Parallels with Lobotomy

Finally, one should beware the tendency to rely on an individual piece of anecdotal evidence (or even a handful of such examples) when assessing whether a treatment "works." Lobotomy was a mutilating and irreversible operation that possessed little or no scientific warrant, and was used in remarkably careless ways on patients who either had no say in the matter, or who were gulled by ruthless enthusiasts like Walter Freeman, who fed them grossly inaccurate information about what was being done to them. Many operations were done on people whose problems were relatively minor and transient, and these less disturbed individuals undoubtedly provided the majority of Freeman's successes.
by Andrew Scull

Answered by Barak Goodman:
The quantitative analysis of lobotomy was meager. The obstacles to a good study of lobotomy were numerous: the patients were often abandoned in mental hospitals and therefore hard to access; controlled studies were of course impossible; and no two patients got the same operation (Freeman's operation was truly "a stab in the dark"). The stigma attached to the operation made it a less than desirable area of research and study. Perhaps the most thorough analysis was done by Freeman himself, who kept in touch with hundreds of his patients and tried to assemble data to support lobotomy's efficacy. I think we have to regard that data as suspect.

Occasionally, after the fact, lawsuits are launched attempting to secure damages for the victims. This occurred in Canada, for instance, after the death of Ewen Cameron, former president of the American, Canadian, and World Psychiatric Associations, and a member of the Nuremberg medical tribunal which had investigated Nazi doctors. Cameron, practicing at McGill University, had experimented with "depatterning" and "psychic driving," extraordinary experiments where, inter alia, he wiped out patients' memories with repeated electroshocks designed to reduce those subjected to them to the status of helpless, incontinent "infants," whose psyches he then purported to rebuild. Cameron at his death was a highly respected figure in his profession. Only after it emerged that much of this work had been secretly supported by the CIA were lawsuits brought, some of which were successful in securing monetary damages for his victims and/or their families. Whether money could ever adequately compensate for what has been done, for suicides and ruined lives, is very doubtful, as I'm sure you would agree. But the legal acknowledgement of the depth of the wrong that has been wrought is, of course, worth something.

Andrew Scull

My father was aiming to disconnect the thalamus from the frontal cortex

The positive(sic!) consequences of cutting between thalamus and frontal cortex were loss of fear and anxiety. The negative consequences of cutting were loss of social inhibition (loss of guilt, shame, fear of disapproval) and loss of the ability to think ahead (no ambition, eating to excess, inability to read the minds of others).

" People who start taking Prozac, Miltown, or other tranquilizers no longer suffer anxiety and fear of the future, but they lose ambition, libido, and the capacity for deep feelings. That is the cost of treatment. Neither surgery nor drugs cure the mental illness. They only relieve the suffering, and the cost is high.

Most patients who are not suffering too much prefer to continue to suffer than to accept the loss. Other patients suffer so intensely that they kill themselves rather than continue living.

Walter Freeman III

http://www.pbs.org/wgbh/amex/lobotomist/forum/day2.html

Lobotomy lauded as a successful surgery. History repeating itself?

Now while there certainly were doctors and surgeons who worried about doing this surgery, and approached it very cautiously, nearly all of those who initially tried it reported good results, and published their findings in medical journals. Indeed, in 1943, a researcher tallied up the results of 618 lobotomies performed at 18 different sites in the United States and Canada, and concluded that 518 patients were "improved" or "recovered," and that only eight had been made worse by the surgery. The researcher concluded: "We have known for a long time that man may get on with one lung or one kidney, or part of the liver. Perhaps he may get on, and somewhat differently, with fewer frontal fiber tracts in the brain."

The surgery did what scientists said it did; the question is why did they judge this to be a good thing for those said to be mentally ill? It was that evaluation process that provided a context for Freeman and others to do the surgery.

So, could something like this happen today? Could psychiatry -- or some other branch of medicine -- adopt a form of care that we would later come to see as harmful? The history of medicine certainly warns us that doctors can be deluded about the merits of their therapies, and today that whole decision-making process is greatly influenced by pharmaceutical companies' money, which only increases the possibility of medicine going astray. The lobotomy story really should remind us of that possibility.

Robert Whitaker

http://www.pbs.org/wgbh/amex/lobotomist/forum/day1.html

Orthodeoxia

Orthodeoxia-an uncommon presentation following bilateral thoracic sympathectomy
P V van Heerden, P D Cameron, A Karanovic, M A Goodman. Anaesthesia and Intensive Care. Edgecliff:Oct 2003. Vol. 31, Iss. 5, p. 581-3

Abstract (Summary)

We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.

Less common associations with orthodeoxia are atypical pneumonia3, trauma8, organophosphate poisoning10 and progressive autonomic failure12.

The surgical procedure, which interrupted both sympathetic trunks, probably resulted in "sympathectomy" of the lung with consequent vasoplegia of the pulmonary circulation and blunting of the HPV response.

The combination of areas of reduced ventilation in the lung, together with blunted HPV, resulted in profound oxygen desaturation in our patient when she sat up in bed.

As antibiotics and chest physiotherapy improved the collapse/consolidation of the lungs, the patient became less dependent on artificial means of maintaining pulmonary vascular tone, so that the noradrenaline and then the almitrine could be weaned without incident. Presumably there will be some return of sympathetic tone to the pulmonary circulation with time.

It was not the intention of the authors to describe all the physiological consequences of thoracotomy or thoracoscopy, with or without one-lung ventilation, in this short communication. Clearly these procedures on their own can have significant effects on lung physiology, quite apart from the unique confluence of factors producing orthodeoxia in the patient presented in this case report.

Copyright Australian Society of Anaesthetists Oct 2003

Strong parallels with Lobotomy - What has changed?

One of the most horrifying medical treatments of the 20th century was carried out not clandestinely, but with the approval of the medical establishment, the media and the public. Known as the transorbital or "ice pick" lobotomy, the crude and destructive brain-scrambling operation performed on thousands of psychiatric patients between the 1930s and 1960s was touted as a cure for mental illness.

Freeman's operation reflected the neurologist's peculiar combination of zealotry, talent, hubris and, as one of his trainees noted, craziness.

Undaunted by his failures, Freeman's pitch that lobotomy cured mental illness was seized on by the press -- the Washington Star called it among "the greatest innovations of this generation," and the New York Times pronounced it "history-making." Many doctors embraced it as a 10-minute operation that promised to empty mental hospitals and return patients to their families. Opponents, mostly psychiatrists who practiced Freudian talk therapy, didn't matter much: In those days public criticism of a doctor by his peers was regarded as unethical.

The story of how Freeman sold his procedure to credulous colleagues, assiduously courted the press and convinced desperate families that sticking an ice pick through a patient's upper eye sockets and twirling it like a swizzle stick through brain matter would cure psychosis, depression or troublesome behavior is the ultimate in cautionary medical tales.

The issue at the heart of this powerful and unsettling film is not, as one writer puts it, "how a man could go off the rails, but how science could go off the rails."

'Lobotomist' Serves as a Warning

Documentary Shows Damage Done When Medicine Goes Awry

By Sandra G. Boodman

Washington Post Staff Writer
Tuesday, January 15, 2008; Page HE01