Given that lobotomy was putting a large needle in someone's eye socket and swinging it around in their brain to destroy a bunch of tissue at random, I would hope not.
The article gives one case where it had the desired outcome. Indeed it is just one, but given how it was administered willy-nilly for all kinds of ailments, it does make one wonder if the other violent suicidal cases had improvements.
I would think we know more about the brain now to have better treatments than random stabbing. Would you like to get stabbed literally randomly in the brain to treat suicidal tendencies?
Good question. In much the same way that cancer patients literally have to poison themselves with chemo drugs to fight a greater ailment with sporadic success rates, I'd argue that if there was no other alternative and that the road I was on would lead to a violent death, then... yes?
With chemotherapy, we have literally have so much empirical evidence that the benefits far outweigh the risks. We understand the mechanism of action of chemotherapy enough to assess its risk profile.
With lobotomies, we understand enough about the brain now to know that the risk profile is extremely bad. Additionally, empirical evidence has shown that outcomes are pretty bad anyway! We have better tools and ways to understand the brain now to not give people a brain-destroying "treatment" that is basically a random, low chance of success. Would you reasonably prescribe getting shot in the head as a treatment if it had worked on one person?
(Sorry, I'm not trying to be beligerent, only to keep an open mind.)
It's kind of why I wanted to know more about the stories of the people the procedure worked for, just in case there really is some evidence it provides a benefit in some niche category. Though, yeah, I'm not betting on it.
You aren't wrong to be curious, but you are going to get unhelpful and emotional answers when asking about this.
You should genuinely read the wikipedia page on this topic: https://en.m.wikipedia.org/wiki/Lobotomy it will answer your questions and reveal the horror of what you are asking about and why people respond the way they do.
To sum up though; the procedure was mostly performed on women and children, who were also frequently not aware of what was being done to them (not consenting), on men it was mostly performed on homosexuals. The best case outcomes came at the cost of 'decreased psychic complexity', a sort of 'permanent childhood'. The worst cases don't bear repeating here.
I would also like to caution you, when reading on this, note whose voice is present; is it ever the subject who reports positive outcomes?
No, the article gives one case where someone had reported success, do we get the words of the person who had the spike in their brain? I would caution you against assuming best intent in this context because describing her as being at peace.. it describes some one as going from difficult to control to compliant. We don't have reason to believe it was a miracle cure, except possibly from the perspective of her caregivers.
That reminds me of the deeply troubling lobotomy storyline in Bojack Horseman. 2500 lobotomies by a single doctor. Makes you wonder how many were used to conveniently silence difficult people -- people whose mental illnesses were seen to be a burden to their surroundings.
Absolutely insane, that someone believes that randomly destroying parts of the brain will "cure one's depression", or other illnesses (like mental health issues or migraines). This is an insanely depressing read.
> by 1951, almost 20,000 lobotomies had been performed in the United States
> On average, there was a mortality rate of approximately 5% during the 1940s.
> He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot.
It helped in many cases, but it was bad in many cases. I'd like to see an statistic and also read carefully what is the definition of a "success" case.
Turning a 'violently suicidal' person into a zombie might seem like a success from the perspective of those who have to live with/take care of them/etc. Then again euthanasia should also be very effective if that's your only goal.
Yes; in the article, there were some lucky cases, some not so lucky:
> Anna Ruth Channels suffered from severe headaches and was referred to Freeman in 1950. He prescribed a transorbital lobotomy. The procedure cured Channels of her headaches, but it left her with the mind of a child, according to her daughter, Carol Noelle.
On the whole, I'd say it's an utterly barbaric, even idiotic, procedure. As I said, believing that random tissue damage has "healing properties" is so idiotic I cannot believe it. At least if it was specific to some parts of the brain, e.g. "for depression, destroy this part of the brain," it'd be a bit more understandable (not by much though).
The insanity is with the randomness! Precisely destroying a small part of the brain with focused ultrasounds is almost miraculous for people with debilitating essential tremors and research are underway to fine tune that technique for parkison.
Electro convulsive therapy is still routinely performed when pharmaceutical options have been exhausted, and damaging the brain is the intent.
I went through a few rounds myself in modern day America where we pride ourselves in not being barbarians. The first time I did not even consent, my spouse did it for me (in the 80s). To this day I never fully recovered. And yet if I complain people will just point to "studies" that say it works. Guess what, such studies also existed for lobotomy.
To the credit of the poor adjunct who taught my freshman psych 101 course in college, and assigned reading Thomas Szasz as part of it, what I've learned is that Thomas Szasz, while outspoken, was not wrong:
Technically, if you think about that, we're doing neurosurgeries to remove parts of the brains when necessary.
I could imagine that severing the connection between lobes could affect someone's mental state in a positive way.
However, 2500 surgeries, some of them with great results, some of them resulted in deaths and many in between. It's a game of chances, not a science.
Seems like this dude did not understand what is it exactly he is doing and randomly poked holes in people hoping it would work.
It would have been interesting to read a journal of someone who had the procedure.
I’m reminded of this article. There are very rarely placebo surgeries done, so it is an entire arm of medicine that is running wild without proper controls being done.
If you’ve had a lobotomy surgery, you have a huge tendency to believe it maybe did something positive. An interesting study would have been just tell people that they had a lobotomy. If I had to guess, I bet the success rate would be much higher that actual lobotomy.
I think the only think he knew was that he was offering a procedure to turn problematic family members into vegetables, that was the whole business model
Electroshock therapy was also a common treatment for mental illness.
My grandma received it several times...to try to deal with her emotions about my abusive alcoholic grandfather.
For as much as older generations criticize Millennials and Gen Z for being "snowflakes," I'm not sure my grandma's "Greatest Generation" actually handled things better.
Effects don't last that long (long enough though to get someone out of debilitating depression or mania and time for proper treatment) and need repeated courses to sustain.
There are still issues with memory, where one looses maybe a few days, but also could loose years.
They call it electro-convulsive therapy now, or just ECT. The objective is to induce a seizure. The idea is that electrical activity in the brain has been observed to be more stable following a seizure. ECT is still applied and apparently there are documented improvements.
It’s not generally done like in One Flew Over the Cuckoo’s Nest. The pulses, voltages, and currents are apparently small and precise.
More recently, “transcranial magnetic stimulation” has been reported similarly effective and seems to be considered something of an evolution beyond ECT, using magnetic fields instead of electric current, and avoiding the need for sedation etc.
I don’t fully understand it all, and I gather there are still a lot of questions about the exact mechanism. The research done so far is said to support some beneficial outcomes in hard-to-treat cases.
As with so many mental health issues, however, doing rigorous double blind studies for example is difficult or impossible.
Anyway, better practice is no longer to just strap people in and shock people in the brain.
After Rosemary was mildly sedated, "We went through the top of the head," Dr. Watts recalled. "I think she was awake. She had a mild tranquilizer. I made a surgical incision in the brain through the skull. It was near the front. It was on both sides. We just made a small incision, no more than an inch." The instrument Dr. Watts used looked like a butter knife. He swung it up and down to cut brain tissue. "We put an instrument inside", he said. As Dr. Watts cut, Dr. Freeman asked Rosemary some questions. For example, he asked her to recite the Lord's Prayer or sing "God Bless America" or count backward... "We made an estimate on how far to cut based on how she responded." When Rosemary began to become incoherent, they stopped.
If you have a hard time understanding what type of rigor thinking guided this; one on-the-fly "theory" from Freeman is offered by the wiki article on lobotomy[0]:
Walter Freeman coined the term "surgically induced childhood" and used it constantly to refer to the results of lobotomy. The operation left people with an "infantile personality"; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the "personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist." He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behaviour, Freeman advised a system of rewards (ice cream) and punishment (smacks).
I like how lobotomies ended, not because the professionals decided to quit being barbaric, but because Thorazine got you the same results on a subscription basis.
Yeah, apparently stimulants for adhd also make some permanent changes to personality, generally in the direction desired by those choosing to take them. The question brought up is if now as then, the pressures of society bias that choice to coerce confirmity.
I have zero doubt we will look back at the current medication pushing for "results" in the future, as we do at the physical implementations of the past.
AFAIK, we are pretty unsure how many medications actually work in the mental health field instead only seeing if they return 'results' similar to what we are originally aiming for.
Behind the Bastards has a good couple episodes about Walter Freeman[1]. If you want a good review of exactly how fucked up lobotomies are and what kind of person decides “yeah I could jam an ice pick in a brain”, take a listen.
We're still doing psychosurgery - far more precise and advanced than Freeman and Watts's lobotomies, but not fundamentally different. Today the most common targets are in the cingulate gyrus rather than the prefrontal cortex, but we're still basically cutting or burning out bits of brain. It has become comparatively rare due to the wide array of treatment options now available for severe mental illness, but psychosurgery may still be the least-worst option for people with debilitating and intractable depression, OCD or chronic pain where all other treatments have failed.
Freeman was undoubtedly a cowboy, but his poor practice has warped our understanding of psychosurgery. Freeman didn't invent the lobotomy and was widely condemned by many of his contemporaries, including his former surgical partner James Watts. We overlook the extraordinary suffering caused by severe mental illness and forget just how few treatments existed prior to the great pharmaceutical revolution of the 1950s. Freeman's more conservative contemporaries were, for the most part, responsible clinicians trying to do their best for patients who were experiencing unbearable suffering and had no better options.
Before we make idealizing comparisons between "barbaric pasts" and seemingly enlightened presents (the "arrogance of the present" in which we assume that whatever we do now is knowledgable, good, just, right, at the end point of progess), let's remember that today's "medications" were largely chance discoveries, where the "chance" consisted of the recognition that they would calm patients and make them more manageable - and in this light, they were praised, in their time, as "chemical lobotomy".
At the same time, DSM-V continues to define a "disorder" as something intimately connected with "distress."
These are real people, in great suffering, and we still don't have answers for many of the diagnostic codes found in the DSM.
Modern psychiatry and neurology may never substantially improve in addressing these disorders, as the human brain is the most complex object known to exist, perhaps beyond comprehension.
DSM-IV definition of mental disorder:
A: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual.
B: Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
C: Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one).
D: A manifestation of behavioral, psychological, or biological dysfunction in the individual.
E: Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.
Other considerations
F: No definition adequately specifies precise boundaries for the concept of ‘mental disorder’.
G: The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations.
Psychiatric diseases did exist thousands of years ago. OCD is a disease I know of. Yes, medication does not cure the underlying illness. And yes, it allows a patient to function in society. Which is, considering everything, a good thing. Being so depressed that you are bed ridden and your body hurts, or so agitated that you could not sleep for days puts a temporary chemical lobotomy in relation.
There's a lot to be morally repulsed by in this article, but shockingly little scientific discussion of the actual procedure. Kind of feels like a "wow, just wow" article.
There's a memoir Dully co-authored and published not too long after this article. There was also another article where, if memory serves me right, where he spoke about what it felt shortly after the lobotomy. Although I might be misremembering and it could also be another patient's account. Regardless, it is horrific.
Another atrocity is the reason a Freeman colluded with a controlling and abusive step-mother to lobotomize her son.
> According to Freeman's notes, Lou Dully said she feared her stepson, whom she described as defiant and savage looking. "He doesn't react either to love or to punishment," the notes say of Howard Dully. "He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it he says 'I don't know.' He turns the room's lights on when there is broad sunlight outside."
You must understand that families of these times endured the mentally ill with no hope of improvement for the entirety of their lives.
Yes, reading the article makes me gasp with the information and experience that is enabled by a century of neuroscience, but people in that period had no such option.
The particular subject of the article, a normal child who was lobotomized by a "wicked stepmother" (who later rendered him homeless), was enabled by profound medical malpractice. The surgeon cannot have doubted that the child was completely normal, and the procedure uncalled-for, equivalent to performing a triple bypass on a healthy heart.
Even in modern epilepsy, there is sometimes recourse for "resective surgery" in the hope of quelling seizures, but this is far more informed and exact than the subject of this article.
Thanks for some nuanced thoughts. I do understand the usual arguments for these surgeries at the time, which often overlap with arguments for why Freeman should have been absolved of accountability for his actions:
Other methods were not available, the broader medical community did not seem to object, the medical standards were less developed, it was more acceptable for physicians to experiment and learn as they went, some good came out of it, and Freeman did seem to believe in the efficacy of the procedures.
Some of these arguments are stronger than others. Freeman's showmanship (including a death of a patient for a photo-op in the middle of a surgery), and refusal to wear sterile gloves were against medical standards at the time. The broader community was misinformed, as anecdotal evidence of successful procedures was spread by supporters of the procedure, while the atrocious consequences of it were under-reported. Freeman believing that the procedures were effective is difficult to disprove, but we know that such an assumption depends on veracity of a man who has shown to not be a trustworthy professional, and we do know that Freeman knew that the majority of his procedures had significant negative consequences. Some good came out of not only Freeman's work, but also work of the regime-aligned Nazi scientists, especially in the fields of birth control, medical imaging, and aerospace; and this very extreme case illuminates that invention doesn't always justify the means. The argument about the evolution of medicine in the US is more convincing - indeed, the current evidence-based medical approach evolved over time from a much more experimental one. This can be seen in the change of Hippocratic oaths medics would take throughout history. The argument for no better treatment being available is also a strong one - we have a framework around compassionate use or compassionate access to experimental treatments when nothing else is available today. But overall, the arguments, except for a few, are weak with hindsight.
It is important to acknowledge that Freeman faced no repercussions for his actions while he was alive - neither legal nor the widespread moral condemnation he is associated with today. People truly did not know what to make of it. But I ask - if a crime against humanity is committed but it takes humanity some time to recoil and it goes unpunished, is it not a crime?
It's definitely a very interesting topic. I personally don't believe that Freeman didn't know what he was doing, or that he had no reason to know his work was unethical. A man of his age and education shouldn't be as naive. It's more difficult to blame the families, though in this case, the memoir and other recollections do say that the stepmother was probably motivated by a hatred for her son.
> the broader medical community did not seem to object
It seems there was quite a bit of controversy between Freeman and the more scientifically conservative medical community. James Watts, who originally partnered with Freeman and shared a practice with him, left "in disgust" due to the irresponsible application of lobotomy. Other professionals, like John F Fulton, have criticized Freeman's procedure for its lack of precision and broad collateral damage.
In the mid 1950s, the whole field was changed fundamentally by the introduction of the first antipsychotic drugs. Yet Freeman continued to perform his operation well over a decade after that.
> Freeman faced no repercussions for his actions while he was alive
He did eventually lose his medical license in 1967 and lived to see his views fall out of favor with neurologists/surgeons and patients alike (but not for long, he died a few years later).
I agree that it's a fascinating part of our recent history. I wish there was some way to get insight from the future about which of our currently accepted treatments will be seen as inhumane or counterproductive or simply bizarre in 50 years.
Thanks for the additional context about the medical community. Yes, it seems like individual people objected to Freeman’s work in his lifetime, even if there was no overall consensus on it. This is important to note, because it further diminishes the argument that Freeman could have naively believed he was doing good. Especially in the 60s.
As for repercussions, it seems like Freeman was specifically told by some authority not to perform these procedures anymore in Feb 1967, but his license to practice as a physician was not revoked.
Yes, indeed, medicine is evolving rapidly. I’m betting that our diet fads will look very barbaric in 2050, when we should have much better metabolic agents, not unlike Semaglutide. Transplanting donor organs that would be rejected will hopefully also fall out of fashion. And, I would hope, our reactive, emergency-based approach to healthcare will be replaced by preventative efforts. Nevertheless, I don't think we’re doing anything that will be seen in 50 years to be quite as barbaric as we see lobotomies now.
Thanks for your thoughts, I think the context you're contributing is fantastic.
In both cases, the men have committed a severe injustice to society. And in both cases, it seems like they knew better than to do it, but chose to do it, anyways. I don't know if I can absolve Midgley of his moral duties to society in my mind, similar to Freeman.
What's a crime is a bit subjective, but different frameworks give us different definitions. Legally, a crime is something that breaks a norm enshrined in law. It is not unlikely that these men have not committed crimes in that sense. Morally, a crime is a deliberate injustice that harms others. With this definition, I think that these men have committed crimes.
And in some ways, it would be easier to forgive them, if they would admit to having committed a crime or an injustice. There's a very interesting talk by Elizabeth Bruenig on this [0], and she is much more articulate in philosophy than I will ever be. But I do think that once we can say that "if this person just admitted their wrongs, society could heal", that is some evidence of a moral crime having been committed.
> Pride, wrath, sloth, lust, greed, envy, and gluttony
I am not a religious man, but I think this is a good framework to judge the actions of Midgley and Freeman through. I would also add callous, ruthless ambition to that list. Allowing men like this to succeed is certainly nothing to be proud of for us as society.
I was told by a leader and pioneer in the radiotherapy space that he believed that in 10 years we would view radiation therapy like this, caveman technology with a big blunt hammer.
He believes biologics will take over.
If you dig into them, radiotherapy is largely archaic 60s and 70s technology other than a few shining g stars like Proton Therapy, etc.
I always thought radio was less damaging overall. I had been a caregiver for a family member with cancer and I recall radiation was causing burns, nausea, fatigue - but chemo was 100x all that. Chemo accumulates over weeks (she had one session/week) - first month is "ok, we will make it through it". Then it becomes unbearable.
1950s: "This teenager girl is "hysterical", let's put an ice pick through her eye socket"
2020s: "This teenager girl is depressed, lets cut off her breasts and pump her full of testosterone"
If you seriously can't/won't see the difference between an ice pick lobotomy and (voluntary, lifesaving) gender-affirming care then I don't know how to help you.
Rephrasing with a euphemism still doesn't make it appropriate to inflict upon children, who are really far too young (some only 12 years old) to consent, such serious surgical interventions that cause them lifelong damage.
You really made a throwaway just to spread far-right talking points about trans kids? Christ, dude.
Also twelve-year olds are not routinely getting gender-affirming surgery, full stop. Most twelve year olds don't even have complete secondary sex characteristics yet. How are you going to get top surgery if you barely have breasts?
As a proud Republican, you calling some point of view "far right" does not automatically invalidate it, no matter what you think. Dismissing alternative opinions makes you seem bigotted, not more intelligent.
Blood letting and lobotomies were believed to be "life-saving" and grounded in science. I am willing to bet there had been quite a few kids with mental issues that received lobotomy back then would end up getting "gender affirming" care nowadays.
Based on detrans stories online I do not believe these procedures are "voluntary". Coercion seems common. At least that's what had been said in Congress under the oath.
You mean the people testifying before Congress who were later linked to a small Evangelical astroturfing movement seeking to push anti-trans legislation across the country?
> Radical and gender-critical feminists, conservatives, and faith-based groups would like everyone to believe that gender dysphoria can be cured simply by adopting dangerous beliefs. They want you to think that praying, undergoing conversion therapy, etc., can cure and change you. I can attest that all of their treatments failed to work in my case. Publicly, I sustained during that tenuous time by lying to myself and others that what they said worked. I also shamefully sold their ideologies to the media and the public while overdosing on estrogen supplements in private, trying to desperately lower my testosterone level. My actions resulted in a dangerous blood clot which threatened my health and life.
Starting HRT is the single best thing I've ever done for my mental health. You choosing to believe that this is a form of coercion, or mutilation, or lobotomizing stands in direct opposition to established medical practice and countless personal testimonies. (And I should hope you can recognize that modern medical practice is far more advanced than the medicine practiced by Victorian-era bloodletting practioners.)
The regret rate for gender-affirmating surgical care is about 1% btw.
An author I admire greatly, Janet Frame, has a brush with this -
"After a suicide attempt she spent eight years in mental hospitals in New Zealand, receiving 200 electroshock treatments. She was about to have a lobotomy when a hospital official read that she had won a literary prize. She was released.
Later, a panel of psychiatrists determined that she had never had schizophrenia.. she was not mentally ill, just different from other people."
82 comments
[ 3.0 ms ] story [ 421 ms ] threadWith chemotherapy, we have literally have so much empirical evidence that the benefits far outweigh the risks. We understand the mechanism of action of chemotherapy enough to assess its risk profile.
With lobotomies, we understand enough about the brain now to know that the risk profile is extremely bad. Additionally, empirical evidence has shown that outcomes are pretty bad anyway! We have better tools and ways to understand the brain now to not give people a brain-destroying "treatment" that is basically a random, low chance of success. Would you reasonably prescribe getting shot in the head as a treatment if it had worked on one person?
It's kind of why I wanted to know more about the stories of the people the procedure worked for, just in case there really is some evidence it provides a benefit in some niche category. Though, yeah, I'm not betting on it.
You should genuinely read the wikipedia page on this topic: https://en.m.wikipedia.org/wiki/Lobotomy it will answer your questions and reveal the horror of what you are asking about and why people respond the way they do.
To sum up though; the procedure was mostly performed on women and children, who were also frequently not aware of what was being done to them (not consenting), on men it was mostly performed on homosexuals. The best case outcomes came at the cost of 'decreased psychic complexity', a sort of 'permanent childhood'. The worst cases don't bear repeating here.
I would also like to caution you, when reading on this, note whose voice is present; is it ever the subject who reports positive outcomes?
https://medium.com/the-dot-and-line/we-need-to-talk-about-bo...
> by 1951, almost 20,000 lobotomies had been performed in the United States
> On average, there was a mortality rate of approximately 5% during the 1940s.
> He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot.
It helped in many cases, but it was bad in many cases. I'd like to see an statistic and also read carefully what is the definition of a "success" case.
Turning a 'violently suicidal' person into a zombie might seem like a success from the perspective of those who have to live with/take care of them/etc. Then again euthanasia should also be very effective if that's your only goal.
> Anna Ruth Channels suffered from severe headaches and was referred to Freeman in 1950. He prescribed a transorbital lobotomy. The procedure cured Channels of her headaches, but it left her with the mind of a child, according to her daughter, Carol Noelle.
On the whole, I'd say it's an utterly barbaric, even idiotic, procedure. As I said, believing that random tissue damage has "healing properties" is so idiotic I cannot believe it. At least if it was specific to some parts of the brain, e.g. "for depression, destroy this part of the brain," it'd be a bit more understandable (not by much though).
I went through a few rounds myself in modern day America where we pride ourselves in not being barbarians. The first time I did not even consent, my spouse did it for me (in the 80s). To this day I never fully recovered. And yet if I complain people will just point to "studies" that say it works. Guess what, such studies also existed for lobotomy.
https://www.google.com/books/edition/Coercion_as_Cure/hYdLS6...
However, 2500 surgeries, some of them with great results, some of them resulted in deaths and many in between. It's a game of chances, not a science. Seems like this dude did not understand what is it exactly he is doing and randomly poked holes in people hoping it would work.
It would have been interesting to read a journal of someone who had the procedure.
https://www.skepdoc.info/ian-harris-on-surgery-the-ultimate-...
If you’ve had a lobotomy surgery, you have a huge tendency to believe it maybe did something positive. An interesting study would have been just tell people that they had a lobotomy. If I had to guess, I bet the success rate would be much higher that actual lobotomy.
This makes me think that something akin to electroconvulsive therapy would have caused remission.
My grandma received it several times...to try to deal with her emotions about my abusive alcoholic grandfather.
For as much as older generations criticize Millennials and Gen Z for being "snowflakes," I'm not sure my grandma's "Greatest Generation" actually handled things better.
https://www.healthdirect.gov.au/electroconvulsive-therapy-ec...
Effects don't last that long (long enough though to get someone out of debilitating depression or mania and time for proper treatment) and need repeated courses to sustain.
There are still issues with memory, where one looses maybe a few days, but also could loose years.
It’s not generally done like in One Flew Over the Cuckoo’s Nest. The pulses, voltages, and currents are apparently small and precise.
More recently, “transcranial magnetic stimulation” has been reported similarly effective and seems to be considered something of an evolution beyond ECT, using magnetic fields instead of electric current, and avoiding the need for sedation etc.
I don’t fully understand it all, and I gather there are still a lot of questions about the exact mechanism. The research done so far is said to support some beneficial outcomes in hard-to-treat cases.
As with so many mental health issues, however, doing rigorous double blind studies for example is difficult or impossible.
Anyway, better practice is no longer to just strap people in and shock people in the brain.
https://en.wikipedia.org/wiki/Rosemary_Kennedy
Walter Freeman coined the term "surgically induced childhood" and used it constantly to refer to the results of lobotomy. The operation left people with an "infantile personality"; a period of maturation would then, according to Freeman, lead to recovery. In an unpublished memoir, he described how the "personality of the patient was changed in some way in the hope of rendering him more amenable to the social pressures under which he is supposed to exist." He described one 29-year-old woman as being, following lobotomy, a "smiling, lazy and satisfactory patient with the personality of an oyster" who could not remember Freeman's name and endlessly poured coffee from an empty pot. When her parents had difficulty dealing with her behaviour, Freeman advised a system of rewards (ice cream) and punishment (smacks).
[0]https://en.m.wikipedia.org/wiki/Lobotomy
AFAIK, we are pretty unsure how many medications actually work in the mental health field instead only seeing if they return 'results' similar to what we are originally aiming for.
[1] https://spotify.link/rS6ePKIXvDb
Freeman was undoubtedly a cowboy, but his poor practice has warped our understanding of psychosurgery. Freeman didn't invent the lobotomy and was widely condemned by many of his contemporaries, including his former surgical partner James Watts. We overlook the extraordinary suffering caused by severe mental illness and forget just how few treatments existed prior to the great pharmaceutical revolution of the 1950s. Freeman's more conservative contemporaries were, for the most part, responsible clinicians trying to do their best for patients who were experiencing unbearable suffering and had no better options.
https://en.wikipedia.org/wiki/Psychosurgery
Joanna Moncrieff makes this explicit in her book, "The Bitterest Pills". Also elaborated on here: https://www.psycovery.com/images/Postpsychiatrys-challenge-O...
We're still doing the same thing, just without knives (and, as the comment noted, often also WITH knives).
These are real people, in great suffering, and we still don't have answers for many of the diagnostic codes found in the DSM.
Modern psychiatry and neurology may never substantially improve in addressing these disorders, as the human brain is the most complex object known to exist, perhaps beyond comprehension.
DSM-IV definition of mental disorder:
A: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual.
B: Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.
C: Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one).
D: A manifestation of behavioral, psychological, or biological dysfunction in the individual.
E: Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.
Other considerations
F: No definition adequately specifies precise boundaries for the concept of ‘mental disorder’.
G: The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161428/
In a way, it's comforting to know that newspapers back in the 1950's were as susceptible to BS as modern day TikTok influencers.
Maybe the technology / form factor isn't the underlying issue afterall.
fixed it.
Imagine the despair of a mind unable to express itself through voice or other action.
Arguably still more 'humane' than it ever was.
Another atrocity is the reason a Freeman colluded with a controlling and abusive step-mother to lobotomize her son.
> According to Freeman's notes, Lou Dully said she feared her stepson, whom she described as defiant and savage looking. "He doesn't react either to love or to punishment," the notes say of Howard Dully. "He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it he says 'I don't know.' He turns the room's lights on when there is broad sunlight outside."
I cannot possibly imagine a physician being so incompetent. It really feels like he was the contrarian Ivermectin proponent of his time. This is an interesting read: https://en.wikipedia.org/wiki/Walter_Jackson_Freeman_II#Medi...
Yes, reading the article makes me gasp with the information and experience that is enabled by a century of neuroscience, but people in that period had no such option.
The particular subject of the article, a normal child who was lobotomized by a "wicked stepmother" (who later rendered him homeless), was enabled by profound medical malpractice. The surgeon cannot have doubted that the child was completely normal, and the procedure uncalled-for, equivalent to performing a triple bypass on a healthy heart.
Even in modern epilepsy, there is sometimes recourse for "resective surgery" in the hope of quelling seizures, but this is far more informed and exact than the subject of this article.
Unfortunately, it had to start somewhere.
https://en.m.wikipedia.org/wiki/Epilepsy_surgery
Other methods were not available, the broader medical community did not seem to object, the medical standards were less developed, it was more acceptable for physicians to experiment and learn as they went, some good came out of it, and Freeman did seem to believe in the efficacy of the procedures.
Some of these arguments are stronger than others. Freeman's showmanship (including a death of a patient for a photo-op in the middle of a surgery), and refusal to wear sterile gloves were against medical standards at the time. The broader community was misinformed, as anecdotal evidence of successful procedures was spread by supporters of the procedure, while the atrocious consequences of it were under-reported. Freeman believing that the procedures were effective is difficult to disprove, but we know that such an assumption depends on veracity of a man who has shown to not be a trustworthy professional, and we do know that Freeman knew that the majority of his procedures had significant negative consequences. Some good came out of not only Freeman's work, but also work of the regime-aligned Nazi scientists, especially in the fields of birth control, medical imaging, and aerospace; and this very extreme case illuminates that invention doesn't always justify the means. The argument about the evolution of medicine in the US is more convincing - indeed, the current evidence-based medical approach evolved over time from a much more experimental one. This can be seen in the change of Hippocratic oaths medics would take throughout history. The argument for no better treatment being available is also a strong one - we have a framework around compassionate use or compassionate access to experimental treatments when nothing else is available today. But overall, the arguments, except for a few, are weak with hindsight.
It is important to acknowledge that Freeman faced no repercussions for his actions while he was alive - neither legal nor the widespread moral condemnation he is associated with today. People truly did not know what to make of it. But I ask - if a crime against humanity is committed but it takes humanity some time to recoil and it goes unpunished, is it not a crime?
It's definitely a very interesting topic. I personally don't believe that Freeman didn't know what he was doing, or that he had no reason to know his work was unethical. A man of his age and education shouldn't be as naive. It's more difficult to blame the families, though in this case, the memoir and other recollections do say that the stepmother was probably motivated by a hatred for her son.
It seems there was quite a bit of controversy between Freeman and the more scientifically conservative medical community. James Watts, who originally partnered with Freeman and shared a practice with him, left "in disgust" due to the irresponsible application of lobotomy. Other professionals, like John F Fulton, have criticized Freeman's procedure for its lack of precision and broad collateral damage.
In the mid 1950s, the whole field was changed fundamentally by the introduction of the first antipsychotic drugs. Yet Freeman continued to perform his operation well over a decade after that.
> Freeman faced no repercussions for his actions while he was alive
He did eventually lose his medical license in 1967 and lived to see his views fall out of favor with neurologists/surgeons and patients alike (but not for long, he died a few years later).
I agree that it's a fascinating part of our recent history. I wish there was some way to get insight from the future about which of our currently accepted treatments will be seen as inhumane or counterproductive or simply bizarre in 50 years.
As for repercussions, it seems like Freeman was specifically told by some authority not to perform these procedures anymore in Feb 1967, but his license to practice as a physician was not revoked.
Yes, indeed, medicine is evolving rapidly. I’m betting that our diet fads will look very barbaric in 2050, when we should have much better metabolic agents, not unlike Semaglutide. Transplanting donor organs that would be rejected will hopefully also fall out of fashion. And, I would hope, our reactive, emergency-based approach to healthcare will be replaced by preventative efforts. Nevertheless, I don't think we’re doing anything that will be seen in 50 years to be quite as barbaric as we see lobotomies now.
I very much admire your questions, and the mind behind them.
> But I ask - if a crime against humanity is committed but it takes humanity some time to recoil and it goes unpunished, is it not a crime?
You must admit that crime is subjective. Let us consider leaded gasoline and freon:
https://en.m.wikipedia.org/wiki/Thomas_Midgley_Jr.
This man is a supervillain of the environment. He was a hero of his day. Accolades are subjective.
>But overall, the arguments, except for a few, are weak with hindsight.
We must escape from many things, to escape from our past.
Are you sure that you know them all?
Pride, wrath, sloth, lust, greed, envy, and gluttony.
To pursue:
Humility, meekness, zeal, chastity, generosity, charity, and temperance.
In both cases, the men have committed a severe injustice to society. And in both cases, it seems like they knew better than to do it, but chose to do it, anyways. I don't know if I can absolve Midgley of his moral duties to society in my mind, similar to Freeman.
What's a crime is a bit subjective, but different frameworks give us different definitions. Legally, a crime is something that breaks a norm enshrined in law. It is not unlikely that these men have not committed crimes in that sense. Morally, a crime is a deliberate injustice that harms others. With this definition, I think that these men have committed crimes.
And in some ways, it would be easier to forgive them, if they would admit to having committed a crime or an injustice. There's a very interesting talk by Elizabeth Bruenig on this [0], and she is much more articulate in philosophy than I will ever be. But I do think that once we can say that "if this person just admitted their wrongs, society could heal", that is some evidence of a moral crime having been committed.
> Pride, wrath, sloth, lust, greed, envy, and gluttony
I am not a religious man, but I think this is a good framework to judge the actions of Midgley and Freeman through. I would also add callous, ruthless ambition to that list. Allowing men like this to succeed is certainly nothing to be proud of for us as society.
[0] https://www.youtube.com/watch?v=87EYmV6v_nE
He believes biologics will take over.
If you dig into them, radiotherapy is largely archaic 60s and 70s technology other than a few shining g stars like Proton Therapy, etc.
Look at the gammaknife for God's sake: https://en.m.wikipedia.org/wiki/Radiosurgery
Even the big fancy new Cyberknife, etc. were all designed and architected decades ago and are relics of another age.
Also twelve-year olds are not routinely getting gender-affirming surgery, full stop. Most twelve year olds don't even have complete secondary sex characteristics yet. How are you going to get top surgery if you barely have breasts?
Based on detrans stories online I do not believe these procedures are "voluntary". Coercion seems common. At least that's what had been said in Congress under the oath.
https://www.motherjones.com/politics/2023/03/anti-trans-tran...
Including one "detrans" activist who disavowed her former anti-trans stance, describing it as a form of self-harm, and then went on to retransition?
https://elisashupe.wordpress.com/2022/03/03/elisa-shupe-sett...
> Radical and gender-critical feminists, conservatives, and faith-based groups would like everyone to believe that gender dysphoria can be cured simply by adopting dangerous beliefs. They want you to think that praying, undergoing conversion therapy, etc., can cure and change you. I can attest that all of their treatments failed to work in my case. Publicly, I sustained during that tenuous time by lying to myself and others that what they said worked. I also shamefully sold their ideologies to the media and the public while overdosing on estrogen supplements in private, trying to desperately lower my testosterone level. My actions resulted in a dangerous blood clot which threatened my health and life.
Starting HRT is the single best thing I've ever done for my mental health. You choosing to believe that this is a form of coercion, or mutilation, or lobotomizing stands in direct opposition to established medical practice and countless personal testimonies. (And I should hope you can recognize that modern medical practice is far more advanced than the medicine practiced by Victorian-era bloodletting practioners.)
The regret rate for gender-affirmating surgical care is about 1% btw.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/
That's less than the regret rate for hip replacement surgery, which is about 7%.
https://arthroplasty.biomedcentral.com/articles/10.1186/s428...
"After a suicide attempt she spent eight years in mental hospitals in New Zealand, receiving 200 electroshock treatments. She was about to have a lobotomy when a hospital official read that she had won a literary prize. She was released.
Later, a panel of psychiatrists determined that she had never had schizophrenia.. she was not mentally ill, just different from other people."
https://www.nytimes.com/2004/01/30/books/janet-frame-79-writ...
Her book Faces in the Water describes the experience, it's chilling.