This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated.
2000 First Web Report
In 1847 an Irish workman, Phineas Cage, shed new light on the field of neuroscience in a rock blasting accident which sent an iron rod through the frontal region of his brain. Miraculously enough, he survived the incident, but even more astonishing to the science community at the time were the marked changes in Cage’s personality after the rode punctured his brain. Where before Cage was characterized by his mild mannered nature, he had now become aggressive, rude and "indulging in the grossest profanity, which was not previously his custom, manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires" (1) according to the Boston physician Harlow in 1868. However, Cage sustained no impairment with regards to his intelligence or memory (1). This incident provoked scientists to ask the question, "can alteration of the brain structure lead to differences in personality?" and if so, then "are there specialized regions of the brain responsible for the function of different elements of our personal character?" Thus, completely by chance, the foundational discoveries for the development of frontal lobotomy were laid.
Beginning in the late 1800’s, experimental surgeries involving various incisions slicing or destroying parts of the frontal cortex were performed on a variety of subjects in an effort to produce a calming effect in their behavior. In 1935, Dr. John Fulton presented the results of his research on a pair of chimpanzees at a conference for neurology. Fulton had "removed completely the frontal lobes" (4) of the chimps and observed that after the surgery they appeared significantly calmer than before the operation as he was unable to "generate experimental forms of neurosis in the animals"(1). Attending this conference were two neuro-scientists, Egas Moniz and Walter Freeman, both of whom would become major figures in the practice of lobotomy. Egas Moniz was particularly fascinated by the idea of the behavioral changes in Fulton’s chimps and posed the shocking question, "If the frontal lobe removal prevents the development of experimental neurosis in animals and eliminates frustrational behavior, why would it not be possible to relieve anxiety states in man by surgical means?" (1). Although many in attendance were appalled at Moniz’ suggestion, Freeman was inspired by the possibilities opened by the suggestion of what would come to be termed psychosurgery.
Soon after the conference, Moniz and the Freeman began exploring the possibilities of lobectomy (the cutting of the frontal lobes of the brain) as a method of eliminating certain mental illnesses. For example, in diseases such as obsessive compulsive disorder, it was thought that the symptoms were the result of hyper-metabolic activity in the frontal cortex–repeated patterns of brain function which were able to dominate over other patterns (7). Moniz and Freeman thought that by cutting the nerve fiber connections between the frontal cortex and thalamus which conducts sensory information in the brain, these repetitive patterns would be eliminated (4). Thus, in 1936, Moniz published his written research on his first human frontal lobotomy and shortly after, Walter Freeman performed the first lobotomy in the United States (2).
While Moniz can be attributed with the first implementations of human lobotomy (or lobectomy as he termed it), it was Freeman, with the assistance of neurosurgeon James Watts who was able to steer the procedure into the mainstream of psychological medicine. They started with Moniz’s original method, which he called the "pre-frontal lobotomy" which involved the insertion of a wire knife (leukotome) into many holes in the brain and then, with a few swinging motions, massacring the brain matter and presumably alleviating the psychotic symptoms in the patient (4). They revised this procedure, calling it the "Freeman-Watts Standard Procedure" (4). However, frustrated with the messiness and inconvenience of the surgery, Freeman came upon an idea which would simplify the surgery and make it administrable by less specialized medical professionals. In 1945, inspired by similar practices in Italy at the time, Freeman introduced the idea of the "ice-pick" or transorbital lobotomy (2). The procedure involved the insertion of an actual ice pick into the brain via the eye socket. Freeman describes his new technique in a letter to his son: "This consists of knocking them out with a shock and while they are under the "anesthetic" thrusting an ice pick up between the eyeball and the eyelid through the roof of the orbit actually into the frontal lobe of the brain and making the lateral cut by swinging the thing from side to side." (5). Due to the extreme brutality of this procedure, James Watts broke his partnership with Freeman. Indeed, many notable surgeons were reputed to have fainted while watching Freeman perform his surgery and many others refused to do lobotomies (1). However, with the avidity of Freeman and cooperation of other surgeons around 18,000 lobotomies were performed in the US between 1939 and 1951. It was not until the 50’s that opposition to lobotomy became especially vocal and finally with the introduction of anti-psychotic medications such as Thorazine doctors became less and less reliant on lobotomy to treat patients (4). Freeman performed his last lobotomy in 1967 which resulted in fatality when he nicked a blood vessel and the patient bled to death.
The practice of lobotomy has special significance, not only has a dark epoch in the history of neuroscience, but in the understanding of how a scientist can most effectively approach the brain. One of the major failures of the proponents of lobotomy was that they did not seem to acknowledge the extreme specificity of brain structure. A lobotomy–the insertion wiggling around of a rather large instrument in the frontal cortex and-- is a highly unspecific procedure. It attacks the problem at too high a level of boxes. This can account for the extreme diversity of outcomes of the surgery. There were many recorded fatalities and many patients were crippled for the rest of their lives when it was expected that they would become simply more docile and calm. Rosemary Kennedy, the mildly retarded daughter of Joseph and Rose Kennedy, received a lobotomy at the request of her father which left her permanently disabled and completely dependent. The same was true for Rose Williams, sister of playwright Tennessee Williams (7) . It can be argued that every lobotomy performed resulted in catastrophe, since each one deprived the patient of his/her personality–the surgery had the effect of making its recipients passive zombies, in essence. A report from Freeman’s first surgery on a 63 year old woman describes her as changing her mind about the operation when she found out that her hair would have to be shaved off. In an effort to placate her, the doctors assured her (falsely) that they would save her hair for her after the lobotomy. Consenting, the surgery was done and when she woke up, Freeman notes that, "she no longer cared" (1) . Such was the effect of lobotomy in all of its stages of development–massacre of the brain resulting in massacring of the personality.
2)"Lobotomy's Back", An article by F. Vertosick, Jr. as published in Discover Magazine, Oct. 1997.
3)History of Lobotomy, A very brief overview of this history of the procedure, put out by PBS.
4)Excerpt from The History of Psychosurgery, by R.M.E. Sabbatini, PhD.
5)Great and Desperate Cures, by Elliot Valenstein. New York:Basic Books, 1986.
6)OCD and the Brain, Andrew Hollander's web paper on Obsessive Compulsive Disorder.
7)Lobotomy's Hall of Fame, Sabbatini's notes on famous recipients of lobotomy.
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