www.antipsychiatry.org

The Brain-Butchery Called

PSYCHOSURGERY

by Lawrence Stevens, J.D.

Most people think psychosurgery, or lobotomy, is not done anymore. Unfortunately, this is not true. In fact, as New York University School of Medicine psychiatry professors Harold I. Kaplan and Benjamin J. Sadock say in their textbook Clinical Psychiatry, published in 1988, "interest in psychosurgical approaches to psychiatric disorders has only recently been rekindled" (Williams & Wilkins, 1988, p. 381). An article in the March 1999 Journal of Clinical Neuroscience titled "Contemporary Psychosurgery" says "Psychosurgery is a safe and relatively effective treatment which should be offered to patients with intractable obsessive compulsive disorder (OCD), major affective disorders, and chronic anxiety states after a minimal period of 2 to 5 years and after all other reasonable treatments have been tried" (J.V. Rosenfeld & J.H. Lloyd, Departments of Neurosurgery and Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia, J. Clin Neurosci 1999 Mar;6(2):106-112). In the April 1990 issue of the Harvard Medical School Health Letter, Dr. Michael Jenike, Associate Professor of Psychiatry at Harvard Medical School, advocates psychosurgery for treatment of obsessive-compulsive disorder ( p. 8). An article defending psychosurgery appeared in the March/April 1992 issue of Psychology Today magazine: The article describes a psychosurgical operation done in 1990 and reports that "there are still at least 200 to 300 openly declared psychosurgeries labeled as such each year being performed by a few dozen surgeons here and abroad" (p. 34).
      What is psychosurgery? University of Michigan neuroscience professor Elliot S. Valenstein, Ph.D., defines psychosurgery as a "brain operation for the purpose of alleviating a severe psychiatric disorder in the absence of any direct evidence of neuropathology" (Behavior Today, June 28, 1976, p. 5). The following definition appears in a psychiatric textbook: "Psychosurgery is the surgical intervention to sever fibers connecting one part of the brain with another or to remove, destroy, or stimulate brain tissue with the intent of modifying or altering disturbances of behavior, thought content, or mood for which no organic pathological cause can be demonstrated" (John Donnelly, M.D., Sc.D., in: Kaplan & Sadock, Comprehensive Textbook of Psychiatry/IV, 1985, p. 1563).
      The term psychosurgery is as illogical as many of the other words used in psychiatry. Psychiatry professor Thomas Szasz, M.D., has correctly said the term "psychosurgery" is illogical, because the psyche is not a part of the body, and therefore it is completely impossible to do surgery on it. Saying a psychiatrist or a surgeon is going to operate on someone's psyche is as illogical as saying he is going to operate on the person's soul. Although psychosurgery is obviously done on the brain, there is good reason for not calling it brain surgery, since unlike psychosurgery, brain surgery deals with known abnormalities in the brain, such as brain tumor or intracranial hemorrhage. What is magical about the word "psychosurgery" is somehow it seems to justify psychiatrists or other physicians doing surgery on brains that as far as are known are biologically perfectly healthy! (Thomas Szasz, The Myth of Psychotherapy, Anchor Press, New York, 1978, pp. 6-7.)
      "Psychosurgery" goes by various names for variations of what is generally known as lobotomy. Since the term lobotomy has such stigma attached to it, those who perform this operation and its variations usually use other terms to describe it. Among these terms are cingulotomy, capsulotomy, and leukotomy.
      The first I recall learning about psychosurgery, or lobotomy, was in an abnormal psychology class I took in college when our professor, a psychologist, described the operation to us. One type of lobotomy he described involves drilling two holes in the "patient's" skull on each side of the forehead at the top at about the hairline to allow access to the frontal lobes of the brain where intellectual mental functioning, thinking, and creation of emotion is believed to take place. In one version he described a cylindrical shaped device that resembles an apple corer is inserted into both sides of the brain, and a cylindrical shaped piece of each frontal lobe is removed. In other versions of the operation, a scalpel is inserted to sever connections in the frontal lobes or between the frontal lobes and other parts of the brain. In one type of lobotomy, instead of drilling holes in the skull, each eyeball is moved to the side, and a scalpel is inserted through each eye socket into the frontal lobes of the brain, and, our professor said, "the scalpel is moved like this", as he wiggled his finger from side-to-side. In his book Molecules of the Mind: The Brave New Science of Molecular Psychology, University of Maryland Professor Jon Franklin describes the same operation this way: "forcing a thin, ice pick-like instrument through the patient's eye socket and then waving the point around in the brain" (Dell Pub. Co., 1987, p. 64). In their textbook Synopsis of Psychiatry, published in 1988, psychiatry professors Harold I. Kaplan and Benjamin J. Sadock say the "surgical" instrument used in transorbital lobotomy or leukotomy not only is "like" an ice pick; they say it is an ice pick (p. 531). According to two supporters of psychosurgery, the inventor of this method of psychosurgery was Dr. Walter Freeman, and "His [Dr. Freeman's] initial operating instrument was in fact an icepick taken from his kitchen drawer" (Rael Jean Isaac & Virginia C. Armat, Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill, Free Press/Macmillan, Inc., 1990, p. 179). Although my psychology professor didn't use this specific analogy, he made it unmistakably clear that he thought lobotomy is as unscientific and senseless as trying to repair a malfunctioning television set by drilling a hole in its cabinet, inserting a machete, and rattling it around inside the TV cabinet. In other words, lobotomy is indiscriminate infliction of damage in the frontal lobes of the brain. The Bantam Medical Dictionary says what it calls the "modern" version of lobotomy that is done today is more refined and involves making "selective lesions in smaller areas of the brain" (1981, p. 233). However, I think the claim that the more recent versions of lobotomy are more rational than the types which have been done in the past is questionable, even if they are less damaging.
      Nancy Andreasen, M.D., Ph.D., describes modern psychosurgery as follows in her book The Broken Brain: The Biological Revolution in Psychiatry, published in 1984: "Whereas the older technique of `prefrontal lobotomy' involved cutting large amounts of white-matter tracts, the modern technique of psychosurgery emphasizes the selective cutting of very tiny and quite specific portions of the tracts connecting the cingulate gyrus to the remainder of the limbic system. This technique is assumed to break up the reverberating circuits of the limbic system and thereby stop the self-perpetuating cycle of emotional stimulation [emphasis added]" (Harper & Row, p. 214). The use of the word assumed is an admission that psychosurgeons don't really know what they are doing from a biological perspective. Similarly, the authors of the aforementioned article, "Contemporary Psychosurgery" in the March 1999 Journal of Clinical Neuroscience admit: "The optimal site and size of the lesions remains to be established." Just as in the case of psychiatric drugs and electroshock, psychosurgery is done on the basis of its effects, not on a knowledge of what it does biologically. Psychosurgery makes as little sense as cutting wires in your personal computer because it is running a software program you dislike, since what we call "mental illness" usually is a result of learning (programming) or lack of it that results in behavior we dislike, not biological malfunction, despite speculative biological theories of mental illness you may hear.
      What might be the effect of, to use Dr. Andreasen's words in the above quotation, "cutting of very tiny and quite specific portions of the tracts connecting the cingulate gyrus to the remainder of the limbic system"? According to neuroscientist and PET scan pioneer Marcus Raichle of Washington University in St. Louis, the cingulate gyrus is shown by positron emission tomography or PET scan studies of the brain to be a center for solving word problems. It also activates whenever "subjects are told to pay attention...It also shines with activity when researchers ask volunteers [whose brains are being studied by PET scans] to read words for colors--red, orange, yellow--written in the `wrong' color ink, such as `red' written in blue" (Newsweek, April 20, 1992, p. 70). In other words, the cingulate gyrus is responsible for some aspects of intelligence.
      The choice of the cingulate gyrus or other parts of the limbic system in the brain as the target of modern versions of lobotomy is based on the belief that the limbic system is responsible for emotions that are often considered the corpus or body or substance of mental "illness". However, destroying a person's ability to experience emotions isn't necessarily that simple. An article published in 1988 points out: "...when it comes to fear, anger, love, sadness or any of the complicated mixtures of feeling and physical response we label emotions, a loose network of lower-brain structures and nerve pathways called the limbic system appears to be key. ... The most recent research, however, indicates that the experience of emotion has less to do with specific locations in the brain and more to do with the complicated circuitry that interconnects them and the patterns of nerve impulses that travel among them. `It's a little like your television set,' says neuroscientist Dr. Floyd Bloom of the Scripps Clinic and Research Foundation. `There are individual tubes, and you can say what they do, but if you take even one tube out, the television doesn't work.'" (U.S. News & World Report, June 27, 1988, p. 53). This probably explains why victims of "psychosurgery" often emerge from the operation so mentally incapacitated they are not able to live without nursing care, even when they were able to do so before they had "psychosurgery".
      Psychosurgery being brain damage and nothing but brain damage is even more obvious than in the cases of psychiatric drugs and electroshock. Each of these "therapies" achieve approximately the same end, albeit by different means. When I started my library research on psychosurgery I thought psychosurgery is worse, but the evidence indicates that isn't necessarily true: It depends on what drugs are used and for how long, how many electroshock "treatments" are given, the voltage and shock duration used, and on how much cutting the psychosurgeon does. In her book, Dr. Andreasen also says that "While we know a great deal about the motor, sensory, and language systems, and quite a lot about the memory system, the frontal system is still a poorly understood frontier area" (p. 118). She refers to this part of the brain as "the mysterious frontal lobe" (p. 95). Yet, despite our ignorance of what the frontal lobes do and how they work, it is in this very area of the brain that "psychosurgery" is done! The frontal and temporal lobes of the brain get most of the current in electroshock. The frontal lobes are among the parts of the brain damaged by psychiatric drugs. In his book The Brain, Richard M. Restak, M.D., says that "psychosurgical operations turned out to have exacted an unacceptable cost. Many of the patients were changed so utterly that their friends and relatives experienced difficulty accepting them as the same individuals they knew before the operation." This contributed to what he calls "the decline of psychosurgery" (Bantam Books, 1984, p. 151). That it is a decline rather than abolition is unfortunate. In his book, The Second Sin, psychiatry professor Thomas Szasz says "When a person eats too much, his intestines are short-circuited: this is called a `bypass operation for obesity.' When a person thinks too much, his brain is short-circuited: this is called `prefrontal lobotomy for schizophrenia.'" (Doubleday, 1973, pp. 61-62).
      The use of brain-damaging "treatments" like lobotomy, electroshock, and psychiatric (particularly neuroleptic) drugs illustrates the stupidity, arrogance, and audacity of psychiatrists and other physicians who use these so-called treatments. Rather than showing concern for people stricken by biological or psychological infirmities or disadvantages or weaknesses, these biological "therapies" reveal both foolishness and callous disregard for human rights, human life, and human welfare--particularly in the case of involuntary administration, which is still done, at least in the cases of psychiatric drugs and electroshock. While brain damage from psychiatry's drugs may not have been apparent from the start, it is or to any person with normal intelligence and common sense should have always been obvious that electroshock and "psychosurgery" are brain damaging. Electroshock and "psychosurgery" are therefore especially sad chapters in psychiatry's history of senselessly searching for physical causes and physical "treatments" of what has never been demonstrated to be the result of a physical or biological problem. Even if some of the peculiar or socially unacceptable behavior or irrational thinking we call mental illness is partly or entirely caused by biological abnormality, today it is treated with methods that are irrational and harmful to psychiatric patients. The shamefulness of the psychosurgical part of psychiatry's history--and in some places, its present--is generally recognized, even among most psychiatrists. That is why psychosurgery is seldom mentioned by psychiatrists today.
      Like most quack therapies, even "psychosurgery" has supporters not only among its practitioners but also among at least a few of those who have received it--or perhaps I should say at least a few of those who have, psychologically speaking, survived it. The amount of damage done by "psychosurgery" varies widely. The extent of damage depends on how much and what parts of the brain are severed. It turns some people into vegetables, but if the psychosurgeon cuts very little it may affect the "patient" little or in no noticeable way, except for power of suggestion or placebo effect. Much like those who believe their lives have been lengthened by coronary bypass surgery contrary to scientific evidence showing no increased longevity from the operation for most people who undergo it (see Thomas J. Moore, Heart Failure: A Critical Inquiry Into American Medicine and the Revolution in Heart Care, Random House, 1989, pp. 113-125), the survivors of "psychosurgery" sometimes emerge from the ordeal of the operation with a strong psychological need to believe they have benefited from the surgery and so may claim they have. But it is hard to believe they really have, for the same reason it would be hard to believe a computer programming error was corrected not by altering the programming but by disabling a part of the computer. This is especially true considering how little is known about the brain today. Like psychiatric drugs and electroshock, "psychosurgery" may seem to some to be helpful if it eliminates the so-called symptoms of so-called mental illness. If a person is disabled enough, all of his or her "symptoms" of anything (including desirable personality traits) will be "cured". But disabling a computer is not a solution for bad programming, and disabling a person's brain is not a cure for socially/culturally inappropriate learning and resulting socially/culturally unacceptable thinking, display of emotion, or behavior--whether the means used to disable the person's brain is drugs, electroshock, or "psychosurgery".
      Since "psychosurgery" is probably not done today where ever you or those you care for may seek "therapy", of what relevance is it to those considering psychiatric or psychological "help" or counselling? Physicians once did bloodletting, but that isn't reason to avoid health care now. One difference is that many, maybe most, of the psychiatrists and other physicians who have done "psychosurgery" are still alive today. In contrast, the days of bloodletting are so long past that probably there are no living physicians who have done bloodletting. The fact that bloodletting was done says little or nothing about modern day health care for physical ailments. "Psychosurgery", on the other hand, is part of psychiatry's recent past, and still in some places, its present. Just as bloodletting said something about incorrect theory and the state of ignorance in health care in the past, brain damaging "therapies" such as "psychosurgery", electroshock, and psychiatric drugs reveal much about incorrect theory and ignorance in psychiatry today.

THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has included representing psychiatric "patients". His pamphlets are not copyrighted. You are invited to make copies for distribution to those who you think will benefit.

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Recommended reading:
Brief History of the Lobotomy (http://www.scc.net/~lkcmn/lobotomy/lobo/brief.html)

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2002 UPDATES
"Lobotomy was not surgery of the soul.  This was surgery that removed the soul.  ...  But the trial results published in the medical journals never captured this sense of profound loss.  The journal articles conveyed a different reality, telling in general of an operation that could transform hopelessly lost patients on back wards into happy people, some of whom were working and leading fulfilling social lives.  ...  Why did those who performed this surgery in the late 1930s and early 1940s see their patients' outcomes through such a rosy lens?  For this is clearly what they saw."  Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Perseus - Cambridge, Massachusetts, 2002), p. 127, in a chapter titled "Brain Damage as Miracle Therapy."
      This absurd perception of lobotomy as beneficial was similar to today's psychiatrists' perception of psychiatric drugs and elecroconvulsive brain damaging (electroconvulsive "therapy" or ECT) as beneficial.  And today's psychiatrists' perception of modern psychiatric drugs and ECT as beneficial is as foolish as the favorable perception of lobotomy among psychiatrists of the 1930s and 1940s.

Psychosurgery victim wins $7.5 million jury verdict
According to a report in the June 24-July 1, 2002 issue of The National Law Journal, a combined cingulotomy and capsulotomy at the Cleveland Clinic in Cleveland, Ohio (U.S.A.) in attempt to cure a 62 year old woman's obsessive-compulsive disorder (washing her hands and taking showers frequently) "left her without control of her limbs or bodily functions."  The patient thereafter won a $7.5 million jury verdict against Cleveland Clinic.  The Clinic is appealing the verdict.  (Peter Page, "$7.5 Million - Jury slams Cleveland Clinic," The National Law Journal, June 24-July 1, 2002, page A4)

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