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In America, Dr. Walter Freeman, a neurologist, read an article Moniz published about the leukotomies he had performed. He requested the monograph, and after reading it, showed it to his colleague, James Watts, a neurosurgeon. He and Watts soon formed a partnership-Freeman navigated while Watts did the cutting. Their first surgery was performed on a 63-year old woman from Kansas. After the operation, she stopped caring about anything, including whether she was in a hospital or at home. Freeman and Watts continued to operate, experimenting with tool design and operating technique. They came up with the "Freeman-Watts standard lobotomy," which involved drilling holes on either side of the head, then breaking away enough skull for the 6-inch cannula, the tubing from a heavy-gauge hypodermic needle. It would be put into one hole, pointing at the opposing hole. A blunt knife would be put into the path made by the cannula, then swung in two arcs, cutting nerve matter. This would be repeated on the other side. They began performing these lobotomies with the patient under only a local anesthetic, asking the patient to talk or sing songs so that they could keep cutting until the patient began to show signs of disorientation. (2).
Freeman decided that it should not be necessary for a lobotomy to be performed by a neurosurgeon; he should be able to do them himself. Influenced by an Italian who had used a trans-orbital technique to perform lobotomies, he was inspired to use an ice pick to puncture the brain instead of using knives. He would puncture through skin, subcutaneous tissue, bone and meninges with a common ice pick to reach the brain through the roof of the eye orbits. Freeman would then swing the pick to sever the prefrontal lobe. The operation took only a few minutes and used local anesthesia, but the procedure was so horrid that veteran neurosurgeons and psychiatrists could not bear it, even fainting at the sight of it. Watts ended his partnership with Freeman. (1).
Between 1939 and 1951, mental asylums were flooded with patients due to World War II. During this time, in the United States alone over 18,000 lobotomies were performed on veterans, prisoners, rebels/political opponents, and even misbehaving children. (1).
Schizophrenia was also a common illness to be treated with lobotomy. (2). The frontal lobe controls behavior, social adjustment, impulse control, and emotions. (5). The prefrontal cortex in particular invokes responses guided by knowledge and memory. The hippocampus also plays a role in memory maintenance and retrieval in addition to providing a sense of context. (3). The hippocampus, shown to be altered in schizophrenic subjects, is a major part of the limbic system. (8). The limbic system triggers instinctive and other psychomotor patterns, ensuring homeostasis. Neocortical centers of cognition translate the most minute changes in the chemical balance into emotions, which contributes to consciousness. (9).
Through neuropsychological tests and measures of physiological function, abnormalities have been found in the frontal lobe of schizophrenics. Magnetic resonance imaging (MRI) studies have found reduced volume of the frontal lobe, one study finding reduced white matter but not grey. White matter connected the sections of grey matter of the brain together. However, these studies have produced inconsistent results, possibly due to MRI technique in studying the brain. They do suggest, however, that there is a relationship between abnormal frontal lobe areas and symptoms of schizophrenia. (6).
Schizophrenia may be due to synaptic malfunction or damage, in particular the glutamate synapse. This abnormal function leads to a loss of interneural activity. (7). Studies have also suggested that an abnormal number of neuron receptors could be one of the causes of schizophrenia. One study shows a decrease in serotonin2A receptors and an increase in GABA2A receptors; another shows a decrease in muscarinic1 receptors. (8).
Lobotomy was used to bypass the abnormalities in the frontal lobe by taking it out of the equation altogether. This treatment was so economical and so comparatively easy that the number of lobotomies soared-leading to the awarding of the 1949 Nobel Prize for Medicine to Dr. Moniz. However, while the patient was calmer after the procedure, they often had a loss of personality as well. (2). The death rate of the ice pick procedure was fairly high at 6%, and there was also a 1% epilepsy rate and 1.5% marked disinhibition. John Fulton, whose chimpanzees triggered the outburst of lobotomies, joined others to protest the radical technique. (4).
The use of lobotomy has declined greatly since its initial popularity. Nolan Lewis, the Director of the New York State Psychiatric Institute at the time, spoke for many opponents of lobotomy when he said, "Is quieting a patient a cure? Perhaps all it accomplishes is to make things more convenient for those who have to nurse them. It disturbs me to see the number of zombies that these operations turn out. It should be stopped." (2). However, the effect of lobotomy on patients with mental illnesses such as schizophrenia, so that we know more today about the role of the frontal lobe in the human brain.
2)Brief History of the Lobotomy, An excellent history of the lobotomy.
3)Context and Cognition in Schizophrenia,
5)Frontal Lobe, A short explanation of the frontal lobe.
6)Prefrontal Cortex and Schizophrenia: A Quantitative MRI Study,
7)Recent Advances in the Neurobiology of Schizophrenia, A thorough description of chemical reactions in the brain - heavy terminology.
8)Molecular Schizophrenia Division,
9)The Security Circuit: A Proposed Construct for the Central Nervous System,
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