Lobotomy- the notorious procedure unveiled

Yesterday I watched a Horizon episode detailing the traumas of living with OCD. One of the opening scenes revealed that the infamous lobotomy was previously used to treat patients with OCD. Firstly, I feel compelled to dismiss common misconceptions regarding OCD; merely maintaining tidiness or alphabetising a CD collection wouldn’t label you as OCD. OCD is a disorder that has a neurobiological basis.  People who have OCD are driven by obsessions (persistent, uncontrollable thoughts, impulses, or images that are intrusive, unwanted and disturbing) to perform compulsions (repetitive behaviors often called rituals) in an attempt to reduce anxiety, fear, worry, doubt and distress created by the obsessions.  These rituals may work, but the relief is only temporary.  Unfortunately, getting even momentary relief from obsessions makes it more likely that individuals will perform rituals whenever they experience obsessions.  Over time, the cycle continues, and OCD frequently gets worse. This self perpetuating cycle of ritualistic behaviour often leads to suicidal thoughts and severely diminished quality of life.

It consists of cutting or scraping away most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain. While some patients experienced symptomatic improvement with the operation, this was achieved at the cost of creating other impairments, and this balance between benefits and risks contributed to the controversial nature of the procedure.  For Moniz, the lobotomy’s curator, “to cure these patients,” it was necessary to “destroy the more or less fixed arrangements of cellular connections that exist in the brain, and particularly those which are related to the frontal lobes,” thus removing their fixed pathological brain circuits. Moniz believed the brain would functionally adapt to such injury, thus resulting in a rectification of the prior mental disorder.  As aforementioned, the purpose of the operation was to reduce the symptoms of mental disorder, and it was recognized that this was accomplished at the expense of a person’s personality and intellect. Following the operation, spontaneity, responsiveness, self-awareness and self-control were reduced. Activity was replaced by inertia, and people were left emotionally blunted and restricted in their intellectual range. These observations were noted by British psychiatrist Maurice Partridge, among a study group of 300 patients.

The first prefrontal leucotomy on American soil was performed at the George Washington University Hospital on 14 September 1936 by the neuropsychiatrist Walter Freeman and his friend and colleague, the neurosurgeon, James W. Watts. Freeman proceeded to develop the idea of approaching the frontal lobes through the eye sockets instead of through drilled holes in the skull. In 1945 he took an icepick from his own kitchen and began testing the idea on grapefruit initially, then cadavers. This new “transorbital” lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose. The orbitoclast was malleted five centimetres into the frontal lobes, and then pivoted forty degrees so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimetres  into the brain, before being pivoted around twenty-eight degrees each side, to cut outwards and again inwards. All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side.

The lobotomy’s apparent brutality and contradiction of a person’s human rights is why the USSR headed the ban of the lobotomy in 1950. This procedure completely fascinates me; partially due to it permittivity, partially due to its occasional success and partially due to the fact people were willing to undergo such a treatment. If anything, patient’s willingness to accept an infantile existence to rid themselves of their mental disease, elucidates the power mental diseases can exert.

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