Psychosurgery
Psychosurgery
Psychosurgery-the use of surgery on the
brain to treat psychological functions.
Egas Moniz pioneered the technique and it
was developed by Walter Freeman.
Based on 2 observations :
A lab chimp pacified by operation on frontal
lobes.
Tumour operation on a human frontal lobe
without causing intellectual damage.
Techniques
Leucotomy
o A narrow device was inserted (via holes
made in the skull) into the frontal lobe.
o The blade of the leucotome was then
extended and rotated to lesion a core of
tissue.
o This was repeated several times to
destroy pieces of prefrontal cortex.
Techniques
Transorbital lobotomy
o Used a special knife called an ‘ice pick’.
o Inserted under the eye lid and into the
back of the eye socket.
o This was used to break through the skull
into the brain & was moved around to
destroy connections between the
prefrontal area & other brain areas.
o This was repeated on both hemispheres.
Why used?
Used on patients who were emotionally unstable
and violent & did not respond to other forms of
therapy.
It generally had the effect of relieving emotional
distress & anxiety and calmed the patient down.
As a result the surgery became common.
Tooth & Newton (1961) reported that more than
10,000 operations were performed in the UK.
Side effects
Such procedures are now rare because of
their severe side effects. Problems
include:
 Changes in personality.
 Lethargic, apathetic, irresponsible, socailly
withdrawn.
 Lacked ability to plan their own behaviour.
Evaluation
• Evidence for which lobotomies were based
was very limited. Findings from the
chimpanzee may not be relevant to
humans due to brain structure & function.
• Findings from the human case may not be
generalisable, as the medical reason for
the lobotomy was a physical not a
psychological one.
Evaluation
• The rapid growth of the technique was based on its use
for reducing stress & making difficult individuals more
manageable for staff in institutions. This is unethical.
• Moniz & Freeman claimed high success rates for their
operations. This was supported by Pippard(1955) who
found worthwhile or good results for 62% of
leucotomised depressive patients & good results with
50% of those with affective disorders.
• In 95% of these cases Pippard reported no more than
slight personality changes.
• However, many other sources reported severe side
effects and original procedures were abandoned.
Current Procedures
Bilateral cingulotomy is now occasionally
performed. Used to help very depressed
patients, sufferers of OCD & to reduce
pain in cancer patients.
This techniques uses very accurate MRI to
assist surgeons to identify the exact
location of the area to be lesioned. A fine
electrode destroys the tissue directly.
Evaluation of current procedures
• Mixed evidence. Seems to reduce pain, it does not
appear to affect the pain threshold.
• Similar side effects. Cohen et al (1999) compared the
pre-operative performance of 12 cingulotomoy patients
being treated for chronic pain with 20 control patients
also with chronic pain. Over 60% of the cingulotomy
patients reported less pain post operatively and most
required less medication to control their pain. However,
Cohen et al found some consistent post-operative
problems. On average these patients lacked the ability to
spontaneously initiate responses (such as verbal
responses) & showed deficits in attention compared with
the controls.
Evaluation of current procedures
• Investigating the use of cingulotomy for OCD,
Baer et al (1995) followed 44 patients. They
found the treatment to be effective in 32% of
cases and partially in a further 14%. Some
patients reporter side effects including seizures.
• Mashour et al(2005) suggests that
psychosurgery is a much safer & ethically sound
approach because of the usefulness of modern
elecrical brain-stimulation techniques.