Wednesday, June 24, 2009

Also known as a leukotomy, lobotomy is a neurosurgical procedure which consists of cutting the connections to and from the prefrontal cortex of the cerebrum. Psychiatrists and neurosurgeons no longer perform lobotomies on patients. Now they use various drugs, such as antipsychotic chlorpromazine (Thorazine), and psychological therapies to treat mental health issues. Lobotomies were used mainly from the 1930s to 1950s to treat a wide range of severe mental illnesses, including schizophrenia, clinical depression, and various anxiety disorders. The patient's informed consent in the modern sense was often not obtained.

Lobotomy is a surgical incision into the frontal lobe of the brain to sever one or more nerve tracts, a technique formerly used to treat certain mental disorders but now rarely performed. In 1935, Portuguese physician and neurologist António Egas Moniz pioneered a surgery he called prefrontal leucotomy. The procedure involved drilling holes in the patient's head and destroying tissue in the frontal lobes by injecting alcohol. He later changed technique, using a surgical instrument called a leucotome that cut brain tissue by rotating a retractable wire loop. Moniz was given 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 the Freeman-Watts procedure (the "precision method," the standard prefrontal lobotomy).

The Freeman-Watts prefrontal lobotomy still required drilling holes in the scalp, so surgery had to be performed in an operating room by trained neurosurgeons. Walter Freeman believed this surgery would be unavailable to those he saw as needing it most: patients in state mental hospitals having no operating rooms, surgeons, or anesthesia, and limited budgets. 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.

Phineas Gage case was an accidental lobotomy in which Phineas became almost childish in his behavior, unwilling to listen to others and often using obscenities. The part of Phineas' brain that had been destroyed by this accidental lobotomy was the orbitofrontal cortex in situated in the frontal lobe.