Psychosurgery, also called neurosurgery for mental disorder (NMD), is the
neurosurgical treatmentNeurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist
Gottlieb BurckhardtJohann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation...
. The first significant foray into psychosurgery in the twentieth century was conducted by the Portuguese neurologist Egas Moniz. During the mid-1930s he developed the operation known as leucotomy. The practice was enthusiastically taken up in America by the
neuropsychiatristNeuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
Walter Freeman and the
neurosurgeonNeurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
James W. WattsJames Winston Watts was a neurosurgeon, born in Lynchburg, Virginia and a graduate of the Virginia Military Institute and the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman...
who devised what became the standard prefrontal procedure and named their operative technique
lobotomyLobotomy "; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy . It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain...
. After World War II, Freeman broke with Watts and introduced a modification of the procedure which he termed transorbital lobotomy. This simplified procedure where an ice-pick or similar instrument entered the brain through the eye socket dispensed with the need for a neurosurgeon and became subject to widespread use in America. In spite of the award of the
Nobel prizeThe Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...
to Moniz in 1949 the lobotomy was largely discredited and replaced by
chlorpromazineChlorpromazine is a typical antipsychotic...
in the 1950s. Other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is regulated and only used in a few centres on small numbers of people with depression or
obsessive-compulsive disorderObsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...
(OCD) who have already undergone years of treatment.
In some other countries it is used in the treatment of
schizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and
addictionSubstance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....
.
Psychosurgery is a collaboration between psychiatrists and neurosurgeons. During the operation, which is carried out under a
general anaestheticA general anaesthetic is a drug that brings about a reversible loss of consciousness. These drugs are generally administered by an anaesthesia provider to induce or maintain general anaesthesia to facilitate surgery...
and using
stereotacticStereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation,...
methods, a small piece of
brainThe human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
is destroyed or removed. The most common types of psychosurgery in current or recent use are capsulotomy,
cingulotomyBilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of obsessive-compulsive disorder, depression and addiction. It is also, rarely, used in the treatment of chronic pain...
, subcaudate tractotomy and limbic leucotomy. Lesions are made by radiation, thermo-coagulation, freezing or cutting. About a third of patients show significant improvement in their symptoms after operation.
Advances in surgical technique have greatly reduced the incidence of death and serious damage from psychosurgery; the remaining risks include seizures, incontinence, decreased drive and initiative, weight gain, and
cognitiveIn science, cognition refers to mental processes. These processes include attention, remembering, producing and understanding language, solving problems, and making decisions. Cognition is studied in various disciplines such as psychology, philosophy, linguistics, and computer science...
and
affectiveAffect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
problems.
Currently, interest in the neurosurgical treatment of mental illness is shifting from
ablativeAblation is removal of material from the surface of an object by vaporization, chipping, or other erosive processes. This occurs in spaceflight during ascent and atmospheric reentry, glaciology, medicine, and passive fire protection.-Spaceflight:...
psychosurgery (where the aim is to destroy brain tissue) to
deep brain stimulationDeep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain...
(DBS) where the aim is to stimulate areas of the brain with implanted
electrodeAn electrode is an electrical conductor used to make contact with a nonmetallic part of a circuit...
s.
Early psychosurgery
There is evidence that
trepanningTrepanning, also known as trephination, trephining or making a burr hole, is a surgical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases. It may also refer to any "burr" hole created...
(or trephining) — the practice of drilling holes in the skull — has been in widespread, if infrequent, use since 5000 BC. This may have been done in an attempt to allow the brain to expand in the case of
increased brain fluid pressureIntracranial pressure is the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid . The body has various mechanisms by which it keeps the ICP stable, with CSF pressures varying by about 1 mmHg in normal adults through shifts in production and absorption of CSF...
, for example, after head injuries. However, psychosurgery as understood today was not commonly practiced until the 1930s.
Gottlieb Burkhardt
The first systematic attempt at human psychosurgery is commonly attributed to the Swiss psychiatrist
Gottlieb BurckhardtJohann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation...
. In December 1888 Burckhardt operated on the brains of six patients (one of whom died a few days after the operation) at the Préfargier Asylum, cutting out a piece of
cerebral cortexThe cerebral cortex is a sheet of neural tissue that is outermost to the cerebrum of the mammalian brain. It plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. It is constituted of up to six horizontal layers, each of which has a different...
. He presented the results at the Berlin Medical Congress and published a report, but the response was hostile and he did no further operations.
Early in the 20th century Russian neurologist
Vladimir BekhterevVladimir Mikhailovich Bekhterev was a Russian Neurologist and the Father of Objective Psychology. He is best known for noting the role of the hippocampus in memory, his study of reflexes, and Bekhterev’s Disease...
and Estonian neurosurgeon
Ludvig PuuseppLudvig Puusepp , was an Estonian surgeon and researcher and the world's first professor of neurosurgery.-Early life:...
operated on three patients with mental illness, with discouraging results.
Egas Moniz
But it was the Portuguese neurologist Egas Moniz who, in 1935, was responsible for introducing psychosurgery into mainstream psychiatric practice, and coined the term "psychosurgery". Moniz developed a theory that people with mental illnesses, particularly "obsessive and melancholic cases" had a disorder of the
synapseIn the nervous system, a synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell...
s which allowed unhealthy thoughts to circulate continuously in their brains. Moniz hoped that by surgically interrupting pathways in their brain he could encourage new healthier synaptic connections. In November 1935, under Moniz's direction, surgeon Pedro Almeida Lima drilled a series of holes on either side of a woman's skull and injected
ethanolEthanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...
to destroy small areas of subcortical white matter in the
frontal lobeThe frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
s. After a few operations using ethanol, Moniz and Almeida Lima changed their technique and cut out small cores of brain tissue. They designed an instrument which they called a leucotome, and called the operation a leucotomy (cutting of the white matter). After twenty operations they published an account of their work. The reception was generally not friendly but a few psychiatrists, notably in Italy and the US, were inspired to experiment for themselves.
Walter Freeman and James Watts
In the US, psychosurgery was taken up and zealously promoted by neurologist Walter Freeman and neurosurgeon
James WattsJames Winston Watts was a neurosurgeon, born in Lynchburg, Virginia and a graduate of the Virginia Military Institute and the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman...
. They started a psychosurgery program at
George Washington UniversityThe George Washington University is a private, coeducational comprehensive university located in Washington, D.C. in the United States...
in 1936, first using Moniz's method but then devised a method of their own in which the connections between the prefrontal lobes and deeper structures in the brain were severed by making a sweeping cut through a burr hole on either side of the skull. They called their new operation a
lobotomyLobotomy "; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy . It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain...
.
Freeman went on to develop a new form of lobotomy which dispensed with the need for a neurosurgeon. He hammered an ice pick-like instrument, an orbitoclast, through the eye socket and swept through the frontal lobes. The transorbital or "ice pick" lobotomy was done under
local anesthesiaLocal anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
or using
electroconvulsive therapyElectroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
to render the patient unconscious and could be performed in mental hospitals lacking surgical facilities. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in psychiatic hospitals. Freeman's patients included 19 children, one of whom was 4 years old.
Popularization and decline
The 1940s saw a rapid expansion of psychosurgery, in spite of the fact that it involved a significant risk of death and severe personality changes. By the end of the decade, up to 5000 psychosurgical operations were being carried out annually in the US. In 1949, Moniz was awarded the
Nobel Prize for Physiology or Medicine. But psychosurgery went into rapid decline in the 1950s, due to the introduction of new drugs and a growing awareness of the long-term damage caused by the operations, as well as doubts about its efficacy.
Procedural innovations
Beginning in the 1940s various new techniques were designed in the hope of reducing the adverse effects of the operation; William Scoville's orbital undercutting, Jean Talairach's anterior capsulotomy, and Hugh Cairn's
bilateral cingulotomyBilateral cingulotomy is a form of psychosurgery, introduced in 1948 as an alternative to lobotomy. Today, it is mainly used in the treatment of obsessive-compulsive disorder, depression and addiction. It is also, rarely, used in the treatment of chronic pain...
. Stereotactic techniques made it possible to place
lesionA lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s more accurately, and experiments were done with alternatives to cutting instruments such as radiation. By the 1970s the standard or transorbital lobotomy had been replaced with other forms of psychosurgical operations.
1970s to the present
During the 1960s and 1970s psychosurgery became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Surprisingly, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures. In this new, regulated era, a few facilities in some countries, such as the US, continue to use psychosurgery on small numbers of patients, with the number of operations declining further over the 30 years, a period during which there have been no major advances in ablative psychosurgery.
Neurological effects
The
frontal lobeThe frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or
prefrontalThe prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior...
area is involved in impulse control, judgement with everyday life and situations, language, memory, motor function, problem solving, sexual behaviour, socialization and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour.
The efficacy is not high: one study of cingulotomy (which usually involves a 2–3 cm lesion in the
cingulumThe cingulum is a collection of white matter fibers projecting from the cingulate gyrus to the entorhinal cortex in the brain, allowing for communication between components of the limbic system....
near the
corpus callosumThe corpus callosum , also known as the colossal commissure, is a wide, flat bundle of neural fibers beneath the cortex in the eutherian brain at the longitudinal fissure. It connects the left and right cerebral hemispheres and facilitates interhemispheric communication...
) found improvement in 5 out of 18 patients.
Present day
All the forms of psychosurgery in use today (or used in recent years) target the limbic system, which involves structures such as the
amygdalaThe ' are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae are considered part of the limbic system.-...
,
hippocampusThe hippocampus is a major component of the brains of humans and other vertebrates. It belongs to the limbic system and plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation. Humans and other mammals have two hippocampi, one in...
, certain
thalamicThe thalamus is a midline paired symmetrical structure within the brains of vertebrates, including humans. It is situated between the cerebral cortex and midbrain, both in terms of location and neurological connections...
and hypothalamic nuclei,
prefrontalThe prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas.This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior...
and
orbitofrontal cortexThe orbitofrontal cortex is a prefrontal cortex region in the frontal lobes in the brain which is involved in the cognitive processing of decision-making...
, and
cingulate gyrusThe cingulate cortex is a part of the brain situated in the medial aspect of the cortex. It includes the cortex of the cingulate gyrus, which lies immediately above the corpus callosum, and the continuation of this in the cingulate sulcus...
— all connected by fibre pathways and thought to play a part in the regulation of emotion. There is no international consensus on the best target site.
Anterior cingulotomy was first used by
Hugh CairnsSir Hugh William Bell Cairns was a British neurosurgeon.Hugh Cairns was born in Port Pirie, but came to Adelaide for his secondary education at Adelaide High School and tertiary education at the University of Adelaide...
in the UK, and developed in the US by H.T. Ballantine jnr. In recent decades it has been the most commonly used psychosurgical procedure in the US. The target site is the anterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region.
Anterior capsulotomy was developed in Sweden, where it became the most frequently used procedure. It is also used in Scotland. The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei.
Subcaudate tractotomy was the most commonly used form of psychosurgery in the UK from the 1960s to the 1990s. It targets the lower medial quadrant of the frontal lobes, severing connections between the limbic system and supra-orbital part of the frontal lobe.
Limbic leucotomy is a combination of subcaudate tractotomy and anterior cingulotomy. It was used at
Atkinson Morley HospitalAtkinson Morley Hospital was located at Copse Hill, Wimbledon, London , SW20, England from 1869 until 2003. The hospital was noted as one of the most advanced brain surgery centres in the world, and in particular for the first use of computed tomography on a human being in 1972 by Godfrey...
London in the 1990s and also at
Massachusetts General HospitalMassachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
.
Amygdalotomy, which targets the
amygdalaThe ' are almond-shaped groups of nuclei located deep within the medial temporal lobes of the brain in complex vertebrates, including humans. Shown in research to perform a primary role in the processing and memory of emotional reactions, the amygdalae are considered part of the limbic system.-...
, was developed as a treatment for aggression by Hideki Narabayashi in 1961 and is still used occasionally, for example at the
Medical College of GeorgiaGeorgia Health Sciences University formerly known as, and now home of the, Medical College of Georgia , is a public academic health center, with its main campus located in the Medical District of Augusta, Georgia. It is the smallest of four research universities in the University System of Georgia...
.
There is debate about whether or not
deep brain stimulationDeep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain...
(DBS) should be classed as a form of psychosurgery.
Endoscopic sympathetic block (a form of
endoscopic thoracic sympathectomyEndoscopic thoracic sympathectomy is a surgical procedure where certain portions of the sympathetic nerve trunk are destroyed. ETS is used to treat hyperhidrosis, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is palmar...
) for patients with
anxiety disorderAnxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
is sometimes considered to be a psychiatric treatment, despite it not being surgery of the brain. There is also renewed interest in using it to treat
schizophreniaSchizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. ESB disrupts brain regulation of many organs normally affected by emotion, such as the heart and blood vessels. A large study demonstrated significant reduction in "alertness" and "fear" in patients with social phobia as well as improvement in their quality of life.
Asia
In China psychosurgical operations which make a lesion in the
nucleus accumbensThe nucleus accumbens , also known as the accumbens nucleus or as the nucleus accumbens septi , is a collection of neurons and forms the main part of the ventral striatum...
are used in the treatment of drug and alcohol dependence. Psychosurgery is also used in the treatment of schizophrenia, depression, and other mental disorders. Psychosurgery is not regulated in China, and its use has been criticised in the West.
India had an extensive psychosurgery programme until the 1980s, using it to treat addiction, and aggressive behaviour in adults and children, as well as for depression and OCD.
Cingulotomy and capsulotomy for depression and OCD continue to be used, for example at the BSES MG Hospital in Mumbai.
In Japan the first lobotomy was performed in 1939 and the operation was used extensively in mental hospitals. but psychosurgery fell into disrepute in the 1970s, partly due to its use on children with behavioural problems.
Australia and New Zealand
In the 1980s there were 10-20 operations a year in Australia and New Zealand. The number had decreased to one or two a year by the 1990s. According to one report, no operations have been carried out since 2000, although the Victorian Psychosurgery Review Board dealt with 3 applications between 2006 and 2008.
Europe
In the twenty year period 1971-1991 the Committee on Psychosurgery in the Netherlands and Belgium oversaw 79 operations. Since 2000 there has been only one centre in Belgium performing psychosurgery, carrying out about 8 or 9 operations a year (some capsulotomies and some DBS), mostly for OCD.
In France about five people a year were undergoing psychosurgery in the early 1980s.
In 2005 the Health Authority recommended the use of ablative psychosurgery and DBS for OCD.
In the early 2000s in Spain about 24 psychosurgical operations (capsulotomy, cingulotomy, subcaudate tractotomy, and hypothalamotomy) a year were being performed. OCD was the most common diagnosis, but psychosurgery was also being used in the treatment of anxiety and schizophrenia, and other disorders.
In the UK between the late 1990s and 2010 there were just two centres using psychosurgery: a few stereotactic anterior capsulotomies are performed every year at the
University Hospital of WalesUniversity Hospital of Wales , opened in November 1971, is a major 1000-bed hospital situated in the inner city district of Heath in Cardiff, Wales...
, Cardiff, while anterior cingulotomies are carried out by the Advanced Interventions Service at
Ninewells HospitalNinewells Hospital is one of the largest teaching hospitals in Europe, based on the western edge of Dundee, Scotland. It is internationally renowned for introducing laparoscopic surgery to the UK as well as being a leading centre in developing fields such as the management of cancer, medical...
, Dundee. The patients have diagnoses of depression, obsessive-compulsive disorder, and anxiety. Ablative psychosurgery was not performed in England between the late 1990s and 2010, although a couple of hospitals have been experimenting with DBS. In 2010
Frenchay HospitalFrenchay Hospital is a large hospital situated in Frenchay, South Gloucestershire, on the outskirts of Bristol, England, part of the North Bristol NHS Trust....
, Bristol, performed an anterior cingulotomy on a woman who had previously undergone DBS.
In Russia in 1998 the Institute of the Human Brain (Russian Academy of Sciences) started a programme of stereotactic cingulotomy for the treatment of drug addiction. About 85 people, all under the age of 35, were operated on annually. In the former USSR, leucotomies were used for the treatment of schizophrenia in the 1940s, but the practice was prohibited by the Ministry of Health in 1950.
North America
In the US the
Massachusetts General HospitalMassachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
has a psychosurgery program. Operations are also performed at a few other centres. In Mexico psychosurgery is used in the treatment of anorexia.
South America
Venezuela has three centres performing psychosurgery. Capsulotomies, cingulotomies and amygdalotomies are used to treat OCD and aggression.
Individuals who underwent lobotomy
- Josef Hassid
Josef Hassid was a Polish violinist.Born 28 December 1923 in Suwałki, Poland, as Joseph or Józef Chasyd, second youngest of four children, he lost his mother when he was ten and was brought up by his father Owseij who took charge of his career.After lessons with a local violin teacher he studied...
: Polish violin prodigy and schizophrenic who died at 26.
- Rosemary Kennedy
Rose Marie "Rosemary" Kennedy was the third child and first daughter of Rose Elizabeth Kennedy née Fitzgerald and Joseph Patrick Kennedy, Sr., born little more than a year after her brother, future U.S. President John F. Kennedy...
: Walter Freeman's most famous patient and sister of President John F. KennedyJohn Fitzgerald "Jack" Kennedy , often referred to by his initials JFK, was the 35th President of the United States, serving from 1961 until his assassination in 1963....
.
- Rose Williams: Sister of Tennessee Williams
Thomas Lanier "Tennessee" Williams III was an American writer who worked principally as a playwright in the American theater. He also wrote short stories, novels, poetry, essays, screenplays and a volume of memoirs...
.
- Howard Dully
Howard Dully is one of the youngest recipients of the transorbital lobotomy, a procedure performed on him when he was 12 years old. Dully received international attention in 2005, following the broadcasting of his story on National Public Radio...
: One of Walter Freeman's youngest patients, author of My Lobotomy (2007).
Fictional examples
- In Unruhe
"Unruhe" is a 1996 episode of The X-Files television series. It was the fourth episode broadcast in the show's fourth season, and the first episode to air on Sunday night when the show was moved from Fridays to Sundays. "Unruhe" features a man who kidnaps women and lobotomizes them...
, Ep. 4 Season 4, of the TV show The X-FilesThe X-Files is an American science fiction television series and a part of The X-Files franchise, created by screenwriter Chris Carter. The program originally aired from to . The show was a hit for the Fox network, and its characters and slogans became popular culture touchstones in the 1990s...
, serial killer Gerry Schnauz performs lobotomies on women he intends to save from mental 'unrest.'
- Frances Farmer
Frances Elena Farmer was an American actress of stage and screen. She is perhaps better known for sensationalized and fictional accounts of her life, and especially her involuntary commitment to a mental hospital...
: Though Farmer is the person perhaps best associated in the public mind with lobotomy due to its depiction in the fictionalized biographical film FrancesFrances is a 1982 American drama film starring Jessica Lange, Kim Stanley, and Sam Shepard. When it was released this film was advertised as a purportedly true account of actress Frances Farmer's life but the script was largely fictional and sensationalized...
, archival medical and other records have conclusively proven Farmer never underwent the procedure. The author who initially alleged the lobotomy later admitted in court he had made it up.http://jeffreykauffman.net/francesfarmer/sheddinglight.html (Footnoted site contains court transcripts which are also available through LexisNexisLexisNexis Group is a company providing computer-assisted legal research services. In 2006 it had the world's largest electronic database for legal and public-records related information...
.)
- Ken Kesey
Kenneth Elton "Ken" Kesey was an American author, best known for his novel One Flew Over the Cuckoo's Nest , and as a counter-cultural figure who considered himself a link between the Beat Generation of the 1950s and the hippies of the 1960s. "I was too young to be a beatnik, and too old to be a...
's famed fictional character, Randle Patrick McMurphy, in One Flew Over the Cuckoo's NestOne Flew Over the Cuckoo's Nest is a novel written by Ken Kesey. Set in an Oregon asylum, the narrative serves as a study of the institutional process and the human mind, as well as a critique of Behaviorism and a celebration of humanistic principles. Written in 1959, the novel was adapted into a...
who was, in the movie, played by Jack NicholsonJohn Joseph "Jack" Nicholson is an American actor, film director, producer and writer. He is renowned for his often dark portrayals of neurotic characters. Nicholson has been nominated for an Academy Award twelve times, and has won the Academy Award for Best Actor twice: for One Flew Over the...
.
- J. Frank Parnell, erratic driver of the radioactive Chevy Malibu in the movie Repo Man.
- A Hole in One
A Hole in One is a 2004 film co-starring Michelle Williams and Meat Loaf. The film marked the feature debut of writer/director Richard Ledes. It received its premiere at the Tribeca Film Festival in 2003.-Plot:...
, a 2004 movie about a young lady who wants an ice pick lobotomy during the height of its popularity.
- Rat Korga, major character in Samuel R. Delany
Samuel Ray Delany, Jr., also known as "Chip" is an American author, professor and literary critic. His work includes a number of novels, many in the science fiction genre, as well as memoir, criticism, and essays on sexuality and society.His science fiction novels include Babel-17, The Einstein...
's science fictionScience fiction is a genre of fiction dealing with imaginary but more or less plausible content such as future settings, futuristic science and technology, space travel, aliens, and paranormal abilities...
novel Stars in My Pocket Like Grains of SandStars in My Pocket Like Grains of Sand is a science fiction novel by Samuel R. Delany. It was part of a planned diptych whose second half, The Splendor and Misery of Bodies, of Cities, remains unfinished; in September 1996 the Review of Contemporary Fiction printed an excerpt.-Plot summary:The...
, voluntarily opts for psychosurgery to make him content to be a slave.
- Session 9
Session 9 is a 2001 American psychological horror film directed by Brad Anderson. It stars David Caruso, Peter Mullan, Stephen Gevedon, Paul Guilfoyle, Josh Lucas, and Brendan Sexton III...
, a 2001 horror movie about a group of men hired to remove the asbestosAsbestos is a set of six naturally occurring silicate minerals used commercially for their desirable physical properties. They all have in common their eponymous, asbestiform habit: long, thin fibrous crystals...
from a defunct mental hospital.
- Hannibal, in which Hannibal Lecter
Hannibal Lecter M.D. is a fictional character in a series of horror novels by Thomas Harris and in the films adapted from them.Lecter was introduced in the 1981 thriller novel Red Dragon as a brilliant psychiatrist and cannibalistic serial killer...
lobotomizes Paul Krendler, played by Ray Liotta[File:Ray Liotta is an American actor, best known for his portrayal of Henry Hill in the crime-drama Goodfellas, directed by Martin Scorsese and his role as Shoeless Joe Jackson in Field of Dreams...
.
- In the book The Bell Jar by Sylvia Plath
Sylvia Plath was an American poet, novelist and short story writer. Born in Massachusetts, she studied at Smith College and Newnham College, Cambridge before receiving acclaim as a professional poet and writer...
, the character Esther Greenwood meets a girl named Valerie in the asylum who has had a lobotomy.
- Iron Maiden
Iron Maiden are an English heavy metal band from Leyton in east London, formed in 1975 by bassist and primary songwriter Steve Harris. Since their inception, the band's discography has grown to include a total of thirty-six albums: fifteen studio albums; eleven live albums; four EPs; and six...
s famous fictional mascot, EddieEddie, also known as Eddie The Head, is the mascot for the British heavy metal band, Iron Maiden. He is a perennial fixture of the group's artwork, appearing in all of their record covers and in their merchandise, which includes t-shirts, posters and action figures...
, was lobotomised on-stage during one of Maiden's live shows; this concert was filmed for German TV but that particular segment was cut out due to being deemed "Too violent". The cover of their fourth album Piece of MindPiece of Mind is the fourth studio album by British heavy metal band Iron Maiden. It was originally released in 1983 on EMI, and on Capitol in the US; it was reissued later on Sanctuary/Columbia Records...
(and many of the following releases) shows Eddie after being lobotomised.
- In Episode 6 of Mortal Kombat Legacy, Raiden
Raiden is a player character in the Mortal Kombat fighting game series. Raiden, also known as Lord Raiden, is a thunder god of the Mortal Kombat universe and protector of Earthrealm. He commands many supernatural abilities such as the ability to teleport, control over lightning, and flight...
is captured at a psychiatric hospital and given a crude lobotomy to "cure" him of his "violent outbursts and delusions" of being a god.
- In the book Cyteen
Cyteen is a Hugo Award-winning science fiction novel by C. J. Cherryh set in her Alliance-Union universe. The murder of a major Union politician and scientist has deep, long-lasting repercussions....
by C. J. CherryhCarolyn Janice Cherry , better known by the pen name C. J. Cherryh, is a United States science fiction and fantasy author...
, psychosurgery involves the use of drugs that bring the mind into a state where it is very receptive to audio and/or visual cues, which help the psychosurgeon to reprogram the individual. This procedure is non-invasive, and involves administering drugs versus actual surgery.
- In the television miniseries Kingdom Hospital
Kingdom Hospital is a thirteen-episode television miniseries based on Lars von Trier's The Kingdom , which was developed by horror writer Stephen King in 2004 for American television...
, the character Mary was killed by a botched lobotomy. In the companion book, The Journals of Eleanor Druse, Eleanor had a transorbital lobotomy in her childhood.
- In the novel Project 17
Project 17 is a young adult novel, written by Laurie Faria Stolarz, published by Hyperion Books in 2007. It tells the tale of six teens who break into the abandoned mental institution, The Danvers State Hospital.- Plot :...
the Denver State Hospital is rumored to have been the founding of lobotomy.
- In science fiction
Science fiction is a genre of fiction dealing with imaginary but more or less plausible content such as future settings, futuristic science and technology, space travel, aliens, and paranormal abilities...
, psychosurgery is typically presented as far more advanced than its modern day counterparts, often including such things as selective memory erasure, direct alteration of thoughts, and generally having a higher effectiveness than in reality. Examples of it can be found in books by Alastair ReynoldsAlastair Preston Reynolds is a British science fiction author. He specialises in dark hard science fiction and space opera. He spent his early years in Cornwall, moved back to Wales before going to Newcastle, where he read physics and astronomy. Afterwards, he earned a PhD from St Andrews, Scotland...
, Richard Morgan, and others.
- In Suddenly Last Summer
Suddenly, Last Summer is a 1959 American Southern Gothic mystery film based on the play of the same title by Tennessee Williams. The film was directed by Joseph L. Mankiewicz and produced by Sam Spiegel from a screenplay by Gore Vidal and Williams. The music score was by Buxton Orr using themes by...
(1959 adaptation of the Tennessee WilliamsThomas Lanier "Tennessee" Williams III was an American writer who worked principally as a playwright in the American theater. He also wrote short stories, novels, poetry, essays, screenplays and a volume of memoirs...
play), a wealthy woman named Violet Venable (Katharine Hepburn) wants her niece Catherine Holly (Elizabeth Taylor) lobotomized to silence her talk about Violet's son Sebastian's homosexuality.
- In From Hell (film)
From Hell is a 2001 American crime drama horror mystery film directed by the Hughes brothers. It is an adaptation of the comic book series of the same name by Alan Moore and Eddie Campbell about the Jack the Ripper murders.-Plot:...
, set in Victorian London, Queen Victoria herself (Liz Moscrop) is implicated in ordering lobotomies for several characters in order to "silence" them if they knew too much information. Characters who underwent these crude lobotomies (including Sir William Gull played by Ian Holm), were depicted with shaved heads and in vegetative states. However, in 1888 (the year the story takes place), the lobotomy procedure had not been invented yet.
- In the fourth season of Melrose Place, Kimberly - under the influence of one of her multiple personalities - has Peter committed to a mental institution under false pretenses. She begins to perform a lobotomy on Peter, but is interrupted by Amanda and Michael's rescue attempt.
- In the science fiction series Firefly
Firefly is an American space western television series created by writer and director Joss Whedon, under his Mutant Enemy Productions label. Whedon served as executive producer, along with Tim Minear....
, child prodigy, River Tam, is assumed to have undergone some form of lobotomy against her will, leaving her in a mentally unstable state.
- In the novel Shutter Island
Shutter Island is a best-selling novel by Dennis Lehane, published by Harper Collins in April 2003. A film adaptation was released in February 2010. Lehane has said he sought to write a novel that would be an homage to Gothic settings, B movies, and pulp. He described the novel as a hybrid of the...
and its film adaptation it is indicated that the main character, Teddy Daniels, will undergo a transorbital lobotomy.
- In the movie Sucker Punch
Sucker Punch is a 2011 action-fantasy thriller film, directed by Zack Snyder and co-written by him and Steve Shibuya. It is Snyder's first film based on an original script. The film stars Emily Browning, Abbie Cornish, Jena Malone, Vanessa Hudgens, Jamie Chung, and Oscar Isaac...
, the main character of Babydoll undergoes a frontal lobotomy at the end of the film.
See also
- Egas Moniz
António Caetano de Abreu Freire Egas Moniz , known as Egas Moniz , was a Portuguese neurologist and the developer of cerebral angiography...
- Frontal lobe
The frontal lobe is an area in the brain of humans and other mammals, located at the front of each cerebral hemisphere and positioned anterior to the parietal lobe and superior and anterior to the temporal lobes...
- Gottlieb Burckhardt
Johann Gottlieb Burckhardt was a Swiss psychiatrist and the medical director of small mental hospital in the Swiss canton of Neuchâtel. He is commonly regarded as having performed the first modern psychosurgical operation...
- Lobotomy
Lobotomy "; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy . It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain...
- History of psychosurgery in the United Kingdom
Psychosurgery is a surgical operation that destroys brain tissue in order to alleviate the symptoms of mental disorder. The lesions are usually, but not always, made in the frontal lobes...
- Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
- Phineas Gage
Phineas P. Gage was an American railroad construction foreman now remembered for his improbablesurvival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain's left frontal lobe, and for that injury's reported effects on his personality and...
, who famously suffered an accident in 1848 which destroyed one or both frontal lobes, and who is often incorrectly said to have undergone "the first lobotomy," or (also incorrectly) to have inspired or influenced the development of lobotomy.
- Walter Freeman
- Wylie McKissock
Sir Wylie McKissock, OBE was a British neurosurgeon. He set up the neurosurgical unit at the Atkinson Morley Hospital, was Britain's most prolific leucotomist , and president of the Society of British Neurological Surgeons.McKissock was born in Staines, Surrey. His parents were Alexander Cathie...
External links
- Psychosurgery.org
- Website dedicated to Walter Freeman and the "Ice-Pick Lobotomy"
- New England Journal of Medicine article
- Brain surgery to cure the mind - BBC Radio 4
BBC Radio 4 is a British domestic radio station, operated and owned by the BBC, that broadcasts a wide variety of spoken-word programmes, including news, drama, comedy, science and history. It replaced the BBC Home Service in 1967. The station controller is currently Gwyneth Williams, and the...
documentary on modern psychosurgery
- "Father of the Lobotomy"
- Lobotomy Criticism
- A Brief History of the Lobotomy
- Rotten Library Article on the Lobotomy
- "My Lobotomy" - a 22-minute piece from National Public Radio's All Things Considered
All Things Considered is the flagship news program on the American network National Public Radio. It was the first news program on NPR, and is broadcast live worldwide through several outlets...
about a 56-year-old man exploring a lobotomy he had at the age of 12.
- "Shedding Light on Shadowland" - in-depth essay exploring the propagation of the Frances Farmer lobotomy legend
- "Lobotomy's back - controversial procedure is making a comeback"
- Wall Street Journal. November 2, 2007 The surgeon,... says he has performed nearly 1,000 such procedures(brain surgery), mostly for schizophrenia.