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Lobotomy

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We have come a long way in the medical field and the field of sciences. There is nothing off-limits, and there are many possibilities with the advent of medical technology. Of late in recent years, the most discussed topic is mental health and mental health issues. There are many mental disorders like anxiety disorders which include phobias, panic and obsessive-compulsive disorders. Mood disorders like depression, bipolar disorder, many eating disorders, personality disorders, post-traumatic stress disorder is a trauma-related mental disorder and schizophrenia is a type of psychotic disorder. Some claim mental illnesses have to be treated via surgeries, and it is a long-standing belief. However, now only one attempt is made to subsidize the symptoms via individualized medication, psychotherapy and peer support groups. When surgeries were practised for mental disorder treatments, lobotomy or lobotomy procedure at an all-time high demand. Let us define lobotomy and understand the lobotomy meaning.


What is a Lobotomy?

Let us understand what a lobotomy is. Lobotomy meaning can be understood in simple terms as a very popular psychosurgery to treat severe mental health problems, especially in the mid-twentieth century. It was a very popular form of treatment that was performed to treat mental disorders like schizophrenia, manic depression and bipolar disorder among others. 

When an individual is suffering from any sort of mental disorders, the symptoms show changes in the behaviour of that person. Any individual with mental illness is more likely to display bad behaviour that is socially unacceptable. And this sort of behavioural symptoms is said to be due to damaged neurological connections and damaged brain tissues. And lobotomy procedure is an umbrella term that covers a series of operations or surgical procedures that purposely damage the already damaged brain tissue to treat mental illnesses. The notion was that since the neurological connections were already damaged, the lobotomy procedure could sever these connections completely and fix them.


The History of Lobotomy 

In the early twentieth century, the number of mental illness patients was only rapidly increasing in the world, and the hospitals were finding it impossible to manage this radical problem because there was no certain treatment to help them. 

In the 1880s, Swiss physician Gottlieb Burkhardt began manipulating the brain to calm patients coping with the symptoms of schizophrenia. It was during this time that the lobotomy procedure took centre stage as it was the method that took it closer to the interiors of the brain and treated mental illnesses. The part of the brain that is associated with behaviour and personality is the frontal lobes, and in the lobotomy procedure, the very same lobe is targeted. 

It first began as a treatment method in Europe by the Portuguese neurologist António Egas Moniz in 1935. The first experiments were done in 1935 on chimpanzees by Yale neuroscientist John Fulton and his colleague Carlyle Jacobsen. Later that year, the first human experiments were done by Moniz and his colleague Almeida Lima. According to an article published in the Journal of Neurosurgery, in the year 2011, it was recorded that Moniz reported the lobotomy procedure treatment as a success for patients with conditions such as depression, panic disorder, and mania schizophrenia. 

He was credited with inventing the lobotomy in 1935 and was also awarded the Nobel Prize for Physiology or Medicine of 1949. He was awarded for the "discovery of the therapeutic value of leucotomy in certain psychoses” after 14 years of the discovery and even though it was practised during these years in Europe, the United Kingdom, the United States of America, controversies because of the lobotomy effects were seen more clearly. There were a lot of apprehensions by physicians around the world to go ahead with the lobotomy psychosurgery procedure. However, since it was already gaining momentum, it was adapted in the aforementioned countries. As years went by, the effects seen after the surgery were bladder and bowel incontinence, increased temperatures, vomiting, eye problems, apathy, lethargy, and abnormal sensations of hunger and many more such side effects. It was also reported that the side effects were also mental, and many people also committed suicide following it. And starting from the 1950s, the lobotomy procedure was abandoned due to severe effects and rightly so for the betterment of humanity and health.


Lobotomy Procedure

Lobotomy is also called leucotomy or prefrontal lobotomy or also called prefrontal leucotomy. The traditional lobotomy procedure involves the participation of both the frontal lobe and prefrontal lobe and hence can also be referred to as frontal lobotomy.  

The first step is to inject ethanol into the brain by cutting a hole in the skull, to destroy the fibres or neuron connections to other parts of the brain. When such connections are severed, the frontal lobe is isolated, and the procedure can be carried out independently. The circular lesion that had to be created in the skull for reaching the interiors of the brain to inject ethanol was a surgical instrument called a leucotome introduced by Moniz. The surgical instrument leucotome contained a loop of wire which when rotated led to the lesion created that was required for the surgical operation. 

The physicians who were the early adopters of this procedure were the Italian and American doctors. It was truly a revolutionary technique in the world of psychosurgery for treatment as it was the first of its kind and seemed to calm the brain of people suffering. Amarro Fiamberti, an Italian psychiatrist, first developed a procedure that involved the eye sockets to access the frontal lobes for surgery.

It was this very technique that inspired Freeman to develop the transorbital lobotomy in the year 1945.

Transorbital lobotomy was a method that would not require the traditional form of operation, neither a traditional surgeon nor an operating room. 

This was also called the ‘’Freeman-Watts technique’’ or the “Freeman-Watts standard prefrontal lobotomy” as it was collectively adopted by Walter Freeman and James Watts, two American neurosurgeons. Orbitoclast, a modified ice pick, was the instrument used in this technique. 

It would first be inserted through the patient's eye socket using a hammer and moved side-to-side to separate the frontal lobes from the thalamus. The thalamus is the part of the brain that receives and relays sensory input, and this separation was detrimental to carrying the process successfully. It was a very less strenuous and time-consuming process, and so Freeman travelled to do many such lobotomy procedures in a day. 


Lobotomy Effects

Even though there have been many mental institutions around the world to support mental illness patients and help them through therapy to be able to deal with the daily challenges of life. It was not enough for the institutions to support the increased number of people and was very chaotic as years went by. And since there was no particular treatment for curing it completely, and mental institutions certainly felt pressured to manage and deal with the consequences that the patients inflicted upon them, they did. 

So when lobotomy came about, it was the chaos and pressure that first gained support and later prevalence and popularity of this procedure. There were many surgeries done and physicians adopted it immediately. According to the data it was recorded that the procedures were performed mostly on women than men. Nearly 74 per cent of the surgeries were performed on women. By the time there were reports of certain side effects, no one paid heed and looked into it in detail and went about doing this surgical procedure for many years.

The prevalence of the lobotomy procedure was so prominent and widespread that everybody went on with it and subscribed to this method of treatment. And when there were increasing numbers of reports and pieces of evidence showing that it was the very surgical procedure that led to such severe effects, the medical field experts had to look into it through the lens of thorough research. 

In the United States alone there were 50000 surgeries performed and a few even found relief through them but there were many others who suffered a great deal because of it. The effects were devastating on the patient and their loved ones as well. It was hard on people who had to take care of their family members even after the surgery. Some of the life-altering effects were:-

  • Mental dullness has been going on for some time and affects every aspect of life.

  • Loss of eyesight and compromise in vision due to such an excruciating procedure of the surgery that requires piercing in the eye sockets and certain body types are not designed to be tolerant to such a procedure.

  • When neuron connections are cut completely from other body parts or brain parts, the mind and body are separated, and one is no longer in control of their actions per se.

  • They become uninhibited and do whatever they want, and as they please without thinking about the consequences it might have on others, even their children.

  • This uninhibitedness has led to many grave steps like committing suicide and even exhibiting and displaying suicidal behaviours.

  • Due to no control over bodily functions, bladder and bowel movements are also hasty and unprecedented.

  • They have no control over their appetite, sometimes they feel overly hungry and eat a lot and then go on for days without food, and this has contributed to many suffering from eating disorders.

  • They are also no longer in control of their emotions and lash out at everybody and are no longer capable of hearing what the other person has to say.

  • Due to this inability to look out for others because they can no longer take care of themselves, they lack empathy and compassion and act hurriedly and impulsively.

  • They are also shunned from society because of such extreme effects and unacceptable display of behaviour, and that affects them very negatively and has irreversible changes in their lives, it is never the same.

  • Other effects include fever, vomiting, and are not limited to mental problems.

  • The mental dullness leads to lethargy, and they cannot lead a capable, conscious and active lifestyle.

Conclusion

The problems of mental illness are not a novice, it has been around for centuries. Even though lobotomy has seen its start and peak, the decline was also not very far. The process was banned after many effective alternatives were found. Now some drugs and medications are antipsychotic and antidepressant which are available. And one is always given an individualistic approach for their specific problem rather than going for one general method for all kinds of mental problems. There has been the introduction of electroconvulsive therapy as well in case drugs are not proving to be effective. 

FAQ (Frequently Asked Questions)

1. Does Lobotomy Work?

Ans. Lobotomy was the first procedure that came into existence in the crisis of mental institutions having to deal with an increased number of mental patients. And so it was immediately accepted as it initially showed many people having less extreme symptoms and calmer brains post-surgery. It was controversial when some people disagreed with the success of this surgical operation and claimed to have the worst effects after the surgery. So it can be said that even though it worked for about one-third of the people, some stayed the same and many more had the worst side effects that no longer matched the reality of the life they once led. 

2. Is Lobotomy No Longer Used to Treat Mental illness?

Ans. It was in the 1950s that those medical practitioners took a step towards preserving humanity and banned the lobotomy procedure and considered it illegal. Many countries like Japan and German abiding by the guidelines removed and shut the practice of this surgical procedure. There were fewer countries however like the USA, UK, Scandinavia and several western European countries who were still continuing to practise this method on a limited scale many years after it got banned. However, it is important to remember that with the income of many advanced procedures and medications, lobotomy no longer holds any relevance or importance. 

3. How Can one Support Patients Suffering From Mental Problems When They are on Drugs?

Ans. The intake of antipsychotic and antidepressant drugs and medications must be prescribed by a doctor. Even with medicines, it is rough to go through life with mental illness and making it hard to make decisions. So one must be empathetic, listen without judging, provide reassurance, do not come to them with a harsh tone, and be kind. We can only do so much to help them so if possible ask them if they need anything. The effects of mental illness are still unfolding and we are all still learning and trying to be responsible and accountable and keep encouraging the ones around us and not bring anybody down intentionally.