Bottle In Front of Me... Frontal Labotomy??? Tough Choice?

If a treatment team’s goal is to make a patient quiet, passive and compliant, then lobotomy is an effective way to go. The destruction of a person’s free will and ability to make choices can be just so darn convenient sometimes. They don’t complain. They don’t talk back. Heck, a lot of the time they won’t even speak until spoken to. True, sometimes patients are damaged so severely that they need to be periodically ask if they have to go to the bath room because they can’t initiate that thought themselves, bu...

If a treatment team’s goal is to make a patient quiet, passive and compliant, then lobotomy is an effective way to go. The destruction of a person’s free will and ability to make choices can be just so darn convenient sometimes. They don’t complain. They don’t talk back. Heck, a lot of the time they won’t even speak until spoken to. True, sometimes patients are damaged so severely that they need to be periodically ask if they have to go to the bath room because they can’t initiate that thought themselves, but isn’t that a small price to pay to keep these other wise troublesome burdens to society still and quiet? No wonder the Portuguese physician and neurologist António Egas Moniz one a Nobel Prize in 1947 for his work. - http://en.wikipedia.org/wiki/L...

There are these people, who have themselves once burden society with their own mental incompetence, who believe that actual recovery from mental illness is possible by trying to give patients meaningful choices and permitting them to participate in an informed, meaningful way in decisions about their own treatment. Those nuts believe that it is the making of choices and the opportunity to fail and learn from that failure that helps regain the loss of control of one’s own life and of one’s own mind. Heck, that’s the exact opposite of a lobotomy, what a pain in the butt that would be. Isn’t it easier to just tell them what to do and lobotomize them so they do it without protest? So what if they might become dependant on care for the rest of their life. Hey, that’s job security.

Then Congress got involved:

“ In 1977, the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery — including lobotomy techniques — was used to control minorities and restrain individual rights.” - http://en.wikipedia.org/wiki/L...

Thank God we now have drugs that do pretty much the same thing. Besides, what could be more profitable than a dozen or so pills that you “… might have to take every day for the rest of your life.”? As long as the right hands keep greasing congress's palms and the public remains sufficiently ignorant and apathetic to the destruction of the spirit and free will of mental health patients, we can continue to pour hundreds of billions of working class dollars every year into the pockets of the very rich people who obviously deserve it so much more than the rest of us do (which is why they pay $3 to our every $8 in terms of all taxation combined relative to net worth). Thank God the rich don’t have to pay hardly anything in the payroll taxes that mostly fund this stuff.

This is an excellent question. Throughout history, those who dedicated their lives to caring for the mentally ill have struggled with this double-edged sword. On one hand, many psychiatric patients have intractable illnesses; while on the other hand, many of our therapies have been maligned by the laity as “atrocities.” If you read enough medical history, you will see that all professions look back in a horror at the treatments of yesterday. Moreover, like other medical professions, many current treatments are wroug...

This is an excellent question. Throughout history, those who dedicated their lives to caring for the mentally ill have struggled with this double-edged sword. On one hand, many psychiatric patients have intractable illnesses; while on the other hand, many of our therapies have been maligned by the laity as “atrocities.” If you read enough medical history, you will see that all professions look back in a horror at the treatments of yesterday. Moreover, like other medical professions, many current treatments are wrought with serious risks and side effects. The decision to treat with pharmacological or somatic modalities is based on a heavy weighing of risks versus benefits. For example, chemotherapy is obviously extremely toxic and dangerous, but the benefits often outweigh the risks. Likewise, all surgery is potentially fatal, however, the risk of, say, not having an appendectomy will usually far outweigh the inherent risk of surgery.

In the early 1900s, prior to the discovery of chlorpromazine in the early 1950s, psychiatric treatment consisted of crude pharmacology (“deep sleep” therapy with bromides, barbiturates and narcotics), and the early somatic treatments (psycho-surgeries, Cardiazol and insulin “shock”, electroconvulsive therapy [which is still far more efficacious than any antidepressant with the 85 to 90% remission rate]). With the discovery of chlorpromazine and the multitude of antipsychotics that the followed, many persons suffering from schizophrenia and other psychotic disorders were able to be discharged from the abhorrent conditions of asylums, which at the time served as a veritable “warehouse for the insane.” The 1950s also brought about the emergence of the first antidepressants, iproniazid and imipramine, giving hope for the first time to many inflicted with intractable depression (especially what was called at the time “endogenous” depression), many of these chronically suicidal, and whose depression had advanced to the inclusion of psychotic features. Lithium, discovered in 1949, but not approved for use in the US until 1970, did the same for a great many suffering from manic-depressive (bipolar) illnesses. All of these medications, the first-generation antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors, and lithium all came with a host of problems, and since that time new generations of antidepressants, mood stabilizers and antipsychotics have emerged, all with far less side effects and risks than their predecessors. However, none of these medications is benign and most psychiatrists first give extensive thought to the risk-benefit ratio before prescribing, and then through thorough and diligent medical care make every effort to mitigate these risks. My prescribing habits reflect those of many of my colleagues: I first discuss with my patients treatment options with favorable risk-benefit ratios, and only with the patient’s full understanding of those risks and benefits do I initiate treatment. Medications with greater potential for harm are only considered after safer treatments have failed. The rare occurrences when patients are treated involuntarily occur in a setting of extreme risk of harm to self or others, most commonly, prevention of suicide.
As to your question about society’s dehumanizing of people with mental illnesses, and the obstacles facing removing the stigma surrounding mental illness: For some reason, the majority of people struggle with the concept of the brain as an organ, seen it differently than other organs that can become diseased like a kidney, thyroid, eye or lung. People have difficulty accepting that who they are and how they act results from the communication between the roughly 100 billion neurons in our brain. As they believe their own personhood to be distinct from this bodily organ, a project that separation (between brain and self) onto others, hence the all too common belief that a person with schizophrenia or bipolar illness should just “get over it.” Without digressing too much, I will just quickly acknowledge that this debate is rife with valid points and counterpoints. There are unquestionably people whose behavior is 100% manifestation of brain pathology (Google search: Phineas Gage) while at the same time there are many people with highly maladaptive behavior that is clearly more attributable to environment (but still 100% responsible for their behavior). However, back to the topic at hand: the distinction between psychiatric and neurological cause of psychiatric illnesses is largely artificial.

An illustrative example would be a person who becomes psychotic who, after investigation, is found to have a brain tumor that is causing auditory hallucinations. The treatment, neurosurgery, is very risky, but undertaken and the patient improves. Most people would not view this treatment as “barbaric,” but rather necessary to return this person to their former quality of life. However, if another person becomes psychotic due to schizophrenia, the general public will often view that treatment (antipsychotic medications in addition to supportive psychotherapy and psycho education) as “atrocious,” even though no other efficacious treatment options exist. Please believe me, if a treatment option emerged for a condition that is less dangerous and the previous drug-of-choice, physicians will jump all over that like white on rice (forget that most physicians truly wish to “First do no harm,” they also wish to not be sued!) No psychiatrist I know wants to inflict on their patients the dreaded side effects antipsychotic medications, e.g. extra-pyramidal symptoms, metabolic syndrome, etc. However, these people direly need treatment. Patients with schizophrenia are at high risk for suicide. Nearly one-third will attempt suicide (Allebeck et al. 1987), and about 1 in 10 will complete suicide (Tsuang 1978), which is roughly 4000 annually. I think that those working in mental health, ranging from social workers in the community to psychiatrists, see people with severe mental illness as distinctly human. The only other people who have the same appreciation for their humanness are the patient’s family and friends. Far beyond writing prescriptions, taking care of patients with schizophrenia involves lending supportive care, coordinating with social services in the community, talking with and providing education to family and friends about their loved one, and many psychiatrists are active in organizations that advocate for expanding rights for mentally ill. As psychiatrists, we take care of the whole person, often even providing nonpsychiatric medical treatment when necessary, as these patients often, and for a whole host of reasons, don’t have access to preventive and primary medical care.

All too often, those who provide mental health are vilified by the press for either doing too little or doing too much. I, admittedly, sometimes feel that the conundrum is hopeless. Don’t prescribe an antipsychotic — the patient becomes worse and harms himself or someone else. Prescribe the antipsychotic and the person suffers from an acute dystonic reaction and gains 40 pounds. Both results are open to criticism. Unfortunately, the criticism is plentiful while new ideas how to help these people are virtually non-existent (despite Scientology's claims) With regard to involuntary hospitalization/treatment: Would the public rather these people who are deemed imminently dangerous be released? Would the psychiatrist who elected not to detain him or her be indemnified from blame if the released person were to commit suicide or some other heinous act? (Don’t forget that psychosis resulting in severe self-neglect can also be fata too.)

I do agree with your viewpoint that all these patients must be either treated for good or leave them as they are rather than complicating the cases after lobotomy operations which may even kill them. I have few records to prove it.

Gottlieb Burckhardt removed pieces of the frontal lobes of six patients in a psychiatric hospital in Switzerland. One died after the operation, and a...

I do agree with your viewpoint that all these patients must be either treated for good or leave them as they are rather than complicating the cases after lobotomy operations which may even kill them. I have few records to prove it.

Gottlieb Burckhardt removed pieces of the frontal lobes of six patients in a psychiatric hospital in Switzerland. One died after the operation, and another was found dead in a river 10 days after release (whether by accident, suicide, or crime is unknown). The others exhibited altered behavior. These experiments marked one of the first forays into the field of psychosurgery.

The Portuguese physician and neurologist António Egas Moniz pioneered a surgery called prefrontal leucotomy in 1935. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later improved the technique using a surgical instrument called a leucotome that cut brain tissue with a retractable wire loop.[2] Moniz won the Nobel Prize for medicine in 1949 for this work.

The American neurologist and psychiatrist Walter Freeman was intrigued by Moniz's work, and with the help of his close friend, a neurosurgeon named James W. Watts, he performed the first prefrontal leucotomy in the U.S. in 1936. Freeman and Watts gradually refined the surgical technique, and created something known as the Freeman-Watts procedure (the "precision method," the standard prefrontal lobotomy). The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so it had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed that this surgery would be unavailable to the patients who needed it most: those that lived in State mental hospitals with no operating rooms, no surgeons, no anesthesia, and very little money. Freeman wanted to simplify the procedure so that it could be carried out by psychiatrists in mental asylums, which housed roughly 600,000 American inpatients at the time.

Freeman decided to access the frontal lobes through the eye sockets, instead of through drilled holes in the scalp. In 1945, he took an icepick from his own kitchen and began to test the new surgical technique on cadavers. The technique was called "transorbital lobotomy," and it involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called a leucotome or orbitoclast) under the eyelid and against the top of the eyesocket. A hammer or mallet was then used to drive the leucotome through the thin layer of bone and into the brain. The leucotome was then moved from side to side, to sever the nerve fibers connecting the frontal lobes to the thalamus. In selected patients, the butt of the leucotome was pulled upward, sending the tip farther back into the brain and producing a "deep frontal cut," a more radical form of lobotomy. The leucotome was then withdrawn, and the procedure was repeated on the other side. Walter Freeman first performed a transorbital lobotomy on a live patient in 1946. This new form of psychosurgery was intended for use in State mental hospitals that often did not have the facilities for anesthesia, so Freeman suggested using electroconvulsive therapy to render the patient unconscious.[3]

Concerns about lobotomy steadily grew. Numerous countries, including the USSR, Yugoslavia, Germany and Japan banned it, as did several U.S. states. Lobotomy was legally practiced in controlled and regulated U.S. centers and in Finland, Sweden, Norway (2005 cases[4]), the United Kingdom, Spain, India, Belgium and the Netherlands.

In 1977, the U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery — including lobotomy techniques — was used to control minorities and restrain individual rights. It also investigated after-effects of the surgery. The committee concluded that some extremely limited and properly performed psychosurgery could have positive effects.

By the early 1970s the practice had generally ceased, but some countries continued small-scale operations through the late 1980s. In France, 32 lobotomies were performed between 1980 and 1986 according to an IGAS report; about 15 each year in the UK, 70 in Belgium, and about 15 for the Massachusetts General Hospital of Boston.[5]

Scale:
Lobotomy procedures were done most frequently in the United States, where approximately 40,000 persons were so treated. Great Britain performed procedures on 17,000 people, and the three Scandinavian countries had a combined figure of approximately 9,300 persons treated.

Cases:
* Rosemary Kennedy, the sister of President John F. Kennedy, was given a lobotomy when her father complained to doctors about the 23-year-old's moodiness. Dr. Walter Freeman personally performed the procedure. Rather than any improvement, however, the lobotomy reduced Rosemary to an infantile mentality including incontinence. Her verbal skills were reduced to unintelligible babble. Her father hid the nature of Rosemary's affliction for years and described it as the result of mental retardation. Rosemary's sister Eunice Kennedy Shriver founded the Special Olympics in her honor in 1968.[citation needed]
* Howard Dully had a lobotomy at 12, after his stepmother was simply tired of his "youthful defiance". At the age of 56 he said, "I've always felt different -- wondered if something's missing from my soul. I have no memory of the operation". Late in his life, Dully uncovered the story of his lobotomy. Crown Publishers published Dully's memoir (co-written by Charles Fleming), My Lobotomy [1], in September 2007.[7][8]
* New Zealand author and poet, Janet Frame was due to have a lobotomy because of a diagnosis of mental illness. She was saved from this procedure by receiving a literary award the day before her operation was to take place.
* French Canadian singer Alys Robi was renowned worldwide during the 1940s. In the 1950s, following many cases of violence and disturbance, she was interned in a Quebec mental hospital where she underwent a lobotomy. She was later released and pursued her career.

Literary and cinematic portrayals:
obotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it. The 1946 novel All the King's Men by Robert Penn Warren described a lobotomy in such nauseating detail "that [it] would have made a Comanche brave look like a tyro [novice] with a scalping knife". The surgeon is portrayed as repressed who couldn't change others with love but instead resorted to "high-grade carpentry work".[9] In Tennessee Williams's 1958 play, Suddenly, Last Summer, the protagonist is threatened with a lobotomy to stop her from telling the truth about her cousin Sebastian.[10] The surgeon said, "I can't guarantee that a lobotomy would stop her—babbling!!!" To which her aunt responded, "That may be, maybe not, but after the operation who would believe her, Doctor?".[11]

A most damning portrayal of the procedure is found in Ken Kesey's 1962 novel One Flew Over the Cuckoo's Nest and the subsequent 1975 movie adaptation. McMurphy was lobotomized after he angrily attacked Nurse Ratched. The operation is described as brutal and abusive, a "frontal-lobe castration". Chief Broom is shocked: "There's nothin' in the face. Just like one of those store dummies." Another patient's surgery changed him from an acute to a chronic condition. "You can see by his eyes how they burned him out over there; his eyes are all smoked up and gray and deserted inside."[9]

Other sources include Sylvia Plath's depiction of a young woman, Valerie, who was lobotomized in her 1963 novel The Bell Jar. The character Esther reacts with horror to her "perpetual marble calm".[9].
For more details please refer to source: http://en.wikipedia.org/wiki/L...

My response revolves around your very last comment about why some can't be viewed as human.

It is human nature to be afraid of something we cannot understand. The details of many of these mental illnesses are surprisingly unknown. Since we cannot understand a lot of what can go wrong with the human mind, some of us may be encouraged to stay away. When many people want these people to be s...

My response revolves around your very last comment about why some can't be viewed as human.

It is human nature to be afraid of something we cannot understand. The details of many of these mental illnesses are surprisingly unknown. Since we cannot understand a lot of what can go wrong with the human mind, some of us may be encouraged to stay away. When many people want these people to be separated from society they get ( and have been for a long while ) categorized differently. They are viewed as faulty or mistakes. Freaks some would go as far to say..

Eventually this category is filled with so many differences some would find it safe to assume they are not even human. They are not aware of their existance, and have no meaning to their own lives. Sometimes I think about how it would be to be in the shoes of someone with a mental disability.. Such as in the movie Awakenings. Robin Williams plays the role of a man who is in a constant comatose state. When they find a way to take him out of it, he starts to live a normal life. Some seen him as being irrelevant and a waste to existence. But in fact he was the same as us and just had a barrier he could not cross.

I feel bad for anyone who is in a position such as this. We should not push those away for having physiological impairments, yet bring them closer so we can further understand the complexities of life and the causes and processes of these disorders.

Besides, wasn't it Einstein who said everything is relative? Are we really "human?" Or do we exist in their world as the impaired? The ones who stress over work and money. The ones who murder, and deceieve. The ones who fight wars for years against each other because we all have a different view of how things should be run. Are we qualified to accurately judge what is normal, and what is not?

Frontal Lobotomies is a form of psychosurgery, also known as a leukotomy or leucotomy (from Greek leukos: clear or white and tomos meaning "cut/slice"). It consists of cutting the connections to and from, or simply destroying, the prefrontal cortex. These procedures often result in major personality changes and possible mental retardation. Lobotomies were used in the past to treat a wide range of severe mental illnesses, including schizophrenia, clinical depression, and various anxiety disorders. After the int...

Frontal Lobotomies is a form of psychosurgery, also known as a leukotomy or leucotomy (from Greek leukos: clear or white and tomos meaning "cut/slice"). It consists of cutting the connections to and from, or simply destroying, the prefrontal cortex. These procedures often result in major personality changes and possible mental retardation. Lobotomies were used in the past to treat a wide range of severe mental illnesses, including schizophrenia, clinical depression, and various anxiety disorders. After the introduction of the antipsychotic thorazine, lobotomies fell out of common use.
i think that it would be dangerous. but if you have a serous mental condition it would be worth the risk.

I think the main flaw in mental health professionals is their inability to understand what mental illness feels like. A quote from the source. You will find it interesting.

If a person shows outward signs of mental illness, it is inherent in our society to be frightened about what we do not understand. I see no hope in providing enough education to change this.
...

I think the main flaw in mental health professionals is their inability to understand what mental illness feels like. A quote from the source. You will find it interesting.

If a person shows outward signs of mental illness, it is inherent in our society to be frightened about what we do not understand. I see no hope in providing enough education to change this.

I do understand how a person ends up with so many medications. This happens even with our primary care physicians. The reason is torts. If you haven't prescribed something that might have helped, you are going to lose the lawsuit. If you do, and something goes wrong, it is likely the manufacturer that is on the hook. Tort reform is needed badly for the patients benefit.

In college (1950's) I worked in a mental health facility in Norman, Oklahoma. I thought then that changes needed to be made. I think that mistreatment of mental patients is on the decline compared to the past. Advocates like you have been very effective.

Our system now is to interfere only when a patient presents a danger to themselves or to others. And proof is required. But the system makes errors. It is in this direction that improvements should be directed.