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of historical import with implications for today…

June 1, 2011

This brief post points to a very disheartening story, but one that all students of psychology should be familiar with. National Public Radio has a story about a man who was given a transorbital lobotomy at the age of 12. Known as the “ice-pick lobotomy”, the procedure was a particularly crude attempt at behavioral neurosurgery that was used widely during the 1950s and 1960s. Basically, a sharp instrument was inserted into the eye socket and was then agitated so that it tore away at the neural tissue (the brain) located in that area (a more complete description of the procedure can be found at the Discovery Health site). The practitioners had only a rough understanding of the brain structures that they were destroying, and little control over what disruption the procedure caused. Indeed, a later study found that the outcomes were roughly 1/3 positive, 1/3 fair, and 1/3 poor – the variability a result of a lack of control in what the procedure actually accomplished. The procedure would damage parts of the prefrontal cortex – a brain region that is structurally complex in that it connects to numerous other brain regions and is behaviorally complex in that it hosts neural processing associated with a wide range of cognitive functions (e.g. attention, problem solving, integration, emotional processing, comprehension, etc.). However, just what connections were disrupted and the degree of damage varied from patient to patient.

The subject of the NPR story, Howard Dully, has written a book about his experiences. The short version is that he was given the lobotomy essentially because he behaved like a preteen boy (moody, didn’t always listen, messy) and his family (especially his stepmother) did not want to deal with those behaviors. Howard was able to function after the procedure (which meant his outcome was not “poor” like some who had the procedure), but he was institutionalized when it did not “cure” him of the behaviors that had led to the lobotomy. He has struggled with the consequences of the damage to his prefrontal cortex throughout his life.

The lobotomy is no longer used as it once was. It was replaced largely by the introduction of psychotropic drugs in the 1960s. Still, the issues associated with the use of the lobotomy are very much alive today. When we attempt to treat people for mental illness, when we try to change behaviors, there are no quick fixes, and we need to proceed carefully. I worry at times that we have traded the ice-pick for the pill bottle, and that despite the amazing advances we have made in understanding the neural circuitry that underlies our behaviors, we are still at risk of creating new Howard Dullys. I am especially worried about this in light of the challenges our nation faces with economic instability, increases in poverty, veterans returning from war, and a focus on limiting health care costs. The treatment of mental illness has been tied to medical practices (and insurance) which has improved access for some, but it has also warped how we think about how we treat people and how they get that treatment. There was an interesting and informative special issue of The American Prospect that looked into several related issues. There is no way to go back to 1960 and return Howard Dully to his original state, but we can do all that we are able to avoid those kinds of mistakes in the future.

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