most alarming, said his father, Patrick Dwyer of North Carolina.

"When he was in the apartment, he was calling for air strikes," Patrick Dwyer said. "He put a mirror out the window to see what was going on. He was being very defensive. Totally not connected to reality. And that's not like him."

more

Lawyers with a conscience?

As far as I know, in spite of all the people who have been left dead or damaged by psychosurgery in Britain, only one person has ever received compensation. There may of course be others that I have not heard about. A short piece about the case appeared in the Times, 14 May 1981.

"NHS Lawyers to be disciplined"

Two senior health authority lawyers are to be disciplined because of a case in which a female patient won a £95,000 compensation claim against the South West Thames Regional Health Authority in January when it failed to defend an action in the High Court.

Mrs Eileen Davey, aged 56, now living in Lincolnshire, was said to have dwindled to a wreck after two leucotomies - operations to remove frontal brain lobe tissue.

The judge said the authority solicitors' handling of the claim was a shambles. A range of disciplinary measures, including dismissal, faces the two lawyers who have not been named.

The authority said last night that the case had been mishandled and as a result a significant loss of public funds had occurred. Apart from the damages, the authority had to pay a five-figure sum in costs."