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Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness
An eminent University of Michigan neuroscientist provides a riveting, definitive history of psychosurgery, or lobotomy, and at the same time sounds an urgent warning about the dangers of radical therapies in all of medicine.
384 pages, Paperback
First published February 1, 1986
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July 28, 2020
'Lobotomy' will conjure up all sort of horrors into the mind of many, and so should it. Yet... This would be judging psychiatry from our own vantage point, without putting such extreme treatment (or supposed so) back into its historical context. This is what the author does brilliantly first and foremost: he stands back, and reflects upon an extreme procedure to try and find out why it could have been accepted so widely despite it being nothing short of a mutilation.
It makes for an interesting read. We see here a battle between neurosurgeons and psychiatrists, psychoanalysts and other therapists, all having differing views of the origins of mental illnesses (let alone how to treat them!) but, all, powerless despite committed to help the sick. We see doctors of all fields striving to 'do good', yet brushing aside (consciously or not) the 'do no harm' part of their oath; an attitude which could only help the acceptance of whatever treatment, as long as it had any sort of benefits. After all, these were also the times of malarial treatment, sleep therapy, insulin coma and other desperate measures to try and cure the insane!
Now, acknowledging the dedication of the medical profession (should we speak of despair in front of truly harrowing conditions?) doesn't mean defending it. Was lobotomy, in whatever form it was practiced, ever justified? Here too the author displays his arguments brilliantly, to come up with a resounding answer: no. And this where this book should be a must-read for anyone interested not only in the history of mental illness, but, also, the medical world as a whole. Here's a lot of red flags which carry on to pop up, even nowadays, in various other health-related fields...
First, there is the dogmatic view according to which mental illnesses are only the product of brain functioning, and, as very specific parts of the brain are performing very specific tasks, since frontal lobes regulates emotions and behaviours operating on them would help cure such somatic diseases. Such tenets are actually still pretty much 'en vogue', yet there all not completely true, and, bottom line, might be just unsubstantial science at best. Elliot Valenstein, in fact, doesn't only debunk such tenets, especially by reminding the damages that had been caused to the brains of lobotomised patients, he also reminds the reader that doctors, at the time, perfectly knew of how flimsy such 'science' was! How on earth did they come to accept lobotomy as a standard practice, then? Well, here's how 'Great and Desperate Cures' makes for a striking read.
Many experts at the time knew of the importance of an holistic approach in treating patients. Psychoanalysis was addressing neurotics, and the importance of the environment and life styles were recognised in addressing psychosis too. An Adolf Meyer, for instance, believed socialisation and therapies, a whole 'life hygiene', to be of crucial importance to help even the most ill. Why such alternatives were not further explored and implemented? In a word: money.
That's right: mental state hospitals were then so underfunded and understaffed that, their inability to cope with a growing numbers of patients, many with challenging behaviours, would not only lead to abuses of all sorts but also an economic argument whereas any cheap procedures which could be performed by undertrained staff, let alone lead to patients being discharged (that is, not being the taxpayers' problem anymore) would be welcome. Enter Walter Freeman and co.
Walter Freeman is now infamous for his practice, yet as this book demonstrate he clearly was the answer to a desperate demand. It's easy, as the author does, to expose him as an ambitious man devoured by a need for 'name and fame', and it's easy to recall his shocking casual demeanour when lobotomising patients - him who had travelled widely across the USA, armed with ice picks and electroconvulsive shock boxes to perform 'office surgeries' as if on a stage. Yet, he wasn't alone and many others have a responsibility too.
The medical community as a whole, of course, for abiding to Freeman's simplistic views of the human brain and having gone along with it because, doing something was, well, better than doing nothing; even if, again, they knew very well the science to be flimsy at best. Governments and society as a whole too (though the author doesn't point the blame specifically here) for not putting enough funding into hospitals and the health care system, leading in the end to such strained conditions and desperate abuses of patients. Last but not least, and especially in the USA (for psychosurgery, despite being practiced the world over, wasn't as widely applied elsewhere) the scientific ignorance coupled with reliance on sensationalism of the mass medias. Most journalists indeed, then as now, are not trained in science, and it shows in their irresponsible headlines. With psychosurgeries, this would have a terrible impact on the popular culture.
All in all, this book might be well balanced and fairly argued, but it remains a terrible indictment of a whole practice, a whole attitude, fed by a systemic failure to address mental illnesses. This might all sound awful, and it is, but let's not forget: Egas Moniz, who had launched such a procedure, received the Nobel Prize in Medicine in 1949; some of its most dedicated practitioners, like Walter Freeman, enjoyed a celebrity status; and the press was no short of making extravagant claims on scientific topics, way beyond their understanding yet which would impact the whole zeitgeist. Are we living in better times?
As the author rightly reminds the reader, lobotomies were not abandoned because they relied on a poor and very simplistic understanding of the human brain. They were not abandoned because they were cruel procedures no short of being a mutilation in dreadful conditions. They were not abandoned because their efficiency was highly doubtful, if and when there was any improvement at all up for debate. Lobotomies were abandoned thanks to a new discovery: chlorpromazine, which will launch the era of drugs as 'a solution for all'. Is that better? The answer to this question is not the topic of this book, but here a fascinating history which won't leave indifferent. Again: a must-read for anyone interested in the health and medical world.
It makes for an interesting read. We see here a battle between neurosurgeons and psychiatrists, psychoanalysts and other therapists, all having differing views of the origins of mental illnesses (let alone how to treat them!) but, all, powerless despite committed to help the sick. We see doctors of all fields striving to 'do good', yet brushing aside (consciously or not) the 'do no harm' part of their oath; an attitude which could only help the acceptance of whatever treatment, as long as it had any sort of benefits. After all, these were also the times of malarial treatment, sleep therapy, insulin coma and other desperate measures to try and cure the insane!
Now, acknowledging the dedication of the medical profession (should we speak of despair in front of truly harrowing conditions?) doesn't mean defending it. Was lobotomy, in whatever form it was practiced, ever justified? Here too the author displays his arguments brilliantly, to come up with a resounding answer: no. And this where this book should be a must-read for anyone interested not only in the history of mental illness, but, also, the medical world as a whole. Here's a lot of red flags which carry on to pop up, even nowadays, in various other health-related fields...
First, there is the dogmatic view according to which mental illnesses are only the product of brain functioning, and, as very specific parts of the brain are performing very specific tasks, since frontal lobes regulates emotions and behaviours operating on them would help cure such somatic diseases. Such tenets are actually still pretty much 'en vogue', yet there all not completely true, and, bottom line, might be just unsubstantial science at best. Elliot Valenstein, in fact, doesn't only debunk such tenets, especially by reminding the damages that had been caused to the brains of lobotomised patients, he also reminds the reader that doctors, at the time, perfectly knew of how flimsy such 'science' was! How on earth did they come to accept lobotomy as a standard practice, then? Well, here's how 'Great and Desperate Cures' makes for a striking read.
Many experts at the time knew of the importance of an holistic approach in treating patients. Psychoanalysis was addressing neurotics, and the importance of the environment and life styles were recognised in addressing psychosis too. An Adolf Meyer, for instance, believed socialisation and therapies, a whole 'life hygiene', to be of crucial importance to help even the most ill. Why such alternatives were not further explored and implemented? In a word: money.
That's right: mental state hospitals were then so underfunded and understaffed that, their inability to cope with a growing numbers of patients, many with challenging behaviours, would not only lead to abuses of all sorts but also an economic argument whereas any cheap procedures which could be performed by undertrained staff, let alone lead to patients being discharged (that is, not being the taxpayers' problem anymore) would be welcome. Enter Walter Freeman and co.
Walter Freeman is now infamous for his practice, yet as this book demonstrate he clearly was the answer to a desperate demand. It's easy, as the author does, to expose him as an ambitious man devoured by a need for 'name and fame', and it's easy to recall his shocking casual demeanour when lobotomising patients - him who had travelled widely across the USA, armed with ice picks and electroconvulsive shock boxes to perform 'office surgeries' as if on a stage. Yet, he wasn't alone and many others have a responsibility too.
The medical community as a whole, of course, for abiding to Freeman's simplistic views of the human brain and having gone along with it because, doing something was, well, better than doing nothing; even if, again, they knew very well the science to be flimsy at best. Governments and society as a whole too (though the author doesn't point the blame specifically here) for not putting enough funding into hospitals and the health care system, leading in the end to such strained conditions and desperate abuses of patients. Last but not least, and especially in the USA (for psychosurgery, despite being practiced the world over, wasn't as widely applied elsewhere) the scientific ignorance coupled with reliance on sensationalism of the mass medias. Most journalists indeed, then as now, are not trained in science, and it shows in their irresponsible headlines. With psychosurgeries, this would have a terrible impact on the popular culture.
All in all, this book might be well balanced and fairly argued, but it remains a terrible indictment of a whole practice, a whole attitude, fed by a systemic failure to address mental illnesses. This might all sound awful, and it is, but let's not forget: Egas Moniz, who had launched such a procedure, received the Nobel Prize in Medicine in 1949; some of its most dedicated practitioners, like Walter Freeman, enjoyed a celebrity status; and the press was no short of making extravagant claims on scientific topics, way beyond their understanding yet which would impact the whole zeitgeist. Are we living in better times?
As the author rightly reminds the reader, lobotomies were not abandoned because they relied on a poor and very simplistic understanding of the human brain. They were not abandoned because they were cruel procedures no short of being a mutilation in dreadful conditions. They were not abandoned because their efficiency was highly doubtful, if and when there was any improvement at all up for debate. Lobotomies were abandoned thanks to a new discovery: chlorpromazine, which will launch the era of drugs as 'a solution for all'. Is that better? The answer to this question is not the topic of this book, but here a fascinating history which won't leave indifferent. Again: a must-read for anyone interested in the health and medical world.
November 13, 2017
Academic read on the history of lobotomy and psychosurgery. While it delves into the history and the men behind the movement, there is little on the patients that were lobotomizrd and their experiences.
March 13, 2012
Fascinating history on psychosugery/lobotomies in the U.S., its rise and decline. Very disturbing but informative.
October 16, 2008
A great introduction to the era of psychosurgery. Chilling.
Want to read
November 8, 2010Recommended from My Lobotomy
December 21, 2024
At once morbidly fascinating and deeply horrifying. Worth the read if you can stomach the reality of it all.
August 2, 2011
That this work was painstakingly researched is obvious; the author seems to have traveled extensively, reviewed published works and personal correspondence of key players, and read numerous volumes and articles on his subject. He illustrates how the living conditions of institutionalized mental patients during the 19th and 20th centuries, society's expectations of medicine, and the climate of the medical community contributed to extreme, and often dangerous, measures.
The burden of caring for the mentally ill wreaked havoc upon families and physicians; pressure to find curative treatment was overwhelming, leading to measures such as chemical and electrical shock, injecting alcohol into the brain, and lobotomy in all of its variations. With no one to protect them, patients were subjected to painful and disfiguring experimentation. Not only were any positive effects generally temporary, if existent, the procedures carried what would now be considered an unacceptable risk of impairment or death. Valenstein shows the constant jockeying for attention among the researchers and practitioners, each wanting maximum credit, and the ways in which the media stoked the fire. Competition was fierce and legislation virtually non-existent, creating an environment in which any opportunity, no matter how rash or dangerous, was taken.
Though the book was written 20+ years ago, Valenstein raises legitimate concerns about climate in which such atrocities could take place, one that he feels persists. Media frenzy, laws that are alternately over restrictive or too lax, medical ambition, and the frustration of a lack of permanent cure are as pervasive now as in the early 1900's.
The burden of caring for the mentally ill wreaked havoc upon families and physicians; pressure to find curative treatment was overwhelming, leading to measures such as chemical and electrical shock, injecting alcohol into the brain, and lobotomy in all of its variations. With no one to protect them, patients were subjected to painful and disfiguring experimentation. Not only were any positive effects generally temporary, if existent, the procedures carried what would now be considered an unacceptable risk of impairment or death. Valenstein shows the constant jockeying for attention among the researchers and practitioners, each wanting maximum credit, and the ways in which the media stoked the fire. Competition was fierce and legislation virtually non-existent, creating an environment in which any opportunity, no matter how rash or dangerous, was taken.
Though the book was written 20+ years ago, Valenstein raises legitimate concerns about climate in which such atrocities could take place, one that he feels persists. Media frenzy, laws that are alternately over restrictive or too lax, medical ambition, and the frustration of a lack of permanent cure are as pervasive now as in the early 1900's.
July 26, 2013
A detailed history of the rise and decline of psychosurgery, mostly focusing on lobotomy.
Some gut-wrenching details that left me reading in fascinated horror, and ultimately with huge amounts of pity for the patients who underwent lobotomy and like surgeries. Especially given the lack of real evidence that they helped people (and more often, ended up with them being far, far worse off), it's amazing that lobotomies were undertaken on so many patients (many sarcastic thanks to Walter Freeman for that).
Some gut-wrenching details that left me reading in fascinated horror, and ultimately with huge amounts of pity for the patients who underwent lobotomy and like surgeries. Especially given the lack of real evidence that they helped people (and more often, ended up with them being far, far worse off), it's amazing that lobotomies were undertaken on so many patients (many sarcastic thanks to Walter Freeman for that).
May 21, 2010
I didn't actually finish this book, but I have renewed it so many times I finally HAD to return it to the library. When I turned it in today I was on page 95, which appeared to be less than one-third of the book.
Fascinating insight into the early, experimental treatments for mental illness. In some cases, patients were considered "incurable" anyway, so why not try anything that might possibly help?
I DO plan to check it out again and finish it one day!
Fascinating insight into the early, experimental treatments for mental illness. In some cases, patients were considered "incurable" anyway, so why not try anything that might possibly help?
I DO plan to check it out again and finish it one day!
November 23, 2015
Very enlightening. Although the author did seem to be anti-psychosurgery, I found his presentation of the facts to be unbiased and thorough. Positive aspects of the results of lobotomy were presented, as were the glaring deficiencies in the follow up to patient outcomes. I believe that the book has provided me with the best overview of the lobotomy period of the metal health profession possible.
Read
January 24, 2013Actually a very interesting from a researcher's viewpoint. Somewhat horrifying (and fascinating) to read the history of psychosurgery, but that would probably be the case for many areas of medicine.
December 28, 2016
Best book written on the subject of psychosurgery. I would not recommend it to a layman but a person working in the medical field could find it very interesting.
December 30, 2018
a fantastic history of the (yet evolving) field of psychiatry. strikes a perfect balance between an academic and an accessible tone, supplemented with wonderful historical photos and reference to foundational books and works. this book inspired my quest for 1st edition copies of psychiatric texts.
October 17, 2012
Interesting in itself, but not a "layman's" read. Too detailed, almost a reference. Still, some really interesting factoids in there.
April 2, 2019
Very hard book to read. Basically the mentally ill were treated likes guinea pigs and the person responsible for a novel prize.
July 7, 2020
A science book that really is a page turner. Very interesting account of the history of psychosurgery and other procedures.
October 3, 2020
The butler did it.
You might think that lobotomy was a bizarre, monstrous, capriciously hazardous, and unscientific intervention in mental illness. It was weirder than that.
You might think that lobotomy was a bizarre, monstrous, capriciously hazardous, and unscientific intervention in mental illness. It was weirder than that.
August 11, 2025
This was a good, thorough history of lobotomies. Yet it was also discouraging to read especially as the lessons of this and other medical scandals have gone unheeded. Many people nowadays would be stunned to learn that the person who invented lobotomies won a Nobel prize, that many of the people who received lobotomies were happy with the results of their treatment, and the role that the media and medical organizations played in fueling the scandal. And sadly, one hundred years later, these same problems creep up in different forms. Valenstein's final chapter was sadly prerscient.
We still have doctors motivated by a desire for fame and glory. They may really believe they are helping but they are blind to the limits and harms of the procedures they have invented or even more dangerously, believe that the ends justify the means.
We still have hospitals in need of procedures to pay for their high overhead costs. While some people may benefit, diagnostic creep ensures that people who won't benefit and will be harmed are given invasive, irreversible procedures that harm instead of heal.
We still have a media that is untrained in the scientific process who uncritically promotes new and risky procedures and do not give them the skepticism that is warranted. They also never cover the peer review that is vital to the assessment of new procedures.
Valenstein wrote a good cautionary tale. It is sad that too few people heeded it.
We still have doctors motivated by a desire for fame and glory. They may really believe they are helping but they are blind to the limits and harms of the procedures they have invented or even more dangerously, believe that the ends justify the means.
We still have hospitals in need of procedures to pay for their high overhead costs. While some people may benefit, diagnostic creep ensures that people who won't benefit and will be harmed are given invasive, irreversible procedures that harm instead of heal.
We still have a media that is untrained in the scientific process who uncritically promotes new and risky procedures and do not give them the skepticism that is warranted. They also never cover the peer review that is vital to the assessment of new procedures.
Valenstein wrote a good cautionary tale. It is sad that too few people heeded it.
May 6, 2022
One of the best books about mental health ‘treatments’. Clearly well researched. Easy to read and follow.
Displaying 1 - 19 of 19 reviews