Psychosurgery is the practice of performing surgery on the brain to treat or alleviate severe mental disease. Its implementation has been sporadic and faddish, and is now almost universally shunned as inappropriate. This term should not be confused with the fraudulent, sleight-of-hand practice of psychic surgery.

There is evidence that trephining (or trepanning) — the practise of drilling holes in the skull for pseudo-medical reasons — was in widespread, if infrequent, use since 5000 BCE. However, psychosurgery as understood today was not commonly practised until the early 20th century.

The first systematic attempts at psychosurgery in humans 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. This procedure is commonly (and incorrectly) called a "lobotomy", although this name should refer to a whole class of unrelated surgeries.

Moniz and Lima obtained 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 US, as a treatment for previously incurable mental conditions. Moniz received a Nobel Prize in 1949.

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.

The procedure was popularized in the United States by Walter Freeman, who also invented the "icepick lobotomy" procedure, which literally used an icepick and rubber mallet instead of the standard surgical leucotome . In a gruesome procedure, Freeman would hammer the icepick 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.

Freeman's advocacy led to great popularity for lobotomy as a general cure for all perceived ills, including misbehavior in children. Ultimately between 40,000 and 50,000 patients were lobotomized, with few if any studies done to see if the treatment was effective. 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.

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.

Psychosurgical interventions such as bilateral cingulotomy are still performed in a small number of severe cases which don't respond to other treatments.

Notables who went under psychosurgery include:

• Rosemary Kennedy
• Rose Williams

Fictional examples of psychosurgery include:

• 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.

See also

• Frontal lobe
• Frances Farmer
• Medical torture
• Phineas Gage

External links

• http://www.lobotomy.info/ - The internet's first and foremost resource concerning the "ice pick lobotomy" ...
• Brain surgery to cure the mind - BBC Radio 4 documentary on modern psychosurgery
• http://www.mcmanweb.com/article-122.htm
• http://www.idiom.com/~drjohn/lobotomy.html - A site critical of lobotomy, both as it was practiced originally and as it is practiced today
• http://www.psychosurgery.org/ - "Remembering the tragedy of lobotomy"
• http://www.ship.edu/~cgboeree/lobotomy.html - "A Brief History of the Lobotomy", by Dr. C. George Boeree

References

• G. Rees Cosgrove, Scott L. Rauch: "Psychosurgery" Neurosurg. Clin. N. Am. 1995; 6:167-176 online version
• Renato M.E. Sabbatini: The History of Psychosurgery. Brain & Mind, September 1997.