Psychosurgery is a term for surgeries of the brain or autonomic nervous system involving the severance of neural pathways to effect a change in behaviour, usually to treat or alleviate severe mental illness. The procedures typically considered psychosurgery are now almost universally shunned as inappropriate, due in part to the emergence of less-invasive methods of treatment such as psychiatric medication. Although the term psychosurgery might imply a broad class of treatments, in reality, it is confined to variations on two themes: A typical modern surgery operation For other meanings of the word, see Surgery (disambiguation) Surgery (from the Greek cheirourgia meaning hand work) is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. ... Comparative brain sizes In the anatomy of animals, the brain, or encephalon (Greek for in the head), is the higher, supervisory center of the nervous system. ... This article is in need of attention from an expert on the subject. ... The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ... Psychopharmacology is the study of the effects of any psychoactive drug that acts upon the mind by affecting brain chemistry. ...

1. leukotomy, prefrontal lobotomy, or cingulotomy: the intentional severing of the prefrontal cortex from the thalamic region of the brain
2. sympathectomy: the intentional severing of the sympathetic nerve trunk

Psychosurgery should not be confused with neurosurgery, though they may seem similar; neurosurgery is surgery intended to treat or alleviate neurological disorders, which may or may not manifest mental illnesses as symptoms. Psychosurgery should also not be confused with the practice of psychic surgery—surgery purportedly performed by paranormal means. A leukotomy refers to what is now more commonly known as a prefrontal lobotomy (leuko: white matter of brain, tomy: cutting). ... Endoscopic Thoracic Sympathectomy (ETS) is a medical procedure where certain sympathetic nerve ganglia are burned, cut or clamped. ... Anatomy and Physiology of the A.N.S. In contrast to the voluntary nervous system, the involuntary or autonomic nervous system is responsible for homeostasis, maintaining a relatively constant internal environment by controlling such involuntary functions as digestion, respiration, and metabolism, and by modulating blood pressure. ... Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous system diseases amenable to mechanical intervention. ... Psychic surgery is allegedly a paranormal surgical procedure. ... Anomalous phenomena are phenomena which are observed and for which there are no suitable explanations in the context of a specific body of scientific knowledge, e. ...

History

There is evidence that trephining (or trepanning)—the practice of drilling holes in the skull for pseudomedical reasons—has been in widespread, if infrequent, use since 5000 BCE. This may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example, after head injuries. (Several documented cases of healed wounds indicate that such crude surgery could be survived back then.) However, psychosurgery as understood today was not commonly practised until the early 20th century. 18th century French illustration of trepanation (Larger Version) Trepanation, also known as trephinning or trepanning, is a form of surgery where a hole is drilled or scraped into the skull, leaving the membrane around the brain intact. ... 18th century French illustration of trepanation (Larger Version) Trepanation, also known as trephinning or trepanning, is a form of surgery where a hole is drilled or scraped into the skull, leaving the membrane around the brain intact. ... (6th millennium BC – 5th millennium BC – 4th millennium BC – other millennia) Events 4713 BC – The epoch (origin) of the Julian Period described by Joseph Justus Scaliger occurred on January 1, the astronomical Julian day number zero. ...

The first systematic attempts at human psychosurgery occurred from 1935, when the neurologist Egas Moniz teamed up with the surgeon Almeida Lima at the University of Lisbon to perform a series of prefrontal leucotomies—a procedure severing the connection between the prefrontal cortex and the rest of the brain. 1935 (MCMXXXV) was a common year starting on Tuesday (link will take you to calendar). ... António Caetano de Abreu Freire Egas Moniz (November 29, 1874 - December 13, 1955) was a Portuguese physician and neurologist. ... The University of Lisbon (Universidade de Lisboa) is a leading public university in Lisbon, Portugal, and is composed by eight faculties. ... The frontal lobe is an area in the brain of vertebrates. ... Comparative brain sizes In the anatomy of animals, the brain, or encephalon (Greek for in the head), is the higher, supervisory center of the nervous system. ...

Moniz and Lima claimed fair results, especially in the treatment of depression, although about 6% of patients did not survive the operation, and there were often marked and adverse changes in the patients' personality and social functioning. Despite the risks the process was taken up with some enthusiasm, notably in the U.S., as a treatment for previously incurable mental conditions. Moniz received a Nobel Prize in 1949. Clinical depression is state of debilitating sadness or melancholy. ... ... List of Nobel Prize laureates in Physiology or Medicine from 1901 to the present day. ... 1949 (MCMXLIX) is a common year starting on Saturday. ...

The initial criteria for treatment were quite steep—only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, depression with risk of suicide and incapacitating obsessive-compulsive disorder were the main symptoms treated. The original leucotomy was a crude operation and the practice was soon developed into a more exact stereotactic procedure where only very small lesions were placed in the brain. Clinical depression is state of debilitating sadness or melancholy. ... Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life; it is sometimes a noun for one who has committed or attempted the act. ... Stereotactic surgery is a minimally-invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation (removal), biopsy, lesion, injection, stimulation, implantation, etc. ... Comparative brain sizes In the anatomy of animals, the brain, or encephalon (Greek for in the head), is the higher, supervisory center of the nervous system. ...

The procedure was popularised in the United States when Walter Freeman invented the "ice pick lobotomy" procedure, which literally used an ice pick and rubber mallet instead of the standard surgical leukotomy. Leaving no visible scars, the ice pick lobotomy was heralded as a great advance in "minimally invasive" surgery, and was eventually done under only local anaesthesia. Dr. Walter Jackson Freeman II (November 14, 1895 – May 31, 1972) was a physician, graduate of Yale and the University of Pennsylvania Medical School, advocate and very prolific practitioner of psychosurgery, specifically lobotomy. ... Icepick. ... A rubber mallet, used in construction, woodworking, and auto-body work. ... A leukotomy refers to what is now more commonly known as a prefrontal lobotomy (leuko: white matter of brain, tomy: cutting). ...

In a minimally invasive procedure, Freeman would hammer the ice pick into the skull just above the tear duct and wiggle it around. Between 1936 through the 1950s, he advocated lobotomies throughout the United States. Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in many medical centres. He reputedly even performed a few lobotomies in hotel rooms. Tears trickling down the cheeks Lacrimation is the bodys process of producing tears, which are a liquid to clean and lubricate the eyes. ... 1936 (MCMXXXVI) was a leap year starting on Wednesday (link will take you to calendar). ... // Events and trends This map shows two essential global spheres during the Cold War in 1959. ...

Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehaviour in children. Ultimately between 40,000 and 50,000 patients were lobotomised. A follow-up study of almost 10,000 patients claimed 41% were "recovered" or "greatly improved", 28% were "minimally improved", 25% showed "no change", 4% had died, while only 2% were made worse off (Tooth, et al. 1961). Lobotomies gradually became unfashionable with the development of antipsychotics and are no longer performed. The era of lobotomy is now generally regarded as a barbaric episode in psychiatric history. A male Caucasian toddler child A child (plural: children) is a young human. ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ...

It is possible that some patients did benefit from the more precise psychosurgery, but there was a strong division amongst the medical profession as to the viability of the treatment and concern over the irreversible nature of the operation and the extension of the surgery into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders, etc). Whatever the truth, psychosurgery was offered in only a few centres, and by the 1960s the number of operations was in decline. The signal improvements in psychopharmacology and behaviour therapy gave the opportunity for more effective and less-invasive treatment. Psychopharmacology is the study of the effects of any psychoactive drug that acts upon the mind by affecting brain chemistry. ... Cognitive therapy or cognitive behavior therapy is a kind of psychotherapy used to treat depression, anxiety disorders, phobias, and other forms of mental disorder. ...

Neurological effect

The frontal lobe of the brain controls a number of advanced cognitive functions, as well as motor control. Motor control is located at the rear of the frontal lobe, and is usually unaffected by psychosurgery. The anterior or prefrontal area is involved in impulse control, judgement, language, memory, motor function, problem solving, sexual behaviour, socialisation and spontaneity. Frontal lobes assist in planning, coordinating, controlling and executing behaviour. The frontal lobe is an area in the brain of vertebrates. ... // Location and Function The prefrontal cortex is the anterior part of the frontal lobes of the brain, lying in front of the motor and associative areas. ...

Thus, the efficacy of psychosurgery was often related to changes in personality and reduced spontaneity (this included making the person quieter and lowering their sex drive). Certain processes related to schizophrenia are also believed to occur in the frontal lobe, and may explain some success. However, certain types of inappropriate behaviours increased as a function of reduced impulse control (in some respects they became more childlike). Further, it decreased their ability to function as a member of the community by reducing their problem solving and planning abilities and making them less flexible and adaptive. It usually had no bearing on IQ except with respect to problem solving. IQ redirects here; for other uses of that term, see IQ (disambiguation). ...

Present day

Psychosurgery today is almost entirely limited to endoscopic thoracic sympathectomy (ETS surgery). While this is normally used for somatic conditions, many patients with anxiety disorder report significant reduction in fear and alertness after this intervention (Teleranta, Pohjavaara, et al. 2003,2004). Endoscopic Thoracic Sympathectomy (ETS) is a medical procedure where certain portions of the sympathetic nerve trunk are burned, cut or clamped. ... Anxiety disorder is a blanket term covering several different forms of abnormal anxiety, fear, phobia and nervous condition, that come on suddenly and prevent pursuing normal daily routines. ...

Today, lobotomy is very infrequently practised. It may be a treatment of last resort for OCD sufferers, and may also be used for people suffering chronic pain. In the latter case, the surgery does not act on the perception of pain, but leads to a lack of concern about the pain. The procedure usually involves a 2–3cm lesion in the cingulum near the corpus callosum. The efficacy is not high, with improvement in 5 of 18 patients (Baer et al., 1995). Lobotomy is no longer used as a treatment for schizophrenia. For other things named OCD, see OCD (disambiguation). ... The cingulum is a collection of white matter fibers projecting from the cingulate gyrus to the entorhinal cortex in the brain. ... The corpus callosum is the largest white matter structure in the mammalian brain. ...

Famous people who underwent lobotomy

• Phineas Gage: Famously suffered an accident in 1848 which severely damaged his frontal lobe. The effects were comparable to a surgical lobotomy.
• Josef Hassid: Polish violin prodigy and schizophrenic who died at 26.
• Rosemary Kennedy: Sister of John F. Kennedy.
• Rose Williams: Sister of Tennessee Williams.

Phineas P. Gage (1823 - May 21, 1860) was a railroad construction worker who suffered an unusual kind of traumatic brain injury which inflicted severe damage to parts of his frontal brain during a work accident. ... 1848 is a leap year starting on Saturday of the Gregorian calendar. ... Josef Hassid was a Polish violinist born on December 28, 1923. ... Rose Marie Kennedy (September 13, 1918 – January 7, 2005) was the third child and first daughter of Joseph and Rose Kennedy. ... For other uses, see JFK (disambiguation) or John Kennedy (disambiguation). ... Thomas Lanier Williams (March 26, 1911 - February 25, 1983), better known by the pen name Tennessee Williams, was a noted playwright. ... Thomas Lanier Williams III (March 26, 1911 – February 25, 1983), better known by the pen name Tennessee Williams, was a noted playwright. ...

Fictional examples

• Frances Farmer: Though Farmer is the person perhaps best associated in the public mind with lobotomy due to its depiction in the fictionalized biographical film Frances, archival medical and other records have conclusively proven Farmer never underwent the procedure. The author who initially alleged the lobotomy later admitted in court he had made it up.[1] (Footnoted site contains court transcripts which are also available through Lexis/Nexus).
• Ken Kesey's famed fictional character, Randle Patrick McMurphy, in One Flew Over the Cuckoo's Nest who was, in the movie, played by Jack Nicholson.
• J. Frank Parnell, erratic driver of the radioactive Chevy Malibu in the movie Repo Man.
• A Hole in One, a 2004 movie about a young lady who wants an ice pick lobotomy during the height of its popularity.
• Rat Korga, major character in Samuel R. Delany's science fiction novel Stars in My Pocket Like Grains of Sand, voluntarily opts for psychosurgery to make him content to be a slave.
• Several victims of a serial killer named Gerry Schnauz in an episode of The X-Files entitled "Unruhe".
• Session 9, a 2001 horror movie about a group of men hired to remove the asbestos from a defunct mental hospital. Without spoiling the movie, it can be said that lobotomies are involved.
• Hannibal, in which Hannibal Lecter lobotomizes Paul Krendler, played by Ray Liotta.
• In the book The Bell Jar by Sylvia Plath, the character Esther Greenwood meets a girl named Valerie in the asylum who has had a lobotomy.
• Iron Maiden's famous fictional mascot, Eddie was lobotomised on-stage during one of Maiden's live shows, this concert was filmed for German TV but that particular segment was cut out due to being deemed "Too violent". The cover of their fourth album Piece of Mind (And many of the following releases) shows Eddie after being lobotomised.

Frances Elena Farmer (September 19, 1913 – August 1, 1970) was an American film actress. ... Ken Kesey (September 17, 1935 – November 10, 2001) was an American author, best known for his novel, One Flew Over the Cuckoos Nest, and as a cultural icon whom some consider a link between the beat generation of the 1950s and the hippies of the 1960s. ... One Flew Over the Cuckoos Nest is a 1975 film directed by MiloÅ¡ Forman. ... Jack Nicholson at Cannes, (2001) Jack Nicholson (born John Joseph Nicholson on April 22, 1937, New York City) is a highly successful, iconic American method actor known for his often dark, comedic portrayals of neurotic characters. ... DVD cover Repo Man is a 1984 cult film directed by Alex Cox, produced by Michael Nesmith, and starring Emilio Estevez and Harry Dean Stanton. ... 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Samuel Ray Chip Delany, Jr. ... Science fiction is a form of speculative fiction principally dealing with the impact of imagined science and technology, or both, upon society and persons as individuals. ... Stars in my Pocket like Grains of Sand (1984) is a science fiction novel by Samuel R. Delany. ... The X-Files was a popular American television series created by Chris Carter. ... Session 9 is a 2001 psychological horror film directed by Brad Anderson. ... 2001: A Space Odyssey. ... Asbestos (a misapplication of Latin: asbestos quicklime from Greek ἄσβεστος: a-, not; sbestos, extinguishable) describes any of a group of fibrous metamorphic minerals of the hydrous magnesium silicate variety. ... Hannibal is a 2001 film, directed by Ridley Scott about Hannibal Lecters time in Italy following his escape from imprisonment. ... Hannibal Lecter as portrayed by Anthony Hopkins. ... Paul Krendler is a fictional character appearing in the latter two novels in Thomas Harriss Hannibal Lecter series, The Silence of the Lambs and Hannibal. ... Ray Liotta Ray Liotta (born December 18, 1955 in Newark, New Jersey) is an American actor best known for his lead role as Henry Hill in Martin Scorseses Goodfellas. ... A self-portrait circa 1951. ... Iron Maiden are a British heavy metal band from east London. ... Eddie, whose full name is Eddie the Head or Edward the Head (see below), is the British heavy metal band Iron Maidens mascot. ... Piece of Mind is a studio album by British heavy metal band Iron Maiden released in 1983 (see 1983 in music). ...

See also

• Frontal lobe
• Neurosurgery
• Medical torture

The frontal lobe is an area in the brain of vertebrates. ... Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure Neurosurgery is the surgical discipline focused on treating those central and peripheral nervous system diseases amenable to mechanical intervention. ... Medical torture is a branch of torture which involves the use of expert medical knowledge or therapies to torture prisoners for the purposes of interrogation or corporal punishment; or the provision of professional medical sanction for the torture of prisoners. ...

External links

• Psychosurgery.org
  • "Oral Histories" from Psychosurgery.org
• Website dedicated to Walter Freeman and the "Ice-Pick Lobotomy"
• New England Journal of Medicine article
• Brain surgery to cure the mind - BBC Radio 4 documentary on modern psychosurgery
• "Father of the Lobotomy"
• Lobotomy Criticism
• A Brief History of the Lobotomy
• Rotten Library Article on the Lobotomy
• "Truth About ETS" - ETS education, editorials, and testimonials. Extensive documentation of sympathectomy side effects.
• "My Lobotomy" - a 22-minute piece from National Public Radio's All Things Considered about a 56-year-old man exploring a lobotomy he had at the age of 12.
• "Shedding Light on Shadowland" - in-depth essay exploring the propagation of the Frances Farmer lobotomy legend

BBC Radio 4 is a British domestic radio station which broadcasts a wide variety of chiefly spoken-word programmes including news, drama, comedy, science and history. ... NPR logo NPR redirects here. ... All Things Considered, sometimes abbreviated ATC, is a news radio program in the United States, broadcast on the National Public Radio network. ...

References

• Baer, L., et al. (1995). Cingulotomy for intractable obsessive-compulsive disorder. Archives of General Psychiatry, 52, 384-392.
• G. Rees Cosgrove, Scott L. Rauch: "Psychosurgery" Neurosurg. Clin. N. Am. 1995; 6:167-176 online version
• Davison, G. C., & Neale, J. M. (1998) Abnormal Psychology (7th Ed.). New York, John Wiley.
• Pohjavaara P, Telaranta T, Vaisanen E. The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block? Nord J Psychiatry 2003;57:55-60. PMID 12745792.
• Renato M.E. Sabbatini: The History of Psychosurgery. Brain & Mind, September 1997.
• Pohjavaara P (2004): "Social Phobia, Etiology, Course and Treatment with Endoscopic Sympathetic Blockade (ESB)" [2]