A History of Psychiatry: From the Era of the Asylum to the Age of Prozac by Shorter Edward

Author:Shorter, Edward [Shorter, Edward]
Language: eng
Format: mobi
Publisher: Wiley
Published: 2003-12-15T05:00:00+00:00

Walter Freeman, a neurologist at George Washington University Hospital in Washington D.C., who popularized lobotomy in the United States. Shown here in 1949 inserting a lobotomy instrument under the patient’s eyelid in order to destroy tissue in the brain’s frontal lobe (courtesy of UP1/Corbis-Bettmann).

The Lobotomy Adventure

The idea of operating on the brain to cure madness does not seem intrinsically unreasonable. Physicians have always intuited that a physical intervention in the brain, perhaps cutting some tract causing compulsive behavior or removing a center producing some malignant protein, might put an end to a pattern of psychosis. In the Middle Ages, doctors fantasized about cutting for the mythical “stone of madness.” In our own time, there is evidence that the course of Parkinson’s disease can be slowed by the transplantation of fetal dopamine-producing neurons.142 It also seems to be the case that ablating the cingulate gyrus, in a cingulotomy, can relieve the symptoms of severe compulsive neurosis.143 These are examples of successful psychosurgery.

The great wave of physical therapies of the 1930s included one unsuccessful example of psychosurgery: lobotomy, or destroying part of one of the brain’s lobes. In the context of the apparent success of such physical interventions as barbiturate narcosis, insulin coma, Metrazol convulsion, and ECT, it began to seem reasonable that operating on the cerebral cortex itself might offer promise. And so psychosurgical notions last seen in the 1880s and 1890s began to resurface.

The modern history of psychosurgery begins with a Swiss asylum psychiatrist named Gottlieb Burckhardt, who earned his MD at Basel in 1860. After a lectureship at Basel, followed by a staff job at the Waldau public asylum, in 1882 Burckhardt became director of the private Préfargier Clinic in Marin near Neuchâtel.144 Here he seems to have experimented widely with various new techniques such as hypnotism.145 Untrained though he was in surgery, he also experimented rather clumsily with operations on various lobes of his patients’ brains. Beginning in December, 1888, he performed psychosurgery on six patients with evident schizophrenia. The operations were not a big success. One of the patients died in convulsions, a second improved, a third and fourth experienced no change, and the last two became “quieter.”146 Burckhardt’s report on his new procedure to the Berlin Medical Congress of 1890 produced disquiet. There was no discussion following the paper, and the participants agreed that complete silence was the best way to avoid attracting attention to the work.147 Burckhardt’s article the following year did occasion a brief flutter.148 But the idea of intervening directly in the parenchyma of the brain was soon abandoned.

Yet a climate of meddlesomeness persisted. In the 1890s, there were efforts in England to relieve the symptoms of neurosyphilis by boring a burr hole (trepanation) in the cranium and incising the meninges to drain away pus or cerebrospinal fluid.149 In unpublished work, the Breslau surgeon Johann Mikulicz attempted in the 1890s to remove the focus of epilepsy by scarifying a portion of the sensory-motor cortex.150 Valentin Magnan, master of the Ste-Anne asylum in Paris,

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.