Gość: AdamM
IP: *.poznan.cvx.ppp.tpnet.pl
06.11.03, 12:15
zachodniej. Uwaga - tekst tylko dla osób o mocnych nerwach:
Fragment:
The Heyday of Lobotomy
So, probably prefrontal leucotomy would fizzle out (Moniz would retire early,
after being shot in the spine by one of his ex-patients, becoming paraplegic)
and be abandoned a few years after being invented. Many psychiatrists,
particularly the psychoanalists were adamantly against it.
However, an ambitious American physician and clinical neurologist, Walter
Freeman, attended the same London conference as Moniz. Later he read Moniz's
reports in the library. He became very excited with the idea and his results,
and teamed up with a neurosurgeon James Watts, to apply the newly invented
technique in American patients. They first operated in September 1936. After
a few cases, he was convinced that leucotomy worked, and started to
propagandize it heavily. He was met with suspicousness and resistance by the
bulk of American neurosurgeons, but he insisted, eventually winning the
reluctant approval of his colleagues. He and Watts perfectioned the
technique, arriving to what he called the "Freeman-Watts Standard Procedure",
which had a precise set of guidelines for the insertion of the leukotome.
Walter Freeman
Freeman was very good in convincing the general press about the promises of
the prefrontal lobotomy (as he called it now), and almost singlehandedly
pushed it as a valid therapeutic procedure across the nation's insane
asylums, hospitals and psychiatric clinics. He also performed with Watts many
operations around the country, but he was dissatisfied with the messiness and
length of the operation, Having heard about an Italian who had developed a
trans-orbital approach to the frontal lobe (i.e., by inserting a leucotome
after making an opening in the roof of the eye orbits), he invented in 1945 a
much quicker and simpler way: the so-called "ice-pick lobotomy". Instead of
a leucotome, which required a surgical trepanning, he used a common tool to
break ice, which could be inserted under local anesthesia by tapping it with
a hammer. The ice pick would perforate skin, subcutaneous tissue, bone and
meninges in a single plunge; and then Freeman would swing it to severe the
prefrontal lobe. This would take no more than a few minutes, with no need to
intern the patient in the hospital. The procedure was so ghastly, however,
that even seasoned and veteran neurosurgeons and psychiatrists would not
stand the sight of it, and sometimes faint at the "production line" of
lobotomies assembled by Freeman. James Watts became distressed with this kind
of operation and broke his ties with Freeman,
Lobotomy took America and some other countries by storm. They were performed
in a wide scale in the 40s, because the mental asylums were brimming over
with cases after the Second World War. Between 1939 and 1951, more than
18,000 lobotomies were performed in the United States, and tens of thousands
more in other countries. It was widely abused as a method to control
undesirable behavior, instead of being a last-resort therapeutic procedure
for desperate cases. In Japan, the majority of the operated cases were
children, many of whom had only problematic behavior or a bad performance at
the school. Inmates in prisons for the insane were widely operated. Families
trying to get rid of difficult relatives would submit them to lobotomy.
Rebels and political opponents were treated as mentally deranged by
authorities and operated. Amateur surgeons would often perform hundreds of
lobotomies without even doing a systematic psychiatric evaluation.
In 1949, Dr. Antônio Egas Moniz was awarded the Nobel Prize for Medicine and
Physiology, in recognition of his creation of the prefrontal leucotomy, This
had the effect of making lobotomy a respectable procedure, and as a result,
in the ensuing three years, more lobotomies were performed than in all
previous years.
The Demise of Lobotomy
Finally, around 1950, the first discordant voices against the lobotomy folly
started to be heard. Scientific evidence for the benefits of lobotomy was not
coming. Even lobotomy's preponents admitted that only one third of the
operated patients would improve, while one-third remained the same, and one-
third got worst (25 to 30 % is the proportion of spontaneous improvement in
many kinds of mental diseases ! Thus, a large proportion of the operated
patients could have recovered without the lobotomy). In the United States, a
major evaluation study called the Columbia-Greystone project was conducted in
1947 and failed to provide evidence of the positive effects of lobotomies.
Many times, the evaluation was performed by the surgeons who did the work,
without any kind of scientific controls.
Ethical objections began to pile up, because of the irreversible damage to
the brain, and also because of the reports of severe collateral effects of
the surgery on the personality and emotional life of the patients. In
addition, the appearance of new antipsychotic and antidepressive drugs, such
as Thorazine in the 50s, gave new means to combat most of the symptoms
experienced by agitated and uncontrollable patients. Neurosurgeons everywhere
started to abandon lobotomy in favour of more humane methods of treatment.
Concern over the protection of patients against lobotomy and similar radical
therapies, particularly in inmates, where release was widely exchanged with
agreement to a lobotomy (a highly unfair, biased and controversial offer);
translated into laws in the United States in the 70s and in many other
countries as well. Psychosurgery was classified as an experimental therapy,
with many safeguards to the patient's rights.
The original lobotomy operation is now rarely performed, if ever, although
many countries still accept psychosurgery as a form of radical control of
violent behavior (Japan, Australia, Sweden and India are among them), In the
Soviet Union, land of psychiatric abuse, lobotomy was outlawed in the 40s,
not because it was not useful to suppress oponents of the Communist régime
(they used other methods, such as forced hospitalization), but because there
was a ideological stance against it.
www.epub.org.br/cm/n02/historia/lobotomy.htm
A.
