better to have a bottle in front of me than a frontal lobotomy

Biology 202
2002 First Paper
On Serendip

better to have a bottle in front of me than a frontal lobotomy

L. B.

In the movie, "One Flew Over the Cuckoo’s Nest," Mcmurphy, the main character, undergoes a frontal lobotomy ("cutting of the lobes") to treat his ‘mental illness,’ after several rounds of ECT were unsuccessful in crushing his spirit. In the final scenes of the movie we see from his disposition that he has been reduced from an animated, hyperactive state to a vegetative state. McMurphy’s friend, Chief, tries to talk him, but he stares straight ahead and does not respond. The movie takes place in an insane asylum in the 1950’s, the height of the lobotomy craze in the United States. Between 1939 and 1950, nearly 20,000 documented lobotomies were performed, and thousands more in other countries (1). At first the procedure was used in lieu of Electronic Shock Therapy, for rowdy patients who did not respond well to ECT. The lobotomy was applied as a ‘"fix-all" solution for people with all kinds of major or minor mental disorders. Of course, such an invasive procedure is meant to be used only as a last resort in severe cases of debilitating illness. Many doctors, looking for a quick fix for their patients, used the procedure in cases of "undesirable behavior." Unfortunately, such a broad criterion meant that anything from Schizophrenia to Obsessive Compulsive Disorder (OCD), to unruly behavior in general could be treated by lobotomy. In Japan many of the people lobotomized were just children who did not behave well or who performed poorly in school.

What started the lobotomy craze? As with any result, it is difficult to say what exactly prompted the explosion in popularity of such a gruesome surgery. We can begin by exploring the origins of lobotomy in general: In the late 19th century, the scientific community was beginning to understand that behavior was largely controlled by could be mapped out in the brain. The German scientist, Friederich Golz began by cutting the frontal lobes on dogs. He noted that even ferocious dogs became more tame and subdued after the surgery (1). In 1892, in an insane asylum in Switzerland, Gottleib Burkhardt was inspired by Golz to try the procedure on human subjects. He treated patients who were having hallucinations to lobotomies. Some of his patients did become more calm after the surgery, and others died from complications. Burkhardt’s strategy was widely criticized, and there was not much heard about lobotomies for nearly half a decade (1).

Why the frontal lobe?? It became more clear in observations of lobotomized patients that scientists’ theories about the frontal lobes of the brain were correct. The frontal lobe is thought to be a sort of control center, and the location of the self in the brain (5). It is involved in some motor function, problem solving (divergent thinking), spontaneity, memory, language, judgment, impulse control, social and sexual behavior. "Patients with frontal lobe damage exhibit little spontaneous facial expression, which points to the role of the frontal lobes in facial expression (Kolb & Milner, 1981). Broca's Aphasia, or difficulty in speaking, has been associated with frontal damage by Brown (1972)," (5). Also, lobotomy patients might seem more calm because frontal lobe damage results in a difficulty in interpreting one’s environment. The patient has trouble responding to questions, and his associative learning skills are impaired. Oddly enough, it’s also been documented that people with frontal lobe damage cannot get a "good-belly laugh," that it, they have trouble comprehending the punch lines of jokes. In a study lead by Dr. Shammi of the University of Toronto, patients with all kinds of brain damage were subjected to the Three Stooges and other humorous material: "The study found that people with right anterior frontal damage had the most disrupted ability to appreciate written and verbal jokes -- and funny cartoons -- compared to the normal control group and people with focal lesions elsewhere in the brain. Individuals with right frontal damage chose wrong punch lines to written jokes and did not smile or laugh as much at funny cartoons or verbal jokes. They showed a preference for silly slapstick humor -- surprising but illogical endings which are the hallmarks of such acts as The Three Stooges.," (5). So, it follows that the frontal lobotomy should result in drastic changes in social behavior.

Why was the change in behavior of subjects viewed as a change for the better? In the mid 1930’s, a scientist at Yale University (Carlyle Jacobson) began experimenting with ‘lobe cutting’ in chimpanzees. In Jacobson’s experiment, aggressive animals became much more calm. In chimpanzees, this change in behavior seemed to occur without any damage to memory or intelligence. A Dr. Fulton performed the same experiment on chimps, yielding similar results. The calm, docile chimps looked to be much better off then they were before the experiment.

At a neurological conference in England, Fulton shared his results with the Portuguese doctor Antonia Egas Moniz. "Moniz knew that certain psychoses, such as paranoia and obsessive-compulsive disorders, involve recurrent thought patterns that dominate all normal psychological processes. Based on Fulton's ideas, he proposed to cut surgically the nerve fibers which connect the frontal and prefrontal cortex to the thalamus, a structure located deep in the brain, which is responsible for relaying sensory information to the cortex. In this way, Moniz reasoned, there might happen an interruption of the repetitive thoughts, allowing a more normal life for the psychotic," (1). Moniz worked to develop a procedure that he called ‘white matter cutting.’ Through two incisions on either side of the brain, 2 ‘ice picks’ were inserted. A few sweeps of the pick sliced through brain tissue in the frontal lobes. Some of his patients with anxiety or depression saw improvements in their disposition, while others saw no improvement at all or even the contrary. Moniz specified that his process, the leucotomy, should ONLY be used in cases where there was no other avenue. He believed that in that a morbidly fixed idea could be removed from the brain by destroying the tissue on which the idea was saved. He thought that patients with severe anxieties and depression, or compulsive or hallucinatory disorders could benefit from the removal of the ideas that plagued them(2). In 1949, Moniz was awarded the Nobel prize for medicine and physiology. Some years later, Moniz was shot in the back by an old patient of his. He became paraplegic.

So, the father of leucotomy was a paraplegic, and the procedure he created was at most a minor success. Why was this not the end of lobotomy? Perhaps unfortunately, a scientist named Walter Freeman was also at the London Conference with Moniz and Fulton. Freeman was hopeful about the potential of leucotomies in psychiatric medicine. The awarding of the Nobel Prize to Moniz was to Freeman an indication that the procedure was respectable and effective. In Sept. of 1936 Walter Freeman and his co-worker, James Watt, set out to reinstate the lobotomy as a medical procedure for those with mental ailments. They heralded the operation, believing themselves that it worked. They developed the "Freeman-Watts Standard Procedure," in an attempt to refine the lobotomy methods being used at the time. The pair toured the country, promoting their procedure and performing it on many patients. Freeman was the driving force in the pair, and he strove to perfect the operation by making it less messy and less time consuming. Their efforts perpetuated the ‘lobotomy craze,’ and by the late 40’s it was an exceedingly popular operation.

People did not begin to realize the ramifications of such a gruesome operation until it became clear, through observation, that lobotomized individuals were far from normal or happy, and that in actuality, the appearance of a less crazed nature had simply been mistaken for (what was in some cases) a total loss of the individual’s personality. In addition, scientists were not getting the results they expected from empirical evidence. It seemed that only 1/3 of the cases yielded any improvement in the patient, while 2/3 of patients remained just as ill as they were initially or, in many cases, their illnesses became worse. Scientist in the 50’s began experimenting with the use of new kinds of psychiatric drugs (such as thorazine) in treating patients, as medication is reversible and brain surgery is not. By the late 50’s, lobotomies had become nearly obsolete, and the status of the procedure was downgraded from effective to experimental. All in all, the lobotomy era seemed to have been a sort of ‘oops’ in psychosurgical science.

Researchers from Mount Sinai Medical School have come to Pilgrim, one of the largest state hospitals in the country to hopefully gain something from the lobotomy tragedy. Dr. Peter Powchik says about the hospital, "If you want to learn why people don’t get better, you do it here." "Powchik and his colleagues administer teststhat assess patients' thought processes and motor coordination. Their preliminary findings show that lobotomies did not help these patients and in some cases may have even triggered more mental illness. The project has turned up evidence that some people who had lobotomies for depression, anxiety or disruptive behavior developed symptoms of schizophrenia following the surgery," (4). Philip Harvey, the coordinator of the research project at Mount Sinai hopes that his teams research may give scientists some clues as to how schizophrenia originates in the brain. He is driven finitude of available time for his research to be done. Lobotomies are so rarely performed now, that compiling data on such a massive scale in the future would be impossible. Their job is an emotionally taxing one, as many of the patients are frighteningly sick, and what is more sad, they will not recover:
"All are elderly and have spent most of their adult lives behind locked doors and barred windows. Some spend their days staring vacantly; others are forever agitated. They range from Frances Kichinski, who no matter what she is doing is always weeping, to Pauline White, who smiles constantly and wonders why the family that exists only in her mind never comes to visit," (4). Harvey laments, "It may have caused some people to be hospitalized for the rest of their lives. It made so many people worse." As for McMurphy, it is clear in the end of the film that he has no way out of the mental hospital, for he is nearly a vegetable, and no one in such a state could be self-sufficient. And so, by killing him, Chief is giving his friend freedom and thus is actually demonstrating an incredible amount of love and reverence for his friend who fell victim to ‘the system,’ as so many others did who are STILL in asylums today.

References

1)History of Lobotomy
2)PBS Website
3)Nobel Prize Website
4)Research Articles
5)The Frontal Lobe