On Sun, 3 Aug 2008 21:02:55 -0700, in alt.support.schizophrenia "Quiet Neighbor"
<private@spamless.net> wrote:
>
>"Sue Bilkers" <sueb@incus.com> wrote in message
>news:8u5c94dttq09gslpovft4qdichp80208ho@4ax.com.. .
>>
>>
>>
>> They don't have a clue.. look at all the so called "treatments" from
>> Electro
>> shock to beatings to cold sheets to chemical lobotomies to insulin shock.
>> They
>> are just experimenting on us. They don't have a clue but they know that
>> the
>> drudge have a huge profit margin and doctors are getting kickbacks of up to
>> $200,000 a year from drug companies.
>>
>>
>> On Sun, 3 Aug 2008 13:38:44 -0700, in alt.support.schizophrenia "Quiet
>> Neighbor"
>> <private@spamless.net> wrote:
>>
>>>I know there is a lot of theory on how the anti-psychotics work..
>>>However,
>>>to the best of my knowledge the state-of-the-art of brain science is an
>>>order of magnitude away from understanding how normal brains work.
>>>
>>>Research on neutralistic seems to be a combination of guesses and
>>>experimental discoveries.
>>>
>>>With unknown causes the schizophrenics can only be modified with drugs.
>>>The
>>>researchers get better and better at using drugs to hide the symptoms of
>>>diseases they do not understand.
>>>
>>>This recent info on protein cleaving is a glimmer of hope for improved
>>>treatments, but the causes remain obscure.
>>>
>>>(I don't belike that there is an excess of particular dopamine receptors,
>>>for example.)
>>>
>>
>
>Then we agree.
>
>I'm almost afraid to ask, but what is a "chemical lobotomy?"
>
Thorazine when it first came out was advertised as a chemical lobotomy. At the
time lobotomies were common so the thorazine was sold as and new and improved
type of lobotomy much more confinement then surgical lobotomy.
VALENSTEIN: It started in the middle to late ’50s, at the time of the
introduction of neutralistic drugs--Thorazine and some of the antidepressants.
There was a whole group of them that came out in the late 1950s. They were often
given in massive doses, and they seemed to be producing the same kind of effects
as a lobotomy. If you’ve seen anybody on drugs like Thorazine, their face is
expressionless and the saliva’s dripping out of the corner of their mouth.
People referred to Thorazine as a chemical lobotomy, and it was much more
convenient than performing surgery. It was more cost-efficient because it didn’t
require a neurosurgeon and it didn’t require intensive postoperative care. So it
very quickly replaced the operations.
STAY FREE!: And the popular media didn’t play a role in that?
VALENSTEIN: No, not really. It was just that within the institutions themselves
there was a switch. People just sort of forgot about lobotomy when the
physicians began to use drugs.
STAY FREE!: Was there also a social or political backlash against the procedure,
kind of what you see going on today against the "talking cure"?
VALENSTEIN: No, there wasn’t, for several reasons. The custom of attacking
medicine and even suing for malpractice didn’t exist at that time, or was almost
nonexistent. Doctors were rarely questioned about anything they tried, and
institutionalized patients were completely at the disposal of the staff in terms
of treatment. And it was almost considered unethical for physicians to criticize
other physicians, which certainly isn’t the case now. So there was a
surprisingly little amount of criticism of lobotomy. There were certainly
psychiatrists who didn’t like the procedure at all and were critical among
themselves. But in terms of public statements and articles in medical journals,
criticism was scarce until the end of the heyday of lobotomy. The backlash
against lobotomy actually came up in the ’70s, when there was a fear of a
revival of the operation and people began to talk about the horrible things that
happened during the lobotomy period.
Search
Better Living Through Lobotomy: What can the history of psycho surgery tell us
about medicine today?
An Interview with Elliott Valentines
By Allison Xanthic Miller | Issue #21
In the mid-1930s, the eminent Portuguese neurologist Egad Monica, nearing the
end of his career, was anxious to secure his reputation in the annals of
science. He attended a medical symposium where a researcher reported marked
behavioral changes in two chimpanzees after he had removed the frontal lobes of
their brains; Monica decided to try something similar in humans. His first
operations (performed by a colleague, because Monica suffered from crippling
gout) consisted of injecting alcohol into several holes in the patients’ skulls.
He soon moved on to cutting brain tissue by inserting an instrument comparable
to a long, thin apple corer into the skull and twisting it around. As modified
over the next fifteen years by other physicians, this procedure became one of
the most widely prescribed treatments for serious mental illness: lobotomy. For
this contribution to medicine, Monica won the Nobel Prize in 1949.
Of course, lobotomy now seems like a medically sanctioned form of torture. The
main theory behind it was that anxiety and agitation could be quelled by
severing the emotional center of the brain from the part that controls
intellect, but the evidence to support this idea was meager. The person
performing the surgery usually couldn’t even see what he was cutting, and
doctors considered patients "cured" after minimal follow-up. Yet, as Elliott S.
Valentines points out in Great and Desperate Cures: The Rise and Decline of
psycho surgery and Other Radical Treatments for Mental Illness (Basic Books,
1986), "Even a surgeon who was convinced that he was not obtaining good results
seldom gave up lobotomy. It was difficult to admit that the effort had been
completely wasted, especially when other surgeons were reporting success. Rather
than abandoning psycho surgery, neuro surgeons much more commonly introduced
some change in the operation in the hope of increasing the success rate."
Though now out of print, Valentines’s book provides the best history of the
lobotomy’s heyday, in the 1940s and ’50s, a story that is not a medical
aberration but rather a cautionary tale. "The factors that fostered [the
operations’] development and made them flourish," writes Valentines, "are still
active today." Valentines, professor emeritus of psychology at the University of
Michigan, took time from his Fourth of July holiday to speak at length to Stay
Free! –Allison Xanthic Miller
STAY FREE!: It seems that in the 1930s, when Egad Monica was doing the first
lobotomies on humans, treating mental illness was urgent for some reason. The
new "somatic" treatments--not only lobotomy but insulin comas and electroshock
treatments [see sidebar]--weren’t just a way to help individuals, they were seen
as something that could help solve a great social crisis.
VALENSTEIN: Well, there was a social crisis, you’re right. Mental institutions,
particularly state institutions and large governmental institutions in all
countries, were becoming more and more overcrowded because there weren’t any
treatments for serious mental illness. They would try anything that held out
hope and wasn’t very costly. Mostly it was somatic treatments, which people
grasped at as a way of getting patients to a point where they could go home.
Governments were concerned about the rising costs of taking care of the mentally
ill, making legislators and the superintendents of institutions very receptive
to anyone who claimed that insulin treatment, electro convulsive shock, or fever
treatment would cure schizophrenia. These somatic treatments tended to be much
less costly and less labor intensive [than psychoanalysis].
STAY FREE!: Why were so many people in mental hospitals?
VALENSTEIN: Lots of people were mentally ill, just as there are many today. But
now they tend to be treated with drugs and outpatient care. If all of these
people were institutionalized, we would have the same kind of problem. Also,
there were some patients who were committed more for the convenience of the
husband or the family--wives who became mentally ill and troublesome. But I
think mainly it was that there’s always a baseline number of mentally ill, and
they kept accumulating in institutions.
STAY FREE!: Were the people who were lobotomized poor?
VALENSTEIN: Probably in most cases they were, but they weren’t all poor by any
means. Private sanatoria, where lobotomies were also performed, catered to
people who had money. It’s well known that President Kennedy’s sister Rosemary
was mentally retarded and became difficult to control when she reached her
twenties. Joseph Kennedy, the father, got the best medical advice he could at
the time from people at Massachusetts General Hospital, one of the most
prestigious places, and his daughter was lobotomized. It wasn’t a very good
outcome, and to this day she’s living in an institution.
STAY FREE!: I guess lobotomy would have been hard to avoid if you were in
psychiatry in the late ’40s and ’50s and you worked in a state hospital.
VALENSTEIN: That’s certainly true. People talked about psychoanalysis--ego and
superego and its and repressed early experiences. But using that for treatment,
particularly in state hospitals, was totally impractical, even if one judged
that it could be effective. Most people today would think that for seriously ill
people, psychoanalysis probably couldn’t help very much. Freud himself didn’t
think psychoanalysis was appropriate for people with schizophrenia.
STAY FREE!: So lobotomy was used to treat schizophrenia and affective disorders
[mood problems such as depression, mania, and bipolarity].
VALENSTEIN: At first it was considered for almost any kind of disorder. After a
while, it was limited to people with affective disorders, people with
obsessive-compulsive disorders. Very deteriorated schizophrenics did receive the
operation when it began to be performed on a huge scale [in the 1940s]. In the
literature, one can sense a feeling that the best results occurred with patients
who had depressive affective disorders, were manic or obsessive in a way that
prevented them from going on with their life.
STAY FREE!: Maybe it was the first time any treatment could actually produce a
change in their personality and their behavior.
VALENSTEIN: Yeah, probably that’s true. There are records from state hospitals
that have come out since I’ve written the book which say that "We’ve tried one
lobotomy on a patient and tried electro convulsive shock, and they’re still
unmanageable. We ought to consider doing a second lobotomy." It was very common
to do a second procedure if the first one didn’t work or didn’t calm a patient
down.
STAY FREE!: How would they adapt the procedure to do it a second time? I mean,
presumably they’ve cut the thing already.
VALENSTEIN: Yeah, but, for example, [Walter Freeman and his partner,
neurosurgeon James Watts] had kind of a standard procedure and a more radical
procedure. The more radical meant that they essentially cut more; they disrupted
more of the connections to the frontal lobes. The literature is filled with
people who have had two and even three lobotomies.
STAY FREE!: Did you ever meet anyone who had had a lobotomy?
VALENSTEIN: Oh, yes. Quite a few. They vary tremendously. Some, you would not
suspect that there was anything especially wrong with them. They may have seemed
a little shallow, but you might not even be struck by that. There were people
who went back to work and held responsible jobs after lobotomies, and others who
essentially became vegetables. Some became very impulsive and childish in their
behavior. The operations were so crude. Different parts of the brain were
damaged, and the outcomes varied widely.
STAY FREE!: Walter Freeman’s transorbital lobotomy did not even require a
surgeon or anesthesia. You wrote that Freeman, after electro shocking the
patient into unconsciousness, used a surgical ice pick to enter the brain
through the eye socket and moved the ice pick from side to side. He performed
these operations in nonmedical settings such as his office, and in one case, a
motel room. Was this invention a popular procedure?
VALENSTEIN: Oh, yes. Freeman spent his summers traveling in order to teach it.
Walter Freeman had quite a reputation in the medical field. He was on a lot of
boards that were setting up the credentialed of psychiatrists and neurologists.
And he was a very charismatic teacher. He had a lot of former students who
became hospital superintendents and were only too willing to have their former
professor come by and demonstrate a new technique. Freeman would train
psychiatrists on cadavers and watch them perform a few procedures, all within a
day and a half. And in the month or two following his departure, they would
perform twenty or thirty such procedures and write them up in the state medical
journals. This went on all over the country.
STAY FREE!: Walter Freeman is kind of the villain of Great and Desperate Cures,
if there is one.
VALENSTEIN: Well, I try to describe him in a more complicated way. First of all,
he was a very smart man. He knew the literature very well, he knew a lot of
anatomy, and he had a rationale for lobotomy, which made some kind of sense in
terms of what specific nerve tracts he thought should be cut. He was very
concerned about his patients and he followed them up in a very conscientious
way, out of his own pocket. I tried to describe him in terms of the conditions
that existed at the time, and his belief that these patients were going to
deteriorate, for which there was some justification because the state hospitals
were very unhealthy. He did have cases in which people were able to be
discharged after operations and went home to their families. Some held jobs, a
few even held responsible jobs. So he was convinced that he was helping to clear
out the state hospitals and really believed he was doing a good thing. I talked
at length to one of Walter Freeman’s sons, Walter Freeman III, because I knew
his father had written an unpublished autobiography. He was a little reluctant
to share it at first. After my book came out, he sent me a letter, and I was
really concerned about his reaction to the book, but he paid me the nicest
compliment. He said he went out after reading the book and bought five copies to
give to his children so they would know something about their grandfather. So I
felt that I had not described him simply as a villain. I think to do that tends
to trivialities the whole story--saying there’s an evil man out there or a group
of men and they did evil things, viewing it only in that context of abnormality.
It was not an abnormality. It was something that was praised. You know, the
Nobel Prize was given to the Portuguese neurologist who introduced prefrontal
lobotomy, Egad Monica.
STAY FREE!: It’s very touching that Freeman sent Christmas cards to all his
lobotomy patients.
VALENSTEIN: That’s right. He mailed thousands of them and made great efforts to
follow up with his patients.
STAY FREE!: He seemed to be very media savvy, judging by both what he was
publishing in the medical journals and in how he dealt with the popular press.
VALENSTEIN: There’s no question that he liked publicity. Practically every time
he went to a meeting, he packed the audience with reporters he knew, and it was
written up in Time magazine, The New York Times, or Life. Media coverage played
a huge role in popularizing the lobotomy. When Freeman went around to the state
hospitals in little rural areas, the local newspaper would make his visit the
lead article. And the superintendents of these places encouraged that because it
made them look good: here they are out in the boondocks and a famous doctor has
visited them.
STAY FREE!: Did Freeman ever contact the local newspaper before he got there?
VALENSTEIN: He probably suggested it at times, but the superintendents would be
only too happy to do it on their own. It not only gave them publicity, it had
practical implications. You could take that to the state legislature and show
them how up-to-date your hospital was and how you needed more funding and things
of that sort. But these articles in the popular media just generated a demand
for the procedure.
STAY FREE!: Was the medical media establishment as big as it is now? We see news
stories every night about some breakthrough.
VALENSTEIN: I’d hesitate to make a comparison, but everyone in those days--I can
remember having lived through them--got Time magazine or sat in a barber chair
and looked through Life magazine. There were three or four large articles on
lobotomy in the Saturday Evening Post or Life, all suggesting that people who
were hopeless could be cured. There wasn’t television, so we didn’t get
bombarded the way we are today, but I think almost everyone browsed through
those magazines. These state asylums were also being covered in all kinds of
articles and books about how horrible they were. Life actually compared
them--unjustifiably--to concentration camps. Right after the end of the war,
when all the pictures of all the camps were being revealed, Life ran pictures of
mental patients, nude, sitting on concrete steps in big halls and rooms that
just reeked of excrement.
STAY FREE!: Why did lobotomy go into decline?
VALENSTEIN: It started in the middle to late ’50s, at the time of the
introduction of neutralistic drugs--Thorazine and some of the antidepressants.
There was a whole group of them that came out in the late 1950s. They were often
given in massive doses, and they seemed to be producing the same kind of effects
as a lobotomy. If you’ve seen anybody on drugs like Thorazine, their face is
expressionless and the saliva’s dripping out of the corner of their mouth.
People referred to Thorazine as a chemical lobotomy, and it was much more
convenient than performing surgery. It was more cost-efficient because it didn’t
require a neurosurgeon and it didn’t require intensive postoperative care. So it
very quickly replaced the operations.
STAY FREE!: And the popular media didn’t play a role in that?
VALENSTEIN: No, not really. It was just that within the institutions themselves
there was a switch. People just sort of forgot about lobotomy when the
physicians began to use drugs.
STAY FREE!: Was there also a social or political backlash against the procedure,
kind of what you see going on today against the "talking cure"?
VALENSTEIN: No, there wasn’t, for several reasons. The custom of attacking
medicine and even suing for malpractice didn’t exist at that time, or was almost
nonexistent. Doctors were rarely questioned about anything they tried, and
institutionalized patients were completely at the disposal of the staff in terms
of treatment. And it was almost considered unethical for physicians to criticize
other physicians, which certainly isn’t the case now. So there was a
surprisingly little amount of criticism of lobotomy. There were certainly
psychiatrists who didn’t like the procedure at all and were critical among
themselves. But in terms of public statements and articles in medical journals,
criticism was scarce until the end of the heyday of lobotomy. The backlash
against lobotomy actually came up in the ’70s, when there was a fear of a
revival of the operation and people began to talk about the horrible things that
happened during the lobotomy period.
STAY FREE!: What brought on the backlash? How did that come about?
VALENSTEIN: Well, there were some scientists who argued that, since we now know
a lot more about the brain, psycho surgery should be revisited. This was at a
time when there was a lot of public concern about violence in the streets. Two
doctors, Frank Ervin and Vernon Mark, had published a book called Violence and
the Brain, which argued that brain abnormalities can cause violence. Word got
out that the Department of Justice, which maintains federal prisons and special
prisons for violent inmates, had some exchanges with the authors. There was a
lot of suspicion that the Department of Justice was going to perform massive
psychosurgical procedures on violent prisoners as a means of social control. So
it became a big issue in some circles. I was at some neuroscience meetings that
discussed the biology of aggression, and people came in and broke up the meeting
and demanded time on the program.
STAY FREE!: Was there any truth to the rumors that lobotomy was being performed
in prisons?
VALENSTEIN: Well, I did some investigation, and there were suspicious things
happening in one prison in California. When I wrote, the warden was very open
and sent me material. It turned out that there were a few operations performed
on prisoners--people who had seizures and behavior abnormalities associated with
the seizures, and the operations were really done in part at least to ameliorate
the number of seizures, which is not uncommon. But these people also had violent
outbursts sometimes associated with the seizures. In general, that’s sort of a
fuzzy borderline between psycho surgery and neurological surgery. Still, I think
the reports of what went on there were grossly exaggerated. But there was this
fear that there was going to be a revival of interest in lobotomy, and it became
a political and a civil rights issue because of the prevalence of minority
groups in prison. I became interested in the topic because in Brain Control
[published in 1973] I had talked a little bit about how certain neurosurgical
procedures were a result of misinterpreting animal experiments.
STAY FREE!: How did the people you were writing about respond to your work?
VALENSTEIN: All the people I talked to were quite open. Occasionally when I
would talk at meetings, a surgeon would stand up and say, "You don’t understand
what was going on; we really helped all of those people," clearly being very
defensive. But I talked to people who not only had performed some of the
procedures but had attempted to study what was going on and had a broader
perspective than, say, a clinician who had just performed the operations. Many
of the people I saw, even though they themselves had participated in it,
recognized that the exuberance that took place just went out of control.
STAY FREE!: What are the parallels between the lobotomy period and what’s going
on today? There’s a lot of enthusiasm for what used to be called somatic
treatment, going after mental disease as a physical set of symptoms. You wrote
about this in your latest book, Blaming the Brain.
VALENSTEIN: The influence of the pharmaceutical companies is so great these days
because of the resources they have at their disposal. There are tremendous
economic factors distorting the practice of medicine, just as there were in the
lobotomy period. It is hard to find any clinicians or researchers who don’t have
vested interests in the development of procedures or drugs. I mean that. Of
course, they will deny that funding from drug companies has an influence, but it
is so subtle that they’re unaware of it themselves. Studies have shown that if
you look at reports on drugs that are competing to treat the same patient
population, and if you look at the connection that the people doing the studies
have with the companies involved, the results that they find--not only the
opinions they express but the actual data--clearly reflect their own vested
interest. I don’t think people really lie, but it happens in very subtle ways,
like disqualifying patients because they are ill with something else. Those same
patients would not be omitted if their outcome supported the conclusions the
researcher wanted. And there are professional interests as well: psychiatrists
have to compete with social workers, clinical psychologists, counselors of all
sorts. Most people who seek help for a mental problem do not go to a
psychiatrist. So there’s a strong economic reason why psychiatrists are very
supportive of drugs: protecting their own turf. That’s not the only reason, but
it certainly has an influence.
###
See also: More than one way to skin a cat
electro convulsive (electroshock) therapy (ECT): In electroshock, a series of
electric pulses delivered to the brain causes a seizure. Today ECT is used most
often to treat major depression after drugs have failed. Scientists think it
works by altering electrochemical pro-cesses in the brain. ECT is controversial
due to side effects that include memory loss and, some argue, brain damage.
Fever treatment: Introduced in 1917 by injecting malaria into patients whom
syphilis had turned insane. Surprisingly effective, the treatment was widely
used before the rise of penicillin and antibiotics.
Insulin coma: In 1933 Manfred Sakel mistakenly gave a diabetic mental patient
too much insulin, which put her into a coma. After he revived the patient, her
psychological symptoms had improved, and the first form of shock treatment was
born.
Metrazol shock therapy: Introduced in 1934 as a safer, easier alternative to
insulin therapy. An injection of Metrazol induced an epileptic seizure.
From the archives 
Linear Mode
