Editing Psychosurgery (section)

===1930s–1950s===

Although there had been earlier attempts to treat psychiatric disorders with brain surgery, it was Portuguese neurologist [[Antonio Egas Moniz|Egas Moniz]] who was responsible for introducing the operation into mainstream psychiatric practice. He also coined the term psychosurgery.<ref name="Kotowicz"/> Moniz developed a theory that people with mental illnesses, particularly "obsessive and melancholic cases", had a disorder of the [[synapse]]s which allowed unhealthy thoughts to circulate continuously in their brains. Moniz hoped that by surgically interrupting pathways in their brain he could encourage new healthier synaptic connections.<ref name="Moniz">{{cite book |first=E. |last=Moniz |year=1956 |contribution=How I succeeded in performing the prefrontal leukotomy |editor-first=A. M. |editor-last=Sackler |display-editors=etal |title=The great physiodynamic therapies in psychiatry: an historical reappraisal |location=New York |publisher=Hoeber |pages=131–137}}</ref> In November 1935, under Moniz's direction, surgeon Pedro Almeida Lima drilled a series of holes on either side of a woman's skull and injected [[ethanol]] to destroy small areas of subcortical white matter in the [[frontal lobe]]s. After a few operations using ethanol, Moniz and Almeida Lima changed their technique and cut out small cores of brain tissue. They designed an instrument which they called a leucotome and called the operation a [[leucotomy]] (cutting of the white matter).<ref name="Moniz"/> After twenty operations, they published an account of their work. The reception was generally not friendly but a few psychiatrists, notably in Italy and the US, were inspired to experiment for themselves.<ref name="Moniz"/>

In the US, psychosurgery was taken up and zealously promoted by neurologist [[Walter Freeman (neurologist)|Walter Freeman]] and neurosurgeon [[James W. Watts|James Watts]].<ref name="Heller">{{Cite journal | doi = 10.1227/01.NEU.0000240227.72514.27 | last1 = Heller | first1 = A. C. | last2 = Amar | year = 2006 | first2 = Arun P. | last3 = Liu | first3 = Charles Y. | last4 = Apuzzo | first4 = Michael L. J. | title = Surgery of the mind and mood: a mosaic of issues in time and evolution | journal = Neurosurgery | volume = 59 | issue = 4| pages = 720–740 | pmid=17038938| s2cid = 22958424 }}</ref> They started a psychosurgery program at [[George Washington University]] in 1936, first using Moniz's method but then devised a method of their own in which the connections between the prefrontal lobes and deeper structures in the brain were severed by making a sweeping cut through a burr hole on either side of the skull.<ref name="Heller"/> They called their new operation a [[lobotomy]].<ref name="Moniz"/>

Freeman went on to develop a new form of lobotomy which could be dispensed without the need for a neurosurgeon. He hammered an ice pick-like instrument, an orbitoclast, through the eye socket and swept through the frontal lobes. The transorbital or "ice pick" lobotomy was done under [[local anesthesia]] or using [[electroconvulsive therapy]] to render the patient unconscious and could be performed in mental hospitals lacking surgical facilities.<ref>{{cite book
| last = El-Hai
| first = Jack
| title = The Lobotomist
| publisher = Wiley
| year = 2005
| isbn = 978-0-471-23292-6
| url-access = registration
| url = https://archive.org/details/lobotomistmaveri0000elha
}}</ref> Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in psychiatric hospitals.<ref name="abnormal psyc">{{cite book | title=Essentials of Abnormal Psychology |edition=4th | first1=V. Mark |last1=Durand | first2=David H. |last2=Barlow | publisher=Thomson Wadsworth | year=2006 | url=http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24 | access-date=2007-02-13 | archive-date=2007-10-20 | archive-url=https://web.archive.org/web/20071020013459/http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24 | url-status=dead }}</ref> Freeman's patients included 19 children, one of whom was 4 years old.<ref>{{cite journal | doi = 10.1176/appi.ajp.2008.08020174 | last1 = Stewart | first1 = D. G. | last2 = Davis | first2 = K. L. | year = 2008 | title = Images in psychiatry: the lobotomist | journal = American Journal of Psychiatry | volume = 165 | issue = 4| pages = 457–58 | pmid = 18381916 }}</ref>

The 1940s saw a rapid expansion of psychosurgery, in spite of the fact that it involved a significant risk of death<ref name="Tooth">{{cite report |first1=G. C. |last1=Tooth |first2=M. P. |last2=Newton |name-list-style=amp |year=1961 |title=Leucotomy in England and Wales, 1942–54 |location=London |publisher=[[His Majesty's Stationery Office]]}}</ref> and severe personality changes.<ref name="Swayze">{{cite journal | last1 = Swayze | first1 = II |name-list-style=vanc| year = 1995 | title = Frontal leucotomy and related psychosurgical procedures in the era before antipsychotics (1935–54): an historical overview | journal = American Journal of Psychiatry | volume = 152 | issue = 4| pages = 505–515 | pmid = 7900928 | doi=10.1176/ajp.152.4.505| citeseerx = 10.1.1.455.9708 }}</ref> By the end of the decade, up to 5000 psychosurgical operations were being carried out annually in the US.<ref name="Swayze"/> In 1949, Moniz was awarded the [[List of Nobel laureates in Physiology or Medicine|Nobel Prize for Physiology or Medicine]].

Beginning in the 1940s various new techniques were designed in the hope of reducing the adverse effects of the operation. These techniques included [[William Beecher Scoville]]'s [[History of psychosurgery in the United Kingdom#Subcaudate tractotomy|orbital undercutting]], Jean Talairach's [[History of psychosurgery in the United Kingdom#Capsulotomy|anterior capsulotomy]], and Hugh Cairn's [[bilateral cingulotomy]].<ref name="Heller"/> Stereotactic techniques made it possible to place [[lesion]]s more accurately, and experiments were done with alternatives to cutting instruments such as radiation.<ref name="Heller"/> Psychosurgery nevertheless went into rapid decline in the 1950s, due to the introduction of new drugs and a growing awareness of the long-term damage caused by the operations,<ref name="Heller"/> as well as doubts about its efficacy.<ref name="Mashour"/> By the 1970s, the standard or transorbital lobotomy had been replaced with other forms of psychosurgical operations.