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Moniz and Lobotomies

Humans intentionally produced one of the best-known forms of brain injury: the prefrontal lobotomy . This is an operation that cuts off communication between the frontal lobes and the rest of the brain. The frontal lobe is not actually removed in a lobotomy; that would be a lobectomy. In a lobotomy, fibers below the frontal cortex are cut, isolating the nerve cells in the frontal lobe from the remainder of the brain. The communication between the frontal lobe and the rest of the brain is interrupted, but the blood supply to the frontal lobe is preserved and the tissue does not die, so there is little scarring. This is also called a leukotomy.

What does a lobotomy involve? Where did the idea come from?

Lobotomies were first performed on humans as a form of therapy by the Portuguese psychiatrist Egas Moniz in 1937. Previous experiments had shown that the surgery had a calming effect on chimpanzees, so Moniz thought it would be useful to calm mental patients who were otherwise difficult to control in the era before psychiatric drugs.

What was true of all the people who received bilateral prefrontal lobotomies?

Moniz shared the 1949 Nobel Prize for his work. Later this was regarded as tragically wrong, because lobotomies turned out to cause serious problems for the people who received them. One research team surveyed all the people who had received prefrontal lobotomies on both sides of the brain and found that not one of them ever returned to productive work.

Moniz evidently got the idea for doing lobotomies on humans from a presentation by two American brain researchers, John Fulton and Carlyle Jacobsen. They described dramatic changes of behavior in a chimpanzee, Becky, who was "tamed" by destruction of the prefrontal cortex. Previously the chimp had been wild and uncontrollable.

After Fulton's presentation, Moniz rose from the audience and asked if the same procedure might be applied to humans in mental institutions who were equally wild and uncontrollable. Fulton said later he was shocked by the suggestion, but Moniz went ahead with exploratory surgery on some mental patients. He found that alcohol injections behind the frontal lobes-which destroyed fibers connecting the frontal lobes with other areas-did indeed calm them down. Reports of a "miracle cure" crossed the Atlantic, and American doctors began performing lobotomies by the thousands in the late 1940s.

What did Dr. Freeman do, and what advice did he give to families?

One American doctor-Walter Freeman-developed a quick and easy technique. He inserted a blade through the eye socket, above the eyeball, and cut the fibers connecting the prefrontal cortex to the rest of the brain. Freeman's technique was so fast that it could be performed on an outpatient basis (without admitting the patient to the hospital). The only obvious aftereffect was a black eye. Sometimes Freeman did not even tell patients they were getting lobotomies. He advised families to "provide the patient with sun glasses rather than explanations" to avoid upsetting them. "Most patients deny having been operated on," he wrote. (Freeman, 1949, reported in Valenstein, 1973, p.285.)

See <> for added details about the history of lobotomy, including principles of Moniz, diagrams, and additional links.

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