Becky, Moniz, and Prefrontal Lobotomy
In 1949, Dr. Egas Moniz was awarded the Nobel Prize in Physiology and Medicine for the development of prefrontal lobotomy a surgical procedure in which the connections between the prefrontal lobes and the rest of the brain are cut as a treatment for mental illness. The prefrontal lobes are the large areas, left and right, at the very front of the brain (see Figure 1.7 on page 16). Moniz s discovery was based on the report that Becky, a chimpanzee that frequently became upset when she made errors during the performance of a food-rewarded task, did not do so following the creation of a large bilateral lesion (an area of damage to both sides of the brain) of her prefrontal lobes. After hearing about this isolated observation at a scientific meeting in 1935,Moniz persuaded neurosurgeon Almeida Lima to operate on a series of psychiatric patients; Lima cut out six large cores of prefrontal tissue with a surgical device called a leucotome (see Figure 1.8). Following Moniz s claims that prefrontal surgery was therapeutically successful and had no significant side effects, there was a rapid proliferation of various forms of prefrontal psychosurgery (see Valenstein, 1980, 1986). One such variation was transorbital lobotomy, which was developed in Italy and then popularized in the United States by Walter Freeman in the late 1940s. It involved inserting an ice-pick-like device under the eyelid, driving it through the orbit (the eye socket) with a few taps of a mallet, and pushing it into the frontal lobes, where it was waved back and forth to sever the connections between the prefrontal lobes and the rest of the brain (see Figure 1.9). This operation was frequently performed in the surgeons office.
Analysis of the Case
Frontal lobotomy was one of the most regrettable chapters in the history of medicine. first of all Moniz relied just on a single case of a chimpanzee. He did not did experiments on any other mammalian species or does not test it on other monkeys so it was not adequately tested. The side effects of this procedure was not considered, after the success of the procedure on 11 female patients he rushed to publish a paper proclaiming his procedure a success. Several months later, many of his patients relapsed, as did one of the chimpanzees; this follow-up information was not publicized. The procedures were “blind” – the exact path of the leucotome could not be determined, so the operations produced mixed results. In some cases, there were improvements in behavior; in others, there was no noticeable difference; and in yet others, the symptoms being treated became markedly worse. it reduced costs: instead of the state paying $35,000 a year to keep an insane patient in an asylum, they could lobotomize him for $250 and send him home.
Consider the example of a patient, He was no longer violent, and the family no longer had to fear him; but he didn’t speak a word, he barely moved, and he didn’t react to anything or anyone. He was incapable of taking care of himself and required constant supervision. He had eruptions of inappropriate sexual behavior with family members. He would do odd things in public like whirling on the sidewalk like a dervish in a slow trance. He even had to be reminded not to swallow food whole without chewing. After 15 years he suddenly recovered the ability to speak but then subjected the family to a surrealistic nonstop flood of fragmented thoughts. It looks like that this so called treatment created zombies like humans who loses the ability to feel and be express their emotions, this was only popular these days because there was no alternative method and there were no anti psychotic drugs in the market these days. A serious question rises after this discussion is that: Is a life without feeling preferable to one spent in torment? Who is to decide? Can psychotic patients give informed consent?. How can these patients give the consent to totally deprive them of their emotions. the lesson we take from all this is that before a proposed treatment is put into widespread use it must be submitted to rigorous scientific testing to evaluate it for safety, effectiveness, and unexpected consequences.