http://www.pbs.org/wgbh/amex/lobotomist/stories/jones_qry.html

This has been a long time in coming. Howard Dully has a book out called “My Lobotomy”. My family has had the chance to honor my grandmother Beulah Jones and make her story known to the world. I have accomplished what I set out to do. Beulah did not die forgotten.

I will post again after the show.

More than anything I am honored, incredibly honored and humbled, to have our family and Beulah’s story remembered as an integral part of American history.

“We should be humble in assuming that our therapies, whatever stage scientific knowledge may have reached, can do what we think they can do. It is to me strange, for example, that Stockholm has never seen fit to withdraw, retroactively, the Nobel Prize it awarded Egas Moniz, in 1949. Moniz invented prefrontal lobotomy. He was, the committee said, “a wonderful man”. Many, then, might have agreed. Now, few would.
The operation, which involved scooping lumps out of the brain, as if it were ice-cream, was subsequently popularised in the US by Walter Freeman who trundled round in his “lobotomobile”, demonstrating his “ice pick and hammer technique” to any hospital that would let him in, and knocking off 10 ops a day in hotel rooms. Nothing could stop his campaign to make America mentally “healthier”.
It would be a commendable act of humility, and an admission that mental health is difficult to define and fiendishly difficult to manufacture, were Stockholm to respectfully rescind that award to Moniz.” (more…)

“When originally I undertook to perform leucotomy it was not without a feeling rather of reproach, for mutilation no doubt it must be. However I first of all went to watch my psychiatrist colleagues applying chemical or electric convulsive therapy - so disturbing was the exhibition at the time that thereupon I decided that the surgical approach was probably a less traumatic measure.”

And American neurosurgeon William Beecher Scoville felt that psychosurgery “is preferred to shock treatment in those depressions requiring more than short courses of shock treatment because of less emotional blunting, memory loss and relapses.”

“The prevalence and economic burden of neuropsychiatric disease are enormous. The surgical treatment of these psychiatric disorders, although potentially valuable, remains one of the most controversial subjects in medicine, as its concept and potential reality raises thorny issues of moral, ethical, and socioeconomic consequence.
This article traces the roots of concept and surgical efforts in this turbulent area from prehistory to the 21st century. The details of the late 19th and 20th century evolution of approaches to the problem of intractable psychiatric diseases with scrutiny of the persona and contributions of the key individuals Gottlieb Burckhardt, John Fulton, Egas Moniz, Walter Freeman, James Watts, and William Scoville are presented as a foundation for the later, more logically refined approaches of Lars Leksell, Peter Lindstrom, Geoffrey Knight, Jean Talaraich, and Desmond Kelly. These refinements, characterized by progressive minimalism and founded on a better comprehension of underlying pathways of normal function and disease states, have been further explored with recent advances in imaging, which have allowed the emergence of less invasive and technology driven non-ablative surgical directives toward these problematical disorders of mind and mood.
The application of therapies based on imaging comprehension of pathway and relay abnormalities, along with explorations of the notion of surgical minimalism, promise to serve as an impetus for revival of an active surgical effort in this key global health and socioeconomic problem.
Eventual coupling of cellular and molecular biology and nanotechnology with surgical enterprise is on the horizon.”

“Eights months ago, surgeons drilled two holes into the skull of a wide-awake Vancouver man and inserted spaghetti-sized electrical wires down through the two sides of his frontal lobes. They left behind a remote control brain pacemaker, which regularly shocks his brain with three volts of electricity, 24 hours a day, seven days a week, powered by a battery pack that sits on his neck. The device is meant to treat his severe depression. It’s part of a controversial clinical trial of a procedure called deep brain stimulation (DBS) that’s jointly run by UBC and VGH, and being partly funded by B.C. health care.

As part of the trial, which is co-sponsored by a Texas-based medical device manufacturer, researchers will also implant five other British Columbia patients through a multi-centre trial also happening in Toronto and Montreal. DBS is also being tested at centres all over the globe, as a treatment for obsessive-compulsive disorder, anxiety, eating disorders, addictions and even violent behaviour. But emerging data on this new technology is raising questions about the effectiveness of the procedure, the link between health care and profits, and the ethics of quick-fix psychological treatments….

It’s the same physiological rationale used to describe lobotomies and their modern counterparts, known as psychiatric neurosurgeries, which are said to be making a comeback at select centres round the globe, including a UBC program started in 2000. DBS is being held up as a good alternative to psychiatric neurosurgeries, because it doesn’t involve permanently destroying pieces of the brain, and because the device can be turned off.” (more…)

“As members of a healing profession that likes to trace its lineage back at least as far as classical Greece and the fabled Hippocrates, physicians pronounce themselves the guardians of our physical welfare - and, in the case of that subordinate branch once called by the derisive term of “mad-doctors” and now preferring to own to the title “psychiatrist”, our mental welfare as well. Like all of those who make the most well-founded and broadly socially accepted claim to the title of professional, medical men (and these days medical women) operate in an arena where the ordinary disciplines of the marketplace seem to fail, or to perform poorly. As lay people, we lack access to their specialized knowledge and expertise, even though the content of their cognitive world may be quite literally of life and death importance to us. In a poor position to second guess their expert judgments or even, in many instances, to grasp the foundations on which their diagnoses and prescriptions are based, and ill-equipped to assess the quality of the care we are about to receive, we are perforce at their mercy. Elaborate social rituals persuade us to grant these strangers our trust, and reassure us that they are motivated, not by the self-interest of the marketplace - the hidden hand that allegedly guides so much of civil society - but by a higher ethical standard, a genuine concern for our well-being and survival and a willingness to subordinate their interests to ours. And so it sometimes proves.
And sometimes not.” (Madhouse: A Tragic Tale of Megalomania and Modern Medicine.Yale University Press, page 276)

The author has this to say about psychosurgery: “Lobotomy, in my judgment, even by the standards of the 1940s ought ultimately to be seen as indefensible, as a number of informed and perspicacious critics argued at the time. But a proper examination of that issue is a debate place and another time.” (page 285)

I hopefully asked Professor Scull if he was thinking of writing a book about the history of psychosurgery but sadly it is not on his list of things to do in the immediate future.

By the late 1950s an estimated 20,000 leucotomies had been carried out in Britain. A few were performed by general surgeons, a few by psychiatrists, but the vast majority were performed by neurosurgeons. And of these neurosurgeons Sir Wylie McKissock (1906-1994) was probably the most prolific, responsible for at least 3,000 leucotomies.
McKissock, who in spite of his Scottish name hailed from Staines in Surrey, is remembered for his achievements in neurosurgery including the treatment of head injuries (he received an OBE for his wartime work) and the treatment of subarachnoid haemorrhages and intracranial aneurysms; and for setting up the world-famous Atkinson Morley’s neurological service. He became President of the Society of British Neurosurgeons and received a knighthood on his retirement in 1971. But his contributions to British psychosurgery seem to have been quietly forgotten.
When McKissock died in 1994, obituaries in the The Times and The Independent newspapers made no mention of psychosurgery. Other tributes were likewise reticent on the subject. For example, psychosurgery was entirely absent from an 800 word article in the Journal of Surgical Neurology in 1988 even though the author Alan Richardson was himself a practitioner of psychosurgery, and a ten page reminiscence in the British Journal of Neurosurgery two years after McKissock’s death containes only the following brief reference to psychosurgery:

“His links to psychiatry were related to his large practice in the 1940s and 1950s as a leucotomist of extraordinary surgical speed, associated with a peripatetic service visiting major institutions in the UK in his motor car with the instrument set in the boot”.

These expeditions in his motor car took McKissock all over the South of England and Wales; among his destinations were St Andrews in Northampton, Graylingwell in Chichester, St Lawrence’s in Caterham, Pen-y-Val in Abergavenny. The institutions (many of them Victorian Asylums) were often situated in pleasant rural locations and in those days the roads were comparatively empty. A visit from a well-known neurosurgeon would have been quite an event and doubtless the red carpet was laid out for McKissock. The operations themselves were quickly done - 15 to 30 minutes each - and so all-in-all these excursions must have been a reasonably agreeable way for McKissock to supplement his income.
Why did McKissock travel round the country rather than having the patients brought to his neurosurgical unit? In the early days of psychosurgery he claimed it was “owing to the extremely unpleasant and dangerous habits of the unfortunates who have been submitted to me for operation, and to the lack of proper facilities for dealing with the habits of such patients in my own neurosurgical unit.” By the 1950s he had become more circumspect, claiming instead it was out of consideration for patients who could be treated in familiar surroundings and receive visits from relatives.
McKissock doesn’t seem to have troubled himself much over the ethics of psychosurgery, although his excursions sometimes resulted in death or disability (some patients were left in what McKissock himself described as a “harmless vegetable state”). What little he wrote on the subject of psychosurgery is largely confined to notes on technique. He admitted that the operation was “academically and scientifically unsound” but felt it was justified if the “experienced psychiatrists” who selected patients felt there was no chance of a cure with other methods of treatment or a spontaneous recovery.
In the early years of his career as a psychosurgeon McKissock used the standard Freeman-Watts technique of leucotomy, drilling two burr holes in the side of his patients’ skulls and severing the connections to the frontal lobes. He was scornful of specially designed leucotomes, referring to John Crumbie’s as a “mechanical egg-whisk” and preferring to operate with an ordinary brain needle. In the late 1940s, as psychosurgeons were experimenting with different techniques in an attempt to avoid some of the complications and devastating effects on personality associated with the standard leucotomy, McKissock devised the “rostral leucotomy” in which holes were drilled in the top of the skull and the cut made in a downwards direction, undercutting Brodmann’s areas 9 and 10 of the frontal cortex. Neuropathologists commented that the resulting lesion was similar to that of Freeman’s transorbital leucotomy although McKissock approached from the opposite direction to Freeman. McKissock had little time for Freeman’s transorbital operation, considering it an offence against “established aseptic surgical principles”. The rostral leucotomy did not however entirely replace the standard procedure; even at the end of the 1950s McKissock was still using the standard technique on a minority of patients.
The last sighting of McKissock in the literature is an appearance at the November 1958 meeting of the Neurological Section of the Royal Society of Medicine where he talked about having performed 125 rostral and 19 standard leucotomies the previous year.