Talk:Lobotomy/Archive 3

Archive 1

Archive 2

Archive 3

Cut: 1970 Dictionary of Psychiatry entry on lobotomy

Primary source in this context - will replace with better text soon.FiachraByrne (talk) 21:01, 23 January 2013 (UTC)

According to the Psychiatric Dictionary published in 1970:

Prefrontal lobotomy is of value in the following disorders, listed in a descending scale of good results: affective disorders, obsessive-compulsive states, chronic anxiety states and other non-schizophrenic conditions, paranoid schizophrenia, undetermined or mixed type of schizophrenia, catatonic schizophrenia, and hebephrenic and simple schizophrenia. Good results are obtained in about 98 percent of cases, fair results in some 35 percent and poor results in 25 percent are thereabouts. The mortality rate probably does not exceed 3 percent. Greatest improvement is seen in patients whose premorbid personalities were 'normal', cyclothymic, or obsessive compulsive; in patients with superior intelligence and good education; in psychoses with sudden onset and a clinical picture of affective symptoms of depression or anxiety, and with behaviouristic changes such as refusal of food, overactivity, and delusional ideas of a paranoid nature.

Prefrontal lobotomy has also been used successfully to control pain secondary to organic lesions. In this case, the tendency has been to employ unilateral lobotomy, because of the evidence that a lobotomy extensive enough to reduce psychotic symptoms is not required to control pain.

According to the same source, prefrontal lobotomy reduces:

anxiety feelings and introspective activities; and feelings of inadequacy and self-consciousness are thereby lessened. Lobotomy reduces the emotional tension associated with hallucinations and does away with the catatonic state. Because nearly all psychosurgical procedures have undesirable side effects, they are ordinarily resorted to only after all other methods have failed. The less disorganized the personality of the patient, the more obvious are post-operative side effects. ...

Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incontinence.

References

Original Research cut

Cutting original research (but not my original text really) which I added some time ago (this was my first article); some of the points may be supportable so just putting here for the moment. FiachraByrne (talk) 23:27, 23 January 2013 (UTC)

The development of the leucotomy procedure by Moniz in 1936, took place at a time when all of the above therapeutic interventions were extreme and experimental forms of therapy, and most posed serious risks to the health of the patients who underwent them. Leucotomy was seen by many psychiatrists as no more severe than therapies such as insulin or cardiazol shock; these apparently successful procedures conceived for the treatment of patients suffering severe mental illnesses helped to create the intellectual climate and medical and social warrants that allowed a surgical procedure as radical and irreversible as leucotomy to appear as a viable and even necessary proposition. Moreover,

References

Not appropriate for lead - stashing here

Not appropriate for lead so just storing here for the moment:

In Ottawa's psychiatric hospitals, for instance, the 153 lobotomies performed in 1953 were reduced to 58 by 1961, after the arrival in Canada of the antipsychotic drug chlorpromazine in 1954.

— Preceding unsigned comment added by FiachraByrne (talk • contribs) 23:31, 23 January 2013 (UTC)

References

Unnecessary detail

Removing detail more appropriate to article on Moniz, Burckhardt or psychosurgery. FiachraByrne (talk) 23:54, 23 January 2013 (UTC)

However, Kotowicz notes a difference, irregularly observed, among medical historians and medical practitioners in their location of the origin of psychosurgery. The latter group, he contends, tend to favour beginning the narrative with Burckhardt while the former group favour starting with Moniz.

Kotowicz, Zbigniew (2005). "Gottlieb Burckhardt and Egas Moniz–Two Beginnings of Psychosurgery". Gesnerus. 62 (1–2): 78–9.

In the context of early psychosurgery, Berrios unusually also refers to the operations performed in 1889 by a surgeon (Harrison Cripps) at the behest of the British psychiatrist Thomas Claye Shaw in which fluid was drawn from the brain of a patient diagnosed with General Paralysis of the Insane. While the purpose of the operation was aimed towards the alleviation of mental symptoms attendant on the condition the procedure did not aim to interfere directly with brain tissue and therefore it has been excluded from most conventional accounts of psychosurgery. Berrios, German E. (1991). "Psychosurgery in Britain and elsewhere: a conceptual history". In Berrios, German E.; Freeman, Hugh (ed.). 150 Years of British psychiatry, 1841–1991. Gaskell. pp. 181–5. ISBN 978-0-902241-36-7. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)CS1 maint: multiple names: editors list (link)

Two temp removals

Two removals: one sentence stating that while Burckhardt was reviled Moniz was accepted by the medical community (largely true); and one sentence stating that Moniz won the Nobel Prize in 1949. Both statements will be reinserted at a later point in article development. Parking them here in the meantime.FiachraByrne (talk) 15:02, 30 January 2013 (UTC)

{{quote box|salign=left|quote=Later, Burckhardt was condemned for his methodology while Moniz's more favorable results earned him acceptance within the psychology community.|source={{sfn|Kotowicz|2005|p=84|ps=}}}} {{quote box|salign=left|quote=Moniz was given the [[Nobel Prize in Physiology or Medicine|Nobel Prize in medicine]] in 1949 ''"for his discovery of the therapeutic value of leucotomy in certain psychoses".''|source=<ref>{{harvnb|Nobelprize.org|2013}}; {{harvnb|Kotowicz|2005|p=78 n. 2}}</ref>}}

Mortality rate for lobotomy

There is a very important issue to address. The issue is what is the mortality rate for lobotomy? See Strecker, Edward; Palmer, Harold; Grant, Francis (1942). "A Study of Frontal Lobotomy—Neurosurgical and Psychiatric Features and Results in 22 Cases with a Detailed Report on 5 Chronic Schizophrenics". American Journal of Psychiatry. 98 (4): 524–532. {{cite journal}}: Unknown parameter |month= ignored (help) The article reports that two patients of twenty-two patients subjected to frontal lobotomy died. The percentage of the proportion of two to twenty-two accounts for 9. It means that 9 percent of patients died following lobotomy. This mortality rate is very high. In most fatal cases, I think, lobotomized patients died from massive cerebral hemorrhage. --Psychiatrick (talk) 17:08, 2 February 2013 (UTC)

Reported mortality rates varied from 2–4 per cent; according to one source (Pressman I think) about 10 per cent of patients suffered from epilepsy after the operation. A 9 per cent mortality rate is way too high. I haven't looked at all at if there was variation in the mortality rate with the use of different procedures (transorbital, prefrontal, rostral, etc). I'm not quite finished with Moniz (I want to expand on the outcomes for his patients etc) and then I'd like to cover Italy before Freeman and the US (the first transorbital operations were performed in Italy) but the mortality rate, together with other outcomes, needs to be covered insofar as the sources (and ideally secondary sources, be they medical or historical) allows for such an evaluation. FiachraByrne (talk) 20:45, 2 February 2013 (UTC)

Source on lobotomies in Sweden calculating a mortality rate of 7.4 per cent based on 700 operations between 1943 and 1960 [1]. That's probably the highest rate I've seen on a decent sized sample. It wasn't so unusual to get very high mortality rates when the procedure was first introduced into a clinical setting (the first 20 or 40 patients). That 7.4 per cent looks pretty atypical to me though. Anyhow, we can gather sources and see what they say. FiachraByrne (talk) 21:09, 2 February 2013 (UTC)

Thank you very much. Psychiatrick (talk) 14:38, 3 February 2013 (UTC)

Psychosurgery in the United Kingdom

Psychosurgery in the United Kingdom is still used. See Christmas, David; Morrison, Colin; Eljamel, Muftah; Matthews, Keith (2004). "Neurosurgery for mental disorder". Advances in Psychiatric Treatment. 10: 189–199. doi:10.1192/apt.10.3.189. Retrieved 4 February 2013. It's English version of the article. Its Russian version for Russian speakers is available from here. Psychiatrick (talk) 00:09, 4 February 2013 (UTC)

Yes, they were operating on a small amount of patients in Dundee (I think), at least until a few years ago (I assume they still are?). They've tended to move away from removing/destroying tissue to stimulation - that had started in the 1970s I think. Focus is on those with severe epilepsy and extreme OCD (I think). But they don't perform lobotomies. See History of psychosurgery in the United Kingdom which gives an account.FiachraByrne (talk) 01:25, 4 February 2013 (UTC)

Quite a bit of WP:OR in that article History of psychosurgery in the United Kingdom; not so much inaccurate as overly reliant on medical papers from the 1940s etc. Needs secondary sources (medical/historical) to interpret those primary sources, ideally.FiachraByrne (talk) 13:50, 4 February 2013 (UTC)

Clarification

As far as I remember, Evgeny Zamyatin in his novel We used the term Great Operation to describe the operation on the frontal lobes. As for the source Serdyukova, O.I. [О.И. Сердюкова] (2011). "Проблема свободы личности в романе Э. Берджесса «Механический апельсин»" (PDF). Вісник Харківського національного університету імені В. Н. Каразіна. Серія: Філологія [The Herald of the Karazin Kharkiv National University. Series: Philology] (in Russian). 936 (61). Kharkiv: 144–146. {{cite journal}}: Unknown parameter |trans_title= ignored (|trans-title= suggested) (help) I can provide the quotation from the source: "У Е. Замятина роман «Мы» завершался лоботомией главного героя (а затем и всех граждан) с целью предотвращения возможных бунтов…" In English: "The novel We by E. Zamyatin ended with the lobotomy of the main character (and then all citizens) for the purpose of preventing possible riots…" --Psychiatrick (talk) 13:30, 4 February 2013 (UTC)

OK. I think, as that list is in chronological order, it should be the first item in that section. I'd also suggest using another phrase rather than "lobotomy"; such as a "frontal lobe operation" or "frontal lobe surgery". In the context of the article it's confusing to refer to lobotomy or leucotomy before the recognised date of the procedure's invention (even though there were lobotomy type operations before Moniz). FiachraByrne (talk) 13:44, 4 February 2013 (UTC)

The cited article by Serdyukova used the term "lobotomy" because Zamyatin’s description of the operation bears the strongest resemblance to lobotomy, although the term "lobotomy" was not yet used in 1924. But I don’t mind if you use the term "frontal lobe operation" for Zamyatin’s description of the operation. I have the other sources to quote: "In Zamyatin's We, for instance, freedom-loving dissidents are sent to the "Operations Department" for therapeutic lobotomies..." (Fiedler, Leslie (1996). Tyranny of the normal: essays on bioethics, theology & myth. D.R. Godine. p. 114.) "Zamyatin dramatizes the potential consequences of such thinking in We, in which the state persuades its citizens to be lobotomized into machinelike 'reliability', to become 'tractors in human form'." (Hughes, Jon (2006). Facing Modernity: Fragmentation, Culture and Identity in Joseph Roth's Writing in the 1920's. MHRA. p. 127. ISBN 1904350372.) Psychiatrick (talk) 15:32, 4 February 2013 (UTC)

In the Wikipedia article We (novel), it says:

In his last journal entry, D-503 indifferently relates that he has been forcibly tied to a table and subjected to the "Great Operation", (similar to a lobotomy),<ref>Erich Fromm's afterword to Nineteen Eighty-Four.</ref> which has recently been mandated for all citizens of the One State. This operation removes the imagination and emotions by targeting parts of the brain with X-rays. After this operation, D-503 willingly informed the Benefactor about the inner workings of the MEPHI. However, D-503 expresses surprise that even torture could not induce I-330 to denounce her comrades. Despite her refusal, I-330 and those arrested with her are sentenced to death, "under the Benefactor's Machine."

Could it be phrased like that? FiachraByrne (talk) 18:08, 4 February 2013 (UTC)

Yes, it could be phrased in this way. One can write "an operation like a lobotomy." By the way, Erich Fromm in his "Afterword to George Orwell’s 1984" (the link is available for all) uses the term "a brain operation similar to lobotomy" in relation to the "Great Operation" described in Zamyatin's novel We. There is also the free unabridged English version of Zamyatin’s novel We in Internet. I’ve again read the English version of We and found the necessary part of text in which Zamyatin describes the Great Operation on the frontal lobes: "The latest discovery of our State science is that there is a center for fancy-a miserable little nervous knot in the lower region of the frontal lobe of the brain. A triple treatment of this knot with X-rays will cure you of fancy, Forever! You are perfect; you are mechanized; the road to one-hundred-per-cent happiness is open! Hasten then all of you, young and old, hasten to undergo the Great Operation! Hasten to the auditoriums where the Great Operation is being performed!" Quoted from Zamiatin, Eugene (1952). We (PDF). New York: E.P. Dutton. p. 167. ISBN 0-525-47039-5. Psychiatrick (talk) 21:14, 4 February 2013 (UTC)

I've made a few changes. Could you check to see if it's ok?FiachraByrne (talk) 22:24, 4 February 2013 (UTC)

It's ok. You have phrased the paragraph in a better way than I did. Thanks a lot. Psychiatrick (talk) 00:08, 5 February 2013 (UTC)

Images

I uploaded a few images to wikicommons which could be used in this article, bio-articles on Freeman and Watts, or in the psychosurgery article. FiachraByrne (talk) 03:04, 14 February 2013 (UTC)

Images of Walter Freeman and James W. Watts from 1941 Saturday Evening Post article on lobotomy

• 
  "Turning the Mind Inside Out", Saturday Evening Post, 24 May 1941, p. 18
• 
  "Turning the Mind Inside Out", Saturday Evening Post, 24 May 1941, p. 19
• "Dr. Walter Freeman, left, and Dr. James W. Watts study an X ray before a psychosurgical operation. Psychosurgery is cutting into the brain to form new patterns and rid a patient of delusions, obsessions, nervous tensions and the like.
  "Dr. Walter Freeman, left, and Dr. James W. Watts study an X ray before a psychosurgical operation. Psychosurgery is cutting into the brain to form new patterns and rid a patient of delusions, obsessions, nervous tensions and the like.
• 
  "Doctor Freeman is the neurologist and analyst, Doctor Watts the surgeon. Here the latter is being helped on with his gloves before operating."
• 
  "A mirror above the operating table shows an actual operation. Doctor Watts is to the right, under the lamp."

Effects section seems lacking in detail

This article seems very in depth in most areas but I was surprised by the "effects" section. It would be interesting to know more post-procedure behavioral details. Also, would be interesting to know if there is anything known about lifespan and other issues after such a procedure. Kap 7 (talk) 22:24, 22 April 2013 (UTC)

I have expanded this section as the tag had been there nearly a year. I removed a couple of references - the Shutts because no-one had come up with clarification and the Freberg because it was only one sentence and the information has been included in the new paragraphs. The new references will be coming shortly. Staug73 (talk) 20:02, 19 May 2014 (UTC)

Here are the removed references: Freberg, Laura A. Discovering Biological Psychology. 2nd ed. Belmont, California: Wadsworth; 2010. ISBN 0-547-17779-8. Shutts, David. Lobotomy: resort to the knife. Van Nostrand Reinhold; 1982. ISBN 978-0-442-20252-1. Staug73 (talk) 20:08, 19 May 2014 (UTC)

Very interesting source

• (open access, too!) Kotowicz, "Gottlieb Burckhardt and Egas Moniz – Two Beginnings of Psychosurgery"

— Preceding unsigned comment added by EEng (talk • contribs) 02:21, 29 June 2013 (UTC)

Focus of the article

I think that this article is better suited for an article titled "History of lobotomy". I came wanting to learn about the procedure, the reasoning behind it, the results obtained, and its side effects, but found that it was difficult to filter this information among all the information regarding the history of lobotomy. I do not mean to say that its history is not relevant for this article, but it should be one section of the article and not its main focus. It should start with a description of the procedure itself that should help non-specialists (like me - I am an economics graduate student) understand well what a lobotomy is.

190.156.105.135 (talk) 05:13, 14 July 2013 (UTC)

Hmmmm. Now that you mention it, I see your point. I suspect that buried somewhere in there is an actual description of what lobotomy is, and the material needs to be rearranged to put that up front. And spinning off a separate article on History of Lobotomy might be a good idea. I haven't the energy, but some excellent editors are watching and with luck one will be inspired to spring into action. EEng (talk) 05:48, 14 July 2013 (UTC)

Ice pick

Opinions please on whether a reference to icepicks in the introduction should be deleted.

I reinstated some text in the introduction from an earlier version on the use of an ice-pick, with references (and there are ample references elsewhere, it's well-known and documented). This was contested and deleted, with a comment that the source supplied was not reliable (quite true). I reinstated the text with a reliable source, and it has been deleted again with the summary including "to include in lead can only be for shock value: "Oh, those horrible doctors! We today would know better!".

What I added is:

1. Notable
2. Relevant
3. Reliably sourced (even by the leading exponent of the technique)

It accurately summarises the procedure, information which was previously missing from the introduction. It also goes some small way to responding to a previous point: "I suspect that buried somewhere in there is an actual description of what lobotomy is, and the material needs to be rearranged to put that up front".

These are the criteria for inclusion. I agree that this is shocking; but it is a shocking fact. It would be wrong for a Wikipedia editor to say something to the effect of "Oh, those horrible doctors! We today would know better!" (unless someone reliable has said this and is cited), but to remove correct text because of what readers may infer is not justified in a complete and unbiased work of reference.

Here is the text in question, with footnotes and references (the footnotes were already in the article, and are cited in the body):

An instrument which was essentially an ice-pick—and sometimes an actual kitchen ice pick was used—was simply passed through the eye-socket and struck with a hammer when in the right position.

Notes

References

Pol098 (talk) 08:35, 10 October 2013 (UTC)

My edit summaries said:

including this in lead is UNDUE for shock value; surgeons have often adapted everyday tools for novel procedures; "Discover Magazine" is hardly if at all more reliable than its corresponding TV program, esp. when article title refers to "Cuckoo doctor"

and

ice picks are [already] appropriately discussed in the article body (though some of [this] material could, perhaps, be usefully added there) but, I repeat, to include in lead can only be for shock value: "Oh, those horrible doctors! We today would know better!"

The salient guideline is WP:BALASPS (underlining added):

An article should not give undue weight to any aspects of the subject but should strive to treat each aspect with a weight appropriate to its significance to the subject. For example, discussion of isolated events, criticisms, or news reports about a subject may be verifiable and impartial, but still disproportionate to their overall significance to the article topic. ... Note that undue weight can be given in several ways, including, but not limited to, depth of detail, quantity of text, prominence of placement, and juxtaposition of statements.

Contrary to what you say, the "ice-pick" material does not "accurately [summarise] the procedure"; in fact that technique was used only by certain practitioners (and only in the US, if I recall correctly). Most reader today don't even know what an ice-pick is -- have never seen one -- so that they're left to envision whatever awful thing their imaginations can come up with. This aspect of the topic is already described appropriately in the body of the article; including it in the lead could almost define inappropriate and undue weight. EEng (talk) 09:24, 10 October 2013 (UTC)

"Stunningly successful"?

I don't think this sentence is entirely supported by the source, and the concept of a "stunningly successful" lobotomy sounds odd (although those are indeed the words used in the article). "At times, the operation has been "stunningly successful", allowing severely ill patients to once again work and socialize normally." This is what the source actually says: "The results of the operations were mixed. Some patients died on the operating table; some committed suicide post-operation. Others were left severely brain damaged and were reduced to a state where they were largely unaware of their surroundings. On the other hand, on occasion the operation proved stunningly successful. In his book, The Last Resort (1998), Jack Pressman discusses the case of Rose Thorner who received a lobotomy in 1947 (pp. 264–270). Rose had been diagnosed as suffering from involutional melancholia. She had spent 10 years on a locked ward where she spent her time asking to be allowed to die, smearing faeces, and assaulting patients and staff. Post-lobotomy she was discharged to a lodging house, where she maintained a busy social life and did voluntary work at a local hospital. Friends considered her recovered and acquaintances found her “100 % normal”.The outcomes of other cases were more ambiguous. Post-lobotomy, patients might no longer be troubled, but still seemed to have lost something. Many had to remain in hospital but became more “manageable”. " Staug73 (talk) 17:12, 16 July 2014 (UTC)

I am replacing it with this which I think more accurately reflects what the source says."Some patients died as a result of the operation and others later committed suicide. Some were left severely brain damaged. Others were able to leave hospital, or became more manageable within hospital." The example given isn't actually of someone returning to work (voluntary work is slightly different). There were of course people who returned to work post-lobotomy (not usually at their previous level) but the next sentence says that anyway. Staug73 (talk) 17:28, 16 July 2014 (UTC)

Absent dates in intro summary

The notable recent dates of the lobotomy use is very conspicuously missing from here/the first paragraph - & it is again brushed under the rug in the following paragraph.

there is a general wave of excessively pro psychiatry in many of these articles... remember these were the guys doing involuntary lobotomies as recently as the 1950's - are we sure we should be excessively pro them?

thanks, lakitu (talk) 03:10, 6 February 2015 (UTC)