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SCIENCE-FOR-THE-PEOPLE  July 2005

SCIENCE-FOR-THE-PEOPLE July 2005

Subject:

Re: Lobotomy Back in Spotlight

From:

Robt Mann <[log in to unmask]>

Reply-To:

Science for the People Discussion List <[log in to unmask]>

Date:

Sat, 16 Jul 2005 10:19:46 +1300

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (162 lines)

        In the circumstances one hesitates to mention the key fact which is
apparently not known to the unreasonable complainants, but it is
interesting enough that I'll take the risk.
        After W2 the US veterans admin had hospitals full of mentally
disturbed men (yes, in those days it was still regarded as wrong to put
women in front-line positions) on whom all known medicine had failed.  It
therefore became ethical to try psychosurgery if there was some reason to
believe it would help.  Lobotomy was an obvious candidate (based on the
famous case of Phineas Gage).
        But the USVA docs, to their everlasting credit, arranged a 'blind'
sham-operated control group who woke up with the operation scars on their
temples but had not had their brains touched.
        The lobotomised patients, as a group, achieved detectable progress.
But, to a comparable extent, so did the control group.  The immediate
conclusion is that if you pay plenty attention to a mentally deranged
person, and if the patient thinks he's getting the very best of treatment,
you have a good chance he'll tend to improve.

        I once had the frightening experience of chatting informally with a
(rtd) prominent Australasian FRACS brain surgeon (now deceased), alluding
to the above facts, and suddenly realising, like a driver braking to a stop
at the edge of a cliff, that I had barely avoided disclosing to him that he
had been doing unwarranted psychosurgery.  He was  -  I suddenly realised
-  unaware of the USVA controlled expts.

        I'm not learned in medical ethics, but my personal opinion is that
complainant Christine Johnson & allies have very little right on their
side.  To apply the hindsight from the USVA expts retroactively to Moniz is
not rational.
        BTW it's widely suspected that the Nobel cttee was in some
difficulty at the time in finding non-Germans for this prize.  One could
hardly say Moniz stands out among Nobel winners.  But he got it at the
time, and it's unreasonable to advocate the notion of cancelling that.  Ms
Johnson should deal with her own feelings, not try to punish a deceased
Portugese who was, at the time, doing OK.

R


> http://news.yahoo.com/s/ap/20050713/ap_on_he_me/lobotomy_debate
> Lobotomy Back in Spotlight After 30 Years
>
> By LINDA A. JOHNSON, Associated Press Writer
>

> The lobotomy, once a widely used method for treating mental illness,
>epilepsy and even chronic headaches, is generating fresh controversy 30
>years after doctors stopped performing the procedure now viewed as
>barbaric.
>
> A new book and a medical historian contend the crude brain surgery
>actually helped roughly 10 percent of the estimated 50,000 Americans who
>underwent the procedure between the mid-1930s and the 1970s. But relatives
>of lobotomy patients want the Nobel Prize given to its inventor revoked.
>
> The lobotomy debate was discussed in an editorial in Thursday's New
>England Journal of Medicine.
>
> Lobotomy was pioneered in 1936 by Portuguese neurologist Egas Moniz, who
>operated on people with severe psychiatric illnesses, particularly
>agitation and depression. Through holes drilled in the skull, Moniz cut
>through nerve fibers connecting the brain's frontal lobe, which controls
>thinking, with other brain regions - believing that as new nerve
>connections formed the patient's abnormal behavior would end.
>
> Moniz, already widely respected for inventing an early brain-imaging
>method, gave sketchy reports that many patients benefited and was awarded
>the Nobel Prize for medicine in 1949.
>
> The procedure was so in vogue that Rosemary Kennedy, former President
>Kennedy's mildly retarded sister, had a lobotomy in the 1940s at age 23.
>She remained in an institution until she died in January.
>
> Other doctors used a more primitive version than Moniz, punching an ice
>pick into the brain above the eye socket and blindly manipulating it to
>sever nerve fibers.
>
> By the late 1930s doctors were reporting many lobotomy patients were left
>childlike, apathetic and withdrawn - not unlike the depiction in the novel
>and movie "One Flew Over the Cuckoo's Nest." Use eventually waned with the
>advent of effective psychiatric drugs in the mid-1950s and the growing use
>of electroshock therapy.
>
> Modern views of lobotomy have led to a call to pull Moniz's Nobel prize.
>
> "How can anyone trust the Nobel Committee when they won't admit to such a
>terrible mistake?" asks Christine Johnson, a Levittown, N.Y., medical
>librarian who started a campaign to have the prize revoked.
>
> Her grandmother, Beulah Jones, became delusional in 1949, was lobotomized
>in 1954 after unsuccessful psychiatric and electroshock treatments, and
>spent the rest of her life in institutions.
>
> One member of Johnson's campaign, retired nurse Carol Noell Duncanson of
>Marietta, Ga., said her mother, Anna Ruth Channels, was lobotomized while
>pregnant to end chronic headaches in 1949. Channels, described as a
>brilliant and vivacious woman, was sent home incapacitated, Duncanson said.
>
> "The woman could not feed herself, she could not toilet, she could not
>speak and she was combative," Duncanson said.
>
> Channels eventually re-learned those things but remained childlike and
>unable to care for her daughters, who spent years in foster care. Her
>husband abandoned her and she lived the rest of her life in a small West
>Virginia town with her mother, who was resentful and ashamed of her, and
>an abusive brother, Duncanson said.
>
> "She never had a life after her lobotomy. She had nothing," the daughter
>said.
>
> Johnson, whose grandmother died in 1989, several years ago started the
>Web site psychosurgery.org to build a support network among families of
>lobotomy patients. Then she and group members began urging removal of an
>article on the Nobel Web site praising Moniz and saying he deserved the
>prize because there were no alternative psychiatric treatments at the time.
>
> The Nobel Foundation refused to remove or change the article. Now Johnson
>is asking Nobel laureates to support her campaign to strip Moniz's Nobel.
>
> "There's no possibility to revoke it," said foundation executive director
>Michael Sohlman, who could not recall a Medicine Prize ever being
>challenged. "It's a nonstarter."
> The Nobel charter has no provision for appeal of a prize awarded, he
>said, and the foundation ignores such criticisms, as it did when
>Palestinian leader Yasser Arafat's Peace Prize was challenged.
>
> Meanwhile, journalist Jack El-Hai recently published "The Lobotomist,"
>about the chief U.S. proponent, neurosurgeon Walter Freeman, who did
>roughly 3,400 operations. He developed the icepick technique.
>
> In the New England Journal editorial, Dr. Barron H. Lerner, a medical
>historian and associate professor at Columbia University College of
>Physicians and Surgeons, wrote that the procedure was a desperate effort
>to help many of the 400,000 patients confined to U.S. mental hospitals at
>mid-century.
>
> He said a small number of patients became calmer and more manageable.
>
> "I think the numbers that were harmed were quite substantial," Lerner
>said in an interview. "It was way overused, and it was used in
>inappropriate circumstances - retardation, anxiety, headaches."
>
> El-Hai began his research eight years ago after meeting a relative of a
>man committed to a mental hospital for epilepsy around 1930 and later
>lobotomized. As he got into his research about Freeman, El-Hai wondered,
>"What led this undeniably gifted and compassionate doctor to champion a
>brain-mutilating procedure and why he stayed with it so long, past the
>point of reason?"
>
> El-Hai said patients no longer felt strong emotions and their behavior
>changed immediately, which was Freeman's goal. But he concluded Freeman
>was driven to be a showman.
>
> ___
>
> On the Net:
>
> NEJM: http://www.nejm.org
>
> Christine Johnson's site: http://www.psychosurgery.org
>  Nobel site on Moniz: http://nobelprize.org/medicine/articles/moniz

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