16 October 2014

The Nobel Prize is awarded for exceptional achievements in science; the last will of Alfred Nobel reads as follows:
“It is my express wish that in awarding the prizes no consideration whatever shall be given to the nationality of the candidates, but that the most worthy shall receive the prize, whether they be a Scandinavian or not”.

In fact, sometimes great achievements and madness are closely related. This is the fine line which is easy to cross when chasing scientific results. The Nobel Prize laureate in Physics and Medicine, Egas Moniz, could tell us something about it. António Caetano de Abreu Freire Egas Moniz – to use his full name – was awarded the Nobel Prize in 1949 for his discovery of the therapeutic value of lobotomy in certain psychoses.

In the 1930s psychiatry and neurosurgery were not highly developed. In most cases, mentally ill persons were not treated but only isolated from society. This innovative technique, lobotomy, seemed to be a chance to treat such patients. Lobotomy is a surgical procedure which involves separation of the prefrontal cortex from the mid-brain. Depending on the applied technique, lobotomy may be prefrontal or transorbital. Egas Moniz conducted the first lobotomy procedure in 1935. He performed prefrontal lobotomy by drilling a hole in the patient’s head and then injecting pure alcohol into the brain.

Lobotomy was meant, among other things, to treat schizophrenia, depression or anxiety.
The first procedure was not entirely successful; the patient was unable to answer a question about who she was. Eventually, she was admitted to a psychiatric ward. Egas Moniz continued his studies. A year after the first lobotomy, he published a paper on the 20 operations he managed to perform. He did not obtain the results he had expected. Lobotomy failed to treat the cause of a disease, it only suppressed the symptoms, and the calmness of people undergoing lobotomy was falsely considered a positive effect of the procedure.

Moniz’s actions may seem insane, however he did not aim to pursue his objective at any cost and prove that lobotomy is the perfect solution. This cannot be said about the heir of the lobotomy procedure – Dr. Walter Freemann. We would now say that he was a celebrity. He had no licence to practice the profession of a surgeon, which in fact did not stop him from performing lobotomy. He was committed to promoting lobotomy across the entire United States and he believed that everybody should be able to perform such a procedure at home. Freeman conducted transorbital lobotomy; he injected a sharp device (most often an ice pick) between the eyeball and brow bone. Next, he twisted the device until the patient became completely calm.

Initially, lobotomy was performed only in mentally ill patients with depression, severe psychosis or schizophrenia. Freeman popularised lobotomy by way of turning a complicated procedure – as it seemed to be at the times of Moniz – into a spectacle. He conducted them mostly in the lights of camera flashes. The patient’s health meant nothing to him. His only concern was the fame he enjoyed thanks to the procedure. The procedures started to be performed in healthy persons who seemed to be hyperactive or moody. The age made no difference; the youngest patient was only four years old. However, the most well-known patient was John Kennedy’s sister, Rosemary, who was lobotomised due to her changing mood and interest in men. She spent the rest of her life in a hospital.

Even though lobotomy was not as prevalent outside the USA, it was performed in many other countries. It is now prohibited but permanently inscribed not only in the black pages of the history of medicine, but also in popular culture e.g. in the novel ‘One Flew Over the Cuckoo’s Nest’ and ’Shutter Island’.

Some patients died during the procedures. The exact number of deaths is not known (it is estimated to be about 4% of fatalities). We do not even know what the exact number of procedures performed is. What we know for sure is that lobotomy made patients completely dependent on others. Patients not only lost their sense of “self”, they were often unable to make independent decisions and eventually they suffered from consciousness disorders. This controversial procedure was abandoned with the invention of a new drug – Thorazine. Let us hope that science in the name of fame and applause will never again deviate from the path of bringing benefits to humanity.

Author: Damian Sojka

• Krzyżowski, J. 2010. Leksykon psychiatrii i nauk pokrewnych [Lexicon of psychiatry and related sciences]. Medyk [Medic], Warszawa.
• Kotowicz, Z. 2005. Gottlieb Burckhardt and Egas Moniz – Two Beginnings of Psychosurgery. Gesnerus 62:77–101

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