The Lobotomy King

August 11, 2009 10:04 AM

The Lobotomist (PBS American Experience) - During his illustrious career as a self-styled neurosurgeon, Walter Freeman performed nearly 3500 lobotomies. [Inspired by this thread]

"My Lobotomy" - a story of one lobotomy recipient's journey to discover the story of his own procedure. (previously)

Review of "The Lobotomist" (link includes the first chapter of the book) in The Guardian.

posted by Burhanistan (73 comments total)

An awful, awful human being. America's Mengele.
posted by Optimus Chyme at 10:07 AM on August 11, 2009

No no no no no.

This was running on my television some months ago, just in the background while I did online stuff and waiting for Beautiful Slumber to approach...

...and every time I looked at the screen, they were showing one human being shoving an icepick into the face of another human being. After about the third time that happened, I turned the sound off so I wouldn't be as tempted to look, and it STILL continued.

I nearly vomited.

Still, the big guy with the huge moustache at the end was pretty hot.
posted by hippybear at 10:09 AM on August 11, 2009 [1 favorite]

After reading the Wikipedia entry for him, I have to turn to humor to cope with the horror I feel about what he did to so many people.

"When all you have is an icepick, everything looks like ..."
posted by zippy at 10:11 AM on August 11, 2009 [2 favorites]

...and every time I looked at the screen, they were showing one human being shoving an icepick into the face of another human being. After about the third time that happened, I turned the sound off so I wouldn't be as tempted to look...

I think I may have discovered your problem.
posted by DU at 10:16 AM on August 11, 2009 [2 favorites]

MetaFilter Fark: Every time I looked at the screen, they were showing one human being shoving an icepick into the face of another human being.
posted by mattdidthat at 10:18 AM on August 11, 2009

"The consistency of the brain has been described as being similar to soft butter, custard, tofu, or somewhere between egg whites and Jell-O."
posted by benzenedream at 10:21 AM on August 11, 2009

A relevant comment from the Eunice Shriver RIP post:


In 1941, when Rosemary was 23, her father was told by her doctors that a cutting edge procedure would help calm her "mood swings that the family found difficult to handle at home". Joseph Kennedy gave permission for the procedure to be performed by Dr. Walter Freeman, the director of the laboratories at St. Elizabeth's Hospital in Washington, D.C., together with his partner, James W. Watts, MD, from the University of Virginia. Watts performed his neurosurgical training at the Massachusetts General Hospital, and later he became the Chief of Neurosurgery at the George Washington University Hospital. Highly regarded, Dr. Watts later became the 91st president of the Medical Society of the District of Columbia. The procedure in question was a lobotomy....Instead of producing the hoped-for result, however, the lobotomy reduced Rosemary to an infantile mentality that left her incontinent and staring blankly at walls for hours. Her verbal skills were reduced to unintelligible babble. Her mother, Mrs. Rose Kennedy, remarked that although the lobotomy stopped her daughter's violent behavior, it left her completely incapacitated.
posted by briank at 10:23 AM on August 11, 2009

The wikipedia page is rather astounding in it's description of his early practice:

Seeking a faster and less invasive way to perform the procedure, Freeman adopted Amarro Fiamberti's transorbital lobotomy and began to perfect it, initially by using ice picks hammered into each frontal lobe through the back of each eye socket ("ice pick lobotomy"). Freeman was able to perform these very quickly, outside of an operating room, and without a surgeon. For his first transorbital lobotomies, Freeman used an actual icepick from his kitchen

Discover Magazine's brief article casts a much different glow on the doctor and his activities than the above-linked Guardian article. From the Discover article:

Unfortunately, along with their madness, they lost their personalities. Freeman fell from institutional favor in the mid-1950s, when long-term studies began to reveal his technique’s failings and drugs like Thorazine came to market. In response he moved his practice west and began to operate on new kinds of patients: discontented housewives, for example, and unruly children. One was four years old.

As for the Guardian article, I wouldn't call "between 40% and 50% of patients showing significant improvement" a high success rate.
posted by filthy light thief at 10:27 AM on August 11, 2009

The Wikipedia entry for "lobotomy" contains this incisive criticism of the procedure's popularity:

In 1948 Norbert Wiener, the author of Cybernetics, said: "...prefrontal lobotomy ...has recently been having a certain vogue, probably not unconnected with the fact that it makes the custodial care of many patients easier. Let me remark in passing that killing them makes their custodial care still easier."

Norbert Wiener Cybernetics, p. 148, The MIT Press, 1948
posted by zippy at 10:32 AM on August 11, 2009 [31 favorites]

Definately don't listen to the "Stuff You Should Know Podcast" episode on Lobotomies. It could make you ill.
posted by blue_beetle at 10:34 AM on August 11, 2009

The real scandal isn't the horror-inducing icepick-in-brain action, and so concentrating on that misses the point. The scandal is the pathologization of ordinary human behavior such as 'rebelliousness', 'delinquency', 'lack of zeal', and so on, used to justify these treatments. When a science is so subjective as to use cultural and social norms as diagnostic criteria, it isn't a science anymore. There isn't a medical treatment for bad behavior, just as their isn't a treatment for bad manners or bad language. I hope we never again resort to that misuse of medicine, attempting to "correct" people just because we disapprove of how - and who - they are.
posted by Sova at 10:35 AM on August 11, 2009 [31 favorites]

sova: unfortunately, there are entire industries (behavioral and medicinal) ready to pathologize behaviors and then sell a "treatment". and enough people (generally people in a caretaker role) desperate to find a solution that they won't look beyond the marketing to see possible (or even likely) bad effects.
posted by rmd1023 at 10:43 AM on August 11, 2009 [4 favorites]

An important aspect of this story that I think is still undertold is that many of them were given to gay men and women to solve their homosexuality, and many of the people who received these lobotomies volunteered. Apparently, this technique was mostly unsuccessful.
posted by Astro Zombie at 10:43 AM on August 11, 2009

It was [Eunice] Shriver who revealed the condition of her sister Rosemary to the nation during her brother's presidency.

"Early in life Rosemary was different," she wrote in a 1962 article for the Saturday Evening Post. "She was slower to crawl, slower to walk and speak. ... Rosemary was mentally retarded." Rosemary Kennedy underwent a lobotomy when she was 23, though that wasn't mentioned in the article. She lived most of her life in an institution in Wisconsin and died in 2005 at age 86.

No disrespect intended, but Eunice Shriver was in on it? Seems like Rosemary was normal in early childhood.
posted by anniecat at 10:47 AM on August 11, 2009

As for the Guardian article, I wouldn't call "between 40% and 50% of patients showing significant improvement" a high success rate.

Really? I saw this show a while back and it sets your heart in a block of ice, with an extra cube leftover to hang out at the back of your throat. But let's not kid ourselves, here. There were basically no pharmeceuitcal treatments for mental illness at that time. You had straightjackets and rubber rooms and being zapped in the head and being dunked in water. And that was all you had, or were likely to have, for the rest of your life. Lobotomy came to be criticised, correctly, as being popular simply because it offered a permanent form of sedation for disturbed patients. But the alternative was not sunshine and rainbows and puppies. For some perhaps, it was occupational therapy and drugs and shriks. And for far too many it was an iron bed in a open ward with dozens of other shreiking, gibberring lunatics, no help and no hope of any. It's a debatable point whether being fully conscious of that fact is better or worse than being permanently numb to it. cf. The Willard State Suitcases.
posted by Diablevert at 10:57 AM on August 11, 2009 [6 favorites]

"As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. "

What?! What could possibly be the reasoning behind this?
posted by kathrineg at 11:05 AM on August 11, 2009

"As those who watched the procedure described it, a patient would be rendered unconscious by electroshock. "

What?! What could possibly be the reasoning behind this?

It's cheaper to administer than general anesthesia.
posted by thisjax at 11:10 AM on August 11, 2009

Undergrad was a lot of years ago, but I remember sitting in a class of extremely skeptical students being lectured on the long way we've come in psychiatric diagnosis and treatment, and how we now perform lobotomies (when done at all) with a wire, and cutting in a circular motion, we carefully estimate the number of connections cut.

I see the Wiki page states that the practice has been discontinued, but like shock treatment, I suspect it still has its adherents.
posted by Durn Bronzefist at 11:12 AM on August 11, 2009 [1 favorite]

Of all the things we currently do to treat people with "problem minds," I wonder which will be seen as barbaric in retrospect.
posted by Afroblanco at 11:12 AM on August 11, 2009 [3 favorites]

And that was all you had, or were likely to have, for the rest of your life.

But medications and treatments did improve. Not to mention the fact that they were used to treat conditions that are transient or not sufficiently severe to warrant such a procedure.

I see what you're saying--and I don't begrudge the people who sought this treatment for their loved ones in an effort to relieve their suffering--but a 40 to 50 percent chance of improvement is not good when you consider the risks and side effects, as well as the possibility of the development of new, safer, and more humane treatments.
posted by kathrineg at 11:12 AM on August 11, 2009

Of all the things we currently do to treat people with "problem minds," I wonder which will be seen as barbaric in retrospect.

This is definitely interesting to think about.

I posit that our some of our treatments for addiction will be seen as barbaric, especially when the addictions come with another diagnosis and treatment for the co-morbid condition is withheld until the addiction is cured.
posted by kathrineg at 11:16 AM on August 11, 2009 [3 favorites]

I remember first reading that article, My Journey, in 2005 and being incredibly freaked out. Sure, the idea of someone doing this to another human is disturbing enough, and the wide spread acceptance of this makes you question how much faith we put into medical science today, etc, etc.

But what got to me was the idea that the very core of what a person is-- their personality, their qualities, their curiosity or sense of humor, was all just sitting around inside a very vulnerable, malleable and misunderstood bag of neurotransmitters and neurons. All it takes to make You, Not You, is a few strokes of an ice pic. That unique spark may not be locked safely away in some immortal soul, separate from your body or mind. It's here, and Walter Freeman took it away from thousands of people.

I realized after reading that article, that my biggest fear was having my personality radically altered. I mean, death of loved ones, and cockroaches still rank up there, but fucking up my brain is tops. Like those PSA's say: avoiding brain fuckage is my anti-drug.
posted by fontophilic at 11:19 AM on August 11, 2009 [5 favorites]

Of all the things we currently do to treat people with "problem minds," I wonder which will be seen as barbaric in retrospect.

I've read Jack El-Hai's excellent book The Lobotomist (linked in the FPP), and that's one of its implicit takeaway points--that the barbarism of the practice was not apparent to those who practiced it: not because they were delusional, but because they didn't know enough about the brain to know what they didn't know. I started that book expecting to hate Freeman, but ended up feeling a little bit sorry for him--he, and most of the people around him, lacked our benefit of hindsight, and so they believed that what they were doing was genuinely morally good.
posted by Prospero at 11:23 AM on August 11, 2009

I see the Wiki page states that the practice has been discontinued, but like shock treatment, I suspect it still has its adherents.

I'd imagine some them are showing up threse days as the disruptive elements in town meetings.
posted by Guy_Inamonkeysuit at 11:28 AM on August 11, 2009 [1 favorite]

Of all the things we currently do to treat people with "problem minds," I wonder which will be seen as barbaric in retrospect.

McCoy: What's the matter with you?

Patient: Kidney... dialysis...

McCoy: Dialysis? What is this, the dark ages? Here, swallow one of these.
posted by Durn Bronzefist at 11:31 AM on August 11, 2009 [5 favorites]

I posit that our some of our treatments for addiction will be seen as barbaric, especially when the addictions come with another diagnosis and treatment for the co-morbid condition is withheld until the addiction is cured.

I just met with a psychiatrist yesterday to discuss standard practices so I can better convey information about the process to the legal team I work with in the drug court, he said that it is ideal to wait until a client has 6 months of abstinence before settling on a final diagnosis and a medication regimen as a lot of people are misdiagnosed as having psychotic and other mental health disorders when presenting symptoms of substance abuse or withdrawal and medicating withdrawal with psychiatric medications can actually complicate the situation further. That timeframe doesn't fit your typical community substance abuse program timeline, so he usually shoots for 2-4 weeks of abstinence. In either situation, if a client is presenting with psychotic symptoms or suicidal ideation he will disregard this and begin treatment immediately. There's no way a psychiatrist is prescribing psychotropic medication to anyone who is actively abusing street drugs. The potential for toxic interaction is too high.

unfortunately, there are entire industries (behavioral and medicinal) ready to pathologize behaviors and then sell a "treatment". and enough people (generally people in a caretaker role) desperate to find a solution that they won't look beyond the marketing to see possible (or even likely) bad effects.

I am very much on board with the mental health recovery model and feel that every client I work with has the right to determine the course of their own treatment, including refusing medication against medical advice. However, it is worth it for you to consider that the severely and chronically mentally ill often do not thrive without medications and treatment, and as a result not only is their quality of life severely impacted but at some point their right to refuse treatment can come into conflict with everyone else's right to public safety. And as a result, many of these people wind up in the prison system receiving truly barbaric treatment of the kind described in books about the old state hospitals. I have had and currently have clients who when not receiving treatment hurt other people or hurt themselves. You are not helping this type of mentally ill person by telling them that an industry is trying to "pathologize their behavior" in order to sell them a "treatment." They're the ones who wind up with a cop's boot on their neck getting whomped to shit with nightsticks when they decomp and go after someone with a knife, not you, so please take that into consideration.
posted by The Straightener at 11:37 AM on August 11, 2009 [19 favorites]

Back in the late 60's i worked through college as an aide at the local psych hospital run by the Sister's of Mercy (ironic, eh?).

Along with helping to administer ECT, I worked with a couple of patients who had been treated via lobotomies. The one that is still vivid in my mind was Father K., a priest who had been resident at the hospital for many years.

Father K paced the ward lighting one cigarette off of another, the ultimate chain smoker, he would easily go through three or four packs a day (and would have had more if he had been allowed to smoke after bedtime). He was actually allowed to keep a stash of porn in his room, it seemed to reduce the tension he was always experiencing and, honestly, kept him in his room and out of sight.

He was a very unhappy man, in three years I never saw him smile, nor did i ever see him clean, his hygiene was terrible.

The lobotomy pretty effectively kept him from ever following through with the anger that seethed inside of him. No matter how he was provoked by other patients, he would reach a point in his response that, from the outside, looked like someone hitting a mental/emotional brick wall... the anger would rise, collide with that barrier, and disappear in a froth like a wave hitting a rock cliff. They couldn't have turned him into much less of a man if they had castrated him...
posted by HuronBob at 11:38 AM on August 11, 2009 [4 favorites]

"Next on NBC, The Lobotomist. He travels the world giving life-changing lobotomies to those in need. Experience the excitement of stories ripped from today's headlines as The Lobotomist (Steve Buscemi) visits war-torn Afghanistan and performs and emergency operation in Dick Cheney (Richard Dreyfuss)."
posted by ...possums at 11:40 AM on August 11, 2009 [1 favorite]

(sic)
posted by ...possums at 11:41 AM on August 11, 2009

He had a "lobotomobile." That was what he called it -- his lobotomobile. That's moving into Batman villain territory.

-----------

Diablevert, given the choice I'd take the lifetime with "gibbering lunatics" any day.

If, as you say, "it's a debatable point whether being fully conscious of that fact is better or worse than being permanently numb to it," then murder should have been an option. If the doctor decides that a patient's life is no longer worth living, it's hard to see how an operation which has a high probability of leaving the patient semiconscious for life is a better option than killing them outright. "Permanently numb" is more or less equivalent to death -- worse if anything.
posted by justsomebodythatyouusedtoknow at 11:48 AM on August 11, 2009 [1 favorite]

Of all the things we currently do to treat people with "problem minds," I wonder which will be seen as barbaric in retrospect.

Nearly everyone I know is on some kind of anti-anxiety or anti-depressant drug. My father, who is a mental health professional and I have discussions about people and their imbalanced brain chemestry. Given the amount of trial and error one goes through with their new prescriptions, balancing doses, side-effects and results, we're nowhere near where we need to be.

All I can think is that before all of this marvelous pharmacology there must have been millions of miserable, self-medicating people. It sure explains the alcohol fueld corporate world of Mad Men.
posted by Ruthless Bunny at 11:48 AM on August 11, 2009

posted by ...possums "Next on NBC, The Lobotomist. He travels the world giving life-changing lobotomies to those in need. Experience the excitement of stories ripped from today's headlines as The Lobotomist (Steve Buscemi)

"Here are your names: Mr. Lobe, Mr. Skull, Mr. Cerebellum, Mr. Neuron, Mr. Medulla, and Mr. Pick.

"Wait, why am I Mr. Pick?"
posted by mattdidthat at 11:52 AM on August 11, 2009 [3 favorites]

The Straightener, I am speaking about therapy more than medication but your point is well taken.
posted by kathrineg at 11:55 AM on August 11, 2009

Next, on EXTREME MAKEOVER: CRANIAL EDITION, we take a family of sad, poor people, and make them HAPPY and poor.
posted by blue_beetle at 11:58 AM on August 11, 2009 [1 favorite]

As a batman villain, his henchmen would have to be named after the Cranial nerves.
posted by benzenedream at 12:02 PM on August 11, 2009

Seeking a faster and less invasive way to perform the procedure, Freeman adopted Amarro Fiamberti's transorbital lobotomy and began to perfect it, initially by using ice picks hammered into each frontal lobe through the back of each eye socket ("ice pick lobotomy"). Freeman was able to perform these very quickly, outside of an operating room, and without a surgeon. For his first transorbital lobotomies, Freeman used an actual icepick from his kitchen

Oh, sure - but when I do it, they call it "murder."
posted by It's Raining Florence Henderson at 12:08 PM on August 11, 2009 [3 favorites]

Re: the widespread practice of prescribing antidepressants, it's my suspicion that more and more the human species is trying to shove its generally well rounded personality into square holes (credit industrialization, specialization and institutional consumerism). If we spent more time outside, exploring and socializing, we'd be much happier animals. After all, that's what we were made to do. It's not so surprising, is it, that putting a free range animal into a 10x10 iron bar cage will lead to pacing, self-mutilation and depression.
posted by seanmpuckett at 12:18 PM on August 11, 2009 [3 favorites]

If we spent more time outside, exploring and socializing, we'd be much happier animals.

True...but what does that have to do with anti-depressants?
posted by kathrineg at 12:21 PM on August 11, 2009

Speaking of Batman -- I remember reading (in paperback reprint) the Shadow books as a kid, then moving on to devour The Avenger and Doc Savage. Doc had a "Crime College," where he'd take hardened criminals, strap them down, and -- er -- cut out their "Crime Gland." The criminals, blissfully free of that nasty bit of brain that contained the criminal impulse, would move on to lead full, complete and productive lives.

This got revisited with a much creepier take -- drooling, imbecilic lobotomy victims -- in the Denny O'Neil DC Comics series in the late '80s; a reflection of the changing times and growing awareness, I guess.

But, in context: 60 years ago, super-heroes performed lobotomies. Routinely.
posted by Shepherd at 12:28 PM on August 11, 2009

Why so serious?
posted by It's Raining Florence Henderson at 12:30 PM on August 11, 2009

posted by seanmpuckett If we spent more time outside, exploring and socializing, we'd be much happier animals.

Xenu approves.
posted by mattdidthat at 12:32 PM on August 11, 2009

I can see how the lack of drugs may have made lobotomies look attractive, but I can't understand how they thought 40% to 50% of patients "improving" qualified it as a successful treatment. Statistics existed then, right?

It all makes sense when you realize "improving" means "become more docile and easy to control." And that didn't change much even when drugs replaced the lobotomy as treatment of choice.
posted by tommasz at 12:39 PM on August 11, 2009 [3 favorites]

I can recall seeing older people with lobotomy scars in Whitby, Ontario (where there was a large mental health facility). They walked around downtown and I recall being freaked out when I'd suddenly notice the indent in the forehead and the distant look in the eyes.
posted by stinkycheese at 12:45 PM on August 11, 2009

I think I read parts of this guy's book (the doctor) when I found it back in the eighties. I remember he said patients would end up with two black eyes as a result.
"Rather than lengthy explanations," he said, "I prescribed that my patients wear sunglasses for a few days."
posted by atchafalaya at 12:49 PM on August 11, 2009

I've worked in a mental institution as a glorified orderly and I couldn't agree more with The Straightener's point about the consequences of not taking your meds for those who are severely mentally ill.

But I've also asked psychiatrists about how well the drugs we give some of these patients work and one doctor expressed it as "hitting a nail with a sledge-hammer." Point being, I think the answer to the question of whether or not what we are doing now will seem barbaric in the future could very well be "yes." I feel pretty strongly that it is better to give people thorazine than an ice pick in the back of the eye socket, but still, thorazine is harsh shit (assuming they're still using that, I don't know...it's been a number of years...).

All that aside, there is something else interesting that is coming up in this thread, which is the pathologization of deviant behavior, and the gray area between deviant behavior that does represent a pathology and that which just makes you distinct in some way from those you interact with in society. There is not necessarily a correlation between your ability to function well in society and your degree of mental illness, which makes this a particularly complex issue. It's impossible, I think, to establish dividing clean lines between those that are mentally ill and those that are not, but it does seem to my untrained (but at least a little experienced) eye that we are pathologizing more human experience these days, at least in the United States, and that there is also more a tendency to medicate as a part of approaches mental health treatment which may not be useful--but frankly, my evidence is all anecdotal.

On the flip side, psycho-pharmacology has been around for a long time, and so have forms of abuse of various substances (by those prescribing and those using), huh?
posted by dubitable at 12:50 PM on August 11, 2009 [1 favorite]

but still, thorazine is harsh shit (assuming they're still using that, I don't know...it's been a number of years...).

IANACP, but thorazine still is in widespread use, as is its more powerful relative haldol.
posted by Burhanistan at 1:01 PM on August 11, 2009

My grandfather consented to my grandmother euphemistically referred to as "an experimental procedure" in the late 40s/early 50s to relieve his chronic blinding headaches. Turned out he had a brain tumor and was given a partial lobotomy. I don't believe it was the Freeman icepick procedure, but it did remove part of his brain, and it didn't work. The brain tumor returned and it eventually killed him in the mid 70s. My grandmother only told her children about this about 15 years ago -- people connected lobotomies with severe mental illness, and that was Something You Didn't Talk About.

I was 3 when my grandfather died, so my faint memories of Gampy consist mostly of the pictures from that time. There's one of the two of us at the breakfast table: I am intently reading a Richard Scarry book while he reads his beloved Sunday Times. (Reading at the table was always allowed in my family except at big dinners.) My mother, who never knew Gampy before the operation, told me she remembered him as a quiet, gentle man who was always happy to just sit and watch the family swirl around him and that he was never without a copy of the NYT.

Dad told me that before the operation, Gampy was just like the rest of the family: lively with a quick wit and a love for puns, creative and curious and enjoyed new knowledge. He was the reason why the family could read at the table. Then, he was just complacent. Not a vegetable by any means, but he was just... there. He didn't speak up, he didn't crack jokes, he just liked to sit and hold his newspaper. If he had memories of his life before, and I'm sure he did, he didn't talk about it -- either nostalgically or with regret -- to the kids.

At the time, Dad attributed the personality change solely to the brain tumor and he was completely devastated when he learned what had really happened. He blames the procedure for robbing his father of, well, himself. I don't think he's also fully forgiven Grandma for withholding this from them for so long.

In short, it's a terrible thing, and I guess our equivalent nowadays of watching a loved one lose themselves in front of us is if they have Alzheimer's. I wouldn't wish either fate on anyone. It is a horrible thing to think about and, according to my dad, even more horrible to watch.
posted by Spatch at 1:09 PM on August 11, 2009 [8 favorites]

Editorial on this:

establish dividing clean lines

should be

establish clean dividing lines

...that is all. Carry on.
posted by dubitable at 1:18 PM on August 11, 2009

Thorazine is still used in the prison system because it's a cheap and they don't care in there whether you like it or not. It's not used so much on the outside.

Haldol is still used cases of really, really severe psychotic disorders. It has truly awful side effects. I understand that life on a medication like Haldol is brutal, but in every case I've seen, the alternative was worse.

I'm not sure if people really understand what life is like for someone who has a legitimate need for medication this powerful. One former client of mine was so delusional without medication that she not only refused to leave the house, she refused to leave her bedroom due to a germ paranoia so bad she wouldn't even use the toilet anymore. She would shit in plastic bags and store them, stacking them along the walls in her room. She was referred to my agency after a health department official was called out by a neighbor. They had to have a Hazmat team go in to clean the place out.

That's no way to live. That's such a tortured existence. Unfortunately, the less-than-perfect alternative is to spend the rest of your life on a heavily sedating medication that comes with a slew of side effects that can include permanent Parkinsons-like tremors. I don't know what to say, it's really hard watching clients cope with medication side effects, and I completely understand why they decide to periodically go off their meds. But then within a week they're back on the psych unit again, because they can't function without it. I have had clients go off medication and commit suicide. The medications are far from perfect, and they are dispensed in a system that is fraught with problems of its own, but doing nothing to help people with severe chronic mental illness because the treatments aren't perfect is not the right answer.
posted by The Straightener at 1:31 PM on August 11, 2009 [4 favorites]

Oral histories of relatives of lobotomy recipients.
posted by Burhanistan at 1:40 PM on August 11, 2009 [3 favorites]

Dude was a psychiatrist. Not a neurologist. He had no experience in neurosurgery and likely really futzed up more than he wanted to.

Psychosurgery is fucked up, and it destroys a lot of neural connections just to treat one problem. Fortunately, the brain is plastic.

Lobotomy, to my knowledge, is looked on within the neurological and neuroscientific fields as pretty much nearly anathema to everything we work for - the brain is so complex that severing an ENTIRE LOBE is a last resort. Of course, the brain can compensate for this, so it's kind of murky.

For example, split-brained patients often have their corpus callosum severed due to having seizures, but in the process they essentially become a person of two minds. Literally. The two halves of their cerebral cortex cannot communicate with one another, and they are only joined at the cerebellum and brainstem and whatever parts of their limbic system aren't severed (I'm not totally up to speed on precisely what happens during a callosotomy) .
posted by kldickson at 2:06 PM on August 11, 2009

And I just realized that my previous post was not organized, but hopefully you sort of can see the mixture of my opinion that psychosurgery is supremely fucked up for the most part (but is sometimes, as in the case of severing the corpus callosum, necessary, but I don't know whether that qualifies as psychosurgery!), and the handful of facts I'm trying to introduce into the conversation.
posted by kldickson at 2:10 PM on August 11, 2009

thorazine still is in widespread use, as is its more powerful relative haldol.

I had a room mate who was a psychiatrist at an emergency room. He said that whenever someone came in and caused problems, he would, in accordance with accepted protocol, dose him up with haldol. Then, one day he said, "I'm going to take haldol today and see what it's like."

He spent the day in what he later described as a waking nightmare. "I'll think twice before I prescribe that again."
posted by StickyCarpet at 2:56 PM on August 11, 2009 [2 favorites]

We watched this last year in my high school A.P. Literature class. It was fascinating, if a bit stomach-turning. The saddest (and most horrifying) anecdote, for me, was the man who related that he had had a lobotomy at the age of four -- and subsequently never had the chance to know the man he could have become without the lobotomy.
posted by punchdrunkhistory at 3:10 PM on August 11, 2009

Ah, well, at least he wasn't part of an evangelical movement like the Church of Trepanation.
posted by Smedleyman at 3:43 PM on August 11, 2009

Of all the horrific things that people do to torture, maim, and cripple one another, I'm somewhat pleasantly surprised that there aren't more forcible lobotomies in the prisons of failed states or as a consequence of out of control gang vendettas. It's one of the worst things I could conceive, and it seems to be beyond the conception of even the most evil.
posted by BrotherCaine at 4:13 PM on August 11, 2009

"If, as you say, "it's a debatable point whether being fully conscious of that fact is better or worse than being permanently numb to it," then murder should have been an option. If the doctor decides that a patient's life is no longer worth living, it's hard to see how an operation which has a high probability of leaving the patient semiconscious for life is a better option than killing them outright. "Permanently numb" is more or less equivalent to death -- worse if anything."

Well, I probably spoke a bit vehemently in my previous comment. But to be clear, I am making a distinction between the patient's and their family's view of the patient's suffering, and the doctor's. I don't think other people should get to decide for you that your life is no longer worth living, no matter what the quality of that life. I do think that patients and their families might have decided to undertake this terrible course in the honest belief it would reduce their loved one's suffering --- indeed, the doc contains testimony from two daughters of a lobotomized woman who, though they have reservations about the procedure, seem to feel that on balance it did do so. (Their mother was a manic depressive subject to extreme mood swings who had tried several times to kill herself, if I recall correctly. Other lobotomy victims interviewed should clearly have never had the procedure.). And I definitely think, as a matter of philosophy, morals, and ethics, that it's unclear what is the "better" life: To live numb to emotion and therefore pain, a slice of your soul lopped off, or to live with a mental illness that causes you tremendous anguish and may well mean the loss of all your freedoms, both large and small? That's a hard damn call, and though now the terrible cost of this fad is clear to us, then I think it was far from clear...
posted by Diablevert at 4:45 PM on August 11, 2009

Of all the horrific things that people do to torture, maim, and cripple one another, I'm somewhat pleasantly surprised that there aren't more forcible lobotomies in the prisons of failed states or as a consequence of out of control gang vendettas. It's one of the worst things I could conceive, and it seems to be beyond the conception of even the most evil.

In the USSR, dissidents were given massive long term doses of antipsychotics which, while lacking the permanence of lobotomies, weren't all that far off in effect.
posted by kersplunk at 4:55 PM on August 11, 2009

"Shock treatment" may or may not be barbaric but it can be effective against deep depression (defining effective as restoring the patient to a relatively normal state of mind, which lobotomy cannot achieve).

Ayahuasca and ketamine may achieve similar results, for similar (unclear) reasons.
posted by aeschenkarnos at 5:05 PM on August 11, 2009

Cutting the corpus callosum is a procedure usually performed on epileptics who suffer from intractable and debilitating seizures. AFAIK, it hasn't been used for any psychiatric purposes, though it certainly has psychological effects.

Weird thing is, for whatever reason, it often works.

As someone whose doctors have routinely suggested the "possibility" of brain surgery: ain't no one going near my brain with a knife. If it was life or death, I might think about it (y'know, if I could think), but I'm not entirely sure I'd consent even then. There is just way too much that we don't know about the brain and anytime we find an area that doesn't seem to "do anything" or seems in any way expendable... turns out to be pretty important. I think I'll keep it, even if mine did happen to be wired by drunken monkeys.
posted by grapefruitmoon at 5:08 PM on August 11, 2009 [1 favorite]

That's a hard damn call, and though now the terrible cost of this fad is clear to us, then I think it was far from clear...

I think the answer is in Norbert Weiner's remark as quoted by zippy. It's an alternative to euthanasia, and it's an alternative to permanent restraint, but it's not a "cure".
posted by aeschenkarnos at 5:11 PM on August 11, 2009

For example, split-brained patients often have their corpus callosum severed due to having seizures, but in the process they essentially become a person of two minds.

I actually work with a woman whose son's particular seizure disorder was so severe that simply cutting the corpus callosum wouldn't do the trick, so a complete hemispherectomy was required. Yeah, they removed half of his brain. The weird thing is that although he has some hemiplegia (I had thought he had a mild case of cerebral palsy or something until I found out his actual disability), he's otherwise in pretty good shape, finishing up a college degree in photography.
posted by infinitywaltz at 5:43 PM on August 11, 2009

"Shock treatment" may or may not be barbaric but it can be effective against deep depression (defining effective as restoring the patient to a relatively normal state of mind, which lobotomy cannot achieve).

Ayahuasca and ketamine may achieve similar results, for similar (unclear) reasons.

I think of this as the "reboot" approach to psychiatry.
posted by kersplunk at 5:57 PM on August 11, 2009 [1 favorite]

Cutting the corpus callosum is a procedure usually performed on epileptics who suffer from intractable and debilitating seizures. AFAIK, it hasn't been used for any psychiatric purposes, though it certainly has psychological effects.

True, but another modern form of psychosurgery, the cingulotomy, is used for very severe cases of OCD and, experimentally, for bipolar. Between that and the stuff people have been doing with implanting vagus nerve stimulators to treat depression, it looks as if psychosurgery is still alive and well.
posted by thisjax at 6:49 PM on August 11, 2009

he's otherwise in pretty good shape, finishing up a college degree in photography

Wow. More about hemispherectomy, from the New Yorker. The brain... amazing and sometimes terrible.
posted by dammitjim at 6:57 PM on August 11, 2009

I'm not sure if people really understand what life is like for someone who has a legitimate need for medication this powerful.

I don't know if you were responding to some of what I was saying or not, but: just to be clear, The Straightener, in no way was I disagreeing with you or intending to contradict your point--just qualify it. I do think it is pretty reasonable (and perhaps obvious) to say that in fifty years we will likely look back on the treatment we are giving people now--including (and perhaps especially) the treatment we give the severely mentally ill, such as those who cannot function on a basic level without medication like thorazine or haldol--and believe that, compared to the treatment that then may exist, the stuff happening now is barbaric. It's a prediction, but I think a fairly conservative one considering how things have been going so far. I have no idea what that treatment may be, but I believe medical science will make progress.

It's absolutely true what you are saying about some people needing this medication to function without existing in a hellish state. I will not debate that for a second. I've spent time with those people, I've seen what it's like (from the outside, at least). But I also saw many people who would go off of their medication because of what it did to them, how it made them feel. Then they would end up walking through the street naked or they would attack their neighbors or whatever, and the cops would pick them up and send them back to the institution in a vicious cycle which they repeated over and over. Again, I'm not meaning to contradict you, but it is true that the current solution is not wonderful, although it may be a solution--dismissing mental illness as being some sort of societal ostracization or the result of estrangement from nature is foolish and dangerous.

In regards to the subject of this thread: even my limited experience of how painful this is for individuals and their familes helps me to imagine how lobotomies may have been looked at not as mutilation but a possible solution to a problem--even if that was wishful thinking. Many of us have a hard time understanding how truly terrible mental illness can be for the person experiencing it as well as their friends and loved ones.
posted by dubitable at 7:29 PM on August 11, 2009 [1 favorite]

Thank you Straightener for taking the psychiatric establishment role for me.

You are not helping this type of mentally ill person by telling them that an industry is trying to "pathologize their behavior" in order to sell them a "treatment.

Unless you are offering an effective alternative i.e. the Osteria House under Loren Mosher.

The lobotomy treatment spawned from a desperate situation. What had once been peaceful mental institutions of between 100 to a maximum of 250 patients in a Kirkbride style asylum had swollen to 2000 patients or more. What was once an attentive staff who enacted an active treatment role, was now a beleaguered staff enacting a custodial, or warehousing role. Into this situation walks Freeman. Patients became manageable, which was the best the hospitals of this time could hope for.

Pharmacological options, when they appeared, were to replace this. But I would say that their main role in treatment is the same.-To keep the patients manageable for the lowest possible cost. Drugs do not cure or treat a mental illness, they manage the symptoms.

There is much evidence that seems to demonstrate that alternative options have equal or better chances of recovery and a much lower rate of relapse than drug based treatments. Not the least of which is the WHO sponsored cross-cultural studies on the course and outcome of schizophrenia. Which could be interpreted to demonstrate that western psychiatry itself is an agent in the severity of schizophrenia. The reasons that non-drug based and are not in more widespread use is a matter of many things, but foremost seem to be funding, infrastructure, current psychiatric dogma and a powerful pharmaceutical lobby.

(sometimes I feel I should footnote all this stuff, but if anyone has questions, I would be glad to provide sources.)
posted by psycho-alchemy at 12:02 AM on August 12, 2009 [1 favorite]

This article gave me nightmares last night. Just sayin'.
posted by HabeasCorpus at 5:25 AM on August 12, 2009

(sometimes I feel I should footnote all this stuff, but if anyone has questions, I would be glad to provide sources.)

I'm curious about the aforementioned WHO sponsored cross-cultural studies on the course and outcome of schizophrenia. When you get the chance, could you please post a link?
posted by Afroblanco at 6:57 AM on August 12, 2009

The Eunice Shriver thread took me to the Wikipedia article on Rosemary Kennedy, where you find this horrifying description of the actual procedure inflicted on her:

We went through the top of the head, I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside," he said. As Dr. Watts cut, Dr. Freeman put questions to Rosemary. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backwards. ... "We made an estimate on how far to cut based on how she responded." ... When she began to become incoherent, they stopped.
—James W. Watts

They decided when to stop by cutting until she became incoherent - the doctors, at least, have to have always intended and understood what they would take from her.
posted by dilettante at 7:40 AM on August 12, 2009

As for the Guardian article, I wouldn't call "between 40% and 50% of patients showing significant improvement" a high success rate.

We take that as good enough for new drugs. It's the destructive side effects that would keep a similar drug from being approved.
posted by dilettante at 7:43 AM on August 12, 2009

The Straightener: To be clear, I recognize that these treatments are absolutely necessary at this point for people with severe problems. I was talking specifically about sova's comment regarding pathologization of ordinary human behavior such as 'rebelliousness', 'delinquency', 'lack of zeal', and so on, used to justify these treatments..

As an example, in the same way that lobotomies were used to treat 'rebellious' and 'difficult' people (not just people who were otherwise incurable at the time), there's an entire industry of people willing to take your kids away to camps to "cure" their difficult behavior problems - generally far out of the purview of any kind of regulation.

Some behaviors are absolutely pathological and need to be treated medically, but a lot of behaviors that previously would've been considered part of the normal spectrum of behavior are being pathologized by people looking to sell alleged treatments.
posted by rmd1023 at 10:19 AM on August 12, 2009

Thank you Straightener for taking the psychiatric establishment role for me.

Oh, please. Every client I've worked with is in outpatient treatment, there's groups and individual therapy sessions and peer specialists among an array of other social supports that we work to connect our clients with. The right to refuse medication as directed by the recovery model for mental health treatment which all good community treatment sites adhere to is upheld at all times. And, you know, all this is going in the drug court, and Philly's drug court is a model court that courts around the world have used to guide their own programs. You want research? Start with the Treatment Research Institute, they've got about 12 years worth of longitudinal studies on our court that show the substance abuse and mental health treatment we provide our clients has a tremendous impact in terms of preventing reincarceration, relapse, and a shitload of other quality of life improvements. You've got a lot of fucking nerve.

But don't worry, the next time one of my clients decomps and winds up getting his ass stomped by a cop I'll be sure to pass along your regards.
posted by The Straightener at 2:25 PM on August 12, 2009 [1 favorite]