The Icepick Surgeon by Sam Kean

Author:Sam Kean [Kean, Sam]
Language: eng
Format: epub
Publisher: Little, Brown and Company
Published: 2021-07-13T00:00:00+00:00

A scene from the famous Bethlem Royal Hospital in England, whose nickname— Bedlam—became synonymous with the wretched state of insane asylums. (From the Rake’s Progress series by William Hogarth.)

Indeed, the most depressing thing about asylums was their air of futility. Patients moaned and wept, rocked and howled, day after day, and nothing the doctors did ever made any difference. Even calling such people patients seems wrong, since that implies the prospect of a cure. Really, they were inmates. Some inmates couldn’t have beds, because they’d smash them and impale people with the pieces. Some couldn’t have clothing because they’d tear it off or soil themselves repeatedly. In some ways, these people were worse off than animals. At least animals are placidly content. These men and women were tormented by their own minds, hour after hour, decade after decade.

Suddenly, Moniz saw a way to save them. If monkeying around inside Becky’s brain had ended her outbursts, then why couldn’t something similar help disturbed human beings? It was worth a shot. Except, instead of removing the frontal lobes, Moniz proposed something subtler: severing the connections between the frontal lobes and the limbic system.

In human beings, the frontal lobes allow for reflection, planning, and rational thought. The limbic system processes raw emotion. These two brain regions are connected by bundles of neurons that send signals back and forth. Moniz speculated that, in the brains of lunatics, their limbic systems had gone into overdrive, revving them up and overwhelming their frontal lobes with a barrage of signals.

Now, Moniz’s theory wasn’t complete bunk—disturbed emotions do overwhelm the brains of some people. But that theory was built on an outdated model of the brain as a sort of hardwired electrical switchboard, with the wires connecting different parts. To Moniz, insanity resulted from faulty wiring, full of shorts and bad connections. So by clipping those bad connections, he could return the brain to equilibrium—curing insanity with the flick of a knife.

Unfortunately, Moniz didn’t seem to realize that information flows both ways in the brain. Emotions can overwhelm the frontal lobes, no question. But the frontal lobes can also send signals back to the limbic system to tamp down on raw emotions and calm us. In fact, a loss of frontal-lobe control is probably what turned Lucy, the other chimp, into such a wreck after her surgery. Without feedback from the frontal lobes, her emotions ran amok.

Again, though, Moniz ignored Lucy, focusing instead on the crisp, clean story of Becky—tormented before, placid afterward. Even more powerfully, he imagined all those millions of people suffering in asylums worldwide, and he vowed to help. Let lesser doctors waste their time with seizures and electroshocks. He would, in his word, “attack” the very roots of mental illness inside the brain, through a new discipline called psychosurgery. And if it won him glory in the process, well, he certainly wasn’t opposed to that.

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