Editing Lobotomy (section)

===Early psychosurgery===
[[File:Gottlieb Burckhardt.jpg|thumb|left|The Swiss psychiatrist [[Gottlieb Burckhardt]] (1836–1907)]]

Before the 1930s, individual doctors had infrequently experimented with novel surgical operations on those deemed insane. Most notably in 1888, Swiss psychiatrist [[Gottlieb Burckhardt]] initiated what is commonly considered the first systematic attempt at modern human [[psychosurgery]].<ref>{{harvnb|Gross|Schäfer|2011|p=1}}; {{harvnb|Heller|Amar|Liu|Apuzzo|2006|p=727}}; {{harvnb|Joanette|Stemmer|Assal|Whitaker|1993|pp=572, 575}}; {{harvnb|Kotowicz|2008|p=486}}; {{harvnb|Manjila|Rengachary|Xavier|Parker|2008|p=1}}; {{harvnb|Noll|2007|p=326}}; {{harvnb|Reevy|Ozer|Ito|2010|p=485}}; {{harvnb|Steck|2010|pp=85–89}}; {{harvnb|Stone|2001|pp=79–92}}; {{harvnb|Suchy|2011|p=37}}; {{harvnb|Mareke|Fangerau|2010|p=138}}; {{harvnb|Ford|Henderson|2006|p=219}}; {{harvnb|Green|Astradsson|Stacey|Aziz|2010|p=208}}; {{harvnb|Sakas|Panourias|Singounas|Simpson|2007|p=366}}; {{harvnb|Whitaker|Stemmer|Joanette|1996|p=276}}</ref> He operated on six chronic patients under his care at the Swiss Préfargier Asylum, removing sections of their [[cerebral cortex]]. Burckhardt's decision to operate was informed by three pervasive views on the nature of mental illness and its relationship to the brain. First, the belief that mental illness was organic in nature, and reflected an underlying brain pathology; next, that the nervous system was organized according to an [[associationism|associationist]] model comprising an input or [[Afferent nerve fiber|afferent system]] (a sensory center), a connecting system where information processing took place (an [[association center]]), and an output or [[Efferent nerve fiber|efferent]] system (a motor center); and, finally, a modular conception of the brain whereby discrete mental faculties were connected to specific regions of the brain.{{sfn|Berrios|1997|p=68|ps=}} Burckhardt's hypothesis was that by deliberately creating [[lesion]]s in regions of the brain identified as association centers, a transformation in behaviour might ensue.{{sfn|Berrios|1997|p=68|ps=}} According to his model, those mentally ill might experience "excitations abnormal in quality, quantity and intensity" in the sensory regions of the brain and this abnormal stimulation would then be transmitted to the motor regions giving rise to [[psychopathology|mental pathology]].{{sfn|Berrios|1997|p=69|ps=}} He reasoned, however, that removing material from either of the sensory or motor zones could give rise to "grave functional disturbance". Instead, by targeting the association centers and creating a "ditch" around the motor region of the [[temporal lobe]], he hoped to break their lines of communication and thus alleviate both mental symptoms and the experience of [[mental distress]].{{sfn|Berrios|1997|pp=69, 77|ps=}}
[[File:Ludvig Puusepp, 1920s.jpg|thumb|right|upright|The Estonian neurosurgeon [[Ludvig Puusepp]] c. 1920]]
Intending to ameliorate symptoms in those with violent and intractable conditions rather than effect a cure,{{sfn|Tierney|2000|p=26|ps=}} Burckhardt began operating on patients in December 1888,<ref>{{harvnb|Whitaker|Stemmer|Joanette|1996|p=276}}; {{harvnb|Berrios|1997|p=69}}</ref> but both his surgical methods and instruments were crude and the results of the procedure were mixed at best.{{sfn|Berrios|1997|p=69|ps=}} He operated on six patients in total and, according to his own assessment, two experienced no change, two patients became quieter, one patient experienced [[Epileptic seizure|epileptic convulsions]] and died a few days after the operation, and one patient improved.{{refn|The patient he thought improved subsequently committed suicide.{{sfn|Stone|2001|p=80}}|group=n}} Complications included motor weakness, [[epilepsy]], [[sensory aphasia]] and "[[word deafness]]".{{sfn|Berrios|1997|p=70|ps=}} Claiming a success rate of 50 percent,{{sfn|Manjila|Rengachary|Xavier|Parker|2008|p=1|ps=}} he presented the results at the Berlin Medical Congress and published a report, but the response from his medical peers was hostile and he did no further operations.{{sfn|Kotowicz|2005|pp=77–101|ps=}}

In 1912, two physicians based in [[Saint Petersburg]], the leading Russian neurologist [[Vladimir Bekhterev]] and his younger Estonian colleague, the neurosurgeon [[Ludvig Puusepp]], published a paper reviewing a range of surgical interventions that had been performed on the mentally ill.<ref>{{harvnb|Bechterev|Puusepp|1912}}; {{harvnb|Kotowicz|2008|p=486|ps=}}</ref> While generally treating these endeavours favorably, in their consideration of psychosurgery they reserved unremitting scorn for Burckhardt's surgical experiments of 1888 and opined that it was extraordinary that a trained medical doctor could undertake such an unsound procedure.<ref name="Kotowicz2005p802008p486">{{harvnb|Kotowicz|2005|p=80}}; {{harvnb|Kotowicz|2008|p=486|}}</ref>
{{Blockquote|We have quoted this data to show not only how groundless but also how dangerous these operations were. We are unable to explain how their author, holder of a degree in medicine, could bring himself to carry them out&nbsp;...<ref>Quoted in {{harvnb|Berrios|1997|p=71}}</ref>}}

The authors neglected to mention, however, that in 1910 Puusepp himself had performed surgery on the brains of three mentally ill patients,{{refn|According to Puusepp, the three patients had manic depression or considered "epileptic equivalents".{{sfn|Feldman|Goodrich|2001|p=149|ps=}}|group=n}}<ref>{{harvnb|Kotowicz|2005|p=80}}; {{harvnb|Kotowicz|2008|p=486|}}; {{harvnb|Berrios|1997|p=71}}</ref> sectioning the [[cerebral cortex|cortex]] between the [[frontal lobe|frontal]] and [[parietal lobe]]s.{{sfn|Feldman|Goodrich|2001|p=649|ps=}} He had abandoned these attempts because of unsatisfactory results and this experience probably inspired the invective that was directed at Burckhardt in the 1912 article.<ref name="Kotowicz2005p802008p486" /> By 1937, Puusepp, despite his earlier criticism of Burckhardt, was increasingly persuaded that psychosurgery could be a valid medical intervention for the mentally disturbed.{{refn|group=n|Puusepp admitted to his 1910 experimentation with psychosurgery in a 1937 publication.{{sfn|Puusepp|1937|ps=}} At that point he had completed a series of 14 leucotomies to relieve aggressive symptoms in patients. Convinced that the results had been positive in these cases, he felt that further research into psychosurgery was warranted.{{sfn|Feldman|Goodrich|2001|p=649|ps=}}}}{{sfn|Kotowicz|2008|p=486|ps=}} In the late 1930s, he worked closely with the neurosurgical team of the Racconigi Hospital near [[Turin]] to establish it as an early and influential centre for the adoption of leucotomy in Italy.{{sfn|Kotowicz|2008|p=477|ps=}}