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Psychosurgery is the scientific treatment of mental disorders by means of brain surgery.
To us it may seem absurd that the destruction of an area of the brain could lead to an improvement of a mental process.
But, consider what happens when another organ in the body threatens the well being of the whole. Many times the only solution is to remove the organ permanently and eliminate the source of the problem.
Ancient Psychosurgery
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Brain surgery is perhaps the oldest of the practiced medical arts. There is evidence of brain surgery dating back to the late Stone Age period. The success rate was very good, even circa 7000 B.C.
Brain surgery was also used for spiritual and magical reasons; usually limited to kings or priests.
Surgical tools were found in South America made of bronze or obsidian. Also Africa showed evidence of brain surgery as early as ,000 B.C. in papyrus writings found in Egypt. "Brain," the word, is used here for the first time in any language.
Hippocrates, the father of medical ethics, left many texts on brain surgery. Many concepts in his writings were still in use two thousand years after his death in 60 B.C.
Some of the most famous ancient brain surgeons were; Aulus Cornelius Celsus of Rome. Galenus of Pergamon, born in Turkey. The physicians of Byzance such as Oribasius and Paul of Aegina. There was also an Islamic school of brain surgery from 800 to 100 A.D., the height of Islamic influence in the world. The greatest Islamic brain surgeon wasAbu Bekr Muhammed el Razi, who lived from 85 to A.D. Aby l'Qluasim Khalaf was also an Islamic brain surgeon that practiced in Cordoba, Spain. He was one of the great influences on western brain surgery.
The early procedure was called Trepanning. The first historical and medical accounts of trepanning were made in 1867, by E.G. Squier, in North America and by Paul Broca in Europe.
In the Medieval times, operations were performed by quack doctors, to extract the so-called "stone of madness", which was believed to be the source of mental illness.
Early Pioneers
The road to scientific psychosurgery started with the discovery that certain parts of the brain controlled temperament, mood and intellect.
A bizarre and well publicize case was very important in the realization of the effects of serious damage to a part of the brain, the prefrontal cortex. It became a classical case in the neurology textbooks.
It was that of Phineas Gage, a young railroad construction supervisor in Vermont. In September 1848, there was an explosion projecting a tamping rod against his head. The rod entered his head through his left cheek, destroyed his eye, traveled through the frontal part of the brain, and left the top of the skull at the other side. He was taken to a local doctor, John Harlow, who took care of him. He could both walk and talk. He not only survived, he recovered. Months later, Gage began to have dramatic changes in mood and behavior. He became extravagant and anti-social. He was no longer "himself".
Phineas Gage became a classical case in the textbooks of neurology. The part of the brain which he had lost, was forever associated to the mental and emotional functions which he had lost.
Scientific neurosurgery started for real in the 1th century. In Boston, in the Massachusetts General Hospital, the first surgery under ether anesthesia was performed in 1867.
In 18, William Macewen, a Scottish general surgeon, reported on 1 patients that he operated on for brain abscesses, 18 of whom were cured. Macewen planned his first brain surgery based on the clinical observations of Paul Broca, who was first to determine the location of the speech center of the brain. Victor A.H. Horsley, also became an important predecessor of psychosurgery, due to his invention of the sterotactic technique and apparatus, in 10. Although he developed the technique for animal experimentation, in the 40's several neurosurgeons, such as Ernst Spiegel, in the United States, and Lars Leksell, in Sweden, developed and used for the first time this technique in delicate, precise and minimally invasive brain surgery.
Harvey Williams Cushing, an American, considered the greatest neurosurgeon of the twentieth century, developed a very influential school. From 105 on, he advanced neurosurgery by developing a series of surgical techniques, which are still in use today.
Lobotomy
In 180, a German scientist named Friederich Golz, while doing surgical experiments with dogs, reported that when the temporal lobes were removed, animals were more tame and calmer than those who were not operated on.
This inspired Gottlieb Burkhardt, a physician and supervisor of an insane asylum in Switzerland, to perform in 18 an operation to remove parts of the cortex of six schizophrenic patients. Some of his patients became calmer after the surgery (two of them died). Burkgardt was opposed and criticized by the medical authorities of his time so very few psychosurgeries of this kind were done in the next forty years.
In 16, the Portuguese neurologist Egas Moniz introduced a surgical operation, prefrontal leucotomy, which after an initial period came to be used particularly in the treatment of schizophrenia. The operation, later called lobotomy, consisted in incisions that destroyed connections between the prefrontal region and other parts of the brain.
At that time there did not exist any effective treatment for schizophrenia. The treatment became popular in many countries all over the world and Moniz received the Nobel Prize in 14.
Among those who followed Moniz' lead, was the nerologist and neurosurgeon team of Walter Freeman and James Wats in the United States. Freeman and Watts perfected the technique, arriving to what he called the "FreemanWatts Standard Procedure", which had a precise set of guidelines for insertion of the leukotome (the instrument for severing the frontal lobe).
Lobotomy took America and some other countries by storm. Between 1 and 151, more than 18,000 lobotomies were performed in the United States. It was widely abused as a method to control undesirable behavior. In Japan, the majority of the operated cases were children, many who simply had behavior problems or bad grades at school. Inmates at prisons for the insane were operated on, and families trying to get rid of difficult relatives would submit them to lobotomy.
Ethical objections began to pile up, because of the irreversible damage to the brain, and because of the severe effects of the surgery on the personality and emotional life of the patients. In addition, the appearance of new antipsychotic and antideppressive drugs, such as Thorazine in the 150's, gave new means to combat most of the symptoms experienced by patients. Neurosurgesns everywhere started to abandon lobotomy in favor of more humane methods of treatment.
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