Psychosurgery, ethics, and media: a history of Walter Freeman and the lobotomy

Neurosurgical Focus - Tập 43 Số 3 - Trang E6 - 2017
James P. Caruso1, Jason P. Sheehan1,2
1Departments of Neurological Surgery, and
2Radiation Oncology, University of Virginia Health System, Charlottesville, Virginia

Tóm tắt

At the peak of his career, Walter J. Freeman II was a celebrated physician and scientist. He served as the first chairman of the Department of Neurology at George Washington University and was a tireless advocate of surgical treatment for mental illness. His eccentric appearance, engaging personality during interviews, and theatrical demonstrations of his surgical techniques gained him substantial popularity with local and national media, and he performed more than 3000 prefrontal and transorbital lobotomies between 1930 and 1960. However, poor patient outcomes, unfavorable portrayals of the lobotomy in literature and film, and increased regulatory scrutiny contributed to the lobotomy’s decline in popularity. The development of antipsychotic medications eventually relegated the lobotomy to rare circumstances, and Freeman’s reputation deteriorated. Today, despite significant advancements in technique, oversight, and ethical scrutiny, neurosurgical treatment of mental illness still carries a degree of social stigma.This review presents a historical account of Walter Freeman’s life and career, and the popularization of the lobotomy in the US. Additionally, the authors pay special attention to the influence of popular literature and film on the public’s perception of psychosurgery. Aided by an understanding of this pivotal period in medical history, neurosurgeons are poised to confront the ethical and sociological questions facing psychosurgery as it continues to evolve.

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Tài liệu tham khảo

Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD, : Deep brain stimulation for obsessive-compulsive disorder: a meta-analysis of treatment outcome and predictors of response. PLoS One 10:e0133591, 201510.1371/journal.pone.013359126208305

Baumeister AA: The Tulane Electrical Brain Stimulation Program a historical case study in medical ethics. J Hist Neurosci 9:262–278, 200010.1076/jhin.9.3.262.1787

Bergfeld IO, Mantione M, Hoogendoorn ML, Ruhé HG, Notten P, van Laarhoven J, : Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: a randomized clinical trial. JAMA Psychiatry 73:456–464, 201610.1001/jamapsychiatry.2016.015227049915

Boockvar JA, Virella A, Kotapka M, Flamm ES, Grady MS: Neurosurgery at the University of Pennsylvania Medical Center. Neurosurgery 46:1223–1228, 20001080725510.1097/00006123-200005000-00040

Braslow JT, Starks SL: The making of contemporary American psychiatry, Part 2: therapeutics and gender before and after World War II. Hist Psychol 8:271–288, 200510.1037/1093-4510.8.3.27116217884

Clifford G (director)Frances [film]. Universal City, CA: Universal Pictures, 198210.1016/j.wneu.2012.07.010

Diefenbach GJ, Diefenbach D, Baumeister A, West M: Portrayal of lobotomy in the popular press: 1935–1960. J Hist Neurosci 8:60–69, 19991162413810.1076/jhin.8.1.60.1766

El-Hai J: The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness. Hoboken: Wiley, 200510.1016/j.wneu.2012.07.010

Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, : A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:730–739, 201610.1056/NEJMoa160015927557301

Faria MA Jr: Violence, mental illness, and the brain—a brief history of psychosurgery: part 1—from trephination to lobotomy. Surg Neurol Int 4:49, 201310.4103/2152-7806.11014623646259

Feldman R, Bailey RA, Muller J, Le J, Dirani R: Cost of schizophrenia in the Medicare program. Popul Health Manag 17:190–196, 20142415666510.1089/pop.2013.0062

Feldman RP, Goodrich JT: Psychosurgery: a historical overview. Neurosurgery 48:647–659, 200110.1097/00006123-200103000-0004111270556

Forman M (director): One Flew Over the Cuckoo’s Nest [film]. Beverly Hills: United Artists, 1975

Freeman W: Charles H. Frazier, in Walter Freeman and James Watts Collection, 1918-1988, Collection No. MS0803.UA. Washington, DC: George Washington University Special Collections Research Center (https://library.gwu.edu/ead/ms0803.xml) [Accessed July 10, 2017]

Freeman W: Letter from Walter Freeman to Egas Moniz, May 25, 1936, in Walter Freeman and James Watts Collection, 1918-1988, Collection No. MS0803.UA. Washington, DC: George Washington University Special Collections Research Center (https://library.gwu.edu/ead/ms0803.xml) [Accessed July 10, 2017]

Freeman W: Neuropathology: The Anatomic Foundation of Nervous Diseases. Philadelphia: W.B. Saunders, 193310.1016/j.wneu.2013.08.002

Freeman W, Watts J: Prefrontal lobotomy in the treatment of mental disorders. South Med J 30:23–31, 193710.1097/00007611-193701000-00005

Gostin LO: Psychosurgery: a hazardous and unestablished treatment? A case for the importation of American legal safeguards to Great Britain. J Soc Welfare Law 4:83–95, 198210.1080/09649068208414572

Henry T: Brain operations by D.C. doctors aids mental ills. Washington Evening Star. November 20, 1936.

Jimenez F, Nicolini H, Lozano AM, Piedimonte F, Salin R, Velasco F: Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders. World Neurosurg 80:S30.e17–S30.e25, 2013

Jung HH, Kim SJ, Roh D, Chang JG, Chang WS, Kweon EJ, : Bilateral thermal capsulotomy with MR-guided focused ultrasound for patients with treatment-refractory obsessive-compulsive disorder: a proof-of-concept study. Mol Psychiatry 20:1205–1211, 201510.1038/mp.2014.15425421403

Lee S, Rothbard A, Choi S: Effects of comorbid health conditions on healthcare expenditures among people with severe mental illness. J Ment Health 25:291–296, 201610.3109/09638237.2015.110142026654582

Leksell L: The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 102:316–319, 195114914373

Miller A: The lobotomy patient—a decade later: a follow-up study of a research project started in 1948. Can Med Assoc J 96:1095–1103, 196710.1016/j.wneu.2012.07.010

Moniz E: Essai d’un traitement chirurgical de certaine psychoses. Bull Acad Med 115:385–392, 1936

Moniz E: Letter from Egas Moniz to Walter Freeman, June 24, 1936, in Walter Freeman and James Watts Collection, 1918-1988, Collection No. MS0803.UA. Washington, DC: George Washington University Special Collections Research Center (https://library.gwu.edu/ead/ms0803.xml) [Accessed July 10, 2017]

Naesström M, Blomstedt P, Bodlund O: A systematic review of psychiatric indications for deep brain stimulation, with focus on major depressive and obsessive-compulsive disorder. Nord J Psychiatry 70:483–491, 20162710355010.3109/08039488.2016.1162846

Nijensohn DE: Prefrontal lobotomy on Evita was done for behavior/personality modification, not just for pain control. Neurosurg Focus 39(1):E12, 201510.3171/2015.3.FOCUS1484326126398

Nijensohn DE, Savastano LE, Kaplan AD, Laws ER Jr: New evidence of prefrontal lobotomy in the last months of the illness of Eva Perón. World Neurosurg 77:583–590, 201210.1016/j.wneu.2011.02.036

Nuttin B, Wu H, Mayberg H, Hariz M, Gabriëls L, Galert T, : Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry 85:1003–1008, 20142444485310.1136/jnnp-2013-306580

Park RJ, Singh I, Pike AC, Tan JO: Deep brain stimulation in anorexia nervosa: hope for the hopeless or exploitation of the vulnerable? The Oxford Neuroethics Gold Standard Framework. Front Psychiatry 8:44, 201710.3389/fpsyt.2017.0004428373849

Phillips M: The lobotomy files: one doctor’s legacy. Wall Street Journal. December 12, 2013 (https://www.wsj.com/articles/the-lobotomy-files-one-doctor8217s-legacy-1386804524) [Accessed July 10, 2017]10.1016/j.wneu.2013.08.002

Plath S: The Bell Jar. New York: HarperCollins, 2005

Pressman JD: Richard H. Shryock medal essay. Sufficient promise: John F. Fulton and the origins of psychosurgery. Bull Hist Med 62:1–22, 1988

Robison RA, Taghva A, Liu CY, Apuzzo ML: Surgery of the mind, mood, and conscious state: an idea in evolution. World Neurosurg 80:S2–S26, 201310.1016/j.wneu.2013.08.002

Rovit RL, Couldwell WT: A man for all seasons: W.W. Keen. Neurosurgery 50:181–190, 200211844249

Rowland LP: Walter Freeman’s psychosurgery and biological psychiatry: a cautionary tale. Neurol Today 5:70–72, 200510.1097/00132985-200504000-00020

Scoville WB: Selective cortical undercutting as a means of modifying and studying frontal lobe function in man; preliminary report of 43 operative cases. J Neurosurg 6:65–73, 194910.3171/jns.1949.6.1.006518106833

Sheehan JP, Patterson G, Schlesinger D, Xu Z: Gamma Knife surgery anterior capsulotomy for severe and refractory obsessive-compulsive disorder. J Neurosurg 119:1112–1118, 20132382981610.3171/2013.5.JNS13201

Shutts D: Lobotomy: Resort to the Knife. New York: Van Nostrand Reinhold, 1982

Widge AS, Ellard KK, Paulk AC, Basu I, Yousefi A, Zorowitz S, : Treating refractory mental illness with closed-loop brain stimulation: progress towards a patient-specific transdiagnostic approach. Exp Neurol 287:461–472, 201710.1016/j.expneurol.2016.07.02127485972

Williams T: Suddenly Last Summer and Other Plays. London: Penguin Books, 2010