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Biology 202
2001 Third Web Report
On Serendip

Mining for the Self: Lobotomy and the Quest for the I-Function

Alice Goff

A large concern of the field of neurobiology seems to be finding and understanding a connection between the structure and function of the nervous system. What tangible system of tissues is responsible for creating a given perceived output? Some outputs can be more easily traced back to a specific 'motor symphony' and the involved structures isolated. This problem has obsessed generations of scientists. One of the first of this generation of researcher was F.J. Gall who promoted the idea that observable features of the brain could lead to an understanding of specific traits of action (7). Gall's greatest opponent, Marie-Jean-Pierre Flourens published research on localization of function and among his findings was evidence for sensory perception in certain sub-cortical structures (7). However, when Flourens examined the cerebrum he did not get such clean results. He found that damage to the cerebrum would not compromise specific abilities in the patient based on area, but incapacitate the patient in different ways based on the extent of the created lesion. In other words, damage to the cerebrum effected a diminution of 'higher mental faculties' such as "perception intellect and will" according to how great the lesion actually was, not according to where in the hemispheres it occurred (7). His conclusion proposed these higher mental faculties as existing throughout the structures of the cerebrum, and not isolated as with sensory perception. How is it possible to attribute, say elements of personality to a specific structure? Is their a region of the brain responsible for the way we are? A 'nice' region, an 'angry' gland? Here we encounter the ever ephemeral concept of where the I-function lies within the nervous system.

Flourens' experiments, as well as many in the field of physiological psychology involved in great part injuring or impairing a section of the nervous system and then observing resultant changes in behavior. Indeed, much scientific discovery stems from observation of impairment-using disability as a way to understand ability. This method is a bit of turning observations on their heads-what one observes in a damaged patient might provide clues as to what one would observe in a healthy patient. This sort of process of elimination method of observation is an especially applicable tool when the structures and functions involved are little understood. In the case of locating where aspects of personality may come from, this is definitely true-much is left unexplained about what creates a human sense of individuality and character. In the early twentieth century, suddenly there became a tremendous need to understand the structural basis for personality. Veterans returning from World War I often suffered severely from shell shock, and other mental dibilities and the bereaved relatives of lost ones were often also subject to personality disorders (1). Perhaps it was this massive influx of asylum patients, or perhaps just a misled understanding of the complexity of brain function that would spur the trend of one of the darkest medical and neurological periods in history.

Although scientists had long been tinkering around with the function of the behavioral implications of the neo-cortex, the trademark case which seems to have awakened the world to the direct relationship between the brain and personality is that of Phineas Cage. In 1847 this Irish workman was involved in a rock blasting accident which sent an iron rod through the frontal region of his brain. Miraculously enough, he survived the incident, but even more astonishing at the time were the marked changes in Cage's personality after the rode punctured his brain. Where before Cage was characterized by his mild mannered nature, he had now become aggressive, rude and "indulging in the grossest profanity, which was not previously his custom, manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires" (1). According to the Boston physician Harlow in 1868. However, Cage sustained no impairment with regards to his intelligence or memory (1). This observation leads to the conclusion that memory and intellegence must be independent from the structure which controls personality, or the I-function. So Flourens was mistaken in his assumption of the three components of 'higher mental faculties'. Obviously personality is an independent function of an unknown structure.

Besides posing questions of location and structure, the Phineas Cage incident opened doors for scientists by demonstrating to the public that alteration in brain structure could play a significant role in changing the personality of a human being. In Phineas Cage the effect of the inadvertent lobotomy was to make him more aggressive, but could such a procedure be performed medically to the opposite effect? Thus, completely by chance, the foundational discoveries for the development of frontal lobotomy were laid.

Beginning in the late 1800's, experimental surgeries involving various incisions slicing or destroying parts of the frontal cortex were performed on a variety of subjects in an effort to produce a calming effect in their behavior. In 1935, Dr. John Fulton presented the results of his research on a pair of chimpanzees at a conference for neurology. Fulton had "removed completely the frontal lobes" (4). of the chimps and observed that after the surgery they appeared significantly calmer than before the operation as he was unable to "generate experimental forms of neurosis in the animals" (1). Attending this conference were two neuro-scientists, Egas Moniz and Walter Freeman, both of whom would become major figures in the practice of lobotomy. Egas Moniz was particularly fascinated by the idea of the behavioral changes in Fulton's chimps and posed the shocking question, "If the frontal lobe removal prevents the development of experimental neurosis in animals and eliminates frustrational behavior, why would it not be possible to relieve anxiety states in man by surgical means?" (1). Although many in attendance were appalled at Moniz' suggestion, Freeman was inspired by the possibilities opened by the suggestion of what would come to be termed psychosurgery.

Soon after the conference Moniz and Freeman began exploring the possibilities of such a procedure. The reasoning behind their research was as follows. They knew that diseases such as obsessive compulsive disorder operated by repeated patterns of metabolic activity in the frontal cortex (6). These repeated patterns are caused by a defective caudate nucleus in the basal ganglia cells does not perform its normal 'filter' function and lets too many impulses through (8). By severing the nerve fibers of this region they hoped to interrupt the destructive patterns of activity, alleviating the obsessive nature of the patients. In 1936, Moniz published his written research on his first human frontal lobotomy and shortly after, Walter Freeman performed the first lobotomy in the United States (3).

This analysis of the results of such a procedure indicates that the neurologists working on this issue had lost sight of a key element of the history of their research. By assuming that severing neo-cortical tissue to interrupt destructive obsessive-compulsive brain patterns would merely alleviate the problematic symptoms ignores the most remarkable aspect of Phineas Cage-he became a different person mentally after the accident(1). And Cage was not a mental health patient previously-he had no symptoms to cure, instead his inadvertant lobotomy caused him to lose the chracteristics of his disposition which had distinguished him as Phineas rather than George or Frank or Bruce. Replicating such an injury in a psychologically-impaired patient would do more than disrupt detrimental metabolic activity, it would take a profound toll on the character of the subject.

However, this concept was overlooked, largely due to the urgency for a solution to the mass overcrowding of asylums. So the practice of lobotomy continued. Freeman, with the help of his assistant surgeon (Freeman had no surgical experience himself), James Watts, was responsible for developing the crude procedure which became standard lobotomy practice. Starting with Moniz's original method, which he called the "pre-frontal lobotomy" they would insert a wire knife (leukotome) into many holes in the brain and then, with a few swinging motions, slice through the brain matter with the presumably remedial effect of the psychotic symptoms in the patient (4). A testament to the crudity with which they operated, Freeman prided himself on "flying by instruments only" and got quite good at threading the leukotome through one hole and out of the other (1). They revised this procedure, calling it the "Freeman-Watts Standard Procedure" (4). As if this were not grotesque enough, Freeman came upon an idea which would simplify the surgery and make it administrable by less specialized medical professionals. In 1945, inspired by similar practices in Italy at the time, Freeman introduced the idea of the "ice-pick" or transorbital lobotomy (2). The procedure involved the insertion of an actual ice pick into the brain via the eye socket. Freeman describes his new technique in a letter to his son: "This consists of knocking them out with a shock and while they are under the "anesthetic" thrusting an ice pick up between the eyeball and the eyelid through the roof of the orbit actually into the frontal lobe of the brain and making the lateral cut by swinging the thing from side to side." (5). Due to the extreme brutality of this procedure, James Watts broke his partnership with Freeman. Indeed, many notable surgeons were reputed to have fainted while watching Freeman perform his surgery and many others refused to do lobotomies (1). However, with the avidity of Freeman and cooperation of other surgeons around 18,000 lobotomies were performed in the US between 1939 and 1951(1).

While the avidity with which lobotomy was used represents an ignorance of the fact that the surgery deprived its patients of their personalities, the procedure itself reflects the perceptions of brain structure in relation to function at the time. Lobotomy was a procedure which adressed cranial malfunction on a very macro level. The surgery itself had very little precision to it-it was assumed that any damage done to the neo-cortex would suffice in creating the desired effect. Herein lies the great error of the frontal lobotomy-it did not recongnize the high specificity of cerebral structure. If one were to think of the nervous system as a system of boxes, each contained within another like a set of russian dolls, from the brain down to the neurons, lobotomy would be like attacking a problem on the largest scale-breaking the biggest doll to fix the problems of the smallest.

It was not until the fifties that opposition to lobotomy became especially vocal and finally with the introduction of anti-psychotic medications such as Thorazine doctors became less and less reliant on lobotomy to treat patients (4). Already with the development of the 'ice-pick' lobotomy many doctors refused to perform such a brutal procedure. Indeed Dr. Edwin Zabriskie, a professor of clinical neurology who had fought in hand to hand combat in World War I is said to have passed out watching the operation(1). Freeman performed his last lobotomy in 1967 which resulted in fatality when he nicked a blood vessel and the patient bled to death. With Freeman's death, lobotomy became an extinct practice in America, remembered with shudders as a dark and mislead period of medical history.

Despite its associated horrors-lobotomy in effect deprived thousands of people of their personalities, of themselves-it is quite an interesting historical period in understanding the relationship between structure and function of the brain. Again we ask the question, where is the self within the mass of curly lobes and tissues that make up the brain? The fact that by marring the neuronal make up of someone's neo-cortex can essentially change who they are would indicate that the ephemeral 'self' is something that is indeed bound by an organ, a brain. It is not something that floats above us, or that is part of another bodily structure-the brain is the self. Still the question is unsolved: if the brain is equal to the self, if the I-function is indeed held within the brain, where exactly is it? Which lobe, which hemisphere? The question is by no means answered, but certain suggestions can be gleaned from the history of lobotomy. I think that the quest for the I-function is in vain, because it has already been found. If dragging an ice-pick through our frontal neo-cortical material changes who we are, with differing degrees of variation depending on the patient, one can feasibly conclude that personality is not able to be isolated to a single entity within the brain, but is rather a sum of all neo-cortical functions. I would not go as far as to propose that there exists an I-function in all cerebral structures because there is ample evidence that much of our brain functions in ways we are unaware of. However, it seems useful to think of the self in terms of a motor symphony itself, just as is the case with action. Perhaps personality is the sum of the function of neo-cortical activity. Lobotomy, the surgical process which sanctioned the rape of so many people's brain function, at least contributes to neurological science the following: the I-function is very much embedded in neo-cortical structure and damage to this area of the brain will have serious implications on the nature of the patient.

WWW Sources

1)A Brief History of Lobotomy SITE, adapted from Medical Blunders by Robert Youngson.

2) "Lobotomy's Back, by F. Vertosick, Jr. as published in Discover Magazine, Oct. 1997

3) History of Lobotomy , A very brief overview of the history of the procedure, put out by PBS

4)Excerpt from The History of Psychosurgery SITE, by R.M.E. Sabbatini, PhD.

5) Great and Desperate Cures, by Elliot Valenstein. New York: Basic Books, 1986

6) OCD and the Brain, Andrew Hollander's web paper on Obsessive Compulsive Disorder

7) "Mind and Body" , by Robert Wozniak. A discussion of the history of explorations into the relationship between mind and structural function in the brain.

8)Over, Over and Over...New Scientist article about OCD

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