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Psychosurgery: Damaging the Brain to Save the Mind
A history of psychosurgery from icepick lobotomies to present techniques examines the pros and cons of such surgery and reviews the types of procedures used, assessing the moral and medical issues involved.
280 pages, Hardcover
First published April 1, 1992
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August 23, 2024
A CRITIQUE, BUT ULTIMATELY A SOMEWHAT "POSITIVE" ASSESSMENT
Author Joann Ellison Rodgers has also written 'Sex: A Natural History,' 'Cancer,' etc. She wrote in the Foreword to this 1992 book, "should doctors wait until they find all... answers and paths to knowledge before they act to relieve suffering? No... So far as this observer can tell, the history of medicine and psychiatry affirms their view that the way out of the therapeutic dilemma is to grab the proverbial bull by both horns... and to steer the course as best they can. Psychosurgery, drugs, electroconvulsive therapy, and all physical means ever devised to treat mental illness and related disorders are profoundly risky. But they are, for now... the best available. The challenge is to use them selectively and humanely..." (Pg. x)
She recalls, "late in 1988, I was puzzled by the invitation to write a book about psychosurgery... I had evidence that psychosurgery ... was still very much around; it had, actually, never completely gone away. Neurosurgeons and psychiatrists at prestigious institutions were calling---in soft, but nevertheless clear voices---for new research in mind and mood-altering surgery... I discovered that the hard lessons of the past had not so much been passed on as passed over; there were still those willing, even eager, to abuse the power of psychiatry and neurosurgery to achieve their personal visions of social order... And the newer techniques available to brain surgeons potentially made abuse even easier for modern operators..." (Pg. xiv-xv)
She notes, "By 1949, when to the astonishment of many [António Egas] Moniz won the Nobel Prize for his concept ([colleague Walter] Freeman nominated him), doctors had already performed some variety of psychosurgery on at least 25,000 to 30,000 American and 10,000 British patients." (Pg. 13) She recounts, "Freeman in the 1940s tried a variety of instruments on cadavers and settled on a version of an ordinary ice pick taken from his kitchen drawer and later modified... 'A light tap with a hammer,' he wrote in one descriptions, 'is usually all that is needed to drove the point through the orbital plate.' Because this operation required no stitches or conventional anesthesia, nonsurgeons performed it, much to the dismay of neurosurgeons." (Pg. 38) She adds, "As early as the 1940s, it was clear there were lots of failures and bad effects of the operations, and in fact, there was a frantic search for safer operations." (Pg. 48)
She states, however, that "the final legacy of psychosurgery's original promise is that it moved a hardy corps of physicians, surgeons, and advocates for the mentally ill to persist---VERY quietly and VERY selectively---with modifications of psychosurgery that did more good and very little, if any, damage." (Pg. 55) She notes, "success after success is building fans for the new psychosurgery among doctors and patients... to cover operations not principally designed to alter mood or behavior, but which have that effect anyway. For example, operations that interrupt nerve pathways to control pain..." (Pg. 73)
She argues, "In the drive to protect human subjects from any and all experiments, many are subjected to a pathetic quality of life in institutions and a fog of drugs. All but gone is any way to assess the risks and benefits of psychosurgery... and there ARE patients, violent and otherwise, who might benefit from psychosurgery, who see it as a way out from behind prison bars or locked wards and are willing to take the risk." (Pg. 175) She concludes, "The overwhelming consensus among the psychiatrists and surgeons interviewed for this book is that patients are entitled to wider access to psychosurgeries, but that the operations must still be seen as a last resort." (Pg. 202)
This is a reasonably objective view of the subject by an "outsider," that will be of interest to those looking for such a non-technical overview.
Author Joann Ellison Rodgers has also written 'Sex: A Natural History,' 'Cancer,' etc. She wrote in the Foreword to this 1992 book, "should doctors wait until they find all... answers and paths to knowledge before they act to relieve suffering? No... So far as this observer can tell, the history of medicine and psychiatry affirms their view that the way out of the therapeutic dilemma is to grab the proverbial bull by both horns... and to steer the course as best they can. Psychosurgery, drugs, electroconvulsive therapy, and all physical means ever devised to treat mental illness and related disorders are profoundly risky. But they are, for now... the best available. The challenge is to use them selectively and humanely..." (Pg. x)
She recalls, "late in 1988, I was puzzled by the invitation to write a book about psychosurgery... I had evidence that psychosurgery ... was still very much around; it had, actually, never completely gone away. Neurosurgeons and psychiatrists at prestigious institutions were calling---in soft, but nevertheless clear voices---for new research in mind and mood-altering surgery... I discovered that the hard lessons of the past had not so much been passed on as passed over; there were still those willing, even eager, to abuse the power of psychiatry and neurosurgery to achieve their personal visions of social order... And the newer techniques available to brain surgeons potentially made abuse even easier for modern operators..." (Pg. xiv-xv)
She notes, "By 1949, when to the astonishment of many [António Egas] Moniz won the Nobel Prize for his concept ([colleague Walter] Freeman nominated him), doctors had already performed some variety of psychosurgery on at least 25,000 to 30,000 American and 10,000 British patients." (Pg. 13) She recounts, "Freeman in the 1940s tried a variety of instruments on cadavers and settled on a version of an ordinary ice pick taken from his kitchen drawer and later modified... 'A light tap with a hammer,' he wrote in one descriptions, 'is usually all that is needed to drove the point through the orbital plate.' Because this operation required no stitches or conventional anesthesia, nonsurgeons performed it, much to the dismay of neurosurgeons." (Pg. 38) She adds, "As early as the 1940s, it was clear there were lots of failures and bad effects of the operations, and in fact, there was a frantic search for safer operations." (Pg. 48)
She states, however, that "the final legacy of psychosurgery's original promise is that it moved a hardy corps of physicians, surgeons, and advocates for the mentally ill to persist---VERY quietly and VERY selectively---with modifications of psychosurgery that did more good and very little, if any, damage." (Pg. 55) She notes, "success after success is building fans for the new psychosurgery among doctors and patients... to cover operations not principally designed to alter mood or behavior, but which have that effect anyway. For example, operations that interrupt nerve pathways to control pain..." (Pg. 73)
She argues, "In the drive to protect human subjects from any and all experiments, many are subjected to a pathetic quality of life in institutions and a fog of drugs. All but gone is any way to assess the risks and benefits of psychosurgery... and there ARE patients, violent and otherwise, who might benefit from psychosurgery, who see it as a way out from behind prison bars or locked wards and are willing to take the risk." (Pg. 175) She concludes, "The overwhelming consensus among the psychiatrists and surgeons interviewed for this book is that patients are entitled to wider access to psychosurgeries, but that the operations must still be seen as a last resort." (Pg. 202)
This is a reasonably objective view of the subject by an "outsider," that will be of interest to those looking for such a non-technical overview.
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