Better Living Through Lobotomy

What can the history of psychosurgery tell us about medicine today?

| August 19, 2004

The lobotomy has a long and curious history. Originally developed by Portuguese neurologist Egas Moniz, the operation attempted to sever the part of the brain that controls emotion from the part that controls intellect, permanently curbing anxiety and agitation. As the procedure evolved from localized alcohol injections into the disturbingly inaccurate destruction of brain tissue with sharp surgical instruments, the lobotomy became the most widely used treatment for severe mental illness, earning Moniz the Nobel Prize in 1949. Though the operation provided mixed results, physicians were eager to advocate and perform the surgery, and the lobotomy quickly became a medical institution despite its many flaws.

Elliot Valenstein, professor emeritus of psychology at the University of Michigan, argues that though the lobotomy is on the way out, the factors that led to its gross misapplication are still alive and well in the medical community. At the time of the procedure's acceptance, mental illness was seen as a dire social problem with which existing infrastructure was unable to cope; mental institutions were becoming increasingly crowded because they didn't have many effective means for dealing with severe mental illness. Thus, legislators and superintendents eagerly accepted any solution, like lobotomy, insulin coma, or electroshock therapy that promised to cheaply get patients out of asylums. The lobotomy received glowing coverage in the national media, helping spread its acceptance and adoption, and the operation finally went out of vogue in the late 1950's, when 'chemical lobotomies' such as Thorazine, an early antidepressant, proved to be more cost-effective than surgery.

The modern healthcare community is once again preoccupied with somatic treatments, seeing psychological problems as a physical set of symptoms. Just like in the lobotomy period, economic factors are distorting the practice of medicine, since nearly all clinicians or researchers have a vested interest in the development of certain procedures or drugs. A closer analysis of this economic system of mental health is necessary if the mistakes of the medical community are to be avoided.
-- Brendan Themes

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