Where once was horror, can there be hope? The history of "psychosurgery" and its modern development to "neurosurgical treatment of mental disorders"

Institute for the History of Medicine and Medical Ethics, University of Cologne, Germany

Illustrated by slides and original texts, the history of "psychosurgery" in the 20th century will be outlined.

There is no other form of neurosurgery which has ever been so closely related to public interest and in which the influence of social ideals was sometimes stronger than the influence of medical facts. Early forms of psychosurgery as a cult act may reach back about 40,000 years, when trepanations first seem to have been done. The first rational approaches to the operation of "the psyche" by destroying frontal lobes of patients, however, can be found in the 1890s. At this time the frontal lobe as a part involved in emeotions was known from clinical cases where this area was destroyed by accidents or tumors. Observations in the laboratories of Fulton and Jacobson in 1935, on "experimental neurosis" in chimpanzees relieved by frontal lobectomy, inspired Moniz and Lima in Portugal to perform "frontal leukotomy", later called "lobotomy". This procedure consisted of incisions that destroyed connections between the prefrontal region and other parts of the brain to treat patients with schizophrenia, affective disorders and obsessive-compulsive states. The treatment became popular all over the world and Moniz received the Nobel Prize in 1949. Freeman and Watts adopted this technique as "psychosurgery" and called it "standard lobotomy". Developing a quick and easy "trans-orbital" procedure which could be done in a medical office, they laid the practical groundwork for the popularization of leucotomy, which was used as a tool to control undesirable behavior across hospitals and psychiatric clinics in the USA. In the 1940s and 1950s more than 50,000 persons all over the world were subjected to lobotomy--in many cases without an appropriate indication or enough evidence for a scientific basis but with severe side effects in terms of personality changes. With the introduction of effective pharmacotherapy for mental disorders in the mid-1950s, psychosurgery decreased drastically and, due to evidence of its widespread abuse in problem children, rebel adolescnets and political opponents, it was banned in the 1960s and 1970s. Today the term psychosurgery still has the power to recall the nightmare of lobotomy. Since the late 1970s, however--after a long period of counter-effect against the past--there is evidence that psychosurgery can be useful for certain forms of untreatable depressions, anxiety disorders or obsessive-compulsive disorders. Modern techniques in functional and stereotactic neurosurgery may help, for example, cingulotomy to find its place as an effective and minimally-invasive method in the new non-political "neurosurgical treatment of mental disorders."

Session IV -- Poster Session 1
Friday, 15 June 2001, 9:00 - 10:00 am

Sixth Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and
Eighth Meeting of the European Club for the History of Neurology (ECHN)

Cologne, Germany