Comparison study of psychosurgery. Surgery of soul

Contents

Introduction

Chapter1. Lobotomy. Surgery of soul. Theorization.
1.1 Psychosurgery

1.2 The authors of a theory. EGAS Moniz

1.3 The authors of a theory. Walter Freeman

Chapter 2. Сomparison study of psychosurgery

2.1Lobotomy in west countries

2.2Lobotomy in USSR

2.3 Interdiction of lobotomy

2.4 Reflection in the society nowadays

Chapter 3.  Practical systemization

3.1 Inquiry

3.2 Analysis  of the inquiry

Conclusion

Apendix1

Apendix2

Introduction

              Throughout human existence, people faced with severe mental illness of their fellows. At all times different doctors looked at this problem differently. However, I would like to draw attention to this cruel and cold-blooded way of treating mental illness. The name of this method - lobotomy.

  It is common knowledge that the interest in psychosurgery had a significant influence on people of different spheres, the role of this theory, this method as well as interest in the English language and development of medicine in different countries, the desire to learn features, personalities of inventors, doctors determined the relevance of our research.

The main strategic aim of the research was the study of lobotomy as a form of psychosurgery, systematization of theoretical knowledge, a comparative analysis of the use of lobotomy in medicine in the West and in Russia (USSR) and carrying out practical activities on awareness of the population in this area.
To reach this aim the following tasks were assigned:

*Acquaintance with the history of psychosurgery

*Study of brief biographies of the lobotomy inventors

*Сomparison study of psychosurgery in different countries

*Examine the causes of the collapse of this method

*Identification of analogous methods in Russia nowadays

*Conduct social survey

Chapter1. Lobotomy. Surgery of soul. Theorization.
1.1 Psychosurgery

Psychosurgery - section of neurosurgery for the treatment of mental disorders using operations on the brain. Occur after these operations, the condition of the patient is irreversible, so these operations are performed only in the case of very strong and not giving in to any other treatment of the symptoms (especially when severe, chronic anxiety, depression and non-medicinal pain relief).

As you know,  mental illness is an illness of the mind. People with a mental illness may behave in strange ways, or have strange thoughts, in their view or the view of others.

Mental illnesses develop during the life of a person. This may be linked to genes and experience. What is considered as a mental illness has changed over time. What is considered to be a mental illness may not be one in a different culture. 

There are a lot of mental illnesses nowadays and all the scientists try to treat people as they can, but it is tremendously hard to cure diseases. Lobotomy - the form of psychosurgery, neurosurgical operation in which one of the parts of the brain (frontal, parietal, temporal, or occipital) excised or disconnected from other areas of the brain. Prefrontal lobotomy - lobotomy involving partial removal of the frontal lobes. The consequence of this intervention is to eliminate the influence of the frontal lobes to the rest of the structure of the Central nervous system.

Psychosurgery involves severing or otherwise disabling areas of the brain to treat a personality disorder, behavior disorderorother mental illness. Modern psychosurgical techniques target the pathways between the limbic system (the portion ofthe brain on the inner edge of the cerebral cortex) that is believed to regulate emotions, and the frontal cortex, wherethought processes are seated.Lobotomy is a psychosurgical procedure involving selective destruction of connective nerve fibers or tissue. 

It is performedon the frontal lobe of the brain and its purpose is to alleviate mental illness and chronic pain symptoms. 

The bilateralcingulotomy, a modern psychosurgical technique which has replaced the lobotomy, is performed to alleviate mentaldisorders such as major depression, bipolar disorder, or obsessive-compulsive disorder (OCD), which have notresponded to psychotherapy, behavioral therapy, electroshock, or pharmacologic treatment. Bilateral cingulotomies are alsoperformed to treat chronic pain in cancer patients.

As a matter of fact psychosurgery should be considered only after all other non-surgical psychiatric therapies have been fully explored. Muchis still unknown about the biology of the brain and how psychosurgery affects brain function.

Psychosurgery, and lobotomy in particular, reached the height of use just after World War II. Between 1946 and 1949, theuse of the lobotomy grew from 500 to 5,000 annual procedures in the United States. At that time, the procedure was viewedas a possible solution to the overcrowded and understaffed conditions in staterun mental hospitals and asylums. Known asprefrontal or transorbital lobotomy, depending on the surgical technique used and area of the brain targeted, these earlyoperations were performed with surgical knives, electrodes, suction, or ice picks, to cut or sweep out portions of the frontallobe.

Today's psychosurgical techniques are much more refined. Instead of going in "blind" to remove large sections on the frontallobe, as in these early operations, neurosurgeons use a computer-based process called stereotactic magnetic resonanceimaging to guide a small electrode to the limbic system (brain structures involved in autonomic or automatic body functionsand some emotion and behavior). 

There an electrical current burns in a small lesion [usually 0.5 in (1.3 cm) in size]. In abilateral cingulotomy, the cingulate gyrus, a small section of brain that connects the limbic region of the brain with thefrontal lobes, is targeted. 

Another surgical technique uses a noninvasive tool known as a gamma knife to focus beams ofradiation at the brain. A lesion forms at the spot where the beams converge in the brain.Today this method seems ridiculous, and the word itself often "lobotomy" is used as a joke. It has long been understood that the method does not work, but it is unclear how so ever tried something to treat.

In our days, the lobotomy is a clear failure of psychiatry, but before the procedure is performed on any occasion.

1.2 The authors of a theory. EGAS Moniz

The lobotomy was developed in 1935, the Portuguese EGAS Moniz.
The procedure of lobotomy was the following: using Windows Explorer in the brain was introduced loop, and the rotational movements occurred the damage to brain tissue. Doing about a hundred of such operations and after follow-up surveillance of patients had subjective assessment of mental status, Moniz said about the success of this operation and became popular. So, in 1936, he published the results of surgical treatment of 20 of its first patients: 7 of them recovered, 7 improvement occurred, while 6 were not observed no positive dynamics.

In fact, EGAS Moniz was observed only for a few patients, and most of them after the surgery has never seen. Although scientific audience research has been criticized, E. Moniz wrote hundreds of articles and books about the lobotomy. Directly after the message Moniz on his discovery was followed by criticisms from the scientific community: S. Cid argued that the changes observed by Moniz in patients after surgery, ought to match with the consequences of brain injury and that in fact these changes represent a degradation of the personality. Paul Courbon noted that the mutilation of the body is not able to improve its functions and that the brain damage caused by lobotomy, entail the risk of subsequent development of meningitis, epilepsy and cerebral abscesses. Despite this, the message Moniz has led to the rapid acceptance of the procedure on an experimental basis by individual clinicians in Brazil, Cuba, Italy, Romania and the USA.

In 1949 EGAS Moniz was awarded the Nobel prize in physiology or medicine "for the discovery of the therapeutic effects of leucotomy in certain mental diseases".

The method was designed by the Portuguese physician EGAS Moniz, who first conducted an operation called prefrontal leucotomy. He was introduced to the brain loop and rotational movements caused part of the brain minor damage. So Monys treated schizophrenia - he realized that the patients after the surgery is much easier to manage.
Later, another doctor named Walter Freeman "improved" method - began to operate through the upper wall of the socket. Was clearly faster. This procedure we know today under the name transorbital lobotomy. In 1949 year Moniz for his discovery won the Nobel prize, and really untested procedure has been generalized trust. Now it was possible to carry out legally. Soon the lobotomy done to thousands of patients around the world. Exclusively for medicinal purposes, of course.

In our days, the lobotomy is a clear failure of psychiatry, but before the procedure is performed on any occasion. The method was designed by the Portuguese physician EGAS Moniz, who first conducted an operation called prefrontal leucotomy. He was introduced to the brain loop and rotational movements caused part of the brain minor damage. So Monys treated schizophrenia - he realized that the patients after the surgery is much easier to manage.
Relatives of some victims of lobotomy appealed to the Nobel Committee to revoke the award, because the procedure has caused irreparable harm. The Committee refused to consider the request and wrote a refutation, where fully explained than justified the decision of the Committee.

Committee members considered the lobotomy best method of treatment of schizophrenia: it brings results, it is ahead of time, in the end, so why award it is necessary to admit a mistake?

It should be noted that there were no precedents: the Nobel Committee never cancelled award, and probably never will cancel, because it is contrary to its policies. So EGAS Moniz will go down in history as a brilliant doctor.

You may be surprised: as a practice, where the man climb into the eyes of a tool similar to a small axe, became so popular? But the purpose of the doctors was good: to help people suffering from schizophrenia and other severe mental illnesses. Speaking for the lobotomy doctors did not know about all the risks of surgery on the brain. They didn't see what you are doing, but the reason for the operation was justified: psychiatric hospitals were for patients a terrible place, and the procedure could help them to lead something like a normal life.
The problem is that then drugs that could for a long time to calm violent patient, was not. Severe mentally ill could cause great harm to themselves or others, so sometimes required drastic measures. Patients often had to wear a straitjacket and put in a separate room with soft walls. In such circumstances, the violence was commonplace. The treatment was complicated and cruel, and without effective treatment, the schizophrenic and the other patients had no hope of ever leave the hospital.
Lobotomy seemed output from a terrible situation for both patients and doctors. It is a pity that it didn’t exit, but a dead end.

1.3 The authors of a theory. Walter Freeman

After awarding Moniz Nobel prize winner leukotomia began to be applied more widely. American psychiatrist Walter Jackson Freeman became the leading advocate of this operation. He developed a new technique, which was not required to drill the skull of the patient, and called it "transorbital lobotomy". With the filing of Freeman and James watts as the procedure itself, and the name "lobotomy" became more prevalent. His first lobotomy he conducted, using as anesthesia electroconvulsive therapy. He pointed tapered end of a surgical instrument shaped like a knife for chopping ice, bone (eye socket, using a surgical hammer punched a thin layer of bone and introduced the instrument in the brain.

After this movement of the knife handle dissected fibers of the frontal lobes of the brain. Freeman argued that the procedure will remove the mental illness of the patient's emotional component. The first operations were carried out using this knife for chopping ice. Subsequently, Freeman developed for this purpose special tools – leukotom, then orbitoclast.

Moniz was the first who applied a lobotomy. Freeman made it popular. But the pioneers of lobotomy did not approve of the methods to each other. Moniz believed that the method of Freeman (transorbital lobotomy) - not the most responsible way to do an operation on the brain.

Freeman pierced brains of patients for their own good with too much enthusiasm. But the method Moniz had many shortcomings.
Moniz did not follow the fate of their patients. He didn't even have enough studies to draw conclusions. Strange, isn't it? He did surgery on the brain according to the new methodology, which previously and never tested!
Moniz was treated patients and monitored their behavior just a few days after you have cut the links in their heads. Many believe that the criteria to determine whether the patient is actually normal, were biased too wanted the doctor that the result was positive. Explain that Moniz found improvement in most patients, because I wanted to find it. Freeman, though practiced, perhaps more barbaric method, but worked with patients and after surgery. He did not leave them until death.

Freeman invented a special term for people who have just undergone a lobotomy: surgically induced childhood. He believed that no patients with normal mental abilities, distraction, stupor, and other typical effects of lobotomy occur because the patient regresses returns to a younger mental age. But Freeman had no idea that personality can be damaged. Rather, he believed that the patient eventually "grow up" again: re growing up will be quick and will eventually lead to full recovery. And offered to heal the sick (even adults) also, would be treated as a naughty child.

He even offered to parents to spank a grown-up daughter, if she misbehaved, and later to give her ice cream and kiss. Regressive behaviors, which are often manifested in patients after the lobotomy, eventually disappeared only a few: as a rule, people remained mentally and emotionally paralyzed for the rest of my life.
Many patients were unable to control urination. They really behaved like a very naughty children: instantly was excited by different stimuli, showed attention deficit disorder, and uncontrollable anger.

In our days the doctors must first inform the patient about what will be done, what are the risks and possible complications, and only then begin the difficult physical or mental treatment.

The patient, being of sound mind, should be aware of the risk, to make decisions and sign documents.
But in times of lobotomy patients of such rights was not, and to informed consent treated casually. In fact, the surgeons did everything I wanted.
Freeman believed that the mentally ill patient consent to the lobotomy can not give, because they don't understand the whole benefits. But just so the doctor didn't give up. If he could not obtain consent from the patient, he went to relatives in the hope that the agreement will give them. Even worse, if the patient has already agreed, but at the last minute changed his mind, the doctor still did, even if had to "disable" the patient.
In many cases people had to agree on the lobotomy against their will: for they were decided by the doctors or family members who may be hurt and didn't want to, but it was applied to the treatment irresponsible.

Often lobotomy or turned man into a vegetable, or made him more docile, passive and easily manipulated, and often less intelligent. Many doctors perceived it as "progress", because I didn't know how to deal with difficult patients. If lobotomy patient is not killed, then all of irreparable brain damage, the doctors believed the side effects of treatment.

Many people asking about the appeal of inherited Moniz Nobel prize, complained that they themselves or their relatives not only cured, but also caused irreparable damage, which forever made them what they were. There was a case when one pregnant woman had a lobotomy because only headaches, and still she never was: until the end of life ostwalt at the level of a small child, not able to eat or take care of themselves.

Another example: the boy named Howard Dully made a lobotomy at the request of his stepmother - she didn't like that Howard was a difficult child. Freeman seriously recommend this method as a way to change the personality. And he spent his life, forever lost himself.

It is believed that Freeman was too pleased to be able to do legally transorbital lobotomies all patients indiscriminately. He not only is not considered necessary to properly inform the patient about the risks and procedure, but also boasted about their success in front of excited people. Freeman was often completed within ten minutes somehow not enough for complex operations on the brain, even if it was the most useful operation in the world. Unfortunately, the doctor didn't think so.
He spent 25 lobotomy per day. He first thought of "humane" to apply electric shocks to do the surgery until patients were unconscious. Worse, sometimes Freeman held a lobotomy on both hemispheres of the brain just to show off. It is impossible to say how many people life he had broken.

Chapter 2. Сomparison study of psychosurgery

2.1Lobotomy in west countries

The lobotomy was developed in 1935, the Portuguese EGAS Moniz. The first operation was carried out in 1936.
In 1949 EGAS Moniz was awarded the Nobel prize in physiology or medicine "for the discovery of the therapeutic effects of leucotomy in certain mental diseases".
After awarding Moniz Nobel prize winner lakatamia began to be applied more widely. American psychiatrist Walter J. Freeman became the leading advocate of this operation. He developed a new technique, which was not required to drill the skull of the patient, and called it "transorbital lobotomy".
With the filing of Freeman and James watts as the procedure itself, and the name "lobotomy" became more prevalent. His first lobotomy he conducted, using as anesthesia electroconvulsive therapy.

In the 1940-ies lobotomy in the United States acquired a greater incidence of purely economic considerations: "cheap" method it was possible to "cure" many thousands of Americans, contained at that time in closed psychiatric institutions, and could reduce costs for these institutions to 1 million dollars a day. About the success of lobotomy wrote leading Newspapers, attracted the attention of the public. It is worth noting that then there was no effective methods of treatment of mental disorders, and the return of patients from closed institutions in society were extremely rare, and therefore welcomed the widespread use of lobotomy.

In the early 1950's the United States held about 5 thousand lobotomy per year[12]. In the period from 1936 to the end of 1950-ies lobotomies were 40 000-50 000 Americans. The readings were not only schizophrenia, but also severe anxiety and obsessions. Often the lobotomy was performed by doctors who had no surgical training, which was one of the abuses that psihobiologic intervention. Lacking education of the surgeon, Freeman, however, made about 3500 such operations around the country in their van, which was named by him "lobotomobile".

The decline of psychosurgery began in the 1950s, years after it became obvious serious neurological complications of this operation.

2.2Lobotomy in USSR

The initiator of the implementation of prefrontal leucotomy in the USSR was the founder of organic psychiatry Professor A. C. Smaran. He persuaded a prominent neurosurgeon Professor B. Egorov, to engage prefrontal lobotomy. Psychosurgery has acquired not only a brilliant creative neurosurgeon, but also the support of the Institute of neurosurgery, the Director of which in 1947 became B., Egorov, simultaneously held the post of chief neurosurgeon of the Ministry of health of the USSR.

The selection of patients for the lobotomy was very hard. The surgical method was proposed only in cases of failure of previous long-term treatment. All patients underwent General clinical and neurological examination, but also studied psychiatric. Was recorded as the acquisition of emotional, behavioural and social adequacy of surgical activity and possible losses. All this has allowed to develop a certain indications and contraindications to the prefrontal lobotomy.

Since 1945 until 1950 in Leningrad lobotomy was performed in 155 patients.

In may 1950, the psychiatrist Professor Vasily Gilyarovsky invited to return to the discussion of leucotomy in order to prevent its use as a method of treatment in psychiatric institutions.

2.3 Interdiction of lobotomy

In may 1950, the psychiatrist Professor Vasily Gilyarovsky invited to return to the discussion of leucotomy in order to prevent its use as a method of treatment in psychiatric institutions. The issue was again discussed at the Plenum of the all-Union scientific society of neurologists and psychiatrists 22-24 June 1950. The resolution confirmed the previous decision: "to Recognize the application of frontal leucotomy as a method of treatment of mental diseases is appropriate in the case when all other treatment methods have not had a therapeutic impact.

For the resolution voted 28 of 30 Board members, two were against. Professor Gilyarovsky insisted that he recorded his dissenting opinion: "I don't think lakatamia method of treatment that can be recommended psychiatric institutions".

C. A. Gilyarovsky achieved orders of the Ministry of healthcare of the USSR on the verification of the results of prefrontal leucotomy. In the verification report of the Leningrad Institute. C. M. Bekhterev indicated that leucotomy was subjected to 176 patients, of whom 152 - diagnosed with "schizophrenia".

The Commission was demonstrated in 8 patients with good results, but all were found some defects, some organic reduction. The operation was done and surgeons, and psychiatrists. Patients after leucotomy usually translated in other medical institutions, and because long-term outcomes has not been studied as follows.

Soon came an article by the same Gilyarovskogo in the journal "Medical worker" , "the Teachings of Pavlov - based psychiatry. It sharply criticized the method of lobotomy.

In 9th December was signed order No. 1003, prohibiting the use of prefrontal lobotomy.

2.4 Reflection in the society nowadays

In our days the story of such treatment of mentally ill people, many do not know, and those who know often use the word "lobotomy" in everyday life as a joke. However, perhaps if people knew more about what constitutes this action, they would not have used this word as something funny and amusing.

Chapter 3.  Practical systemization

3.1 Inquiry

How different is the attitude to lobotomy in the USSR and in the West?

3.2 Analysis  of the inquiry

Conclusion:

Comparing the ratio to a given operation in the USSR and in the West, we see how different approaches to human life and health.

Literature

•  Freeman W., Watts J.W. Prefrontal leucotomy in the treatment of mental disorders // South Med. J. — 1937. — 30. — 2331.
•  Leksell L. A stereotaxic apparatus for intracerebral surgery // Acta Chir. Scand. — 1949. — 99. — 229233.
•  Valenstein E.S. The history of psychosurgery // Greenblatt S.H. (Ed.) The History of Neurosurgery. — AANS: Park Ridge, 1997.
• Howard Dully “My lobotomy”.
• Доброхотова Т.А., Брагина Н.Н., Зайцев О.С., Ураков С.В, Карменян К.К. Значение психохирургии в изучении соотношений «мозг—психика».
• Rogers L. The Ice Pick Lobotomist: Dr. Walter Freeman.
• Review — Doctoring the Mind: Is Our Current Treatment of Mental Illness Really Any Good? by Richard Bentall, NYU Press, 2009, Review by Roy Sugarman, Ph.D., Aug 25th 2009 in Metapsychology online reviews, Volume 13, Issue 35.
• McManamy J Walter Freeman — Father of the Lobotomy