Bedlam and the Lobotomy: A History of Psychiatry. What is a lobotomy? Consequences of lobotomy Do they do lobotomy now

After the lobotomy, the person changed. Those who were suffering from depression could suddenly begin to rejoice. The patient with schizophrenia ceased to show its signs and began to behave normally.

Lobotomy is a neurosurgical operation in which one of the lobes of the brain is excised or disconnected from other areas. After such manipulations, the frontal lobes of the brain will not affect the rest of the structures of the central nervous system. Lobotomy in the past was subjected to psychiatric patients suffering from mental disorders. The results of such surgeries were deplorable.

The first lobotomy was performed in 1936 by the Portuguese psychiatrist and neurosurgeon Egas Moniz. He was inspired by an experiment on a chimpanzee whose frontal lobes were removed, after which the behavior of the primate changed: she became obedient and calm. He suggested that such an operation would help people in the treatment of schizophrenia. The prefrontal cortex of the human brain completes formation by the age of 20. She is responsible for self-control, coordination, emotion management, concentration, organization, planning, individuality. It was this zone that Egash Moniz violated. After 100 operations, Moniz published the results, according to which a third of his patients recovered.

In 1949, the scientist was awarded the Nobel Prize in Physiology or Medicine. After that, many researchers became interested in Moniz's discovery. The most famous propagandist of lobotomy was the American psychiatrist Walter Jay Freeman. In 1945, he came up with a transorbital lobotomy that could be performed without drilling into the skull. Freeman successfully advertised his method of treating the mentally ill. At the same time, they were treated not only for schizophrenia, but also for obsessive-compulsive disorder. Often lobotomy was performed by doctors who did not have surgical training. Unfortunately, in those years there were no more effective methods of treating mental disorders.

Most lobotomy surgeries have been performed in the USA. In the early 1950s, there were about 5,000 such operations a year in this country. At the same time, homosexuality began to be treated in this way. Sometimes people have undergone this operation for far-fetched and stupid reasons. And most of the patients were women. In those years, their rights were reduced, they often suffered from depression, hysteria, apathy, and it was easy to call them crazy.

After the lobotomy, the person changed. Those who were suffering from depression could suddenly begin to rejoice. The patient with schizophrenia ceased to show its signs and began to behave normally. But then they operated indiscriminately with disparate methods on patients with different diagnoses. Therefore, extremely often the lobotomy ended with unexpected and unacceptable changes in behavior, patients began to suffer from epileptic seizures, brain infections developed, meningitis, osteomyelitis, hemorrhages, body weight increased, people lost control of urination and bowel movements, and in 20% of the operation ended death. The effects of the lobotomy could not be reversed.

After more successful operations, patients did not experience a decrease in intelligence and memory, retained all types of sensitivity and motor activity, there were no impairments in recognition, practical skills and speech, but complex forms of mental activity disintegrated. Their self-control, creative activity decreased, egoism increased. Patients could not perform complex, meaningful and purposeful acts, etc.

The first lobotomy in the USSR was carried out in 1944 according to its own, domestic technique. However, the operation has not gained such popularity in our country as in America. In 1949, very strict requirements for the selection of patients were established, a list of clinics and neurosurgeons who had the right to conduct it was compiled. And at the end of 1950, an order was issued prohibiting the use of lobotomy in general.

The field of psychosurgery is one of the most interesting yet shocking areas of medicine. With the help of psychosurgery, doctors try to quickly change some mental defects or diseases in order to improve the patient's condition. For this, various operations and interventions in the patient's body are carried out. And one of the widely known and almost universally banned operations of a psychosurgical nature is a lobotomy. What is a lobotomy, why is such an operation needed, and does it make sense?

Definition

Lobotomy is a psychosurgical operation, the task of which is to change the functioning of the frontal or other lobes of the brain, including those responsible for self-determination and self-awareness of a person, through surgical intervention. In this case, either the connections between adjacent lobes are interrupted, or the white medulla is removed, due to which the operation received an alternative name - leucotomy. For this, a special tool is used - a leukote, which resembles a small ice knife.

There were several types of lobotomy. For example, performing an operation such as transorbital lobotomy, the doctor inserted the instrument into the patient's eye socket, thus reaching the desired areas of the brain, and then dissecting them. In prefrontal lobotomy, holes were drilled or punched in the patient's skull to intervene in the brain. This is a rather terrible operation, but in some patients who underwent such an intervention, there was an improvement in the psychological state, however, there were few such cases.

History of discovery and development

The idea of ​​a lobotomy belonged to a Portuguese physician named Egas Moniz (or Moniz). This doctor in 1934 participated in the congress of neurologists, where he was supposed to present his work on angiography. At the congress, he was interested in the idea of ​​two colleagues - doctors Jacobsen and Fulton. They talked about their experiment on a monkey named Becky, who suffered from a neurological disorder. Doctors operated on the poor monkey, removing one of its frontal lobes, and also destroying associative connections in the frontal region. As a result, the previously aggressive and irritable Becky became quiet and showed little to no signs of malice. Monitz expressed the idea of ​​carrying out a similar operation on a person, which shocked everyone present. But already on November 12, three months after the end of the congress, Moniz performed the world's first lobotomy on a patient suffering from melancholy and paranoia. He and his assistant drilled two holes in the skull, through which alcohol was injected into the perifrontal region of the brain, which destroyed absolutely all connections between these parts of the brain. After some time, they announced a significant improvement in the patient's well-being, and in the next five weeks they performed 6 more such operations. Subsequently, from operation to operation, the procedure was more and more improved. But their results have been conflicting. Improvements were observed in 7 patients out of 20 to a significant extent, in 7 they were mild, and in 6 no changes were observed at all. But studies by other doctors have shown that the likelihood of symptoms returning or death is very high. Nevertheless, Monitz continued to actively explore the impact of lobotomy on the psyche, for which he even received the Nobel Prize in 1949 as a person who contributed to the cure of certain types of severe psychosis.

Development of the concept of surgical interventions

Moniz's ideas have also interested other doctors around the world. In the United States, the first lobotomy was performed by Walter Freeman and James Watts. But, unlike Monitz, their methodology was different. All intervention was limited to the introduction of an "ice knife" through the patient's eye socket to the brain, after which the frontal lobe was dissected with one movement of the instrument. It was this method of intervention that later became known as the transorbital lobotomy. To increase the effectiveness of anesthesia during the operation was administered using electric shock. And, like Moniz, his American colleagues announced the successful completion of the experiment. In total, about 3500 operations were performed.

Distribution and popularity of psychosurgical operations

Soon, new methods of treating mentally ill people were already widely used in many hospitals. This phenomenon did not bypass the Soviet Union. Research in the field of psychosurgery was then carried out on 400 patients. After studying a number of operations, it was revealed that the consequences for the human psyche after a lobotomy are very severe, in addition, the unfoundedness of this theory and very contradictory research results have contributed. As a result, in 1950 lobotomy was officially banned in the USSR.

But in some countries, such as India, Norway, Finland, Belgium, France, Spain and Sweden, lobotomy was practiced until the end of the 80s. A great contribution to debunking the myth about the usefulness of such operations was made by the Committee for the Protection of Man from Psychosurgical and Behavioral Research, created in America. It was formed in 1977. This body ruled that the operation "lobotomy" is a way to control minorities and individuals, and also declared it ineffective according to research results. Although it was recognized that a small percentage of operations led to positive results.

Carrying out technology

Having understood what a lobotomy is, why such an operation is needed, it is worth mentioning a little about the methodology for its implementation.

Since the brain is biologically able to cope with some minor damage, the removal of the frontal lobes without significant damage can be done without significant harm. At its core, a lobotomy is such a simple operation that even a person who does not have specific medical knowledge can perform it. The whole operation was divided into three stages:

• The first stage - a section of the skin above the eye was cut, first it was necessary to treat it with an anesthetic. In general, anesthesia was not recommended for such operations, since the eye must respond adequately to the intervention.
• Then, at an angle of 15020 degrees, a thin and sharp instrument was inserted through the eye socket. With a simple movement, the frontal lobes were cut out, and since the brain tissue is immune to pain, the patient felt only discomfort in the eyeball.
• After removing the instrument, a probe with a tube was inserted into the incision to remove blood and cell masses. The incision was sutured, and the patient could return to a normal lifestyle after a week.

How is a lobotomy performed (photo)

In this photo you can see one of the many (about 40 thousand) operations that were carried out in the United States. It is led by the popularizer of lobotomy in this country - Dr. Freeman. He uses his own discovery - transorbital lobotomy.

Alternatives

Fortunately, after it was announced that lobotomy is a barbaric and inhuman crime against a person, more humane ways to cure mentally unbalanced and sick people appeared. Increasingly, they began to resort to the previously popular electroshock therapy, and the drug "Aminazin" was also synthesized, which showed much greater efficiency. And in general, psychopharmacology has become more actively used for treatment, and physical effects on the brain have been given secondary importance. The protests of so many relatives and friends of those who were lobotomized were finally satisfied.

The value of lobotomy for medicine

Yet, despite the majority of unfortunate cases, the lobotomy did help some patients improve their mental state. But such an inhumane operation became a kind of intermediate stage, which was quickly overcome, and they switched to using more humane and effective methods than a lobotomy - after all, this is, in essence, digging into the patient's brain with an iron tool.

One can count the American railroad worker Phineas Gage, who in 1848 received a steel rod to the head in an accident. The rod entered the cheek, turned the medulla and exited at the front of the skull. Gage, surprisingly, survived and became the object of close study by American psychiatrists.

Scientists were interested not in the fact that the railway worker survived, but in what changes happened to the unfortunate. Before the injury, Phineas was an exemplary God-fearing person who did not violate social norms. After a 3.2 cm rod destroyed part of his frontal lobes, Gage became violent, blasphemous and sexually intemperate. It was at this time that psychiatrists all over the world realized that brain surgery can significantly change the mental health of a patient.

After 40 years, Gottlieb Burckhardt of Switzerland removed parts of the cerebral cortex from six seriously ill patients in a psychiatric hospital in the hope of alleviating their suffering. After the procedures, one patient died five days later in epileptic seizures, the second later committed suicide, the operation had no effect on two violently mad people, but the remaining two really became calmer and caused less trouble to others. Burckhardt's contemporaries say that the psychiatrist was satisfied with the results of his experiment.

Phineas Greige

The idea of ​​psychosurgery was resurrected in 1935, when encouraging results appeared in the treatment of violent chimpanzees by excision and removal of the frontal lobes of the brain. In the laboratory of primate neurophysiology, John Fulton and Carlisle Jacobson performed operations on the cortex of the frontal lobes of the brain. Animals became calmer, but lost all learning abilities.

The Portuguese neuropsychiatrist Egas Moniz (Egas Moniz), impressed by such results of overseas colleagues in 1936, decided to test leucotomy (the predecessor of lobotomy) on hopelessly ill violent patients. According to one version, the operations themselves to destroy the white matter, which connects the frontal lobes with other areas of the brain, were carried out by a colleague Monica Almeida Lima. The 62-year-old Egash himself could not do this because of gout. And leucotomy was effective: most of the patients became calm and manageable. Of the twenty first patients, fourteen showed improvement, while the rest remained at the same level.

What was this miraculous procedure? Everything was very simple: the doctors drilled a hole in the skull with a twist and inserted a loop that dissected the white matter. In one of these procedures, Egash Monitz was seriously injured - the patient, after dissecting the frontal lobe of the brain, became furious, grabbed a gun and shot at the doctor. The bullet hit the spine and caused partial unilateral paralysis of the body. That, however, did not prevent the scientist from launching a wide advertising campaign for a new method of surgical intervention in the brain.

At first glance, everything was fine: calm and manageable patients were discharged from the hospital, whose condition was hardly monitored later on. This became a fatal mistake.

Egas Moniz and his method of leucotomy

But everything turned out to be very positive for Moniz in the future - in 1949, the 74-year-old Portuguese received the Nobel Prize in Physiology or Medicine "for the discovery of the therapeutic effect of leucotomy in certain mental illnesses." The psychiatrist shared half of the prize with the Swiss Walter Rudolf Hess, who conducted similar studies on cats. This award is still considered one of the most embarrassing in scientific history.

Diagram of a lobotomy

Patient who underwent lobotomy

Ice pick

Freeman at work. Simple toolkit

By the early 1940s, Freeman had so perfected his lobotomy, which consisted in separating the frontal lobes of the brain, that he managed to do without drilling the skull. To do this, he introduced a thin steel instrument into the prefrontal lobes of the brain through a hole, which he had previously pierced above the eye. The doctor had only to "rummage" with the instrument a little in the patient's brain, destroy the frontal lobes, remove the bloodied steel, wipe it with a napkin and proceed with a new lobotomy. With the beginning of the war in the United States, thousands of mentally broken veterans of military operations were drawn, for whom there was nothing to treat. Classical psychoanalysis did not help much, and chemical treatments had not yet appeared. It was much more economical to lobotomize most of the front-line soldiers, turning them into obedient and meek citizens. Freeman himself admitted that the lobotomy "proved to be ideal in the conditions of overcrowded psychiatric hospitals, where there was a shortage in everything but patients." The Veterans Affairs Administration even launched a program to train lobotomists, which had a very negative impact on further psychiatric practice. Freeman also unexpectedly adapted an ice pick (“ice pick”) for a lobotomy tool - this greatly simplified the barbaric operation. Now it was possible to destroy the frontal lobes of the human brain almost in a barn, and Freeman himself adapted a small van, nicknamed a lobomobile, for this purpose.

Patients undergoing psychosurgical intervention

Doctors often performed up to 50 lobotomies a day, which made it possible to noticeably unload psychiatric hospitals in the United States. Former patients were simply transferred to a silent, calm, humble state and released home. In the vast majority of cases, no one monitored people after operations - there were too many of them. More than 40,000 frontal lobotomy surgeries have been performed in the United States alone, a tenth of which was personally performed by Freeman. However, one should give credit to the doctor, he monitored some of his patients.

catastrophic consequences

Freeman wrote in his writings on this subject:

“A patient who has undergone extensive psychosurgery at first reacts to the outside world in an infantile way, dresses casually, performs hasty and sometimes devoid of tact, does not know the sense of proportion in food, in the use of alcoholic beverages, in love pleasures, in entertainment; squanders money without regard for the convenience or well-being of others; loses the ability to perceive criticism; can suddenly become angry with someone, but this anger quickly passes. The task of his relatives is to help him quickly overcome this infantilism caused by surgical intervention.”

The advertising of the founding father of lobotomy Egash Moniz and his follower Freeman, as well as the subsequent Nobel Prize, made such a gross and barbaric intervention in the human brain almost a panacea for all mental illnesses. But by the beginning of the 50s, a huge amount of data began to accumulate, exposing the vicious essence of lobotomy. The fashion for such psychosurgery quickly passed, the doctors unanimously repented of their sins, but almost 100 thousand lobotomized unfortunates were left alone with their acquired ailments.

A paradoxical situation has developed in the Soviet Union. The monopoly of the teachings of Ivan Pavlov, which developed in physiology and psychiatry in the 1940s and 1950s, largely limited the development of medical sciences, but here the effect turned out to be the opposite. After 400 lobotomies, the medical community abandoned the fashionable technique with the wording "to refrain from using prefrontal leukotomy in neuropsychiatric diseases as a method that contradicts the basic principles of IP Pavlov's surgical treatment."

Based on Samuel Chavkin's book “Mind Thieves. A Brief History of Lobotomy".

(wikipedia):

Lobotomy was developed in 1935 by the Portuguese Egas Moniz. He hypothesized that the intersection of afferent and efferent fibers in the frontal lobe could be effective in the treatment of mental disorders.

Prefrontal lobotomy - a type of lobotomy involving partial removal of the frontal lobes. The consequence of such intervention is the exclusion of the influence of the frontal lobes of the brain on other structures.central nervous system. The frontal parts were not damaged, but only the white matter was cut through neuronal connections connecting the frontal parts with other parts of the brain.

In 1949, Egas Moniz was awarded the Nobel Prize in Physiology or Medicine "for his discovery of the therapeutic effects of leucotomy in certain mental illnesses."

The method of transorbital leukotomy (“lobotomy with an ice pick”) developed in 1945 by the American Walter Freeman, which did not require drilling the patient’s skull, was widely used. Freeman became a leading advocate for the lobotomy.

In fact, the entire operation was carried out blindly, and as a result, the surgeon destroyed not only the areas of the brain affected, in his opinion, but also a significant part of the nearby brain tissue.

After the operation, patients immediately became calm and passive; many violent patients prone to fits of rage became, according to Freeman, silent and submissive. As a result, they were discharged from psychiatric hospitals, but how much they "recovered" in fact remained unclear, since they were usually not examined further.

Many patients after a lobotomy lost the ability to think critically, predict the further course of events, were unable to make plans for the future and perform any work, except for the most primitive. As Freeman himself noted, after hundreds of operations performed by him, about a quarter of patients were left to live with the intellectual capabilities of a pet, but "we are quite satisfied with these people ...".

Even in cases where aggressiveness, delusions, hallucinations or depression were stopped in patients as a result of the use of lobotomy, after 5-15 years, the nerve fibers from the frontal lobes often sprouted back into the medulla, and delirium, hallucinations, aggressiveness resumed or depressive phases developed again.

Lobotomy's decline began in the 1950s after serious neurological complications of the operation became apparent. In the future, lobotomy was banned by law in many countries.

In patients with a pronounced frontal syndrome, the performance of specific operations, ability to perform mental actions, storage and use of the available stock of knowledge remain intact, however, it becomes impossible to use them in an expedient way in accordance with a consciously set goal.

These symptoms are most pronounced in the case of a massive (bilateral) lesion of the frontal lobes. When the frontal lobes are affected, patients are not able to independently produce any program of action, and are also unable to act in accordance with the already prepared program given to them in the instructions; the regulatory function of speech is disturbed.

These violations occur against the background of personality changes. : in a patient with damage to the frontal lobes of the brain, the formation of motives mediated by the speech system and intentions to perform certain forms of conscious activity are disrupted, which spreads and affects the entire behavior of the patient. Conscious, purposeful behavior of patients with lesions of the frontal lobes is disintegrated and is replaced by less complex forms of behavior or inert stereotypes. The conditions contributing to the loss of behavior programs are strong external stimuli; volitional behavior in such patients is replaced by a field one (pathological, uncontrolled susceptibility to external influences), voluntary actions into involuntary ones.

(Luria A. R. Higher cortical functions of a person and their disturbances in local brain lesions.).

Patients with massive damage to the frontal lobes retain the constituent elements of the task condition relatively well, but sometimes they simplify (while the simplification is difficult to correct), or replace them, in accordance with inert stereotypes. Such patients are practically unable to keep the question of the task, which is why the task loses its semantic structure, which, according to A.R. Luria, is associated with a violation of the predicative structure of speech and a violation of the dynamics of thinking.

In patients with lesions of the frontal lobes, in most cases, there is a violation of the process of preliminary analysis and loss of the orienting basis of action. Without problems, they solve only such problems where the solution is uniquely derived from the conditions. If analysis (that is, orientation) and finding a solution program are required, they are unable to do this, but instead directly snatch out a fragment of the condition and immediately perform operations.

Pointing out a mistake to a patient with a massive lesion of the frontal lobes does not lead to its correction, moreover, the patient begins to snatch out another fragment of the condition and perform the operations corresponding to it.

In such patients, there is also a violation of the plan for solving the problem. With frontal syndrome, there are also violations of systematic, hierarchically subordinate to the program, operations for solving the problem.

Patients with massive lesions of the frontal lobes either solve directly grasped fragments of the problem using the same fragmentary operations, or use inert stereotypes, formed when solving previous problems, either replace the solution with impulsive guesses, or even perform separate numerical operations, while completely abstracting from the very meaning and conditions of the problem, that is, they can begin to add kilograms to kilometers and so on.

In the most severe cases of frontal syndrome, the disintegration of the action program is supplemented by the inclusion of side actions that have no basis in the condition of the task. Operations cease to be selective, and the intellectual process ceases to be organized. In addition, almost all patients with massive lesions of the frontal lobes, to a greater or lesser extent, demonstrate defect understanding how their operations are going - patients cannot tell how they came to this decision, they only name the last actions taken. Such patients are also unable to correct their mistakes on their own.

Massive lesions of the frontal lobes inevitably entail a violation of the emotional and personal sphere of the patient. With frontal syndrome, all types of emotional phenomena are violated - emotional states, emotional reactions and emotional-personal qualities, while the last, highest, personal level suffers the most. In general, the emotional-personal sphere in frontal syndrome is characterized by an inadequate (non-critical) attitude towards oneself, one’s condition, illness and others, and among the emotional manifestations proper there are: states of euphoria, foolishness, emotional indifference,emotional dullness .

With frontal syndrome, disturbances in the spiritual sphere of a person are noted - interest in work is lost, preferences in music, painting, etc. often change (or completely disappear). Thus, the most distinct disorders are observed in patients with damage to the mediobasal parts of the frontal lobes - such patients are characterized by disinhibition of primitive drives, violations of criticality, impulsivity,affective disorders.

With massive lesions of the convexital parts of the frontal lobes, disturbances in the emotional and personal sphere are more often manifested in the form of apathy, indifference to oneself, one's illness (anosognosia ) and the environment, which occurs against the background of the general phenomena of adynamia and aspontaneity of mental functions, manifested in a given localization of a focal lesion.

Interesting manifestations of interhemispheric asymmetry are observed with damage to the right or left frontal lobe: right-sided lesions are accompanied by uncriticality, motor and speech disinhibition, euphoria, sometimes even anger and aggressive manifestations; left-sided lesions of the frontal lobes, on the contrary, are accompanied by general lethargy, lethargy, inactivity, depression, depressive states.

Changes in the sphere of behavior and psyche are very peculiar. They are referred to as the "frontal psyche". In psychiatric atria, this syndrome was called apathico-abulic: patients seem to be indifferent to the environment, they have a reduced desire to carry out arbitrary actions (motivation). At the same time, there is almost no criticism of their actions: patients are prone to flat jokes (moria), they are often complacent even in a serious condition (euphoria). These mental disorders can be combined with slovenliness (manifestation of frontal apraxia).

With damage to the frontal lobe, mental activity is disrupted, aimed at solving problems and problems. The syndrome also includes disruption of perception of reality behavior becomes impulsive. Planning of actions occurs spontaneously, without weighing the benefits and risks, possible adverse consequences.

Loss of concentration on a particular task. A patient suffering from frontal lobe syndrome is often distracted by external stimuli, unable to concentrate. At the same time, there is apathy, a loss of interest in those activities that the patient was previously fond of. In communication with other people, a violation of the sense of personal boundaries is manifested. Impulsive behavior is possible: flat jokes, aggression associated with the satisfaction of biological needs. The emotional sphere also suffers: a person becomes unresponsive, indifferent. Euphoria is possible, which is abruptly replaced by aggressiveness. Injuries to the frontal lobes lead to a change in personality, and sometimes a complete loss of its properties. Preferences in art, music can change. In the pathology of the right sections, hyperactivity, aggressive behavior, and talkativeness are observed. Left-sided lesion is characterized by general inhibition, apathy, depression, and a tendency to depression.

A normal animal usually tends to some goal, inhibiting reactions to minor, side stimuli; on the contrary, a dog with destroyed frontal lobes reacts to any side stimulus: thus, seeing fallen leaves on a garden path, it grabs, chews and spit them out; she does not recognize her master and is distracted by any side stimuli; she has uninhibited orienting reactions in response to extraneous stimuli, which violates the plans and programs of her behavior, makes her behavior fragmented and uncontrollable. Sometimes meaningful goal-directed behavior in such an animal is replaced by an inert reproduction of stereotypes that have arisen once. So, dogs that previously received food from two feeders located on the right and left, after the removal of the frontal lobes, begin to make long stereotypical “pendulum-like” movements, repeatedly running from one feeder to another, despite reinforcement (see P. K. Anokhin, A. I. Shumilina, 1949)

A monkey deprived of frontal lobes can successfully perform simple acts of behavior guided by direct impressions, but is unable to synthesize signals coming from different parts of the visual field, and thus perform complex behavior programs that require the preservation of memory functions. The experiments of a number of authors have shown that the removal of the frontal lobes leads to the disintegration of delayed reactions and to the impossibility for the animal to subordinate its behavior to a known program (for example, a program based on a successive change - or alternation - of signals). Later work showed that the destruction of the frontal lobes leads not so much to memory impairment, but to a violation of the ability to inhibit orienting reflexes to side, distracting stimuli.

The operated animal was not able to perform tasks for delayed reactions under normal conditions, but could perform them when side, distracting stimuli were eliminated (complete darkness, the introduction of sedative pharmacological agents, etc.).

All this indicates that the destruction of the prefrontal cortex leads to a profound disruption of complex behavioral programs and to a pronounced disinhibition of direct reactions to side stimuli (hyperreactivity), as a result of which the implementation of complex behavioral programs becomes impossible.

A monkey with preserved frontal lobes can endure long pauses, waiting for the appropriate reinforcement, its active reactions intensify only as the moment of the expected signal approaches; in contrast, an animal deprived of the frontal lobes of the brain is incapable of such active expectation and, under conditions of a long pause, makes a lot of unnecessary movements, not correlating them with the moment of the expected stimulus.

Below, analyzing the changes both in the processes of activation and in the course of purposeful conscious activity in case of local brain lesions, we will present various facts pointing to the decisive role of the described functional block of the brain in the processes of programming, regulation, and control of human mental processes.

Howard Dally was only 12 years old when the famous psychiatrist Walter Freeman, who promoted lobotomy as a panacea and "know-how" in the treatment of mental disorders, introduced an orbitoclast (a sharp instrument similar to an ice pick) into the boy's eye sockets and, breaking through a thin bone, cut through the gray matter that connected the frontal lobes with the rest of the brain.

He was rolled into the operating room and "calmed down" with a series of electrical discharges. This is the last thing Dally remembers. The rest was like a blur. Howard woke up the next day with a high fever and swollen, puffy eyes. His head ached, and an uncomfortable hospital gown was put on his body, completely exposing his back.

"It was like a fog in the mind," Howard recalls. "I was like a zombie and had no idea what Freeman had done to me."

The almost complete recovery of Howard Dalli after the operation is akin to a miracle. You would never tell from this man that he had undergone such a cruel procedure in his time. Dally doesn't sound like he's been lobotomized either in his speech or in his eyes.

After the operation, he was an obedient, vegetable creature.

After Dally's surgery could not study normally and work productively, for many years he could not take control of his life and almost drank himself.

Summary

In the case of Howard Dalli, the operation was performed at a young age of 12 years (frontal lobes develop up to 25 years old) and there was a restoration of functionality, for which he had to learn to live anew, i.e. redeveloped frontal lobes.

Because in most patients, including children, such a remission does not occur, it can be assumed that the connections with the frontal lobes were not completely damaged.

The exclusion of the functions of the frontal lobes leads to a limitation only by the reflex level of response.

A person has incomparably more accumulated automatisms than other animals, and therefore, during lobotomy, there are no such pronounced reactions to any stimulus: this is no longer new for him.

From the outside, it is impossible to immediately determine that a person has undergone a lobotomy, all his accumulated reactions, including speech ones, are present with all the characteristic emotionality that was fixed in automatism during awareness. But this is a non-initiative, aimless automaton, which has lost the ability to consciously correct behavior in new conditions (if it jumps over a puddle, then where this puddle has already become familiar to it). He is extremely humble and clumsy. His emotional reactions to the new situation may be strikingly inappropriate.

He is able to learn only at the level of education of reflexes.

He has no subjective experiences and no thoughts simply because he can no longer realize something (there is nowhere to connect the actual image for awareness). He is not even in the basic state of consciousness, as in the first stage of awakening after anesthesia, when everything that happens is not remembered.

You can try to imagine such a state of complete serene thoughtlessness, but it will still be much richer because of the experience of the basic level of significance.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

Author: PhD, pathologist, lecturer at the Department of Pathological Anatomy and Pathological Physiology for Surgery.Info ©

Lobotomy is a psychosurgical intervention that has gone out of practice and is now prohibited, in which one of the lobes of the brain is destroyed or the relationship between it and other parts of the central nervous system is disrupted. In some cases, the frontal lobes were removed. The purpose of the operation was defined as the fight against mental disorders, in which no known conservative method brings results.

In the history of medicine, there are enough facts about the use of a variety of contradictory, scientifically unfounded and even barbaric methods that were offered with a good goal - to cure or alleviate suffering. And if many of them were practiced in antiquity or the Middle Ages due to ignorance, lack of technical and scientific capabilities of healers, then lobotomy is an example of inhumanity that has become quite popular in the recent past.

The lobotomy operation was extremely common in the United States and many Western European countries. In the USSR, the method was also tested, but we must pay tribute to domestic specialists, who quickly raised the question of the expediency, effectiveness, scientific validity of the mutilation operation and banned it. Many sources explain this fact by the peculiarities of the policy and difficult relations of the Soviet Union with America and the countries of the West, but there is also professionalism, caution, and humanity of Soviet doctors.

The term "lobotomy" meant either the removal of some lobes of the brain, more often the frontal, or the dissection of the nerve connecting pathways in order to reduce the influence of the frontal lobe on the rest of the brain. It should be noted that the operation was proposed when the arsenal of specialists in the field of psychiatry and neurophysiology lacked sufficiently informative methods for studying the nervous system, and operations were often performed by non-surgeons at all.

Leukotomy is another name for the operation, which means the intersection of the nerve pathways that lie in the white matter of the brain. This manipulation leads not only to severe neurological symptoms, but also to the patient's loss of control over himself and over his intellect, which is reduced at best to the level of a young child. After a leucotomy, a person remains severely disabled for the rest of his life, unable to exist independently, think, communicate even with loved ones.

It should also be noted that there were no clear indications for lobotomy. That is, it was originally defined as a remedy for hopeless patients, but in view of the fact that it led to an improvement in the manageability of a person, like pets, it began to be practiced under other, unseemly pretexts, and was often carried out even by those who did not need the help of a psychiatrist at all.

The worst thing in the history of lobotomy is that the method was very quickly and very widely spread and popularized not by anyone, but by doctors who, in theory, should save people, and not cripple them. It is interesting that the ardent admirers of the method, who managed to perform thousands of lobotomies in a short time, not only did not repent, but did not realize the scale of the tragedy called “lobotomy” for both patients and their loved ones. Today, no one is given a lobotomy, no matter what the symptoms of a mental disorder.

Good intentions with tragic consequences

So where did the lobotomy come from and why did it become popular so quickly? The answer lies in historical facts and coincidences, the human qualities of individual doctors, the degree of defenselessness of patients in psychiatric clinics, and even the nuances of politics and economics in some countries.

The Portuguese pioneer of lobotomy as a method of treatment in psychiatry is Egas Moniz, who was the first to decide to apply the technique to humans. Previous research had been limited to lobotomy in chimpanzees, but Egash went further, which he himself did not regret in the least, which cannot be said about the relatives of his patients.

The development of the lobotomy of the brain dates back to 1935, when Moniz suggested that the disconnection of the neural pathways of the frontal lobe of the brain could be effective in a number of psychiatric diseases. Without doing enough research and not weighing the risks, the psychiatrist decided to intervene the very next year. Since gout prevented him from doing it on his own, he entrusted the experiment, which he personally supervised, to the neurosurgeon Almeida Lima.

During the operation, the white matter pathways of the frontal lobes connecting these sections with other brain structures were separated, but the lobes themselves were not destroyed, hence the name "leukotomy". Manipulation was announced as a life-saving radical method for hopeless patients.

The operation, which was proposed by E. Moniz, was carried out as follows: with the help of a special conductor, a metal loop was inserted into the substance of the brain, which was to be rotated to destroy the nervous tissue. There was no talk of any more or less adequate anesthesia.

Under the leadership of Moniz, about a hundred lobotomies were performed, moreover, history is silent about the features of patient selection, the definition of indications, and the methods of previous treatment. Assessing the postoperative condition of the patients, Moniz was rather subjective, and the observation itself was limited to a few days, after which the patients fell out of sight of the doctor and no one was particularly worried about their fate.

Having identified lobotomy as an effective method of treatment, Moniz immediately began to promote it among his colleagues, reporting meager observational results, limited to two dozen operated, but presented as reliable evidence of the effectiveness of the new technique. What motivated the doctor and why such a rush is not entirely clear. Maybe it was really a delusion of good intentions, or perhaps a desire to become famous and go down in history. One way or another, the name of Moniz is known in narrow circles and still entered history.

According to data published by Moniz, seven out of 20 operated patients recovered, the same number showed improvement, and six remained without positive dynamics. The adverse effects that inevitably awaited all patients were silent. Actually, the psychiatrist himself did not seek to find out about them, releasing patients on all four sides a few days after the operation.

Today, such a small number of observations seems to be something unrealistic, not capable of giving at least some basis for conclusions, but even in the last century, scientific minds sharply criticized the data of E. Moniz. However, the latter has produced many publications and even books on leucotomy.

“before and after” examples of “successful” lobotomies

The further history of the brain lobotomy unfolded tragically quickly, the operation became extremely popular, and the number of victims of it is estimated in tens of thousands in America alone.

Opponents of the method pointed out that the consequences of the operation are similar to those that occur with traumatic brain damage, focusing on the degradation of the personality. Calling for the abandonment of lobotomy, they explained that irreparable damage to any organ is not capable of making it healthier, and even more so when it comes to such a complex and little-studied structure as the human brain. In addition to the risk of neurological and psychiatric disorders, lobotomy was considered dangerous due to the likelihood of meningitis and brain abscess.

The efforts of opponents of lobotomy were in vain: the operation was adopted as an experimental method of treatment by specialists not only from the United States and South America, but also by psychiatrists in Italy and other European countries. By the way, the indications for it were never formulated, and the experiment was literally put on stream, and not a single practicing doctor was responsible for its result.

In 1949, Egas Moniz was awarded the Nobel Prize for the development of lobotomy as a therapeutic measure for psychiatric pathology. Somewhat later, the relatives of those patients who had undergone barbaric treatment requested that this decision be reversed, but all their requests were denied.

The peak of the use of lobotomy falls on the beginning of the forties of the twentieth century, when it became very popular in the United States. One of the reasons is quite banal: the high cost of maintaining patients and staff of psychiatric wards, which became overcrowded against the backdrop of World War II with former soldiers who experienced extreme stress and could not cope with it on their own. Such patients often turned out to be aggressive or overly agitated, it was quite difficult to control them, there were no special drugs, and the clinics had to maintain a large staff of orderlies and nurses.

Lobotomy was a cheap and relatively easy way to deal with aggressive and uncontrollable patients, so the authorities even organized special training programs for surgeons. It is estimated that the application of the operation would reduce costs by $ 1 million daily. In addition, there were no effective methods of conservative treatment of mental illness at that time, so lobotomy quickly gained popularity.

Dr. Freeman and the ice pick

Meanwhile, the war ended, the number of newly enrolled former military men in psychiatry was becoming less and less. It would seem that there was no longer such a need for a lobotomy. However, not only were operations not suspended. According to some reports, their popularity only began to grow, and surgeons were already able to demonstrate new tools and methods for destroying nervous tissue, not at all embarrassed if the patient turned out to be a child.

In many ways, the widespread use of lobotomy after 1945 was due to the American psychiatrist Walter Freeman, who proposed the so-called transorbital lobotomy. Its difference from the previously used techniques is in the access that lay through the eye socket. Freeman actively promoted leucotomy and performed more than one thousand such operations himself.

By the way, not only the lobotomy looks barbaric, but also the methods of anesthesia. In a number of cases, they were absent altogether, and the same Freeman, during his first operation, provided analgesia to the poor patient with an electroconvulsive effect. After strong electrical discharges, the patient loses consciousness for a short time, but it turns out to be enough to carry out a lobotomy.

Freeman's technique consisted of inserting into the eye socket and then into the brain a sharp instrument resembling an ice pick. Wielding a hammer and such a knife, Freeman got through a bone puncture directly to the brain, in which he cut the nerve fibers. According to the doctor, such treatment was supposed to relieve the patient suffering from a mental illness from aggression, strong emotionality and uncontrollability.

There is evidence that it was the ice pick that became the tool that seemed most suitable for transorbital lobotomy. According to Freeman's relatives, during one of the operations, which, by the way, was not always carried out not only in the operating room, but in the clinic in general, a surgical instrument broke. The action took place at home, and the surgeon had an ice knife at hand, which he hastened to send to the patient's brain. The knife seemed convenient, and thus Freeman, having slightly modified it and provided it with divisions with the designation of length, became the inventor of the leukotome and the orbitoclast.

Freeman lobotomy technique

Recall that the operation was done blindly, that is, neither before nor after, no one conducted any research on the brain, and in those years they did not know about MRI at all. The surgeon or psychiatrist destroyed the areas of the brain that came across the path of the cutting tool, without worrying in the slightest about the extent of the damage that could be done.

In fairness, it should be noted that the first results of lobotomies were indeed positive, because aggressive patients almost immediately became calm and even indifferent to what was happening. However, this does not justify the operation itself, since it was performed in completely different ways for patients with different diagnoses.

In addition, there was no clear system for analyzing the results, and the criterion of cure was the controllability factor of those operated after the intervention. The “calmed down” mental patients left the clinic and no one was interested in their further well-being and fate.

but on the other hand

Almost a decade after the beginning of the experimental use of lobotomy, more rigorous studies of its expediency and even danger began. So, it turned out that mortality after surgery reaches 6%, and among the side effects are convulsive syndrome in a third of patients, obesity, impaired motor function up to paralysis, dysfunction of the pelvic organs, speech, and much more.

But the impact of lobotomy on the personality, intellect and behavior of a person was much more deplorable. In almost all operated patients, the intellect decreased to the level of infancy, control over behavior and actions was lost, emotional lability, indifference, lack of initiative and the ability to purposeful, meaningful actions were observed. I lost criticism of myself about the world around me, the opportunity to make plans, work and live more or less fully in society.

By the way, Freeman himself did not regard such personality changes, which practically ceased to exist, as a negative result of treatment. According to his observations, a quarter of those operated on regressed intellectually to the level of a pet, but became controlled and quiet.

Longer-term observations have shown that 10-15 years after the lobotomy, the connection between the frontal lobes and other brain structures is partially restored, returning to mentally ill people both hallucinations, and delusional disorders, and aggression, but not intelligence. Repeated operations further exacerbated the intellectual and personal changes.

Some Terrifying Facts About Lobotomy

The scale of the unfolding lobotomy campaign is impressive: by the middle of the last century, up to 5,000 of them were carried out annually in America alone. In total, over the period from the first experiment, about fifty thousand American patients were treated, and not only severe schizophrenia, but also neurosis, anxiety disorders, and depression could be the reason for the operation.

Other truly strange circumstances for surgical treatment can be considered the conditions of the operation - in Dr. Freeman's special van, in the ward, and even at home. Without observance of asepsis and antiseptics, with non-sterile instruments, in the presence of a large number of observers.

Lobotomies were widely practiced by psychiatrists, who had a vague idea of ​​​​surgery, the features of operations on the brain and its anatomy. Dr. Freeman himself did not have a surgical education, but he managed to perform about 3.5 thousand lobotomies.

Lobotomy is also being abused under plausible pretexts: it has been done to poorly controlled and hyperactive children, grumpy wives, emotionally unstable young women. By the way, there were much more women among the operated men.

Since the second half of the twentieth century, it was no longer possible to hide the most serious negative consequences of lobotomy. The operation was finally recognized as dangerous and banned at the legislative level. Dozens and thousands of victims of the inhuman method of treatment, broken lives, as well as relatives who actually lost loved ones during their lifetime, are confirmation of not a curative, but a crippling effect on the brain.

In the USSR, psychiatrists and neurosurgeons approached the issue of lobotomy rather cautiously, without rushing to mass destroy the brains of Soviet people with a knife. The first to doubt the expediency of the method was the outstanding surgeon N. N. Burdenko, who instructed his doctoral student Yu. B. Rozinsky to carefully analyze the essence and prospects of lobotomy in severe psychiatric pathology.

However, there were also Freeman and Monish like-minded people in the Soviet Union, in particular, Professor Shmaryan A.S., who actively promoted prefrontal lobotomy and even found a supporter of the method among neurosurgeons - not just someone, but an outstanding neurosurgeon scientist, future director of the Institute of Neurosurgery.

Professor Egorov, who performed lobotomies “at the suggestion” of Shmaryan, approached the question of the operation technique more carefully, using his own modification - osteoplastic trepanation for good revision and orientation at the site of destruction of brain tissue. The "Soviet" version of leucotomy was much more sparing, since it involved only one-sided intersection of the nerve pathways while maintaining the integrity of the ventricular system, pyramidal tracts and basal ganglia.

The patients who went to the lobotomy were selected extremely harshly. The operation was considered expedient only when none of the known conservative methods with long-term use did not give positive dynamics, moreover, including both insulin coma and electric shock.

Before the operation, patients were carefully examined by therapists, neurologists, psychiatrists. After the lobotomy, the observation continued, and the doctors clearly recorded absolutely all changes in the psyche, social adaptation, and behavior of the operated patients. Both positive and negative consequences, including death, were objectively analyzed. Thus, Russian doctors were able to formulate reasons and obstacles to prefrontal lobotomy.

By 1948, based on the accumulated observational data of patients after lobotomies, the operation was recognized in principle as acceptable, but only if it was carried out by a highly qualified neurosurgeon, in a hospital, with irreversible brain damage and the ineffectiveness of all possible methods of treatment.

In parallel, neurophysiology begins to develop, new approaches to neurosurgical techniques for lobotomy are substantiated, new tools and accesses appear. The results seemed satisfactory: more than half of the patients with paranoid schizophrenia improved, and a fifth of them recovered their normal mental status, ability to work and intelligence.

Nevertheless, it was not possible to avoid consequences in the form of "frontal" and intellectual disorders even with the most benign approaches. Disputes between opponents and supporters of psychosurgery did not subside. And if in 1949 lobotomy was classified as a relatively safe and even effective intervention, then a year later, in 1950 it was banned at the government level.

The prohibition of lobotomy in the USSR was dictated more by scientific ideas and the results of clinical trials than by political reasons. Severe psychoneurological changes in the postoperative period did not allow lobotomy to enter the list of officially approved operations.

Lobotomy was banned thanks to the efforts of Professor Gilyarovsky, who repeatedly raised the discussion of this problem among scientists. The checks initiated by him showed that not only surgeons but also psychiatrists intervene, and all patients remain with organic disorders of brain activity expressed to varying degrees.

An end to the history of lobotomy in Russia was put by Gilyarovsky’s devastating article in the journal Medical Worker, where both the method of treatment itself and its justification by American psychiatrists were criticized, and then a publication in Pravda, in which lobotomy was called a pseudoscientific method of bourgeois medicine, which has no place among Soviet doctors, brought up in the spirit of humanism. On December 9, 1950, lobotomy was officially banned in the USSR.

Fortunately, today lobotomy is a horrific past, one of the unsightly examples of scientific research that turned into a tragedy for many thousands of patients and their families. I would like to believe that modern medicine will not come up with a new method of treatment, which will become such a large-scale experiment on humans, carried out with the support of the governments of quite developed countries.

Video: Lobotomy Documentary