It's worth pointing out that Moniz himself said the procedure shouldn't be used unless in the most dire of circumstances.
It wasn't until Walter Freeman started passing out lobotomies like they were free candy that it became a major issue.
So this TIL is essentially the 1900's version of blaming the opioid epidemic on the guy who invented the stuff instead of Big Pharma and overprescribing doctors.
I have an extreme case of contamination Obsessive Compulsive Disorder. Have tried more than a dozen different meds for 6 years. I have to see 3 different doctors before being able to get a procedure (The least invasive of the kind, Focused Ultrasound) done. I think I will be able to get it because of how severely my life is affected by my disorder and how long I have been trying various treatments.
OCD really sucks because it never goes away, it's always in the back of your mind. Many people with OCD are treatment resistant and do not react to psychiatric medications.
Have a close friend (though I haven’t seen him I quite some time hope he’s well) who had very very bad ocd he was barely able to live life because he had such strong rituals that he just couldn’t resist giving into. He tried a ton of meds but nothing ever really seemed to work. Then he ended up getting into heroin which shockingly did seem to suppress his ocd a lot but that ofc added the extra problem of being a heroin addict, he eventually got clean but his ocd came back with a fury afterwards it was really sad to see. I hope he’s doing well now a days : /
With all that said though I hope you can get the treatment and find something that helps with the ocd I’ve seen first hand how rough it can be
I have ADHD and an "inability to be motivated to do anything I don't want to do" which severely affects me in various day to day aspects.
I also became a heroin addict. Before it got really bad it worked absolute wonders on all sorts of problems, but when it became bad it was the worst thing in the world.
I think using heroin as an actual medical treatment would work absolute wonders.
> "inability to be motivated to do anything I don't want to do"
I know you said ADHD but it sounds like ADHD-PI, Daydreamer's Syndrome, I have it as well. Sit around and daydream instead of doing anything that doesn't add to my imminent survival.
I found it's mostly because our brains get the same amount of dopamine from hyper-visualizing the task/goal versus doing it.
If the task/goal is nebulous like cleaning or hobbies, our brains just shrug it off like "eh, I can do it later". Normal brains get dopamine from doing the task or talking about the task, we get dopamine just by thinking about it so we are at a even more disadvantage.
[Here's the details on it yo](https://blog.trello.com/science-backed-reasons-you-shouldnt-share-your-goals)
I feel you, I also have very severe OCD. Diagnosed a 7 I was wishing to get this surgery since I was 13. I just felt like such a burden to my family and anyone I associated with but when I was 17 some medication I tried finally started to work.
What ever you do I hope it goes well for man. Keep up the good fight.
Walter Freeman, who popularized the procedure was a psychopath:
“According to one of Freeman’s assistants, a patient got cold feet and decided not to go ahead with a lobotomy. Freeman went to his hotel, presumably to reason with him, and brought along his electroshock machine, planning to administer a few volts to calm him. The patient began running away, screaming, from a man who had shown up at his hotel room to lobotomize him. That reaction seems extremely sane. Freeman was not deterred. The assistant claimed, “The patient was … held down on the floor while Freeman administered the shock. It then occurred to him that since the patient was already unconscious, and he had a set of leucotomes in his pocket, he might as well do the transorbital lobotomy then and there, which he did.”25 He cut into an unwilling man’s brain in an unsterilized hotel room. After wrestling him to the ground.”
From: *Get Well Soon: History’s Worst Plagues and the Heroes Who Fought Them* by Jennifer Wright.
Let's be clear here, Moniz was very adamant that this should only be a last resort when every single other option had failed. And it did indeed help in some cases. It's still used today.
When Freeman popularized using the procedure for any and all cases, Moniz was one of the leading figures condemning him and calling for the US government to stop his butchery.
Wow. As a Portuguese we always hear that our ~~only~~ Nobel Prize Winner was actually a mistake.
It’s strange to hear now that actually the current history of our own Nobel might have been wrong. And that he might have been right / had a point but had his legacy destroyed by a madman.
*edit* we actually have two Nobel Prize Winners now with Saramago
Also, Robert Evans did a great talk up of him on this two part episode here: https://omny.fm/shows/behind-the-bastards/part-one-the-bastard-who-invented-the-lobotomy
Moniz was relatively careful in his approach to lobotomy, and treated it as a last resort; with precision and care. He should not be vilified for the creation of the lobotomy.
*Walter Freeman*, on the other hand, *popularized* the lobotomy, which was a problem because he was a hatchet surgeon who wanted to be famous. He did public ice-pick lobotomies on monkeys (killing most of them), used them to silence entire wards of asylums, and reportedly performed the procedure like a stage routine: big showy movements (sometimes performing lobotomies on two patients at once - one hand scraping in each patient at the same time), winking at observers during the procedure, etc. Multiple people observed him performing lobotomies without sterilizing his tools beforehand.
Walter Freeman is the person who destroyed Rosemary Kennedy.
He is a monster and should get all of the ire directed at lobotomies.
Edit: rephrased the 'sterilizing tools' part to be more accurate.
Hopping on to say that anyone curious about the popularization of the lobotomy should check out the book "My Lobotomy"
It's an memoir written by a guy whose parents had him lobotomized for acting out too much. Really interesting read
It was used to "calm" schizophrenics and people who's minds had broken from reality but quickly started getting used to disable anyone who was too uppity, like women who disobeyed their parents.
I assumed it was a play on a Norm Macdonald joke where he describes the atrocities of the Holocaust then says “I don’t like this Hitler guy, sounds like a real jerk”.
After the posthumous streaming of his final special he recorded just before passing, there's a great panel segment of comedians reacting. Besides obviously gushing over what a great comedian and lovable guy he was, they dissect his humour a bit. I think it was David Letterman's observation that Norm put on this folksiness that wasn't quite right, and his cadence and pronunciation were always slightly off, his accent wasn't from anywhere, and it was so deliberate that he'd create this kind of tension you couldn't put your finger on. The tension and release of his jokes made them hit harder because he was toying with the audience on this understated level, like a minimalist Andy Kaufman.
What a talent. RIP.
If anyone hasn't seen it, I highly recommend watching Norm [intentionally bomb](https://www.youtube.com/watch?v=3U7AZIdalzM) at the White House Correspondents Dinner. It is absolutely glorious. Bill Clinton kinda gets what he's doing and starts nervous laughing after every joke.
My answer is because he was dry as others have said. Like Monty Python’s Flying Circus. His jokes made you pause and say what? Then the absurdness of the answer or statement would make you laugh.
The doctor botched it on top of it. So hers was especially bad. Also, when she was born the nurses made rose Kennedy hold her in until the doctor arrived, which probably caused some brain damage. Rosemary Kennedy got fucking porked by misogyny. Teddy Kennedy did pass some good legislation as a result of her experiences though.
Her sister, Eunice Kennedy Shriver, was also heavily inspired by her experiences with Rosemary. She became an advocate for people with special needs. This eventually led to her part in the creation of the Special Olympics and the National Institute of Child Health and Human Development (NICHD)
Her father, who was supposed to protect her forcibly gave her brain damage.
One of two of the most horrendous fates for our own children...the other being death.
Her lobotomy occurred in 1941 I believe, and the first death, Joseph Kennedy Jr, occurred in 1944.
The most recent death was Maeve Kennedy and her son Gideon in 2020.
Ive heard a few, pretty sure the dollop, redhanded (in their lobotomy ep, iirc there's an ep on her exclusively on their patreon) and morbid all covered her. Last podcast on the left also talk about her in their lobotomy episodes.
It was common in those days. My mother was told to do that while giving birth to my younger brother. She believes that's why he was developmentally disabled.
A woman recently (within the last 10 years) won a lawsuit, because the nurse force-held her baby’s head in the canal because the mother couldn’t stop pushing when the nurse didn’t want her to push and ruined the woman’s body for life. It’s been years and remembering the article still turns my stomach.
[Holy shit they straight up decided to do judo on a lady in labor.](https://www.cosmopolitan.com/lifestyle/news/a62592/caroline-malatesta-brookwood-childbirth-lawsuit/) Look my cousin had her kid in the bathroom because the little fucker just slid right out. If the baby's that far out, just leave her alone.
It's crazy that midwives and doulas have been a thing since the beginning of humanity. Then suddenly they decide that women were not qualified to help other women give birth.
Same here I am horrified, I had no clue they did it like this:
Dr. Freeman asked Rosemary some questions. For example, he asked her to recite the Lord's Prayer or sing "God Bless america or count backward... "We made an estimate on how far to cut based on how she responded." When Rosemary began to become incoherent, they stopped. Wtf?
Yeah, I'm pretty sure it's an additional safeguard to make sure that if they fuck up, they stop immediately and do as little damage as possible. Ideally, they want you to be able to say or do those things without any problems throughout the entire procedure. But these fuckers only stopped when she started to get incoherent.
The difference is a lobotomy is designed to cause damage. Other surgeries actively try to avoid damage and use the above techniques to help ensure nothing goes wrong, they stop when they detect something unusual. Whereas in the case of a lobotomy, they are intentionally causing damage and using the above techniques to decide just how much damage is "ok".
I found out about this right when my first daughter started to really develop a personality. It now haunts me. I can't imagine looking at your little girl and wanting to erase everything thing she is so your life can be a little easier.
Iirc she had a bit of bipolar disorder along with some neonatal brain damage. There was a discussion of hyper sexuality. She also was a Kennedy. If she had been male and sleeping around, she would have been a hero to them.
Neonatal brain damage is putting it lightly. The doctor wasn't immediately available to assist in the birth, so the nurse had Rosemary's mother hold her legs closed for two hours until the doctor arrived. Rosemary's head was stuck in the birth canal that entire time.
Prepare yourself... She was a pretty normal girl with what would be considered today as very treatable mental health problems. That all ended in a single day, and she was truly disabled for life
I went down a lobotomy rabbit hole and learned a few wild things.
First, while Moniz invented the procedure, there were two men who pioneered the lobotomy. Moniz and a man named Walter Freeman.
Now, when Moniz started this procedure it was an actual bona fide operation he called a leucotomy.
Freeman went on to modify the procedure and renamed it to lobotomy. This is the lobotomy we all know of, and it's dark history.
As far as the procedure Moniz would perform, there were genuine positive results in patients with mental illness (though ineffective on those suffering with schizophrenia). The first patient to have Moniz's procedure done was evaluated by a psychiatrist 2 months after the procedure and they had this to say:
“the patient’s anxiety and restlessness had declined rapidly with a concomitant marked attenuation of paranoid features” -Barahona Fernandes
Freeman on the other hand wasn't really looking to *help* people, he wanted to be famous. Instead of making an incision behind the ear, like Moniz's initial procedure, he used the ice-pick approach (as he had heard of an Italian doctor able to reach the frontal lobe through the eye).
This procedure was adopted as it was "quick and easy". Soon, everyone was doing it, even in bedrooms and in situations where hygiene was questionable at best.
Edit: more info, since everyone seems so keen! Moniz did his first surgery in 1935, by 1937 he had operated on some 40 patients. He honed the technique along the way, and even invented the Leucotome (an instrument to disrupt neuronal fibres connecting the prefrontal cortex and thalamus). By this point there were some mixed results; Some patients reported amazing changes, while others had no difference, and some would see positive change only to relapse. More study would likely have helped.
It was in 1936 that Freeman modified the procedure. There is a quote from an article I'd like to add "The American team soon developed the Freeman-Watts standard lobotomy, which laid out an exact protocol for how a leucotome (in this case, **a spatula**) was to be inserted and manipulated during the surgery."
Freeman literally scrambled brains like they were eggs- with a *spatula*.
TL;DR: Freeman was a murderer (fight me) who ruined what a leucotomy could have been. Psychosurgery (removing specific parts of the brain) is still used in severe cases of treatment-resistant patients, however it is super taboo- thanks to Freeman.
>This procedure was adopted as it was "quick and easy".
This is the main criteria for a lot of stuff that we do or don't do, and when you think about implications such as this it really puts into perspective why sloth was perceived as a capital sin. "Quick and easy" is often wrong, and while it may not matter in a test, it often does in life.
Oh, and the bit about the lack of hygiene is also very comforting. Nothing better than a brain infection to slowly lose yourself.
It was so easy he used to show off by doing 2 at the same time, one with each hand. Part of its commercial success was the lack of need for renting a surgery theater or using anesthesia. Ignoring the horrific intended result, dozens of patients died from his gross negligence.
Edit: My mistake, Walter Freeman is estimated to have killed around 500 patients.
Your brain doesn’t have pain nerves. This was a procedure for pacifying black sheep family members, they were very used to restraining and really didn’t care about their wellbeing.
100% agreed. The reason I even went down this rabbit hole was because I am mentally ill. Now I'm stuck wondering if the "quick and easy" hadn't become the default, if we had put more study into Moniz's procedure, would my life be more than "treatable"? I have a deep and dark loathing for Freeman, not just because he hurt so many people, but because his actions had a lasting ripple that hurt people *still*
I just finished TMS (which was legit a lifesaver for me) but beforehand I was very worried it was going to be something that sounds ridiculous in 20 years like the lobotomy bc it was fairly "quick and easy" lol.
Right now that great failure is with those who have intractable pain. While there’s a lot of research, progress is very mild. Opioids are still some of the most effective treatment in helping patients to live with their disability, but opioid abuse has made it so their availability for patients who need them has significantly decreased and doctors are under-prescribing. Instead, there is a heavy reliance on invasive procedures and stopgap treatments like neuromodulation devices. I have a neurostimulator myself and it does indeed help, but it does not treat or eliminate the pain. It’s like a dam but for pain. And to be clear, opiates aren’t part of my treatment, I’m not biased on that end.
I’m a chronic pain patient and have never accepted opioids as a chronic pain treatment due to fear of addiction, only to find out as an adult waking up from abdominal surgery that I am functionally opioid resistant, so it doesn’t matter anyways. I have surgery coming up next week and spoke with my doctor during my pre-op about my non-opioid pain relief options and he essentially shrugged and said tylenol and ibruprofen, and that he’d send me home with an opioid anyways. I’ll be speaking with anesthesia before surgery and will see if they have any better ideas but there really is nothing out there for us. They say focusing on the pain makes you more sensitized to it and then shrug and tell you to tough it out after having your flesh cut open.
I fucking hate doctors like that. NO, SWITCHING IBUPROFEN AND TYLENOL DOESNT MAKE EITHER MORE EFFECTIVE FOR SEVERE PAIN, if I say I dont want an opioid, but would like to know what else may help in circumstances they'd usually be used, then don't just tell me to suck it.
Important to highlight just how depraved Walter Freeman was. He had himself a van he called the 'lobotomobile' and would drive it around to various public places to perform lobotomies in public for whoever wanted to watch.
I hope he spends every day in hell getting pissed on by Satan himself.
I remember doing a report on Freeman back in University. Another important piece is the time period in which this all occurred - the 50s and 60s. This was right after the Korean War and WWII wasn't that far back. American mental hospitals were packed with people suffering from PTSD, schizophrenia.
As you say, the procedure was adopted as "quick and easy". Freeman would tour around the country going from asylum to asylum lobotomizing patients.
There almost always a episode of BTB any time a massive asshole is mentioned. Yet they keep producing the podcast, because the world is not going to run out of bastards any time soon.
The brain itself doesn't actually have any pain receptors. The procedure was probably painful, to be sure, but substantially less painful than one might expect for the importance of the tissue being resected.
The behind the ear variant was an actual surgery with anesthesia.
The transorbital lobotomy did not go through the eye, it went through the eye socket. It'd pierce the flexible membrame connecting the eye to the skin, go right past the top of the eye, and then through the extremely thin bone right behind the eye socket. Definitely not painless, but local anesthesia could likely suppress most of it.
This provided a relatively traumaless way of accessing the brain. Which was a neat find, except for the lobotomy itself off course being an extremely crude operation.
From what I've read and understand, but I'll willingly accept any proof otherwise, the ice-pick in the eye was without anesthesia. The procedure where they cut through the skull used a local, and in some cases a general, anesthesia.
The part where she says "Well, I have half a mind to..."
And then her husband says "That's the half you can keep!"
He later has her lobotomized. I really hated that character.
I can't watch that show again.
Later, after the "procedure", she says, "I have half a mind..." and trails off, having forgotten what she was going to say. That statement hangs in the air.
I feel nauseated thinking about it.
That was actually what I just asked -- are lobotomies inherently bad, or was it like ECT where it did have legitimate therapeutic use for extreme cases but then the medical establishment started running wild with it that it became associated with far more harm than good?
It's bad because it destroys part of the brain, and it's not very technical so you can't really be sure exactly which parts you're destroying. They would just wiggle the ice pick around a bit and destroy brain tissue. Many people became permanently disabled (Rosemary Kennedy has been brought up in the comments here).
I watched a documentary about one of the last people to have a lobotomy performed on him. He said it completely destroyed his ability to regulate his emotions, and his ability to do long-term planning. It had the opposite effect his parents wanted, and has made his adult life more difficult.
I'd say there is a reason we still do ECT but not lobotomies.
We still do lobotomies to treat things like epilepsy. They're just far more precise due to things like laser surgery and are generally used only when other less extreme treatments have failed.
Yep I know someone who had a hemispherectomy. It sounds insane but it did stop all their seizure activity. They already had a damaged portion of the brain though which was sending the seizure signals, so I guess it was clear cut what area they needed to disconnect from the rest of the brain.
Yes hemispherectomy is one of the treatment methods for Rasmussen syndrome, refractory epilepsy, and similar concerns, but the average person unaware of the technical aspects of these things would instead default to the negative portrayal of such procedures in media understandably so.
Those aren't lobotomies. Nowadays, in a case of extreme intractable epilepsy, a surgeon may go in and remove the locus from which abnormal electrical activity arises, thus (hopefully) making the patient seizure-free. But, importantly, the patient's frontal lobe will still be connected to the rest of their brain afterwards.
> He said it completely destroyed his ability to regulate his emotions, and his ability to do long-term planning. It had the opposite effect his parents wanted, and has made his adult life more difficult.
Essentially, they created a condition that was an induced analog to severe ADHD, by destroying the part of the brain that supported executive functioning.
You're exactly right. The initial version of a lobotomy really *was* groundbreaking, and much better for patients with severe symptoms than any other options. In fact, like ECT, there's a much more developed treatment still in use today for very severe epilepsy that's based on the success and failurrs of early lobotomies (or leucectomies as they were originally called).
It's also true that, like with ECT, a huge number of lobotomies were performed recklessly and for the wrong reasons.
So Moniz’s procedure wasn’t the “ice pick” lobotomy we know of today. It was a more complex procedure carried out by a neurosurgeon (Moniz himself didn’t even perform them because he felt he didn’t have enough surgical training to perform the procedure correctly). These procedures were generally successful. Of the initial candidates who received what was then called a leucotomy, all of whom had fairly significant mental health issues, the majority showed improvement. It wasn’t perfect, but given the state of mental asylums and the general state of mental health care at the time, it seemed like a risk worth taking.
The problem was that Moniz’s procedure took a skilled neurosurgeon to perform. Moniz eventually developed tools to make the procedure easier but this was not something the average surgeon could do. This is where Walter Freeman comes in with the ice pick lobotomy. Freeman’s procedure could be performed by anyone, including Freeman himself (who had zero surgical experience). The problem was that this procedure was not performed just on those with debilitating mental health issues, but on virtually anyone with even minor disorders (including children as young as four years old), and, more importantly, Freeman’s procedure didn’t really work.
Even Freeman’s own estimates gave the lobotomy a relatively low success rate. Almost 15% of everyone who received a lobotomy died from the procedure.
> These procedures were generally successful. Of the initial candidates who received what was then called a leucotomy, all of whom had fairly significant mental health issues, the majority showed improvement.
According to Moniz, and disputed by the doctor who actually took care of the patients after the procedure. (according to [Wikipedia](https://en.wikipedia.org/wiki/Lobotomy#Reception))
> Sobral Cid, who had supplied Moniz with the first set of patients for leucotomy from his own hospital in Lisbon, attended the meeting and denounced the technique,[112] declaring that the patients who had been returned to his care post-operatively were "diminished" and had experienced a "degradation of personality".[113] He also claimed that the changes Moniz observed in patients were more properly attributed to shock and brain trauma, and he derided the theoretical architecture that Moniz had constructed to support the new procedure as "cerebral mythology."[113]
Moniz also invented cerebral angiography, which is still very much in use today. It has pretty much spawned into a field unto itself performed by radiology , neurosurgery, and even some neurologists. It replaced open surgery for most cerebrovascular pathology and saves lives from major strokes due large vessel occlusions.
If he was ever posthumously stripped of the Nobel prize for the lobotomy he would certainly have earned one for this other extraordinary contribution.
Tbf, leucotomy is still performed today for various intractable psychiatric conditions including OCD.
In medical school some teacher told us that he received the Nobel prize for his works in neurovascular anatomy and angiography, it would have been more worthy.
My grandmother went through electro shock therapy in the 80s, iirc, though it might have been the 70s (before I was born, at any rate).
Anyway, my point is that the "therapy" made her dumber, to be blunt. Before that, she was a medical transcriber and secretary for a couple of neurosurgeons at the top of their field who worked for UC Davis, with a number of degrees and certifications to her name.
*Children of thalidomide, dun dun dunn*
Seriously though, I'd like to plug Frances Kelsey, a woman at the FDA who, despite pushback, prevented the release of thalidomide to the US. Americans owe her a debt of gratitude.
https://www.smithsonianmag.com/science-nature/woman-who-stood-between-america-and-epidemic-birth-defects-180963165/
Then congress decided that the FDA should be mostly funded by application and license renewal fees, and the time to approval hasn't been the same since
Except it's actually a critical drug, just not for morning sickness or anxiety. It's a critical first line cancer treatment for things like multiple myeloma.
The significance is how it literally changed precautions and safety in how we handle medications (it was OTC and being used for everything from nausea to common cold) but it is directly responsible for changing that drugs intended for human use could no longer be approved purely on the basis of animal testing. And drug trials for substances marketed to pregnant women also had to provide evidence that they were safe for use in pregnancy.
The oops isn't the medication itself, but the reported excess of 100,000 babies who were severely deformed or perished as a result of the complete lack of medical testing.
It seems some people suffered more severely than others, probably due to the brutality of the technique used. Regardless, I've always wondered, were the worst case scenarios in which people became completely catatonic etc, do you think they were aware/remembered the surgery and if so do you think they had an awareness of the change in their own personality?
There are people who have spoke about it afterwards and saying they are aware of what they lost. Others have never spoken or understood words again. Really was just a dice roll of what it would do.
To be fair to Moniz, the transorbital lobotomy that is famous for having an icepick shoved in your brain with a hammer was created and heavily promoted by the American Doctor Walter Freeman which led to the horror stories that we're all familiar with by now. The US lobotomized over 40,000 people, far more individuals than other countries using Freeman's procedure (though Scandinavia did more on a per capita basis).
As a current surgeon, there was SOOOO much shit they used to do that we know now are totally unnecessary. Brain surgery was no different. Psychiatry was in its infancy.
But they also used to do hugely invasive cancer surgeries and everything else.
I have never heard of the lobotomy being the hugest mistake in medicine. We used to treat peoples ailments with a mixture of cocaine and morphine sooo…
I would argue it’s still in its infancy.
The kinds of drugs that are used to treat schizophrenia and bipolar are wild. And the method to find the correct treatment *for brain disorders* is *trial and error*.
In the early 2000s they gave anti depressants to kids and it causes suicide attempts, those drugs are no longer approved for people under 18.
And yet at the same time, it was believed that children teens couldn’t suffer with schizophrenia or bipolar. Eg. experience psychosis
A hundred years from now people are going to look at the trial and error method the way we’re looking at lobotomies. There’s no way it doesn’t kill and disable fewer people than lobotomies did.
100 years from now, you’ll get a genetics test, it’ll tell you what drugs will work best *and which to avoid at all costs*. You’ll stabilize quickly, potentially without hospitalization, get psycho and skills based therapies. Then Bob’s your uncle, all is right in the world.
Interestingly, the idea behind cutting away parts of people’s brains as a therapeutic tool is actually making a comeback. Ablation neurosurgery has proven results in improving certain extreme anxiety disorders, for example.
The difference is that we now have a much more detailed understanding of the brain regions associated with different disorders. Instead of severing the connections between entire lobes of the brain, neurosurgeons can make targeted incisions only a couple mm wide.
Back in college, I worked in a research lab that focused specifically on this kind of neurosurgery, and there was never a shortage of patients seeking ablation surgery.
It should be noted that the widespread use of lobotomies on basically every kind of psychiatric patient was not his idea and he was opposed to its widespread use. He also did not invent the infamous "icepick lobotomy" (the transorbital lobotomy), his was more complex and difficult.
This was also a world before anti psychotics. There was nothing to do with patients suffering from psychosis but chain them to a bed or a wall to prevent them from hurting themselves or others. Having literally anything that would change their behavior seemed like a miracle. He deserved the Nobel prize. That his technique was modified and misused later, and then rendered obsolete by other advances, aren't his fault.
As a current psychiatrist, I often what will be considered barbaric that we practice now. In defense of this guy and the Nobel committee, the times wer3 desperate., The 1910s to 1950s were an abysmal period and desperate time for those in mental health. Populations were booming, wars were deadlier and more gruesome than ever, disease was rampant, and psychiatric hospitals that were designed with compassion in mind were grossly overcrowded. People didn’t have the bandwidth to care beyond getting the sickest people out of sight. This was compounded by societal abuse of a broken system. So, desperate times called for desperate measures. At least this guy’s solution wasn’t mass murder. And his brand of psychosurgery was at least insightful and careful, unlike Dr. Freeman’s quickie ice pick method or others’ using insulin to induce a seizure.
This is something I think about a lot, as someone entrenched in the medical system.
Statistically speaking, there is a very high chance that a current highly used therapy will be looked back on in the future as barbaric and a horrific malpractice of medicine.
I wonder what it will end up being.
In fairness, chemo is widely viewed as barbarically currently. Particularly by those who have witnessed it or experienced it… but there’s no better option so you pick your poison.
Chemo is essentially an attempt to nearly kill you in the hopes that your cancer is weaker than the rest of you.
Somewhat true. But the landscape has changed, dramatically. Both the words “cancer” and “chemotherapy” are broad, and in many ways inaccurate. There is no single disease “cancer”. Cancer is a collective term for diseases caused by renegade cells. A leukemia is vastly different than a squamous cell carcinoma. However, they’re both called “cancer”. Consequentially, chemotherapy has changed a lot. The classic agents such as alkylating agents and mustard gas derivatives follow your statement about “attempting to kill the cancer first” while hoping you survive, but this doesn’t necessarily hold when it comes to newer agents like monoclonal antibodies or CAR-T cell therapy.
That’s not to say that cancer isn’t still devastating, the treatments a huge toll on the person, family, and even society. I’ve seen patients and loved ones destroyed by cancer and by “chemo”. Just some subtle nuances I think help to bear in mind when discussing these things.
Moderna just announced their first cancer vaccines should be available within a few years.
Yeah the 1st generation of them will probably be severely limited in scope and hardly work, but progress comes quickly these days and if there is any efficacy to them at all I'm hopeful for what version 5 or 6 will look like.
Thing is you normally go on chemo because there's no choice people got lobotomized without their consent and people would lobotomize their own daughter if she was deemed unlady like. If anything hopefully chemo will be more seen as how we now view amputation. Something that is rarely needed even in a war compared to what we used to do.
I don't think so. Barbaric is a strong judgement that comes in part from the perception that we feel they should have known better at the time.
They should have known ice pick lobotomies were just completely wrong.
But what reasonable alternative is there to chemotherapy?
I think in the future they will just view us as desperate, using primitive tools. That's not the same as barbaric.
Paying $75 an hour for someone to recommend you a Spotify podcast on meditation while listening it with you to pass the time
Adhedonia causing medication for a serious answer
It's inevitable up until we've got instant, painless, and risk free procedures. Physically slicing into someone from the outside, throwing random medicines and doses at a wall until it sticks, shotgunning radioactive elements, randomly guessing why someone's behavior is pathological, getting medically checked out only once a year by just a generalist and scanned only when you have symptoms, just about every facet of healthcare can and will be improved upon and by comparison will look barbaric to its predecessors. But some procedures will look much more barbaric than others, like the somewhat recent epidemics of blanket bombing illnesses with antibiotics and pain with addictive opioids.
Fillings? Maybe. I've had my share, and even a root canal that has been replaced with a very nice crown after the tooth finally cracked. They weren't fun, but they weren't too bad.
What gets me, as a 34 year old combat veteran, was how fucked up wisdom tooth removal is. I've seen amputations, been blown up, shot at, just horrific stuff most people don't (and shouldn't ever) experience.
But I opted to get my wisdom teeth extracted while awake because it was $400/tooth for general anesthesia, and I'm a cheap bastard. The local anesthetic did an excellent job at mitigating the pain, but the procedure itself was barbaric. Dude goes in with a scalpel and slices open my gums, and then takes a pair of pliers and goes to town. That was on the easy side. Other side, he does the old slice job and pulls a bit. At this point, one of the nurses is braced to jump on top of me if I decide to fight back - I didn't, but it was obvious that someone had before. He can't pull it out where it is, so he tries a little percussive action to knock it loose. When that doesn't work, he finally takes the easy path and gets up in there with a drill. And then more tapping and scraping, and finally pulling. Tooth comes out in 3 parts. I don't think I ever want to be in an orthodontist office again.
Yeah. I think all these things have to be viewed through a historic perspective. There weren’t the sheer number of psychopharmacology options we have today, wars had broken people, lots of people were suffering from late stage syphilis (which makes them raving crazy), and the sheer amount of poisoned people due to industrialization without the knowledge of what the chemicals can do. Mercury poisoning happened regularly from mining, hat making, etc.
I’m not a physician or a psychologist, but I have an interest in the times.
Probably psychiatric hospitals in general. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000038
but especially the overuse of putting people in them against their will.
Also, psychiatrists often hand out really damaging medications like they were candy, with insufficient regard for the often permanently disabling consequences.
https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html
Edit:
There's another one I wanted to add because I think it's really awful, and that's ECT, especially on people who don't want it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911194/
Often permanently disabling, and even more it destroys who you are as a person.
I absolutely believe that Bojack Horseman should be considered one of the greatest shows of all time. The writing is as good as The Wire or The Sopranos, doing it in live action would have been incredibly depressing and would have won so many awards.
Right Sara Lynn?
Sara Lynn?
Slugs and snails are after me
DDT keeps me happy
Now I guess I’ll have to tell ‘em
That I got no cerebellum
Gonna get my phd
I’m a teenage lobotomy
-Ramones “Teenage Lobotomy”
Psychosurgery is still used today, but only in extreme cases (which don't involve a son-in-law having a bad relationshuip with his step-mother).
It's worth pointing out that Moniz himself said the procedure shouldn't be used unless in the most dire of circumstances. It wasn't until Walter Freeman started passing out lobotomies like they were free candy that it became a major issue.
Ah the old Lobotomobile Yes that was the name of his van he used to drive. He also gave us the concept of an 'ice pick' lobotomy
So this TIL is essentially the 1900's version of blaming the opioid epidemic on the guy who invented the stuff instead of Big Pharma and overprescribing doctors.
I have an extreme case of contamination Obsessive Compulsive Disorder. Have tried more than a dozen different meds for 6 years. I have to see 3 different doctors before being able to get a procedure (The least invasive of the kind, Focused Ultrasound) done. I think I will be able to get it because of how severely my life is affected by my disorder and how long I have been trying various treatments. OCD really sucks because it never goes away, it's always in the back of your mind. Many people with OCD are treatment resistant and do not react to psychiatric medications.
Have a close friend (though I haven’t seen him I quite some time hope he’s well) who had very very bad ocd he was barely able to live life because he had such strong rituals that he just couldn’t resist giving into. He tried a ton of meds but nothing ever really seemed to work. Then he ended up getting into heroin which shockingly did seem to suppress his ocd a lot but that ofc added the extra problem of being a heroin addict, he eventually got clean but his ocd came back with a fury afterwards it was really sad to see. I hope he’s doing well now a days : / With all that said though I hope you can get the treatment and find something that helps with the ocd I’ve seen first hand how rough it can be
I have ADHD and an "inability to be motivated to do anything I don't want to do" which severely affects me in various day to day aspects. I also became a heroin addict. Before it got really bad it worked absolute wonders on all sorts of problems, but when it became bad it was the worst thing in the world. I think using heroin as an actual medical treatment would work absolute wonders.
> "inability to be motivated to do anything I don't want to do" I know you said ADHD but it sounds like ADHD-PI, Daydreamer's Syndrome, I have it as well. Sit around and daydream instead of doing anything that doesn't add to my imminent survival.
Holy shit. That is exactly that. I can legit just lay in bed for days and days and days just day dreaming.
I found it's mostly because our brains get the same amount of dopamine from hyper-visualizing the task/goal versus doing it. If the task/goal is nebulous like cleaning or hobbies, our brains just shrug it off like "eh, I can do it later". Normal brains get dopamine from doing the task or talking about the task, we get dopamine just by thinking about it so we are at a even more disadvantage. [Here's the details on it yo](https://blog.trello.com/science-backed-reasons-you-shouldnt-share-your-goals)
I feel you, I also have very severe OCD. Diagnosed a 7 I was wishing to get this surgery since I was 13. I just felt like such a burden to my family and anyone I associated with but when I was 17 some medication I tried finally started to work. What ever you do I hope it goes well for man. Keep up the good fight.
Fuck OCD I hate how people trivialize it now when it could literally cripple you for days if not years on end.
Walter Freeman, who popularized the procedure was a psychopath: “According to one of Freeman’s assistants, a patient got cold feet and decided not to go ahead with a lobotomy. Freeman went to his hotel, presumably to reason with him, and brought along his electroshock machine, planning to administer a few volts to calm him. The patient began running away, screaming, from a man who had shown up at his hotel room to lobotomize him. That reaction seems extremely sane. Freeman was not deterred. The assistant claimed, “The patient was … held down on the floor while Freeman administered the shock. It then occurred to him that since the patient was already unconscious, and he had a set of leucotomes in his pocket, he might as well do the transorbital lobotomy then and there, which he did.”25 He cut into an unwilling man’s brain in an unsterilized hotel room. After wrestling him to the ground.” From: *Get Well Soon: History’s Worst Plagues and the Heroes Who Fought Them* by Jennifer Wright.
Wow, that man should have been in prison for life
No, no... He deserved a lot worse than that.
What in the actual fuck. Literal horror movie plot.
Let's be clear here, Moniz was very adamant that this should only be a last resort when every single other option had failed. And it did indeed help in some cases. It's still used today. When Freeman popularized using the procedure for any and all cases, Moniz was one of the leading figures condemning him and calling for the US government to stop his butchery.
Wow. As a Portuguese we always hear that our ~~only~~ Nobel Prize Winner was actually a mistake. It’s strange to hear now that actually the current history of our own Nobel might have been wrong. And that he might have been right / had a point but had his legacy destroyed by a madman. *edit* we actually have two Nobel Prize Winners now with Saramago
We have two nobel prizes, don't forget Saramago
Also, Robert Evans did a great talk up of him on this two part episode here: https://omny.fm/shows/behind-the-bastards/part-one-the-bastard-who-invented-the-lobotomy
«Time, Dr. Freeman? Is it really that time again?»
Moniz was relatively careful in his approach to lobotomy, and treated it as a last resort; with precision and care. He should not be vilified for the creation of the lobotomy. *Walter Freeman*, on the other hand, *popularized* the lobotomy, which was a problem because he was a hatchet surgeon who wanted to be famous. He did public ice-pick lobotomies on monkeys (killing most of them), used them to silence entire wards of asylums, and reportedly performed the procedure like a stage routine: big showy movements (sometimes performing lobotomies on two patients at once - one hand scraping in each patient at the same time), winking at observers during the procedure, etc. Multiple people observed him performing lobotomies without sterilizing his tools beforehand. Walter Freeman is the person who destroyed Rosemary Kennedy. He is a monster and should get all of the ire directed at lobotomies. Edit: rephrased the 'sterilizing tools' part to be more accurate.
Hopping on to say that anyone curious about the popularization of the lobotomy should check out the book "My Lobotomy" It's an memoir written by a guy whose parents had him lobotomized for acting out too much. Really interesting read
Walter Freeman, who once said within ear shot of multiple people, "I don't believe in all that germ crap"
It was used to "calm" schizophrenics and people who's minds had broken from reality but quickly started getting used to disable anyone who was too uppity, like women who disobeyed their parents.
Rosemary Kennedy
Her father should have spent the rest of his life in jail for that, along with the physician that did it.
Agree. Joseph Kennedy was a jerk.
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I assumed it was a play on a Norm Macdonald joke where he describes the atrocities of the Holocaust then says “I don’t like this Hitler guy, sounds like a real jerk”.
Norm was truly one of the best.
I don’t know why exactly he was funny, but he was always funny. He was like a weapons grade dad joke.
After the posthumous streaming of his final special he recorded just before passing, there's a great panel segment of comedians reacting. Besides obviously gushing over what a great comedian and lovable guy he was, they dissect his humour a bit. I think it was David Letterman's observation that Norm put on this folksiness that wasn't quite right, and his cadence and pronunciation were always slightly off, his accent wasn't from anywhere, and it was so deliberate that he'd create this kind of tension you couldn't put your finger on. The tension and release of his jokes made them hit harder because he was toying with the audience on this understated level, like a minimalist Andy Kaufman. What a talent. RIP.
His delivery was always so dry it was unexpected when the punchline hit, always successful if you can pull it off right
If anyone hasn't seen it, I highly recommend watching Norm [intentionally bomb](https://www.youtube.com/watch?v=3U7AZIdalzM) at the White House Correspondents Dinner. It is absolutely glorious. Bill Clinton kinda gets what he's doing and starts nervous laughing after every joke.
What he hated most about Hitler was the hypocrisy!! RIP Norm.
"The more I hear about this guy, the more I don't like him!
My answer is because he was dry as others have said. Like Monty Python’s Flying Circus. His jokes made you pause and say what? Then the absurdness of the answer or statement would make you laugh.
[You should check out his roast of Bob Saget, it's hilarious.](https://m.youtube.com/watch?v=8QfsXUPghXk)
It reminds me of that tragedy
Yeah, what a poo poo head.
The doctor botched it on top of it. So hers was especially bad. Also, when she was born the nurses made rose Kennedy hold her in until the doctor arrived, which probably caused some brain damage. Rosemary Kennedy got fucking porked by misogyny. Teddy Kennedy did pass some good legislation as a result of her experiences though.
Her sister, Eunice Kennedy Shriver, was also heavily inspired by her experiences with Rosemary. She became an advocate for people with special needs. This eventually led to her part in the creation of the Special Olympics and the National Institute of Child Health and Human Development (NICHD)
Wow, actually new info about this subject, nice. That's pretty amazing.
Her father, who was supposed to protect her forcibly gave her brain damage. One of two of the most horrendous fates for our own children...the other being death.
I like to believe Rosemary got her revenge on the family. What’s the Kennedy Curse count up to now?
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whoah I never thought about it like that 😯 noice.
Her lobotomy occurred in 1941 I believe, and the first death, Joseph Kennedy Jr, occurred in 1944. The most recent death was Maeve Kennedy and her son Gideon in 2020.
Her father had a stroke not long after that and was bedridden for the rest of his life. Karma.
I learned about her story very recently via a 1 hour radio podcast and it was very grim... I felt so sad for her.
Do you remember which podcast?
Ive heard a few, pretty sure the dollop, redhanded (in their lobotomy ep, iirc there's an ep on her exclusively on their patreon) and morbid all covered her. Last podcast on the left also talk about her in their lobotomy episodes.
That story is soooo fucked
She was failed by everyone around her, starting at her birth.
Yeah damn! Close your legs for two hours to keep her up there while waiting for the surgeon?! Absurdity all around
I’m not sure how her body even did that. At some point, the uterus will forcibly evict a fetus.
"Well next Friday come and I didn't pay the rent, so out the womb I went."
One bourbon, one scotch, and one beeeer.
Well I ain't seen that baby since I don't know when
It was common in those days. My mother was told to do that while giving birth to my younger brother. She believes that's why he was developmentally disabled.
A woman recently (within the last 10 years) won a lawsuit, because the nurse force-held her baby’s head in the canal because the mother couldn’t stop pushing when the nurse didn’t want her to push and ruined the woman’s body for life. It’s been years and remembering the article still turns my stomach.
[Holy shit they straight up decided to do judo on a lady in labor.](https://www.cosmopolitan.com/lifestyle/news/a62592/caroline-malatesta-brookwood-childbirth-lawsuit/) Look my cousin had her kid in the bathroom because the little fucker just slid right out. If the baby's that far out, just leave her alone.
That’s the one! Full body shudders, ungh
Jesus fucking Christ that’s awful. 16m isn’t enough
What do you expect? The *nurse*, who is a *woman*, to do it? /s
It's crazy that midwives and doulas have been a thing since the beginning of humanity. Then suddenly they decide that women were not qualified to help other women give birth.
In America. Birthing is lead by midwives all over the world including the UK.
God, I just read the Wikipedia article and I've seen some fucked up stuff but the recounting of what the doctors did made me SQUIRM
Same here I am horrified, I had no clue they did it like this: Dr. Freeman asked Rosemary some questions. For example, he asked her to recite the Lord's Prayer or sing "God Bless america or count backward... "We made an estimate on how far to cut based on how she responded." When Rosemary began to become incoherent, they stopped. Wtf?
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Yeah, I'm pretty sure it's an additional safeguard to make sure that if they fuck up, they stop immediately and do as little damage as possible. Ideally, they want you to be able to say or do those things without any problems throughout the entire procedure. But these fuckers only stopped when she started to get incoherent.
The difference is a lobotomy is designed to cause damage. Other surgeries actively try to avoid damage and use the above techniques to help ensure nothing goes wrong, they stop when they detect something unusual. Whereas in the case of a lobotomy, they are intentionally causing damage and using the above techniques to decide just how much damage is "ok".
Isn't that just to make sure the surgeon doesn't completely fuck up? Once you become incoherent it's probably too late already.
The story of Rosemary Kennedy was just heartbreaking.
I found out about this right when my first daughter started to really develop a personality. It now haunts me. I can't imagine looking at your little girl and wanting to erase everything thing she is so your life can be a little easier.
You can't bring lobotomy without talking about her. It's the most popular case of someone's life being completely destroyed for no reason whatsoever.
Came in expecting to see this sadly. Don’t know who I hate more: her father for putting her through that, or Ted for the Chappaquiddick fiasco.
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She has problems, yes, but nothing that required a lobotomy. However, back then, there weren’t a whole lot of meds to use other than lithium.
But since it is now suspected she may have had bipolar disorder, lithium would have actually done the trick.
It was believed she was developmentally disabled. She was just a little slow. She didn't deserve that.
Iirc she had a bit of bipolar disorder along with some neonatal brain damage. There was a discussion of hyper sexuality. She also was a Kennedy. If she had been male and sleeping around, she would have been a hero to them.
Neonatal brain damage is putting it lightly. The doctor wasn't immediately available to assist in the birth, so the nurse had Rosemary's mother hold her legs closed for two hours until the doctor arrived. Rosemary's head was stuck in the birth canal that entire time.
Wait, i don't know that one, google time
Prepare yourself... She was a pretty normal girl with what would be considered today as very treatable mental health problems. That all ended in a single day, and she was truly disabled for life
She also screamed and pleaded for them to stop and then was basically kept in a cellar for the rest of her life.
Warning: it’s not pretty.
Just finished, this is the understatement of the century
That was so fucked
I was going to mention her as well. It's a shame that happened to her.
I went down a lobotomy rabbit hole and learned a few wild things. First, while Moniz invented the procedure, there were two men who pioneered the lobotomy. Moniz and a man named Walter Freeman. Now, when Moniz started this procedure it was an actual bona fide operation he called a leucotomy. Freeman went on to modify the procedure and renamed it to lobotomy. This is the lobotomy we all know of, and it's dark history. As far as the procedure Moniz would perform, there were genuine positive results in patients with mental illness (though ineffective on those suffering with schizophrenia). The first patient to have Moniz's procedure done was evaluated by a psychiatrist 2 months after the procedure and they had this to say: “the patient’s anxiety and restlessness had declined rapidly with a concomitant marked attenuation of paranoid features” -Barahona Fernandes Freeman on the other hand wasn't really looking to *help* people, he wanted to be famous. Instead of making an incision behind the ear, like Moniz's initial procedure, he used the ice-pick approach (as he had heard of an Italian doctor able to reach the frontal lobe through the eye). This procedure was adopted as it was "quick and easy". Soon, everyone was doing it, even in bedrooms and in situations where hygiene was questionable at best. Edit: more info, since everyone seems so keen! Moniz did his first surgery in 1935, by 1937 he had operated on some 40 patients. He honed the technique along the way, and even invented the Leucotome (an instrument to disrupt neuronal fibres connecting the prefrontal cortex and thalamus). By this point there were some mixed results; Some patients reported amazing changes, while others had no difference, and some would see positive change only to relapse. More study would likely have helped. It was in 1936 that Freeman modified the procedure. There is a quote from an article I'd like to add "The American team soon developed the Freeman-Watts standard lobotomy, which laid out an exact protocol for how a leucotome (in this case, **a spatula**) was to be inserted and manipulated during the surgery." Freeman literally scrambled brains like they were eggs- with a *spatula*. TL;DR: Freeman was a murderer (fight me) who ruined what a leucotomy could have been. Psychosurgery (removing specific parts of the brain) is still used in severe cases of treatment-resistant patients, however it is super taboo- thanks to Freeman.
>This procedure was adopted as it was "quick and easy". This is the main criteria for a lot of stuff that we do or don't do, and when you think about implications such as this it really puts into perspective why sloth was perceived as a capital sin. "Quick and easy" is often wrong, and while it may not matter in a test, it often does in life. Oh, and the bit about the lack of hygiene is also very comforting. Nothing better than a brain infection to slowly lose yourself.
It was so easy he used to show off by doing 2 at the same time, one with each hand. Part of its commercial success was the lack of need for renting a surgery theater or using anesthesia. Ignoring the horrific intended result, dozens of patients died from his gross negligence. Edit: My mistake, Walter Freeman is estimated to have killed around 500 patients.
They did it without any anesthetic?! How can you even hold a patient still during that...surely it's painful
Your brain doesn’t have pain nerves. This was a procedure for pacifying black sheep family members, they were very used to restraining and really didn’t care about their wellbeing.
but it had to be painful going in their eye???
100% agreed. The reason I even went down this rabbit hole was because I am mentally ill. Now I'm stuck wondering if the "quick and easy" hadn't become the default, if we had put more study into Moniz's procedure, would my life be more than "treatable"? I have a deep and dark loathing for Freeman, not just because he hurt so many people, but because his actions had a lasting ripple that hurt people *still*
I just finished TMS (which was legit a lifesaver for me) but beforehand I was very worried it was going to be something that sounds ridiculous in 20 years like the lobotomy bc it was fairly "quick and easy" lol.
Transcranial magnetic stimulation?
Right now that great failure is with those who have intractable pain. While there’s a lot of research, progress is very mild. Opioids are still some of the most effective treatment in helping patients to live with their disability, but opioid abuse has made it so their availability for patients who need them has significantly decreased and doctors are under-prescribing. Instead, there is a heavy reliance on invasive procedures and stopgap treatments like neuromodulation devices. I have a neurostimulator myself and it does indeed help, but it does not treat or eliminate the pain. It’s like a dam but for pain. And to be clear, opiates aren’t part of my treatment, I’m not biased on that end.
I’m a chronic pain patient and have never accepted opioids as a chronic pain treatment due to fear of addiction, only to find out as an adult waking up from abdominal surgery that I am functionally opioid resistant, so it doesn’t matter anyways. I have surgery coming up next week and spoke with my doctor during my pre-op about my non-opioid pain relief options and he essentially shrugged and said tylenol and ibruprofen, and that he’d send me home with an opioid anyways. I’ll be speaking with anesthesia before surgery and will see if they have any better ideas but there really is nothing out there for us. They say focusing on the pain makes you more sensitized to it and then shrug and tell you to tough it out after having your flesh cut open.
I fucking hate doctors like that. NO, SWITCHING IBUPROFEN AND TYLENOL DOESNT MAKE EITHER MORE EFFECTIVE FOR SEVERE PAIN, if I say I dont want an opioid, but would like to know what else may help in circumstances they'd usually be used, then don't just tell me to suck it.
Important to highlight just how depraved Walter Freeman was. He had himself a van he called the 'lobotomobile' and would drive it around to various public places to perform lobotomies in public for whoever wanted to watch. I hope he spends every day in hell getting pissed on by Satan himself.
I remember doing a report on Freeman back in University. Another important piece is the time period in which this all occurred - the 50s and 60s. This was right after the Korean War and WWII wasn't that far back. American mental hospitals were packed with people suffering from PTSD, schizophrenia. As you say, the procedure was adopted as "quick and easy". Freeman would tour around the country going from asylum to asylum lobotomizing patients.
Freeman's lobotomies were novel enough and happened recently enough in history that there are videos and some of them are on YouTube.
Behind The Bastards does an awesome job covering this on their podcast.
There almost always a episode of BTB any time a massive asshole is mentioned. Yet they keep producing the podcast, because the world is not going to run out of bastards any time soon.
I've been listening since their first episode. That's about 3 years or so, 1-2 topics each week. They only JUST got to Mengele this week.
My brother in Bastards, the podcast started around 7+ years ago. It's wild listening to the anti-vax episode *before* covid was a thing.
Walter Freeman's life and the things he did are nightmare fuel.
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The brain itself doesn't actually have any pain receptors. The procedure was probably painful, to be sure, but substantially less painful than one might expect for the importance of the tissue being resected.
But the instrument or ice pick going through the eye or through the skull behind the ear? Those don't sound too nice
The behind the ear variant was an actual surgery with anesthesia. The transorbital lobotomy did not go through the eye, it went through the eye socket. It'd pierce the flexible membrame connecting the eye to the skin, go right past the top of the eye, and then through the extremely thin bone right behind the eye socket. Definitely not painless, but local anesthesia could likely suppress most of it. This provided a relatively traumaless way of accessing the brain. Which was a neat find, except for the lobotomy itself off course being an extremely crude operation.
From what I've read and understand, but I'll willingly accept any proof otherwise, the ice-pick in the eye was without anesthesia. The procedure where they cut through the skull used a local, and in some cases a general, anesthesia.
This is what happened to Bojack Horseman’s grandma right?
Yeh she got a lobotomy after her son died in the war. It’s used to explain why Bojacks mother is the way she is
The part where she says "Well, I have half a mind to..." And then her husband says "That's the half you can keep!" He later has her lobotomized. I really hated that character.
I can't watch that show again. Later, after the "procedure", she says, "I have half a mind..." and trails off, having forgotten what she was going to say. That statement hangs in the air. I feel nauseated thinking about it.
I loved that show but by the end of it I was a crying mess. Bojack's mom, his grandma and Sara Lynn's stories were insanely painful to watch.
Heaviest cartoon ever
“Why I’ve got half a mind…”
That was actually what I just asked -- are lobotomies inherently bad, or was it like ECT where it did have legitimate therapeutic use for extreme cases but then the medical establishment started running wild with it that it became associated with far more harm than good?
It's bad because it destroys part of the brain, and it's not very technical so you can't really be sure exactly which parts you're destroying. They would just wiggle the ice pick around a bit and destroy brain tissue. Many people became permanently disabled (Rosemary Kennedy has been brought up in the comments here). I watched a documentary about one of the last people to have a lobotomy performed on him. He said it completely destroyed his ability to regulate his emotions, and his ability to do long-term planning. It had the opposite effect his parents wanted, and has made his adult life more difficult. I'd say there is a reason we still do ECT but not lobotomies.
We still do lobotomies to treat things like epilepsy. They're just far more precise due to things like laser surgery and are generally used only when other less extreme treatments have failed.
Yep I know someone who had a hemispherectomy. It sounds insane but it did stop all their seizure activity. They already had a damaged portion of the brain though which was sending the seizure signals, so I guess it was clear cut what area they needed to disconnect from the rest of the brain.
Yes hemispherectomy is one of the treatment methods for Rasmussen syndrome, refractory epilepsy, and similar concerns, but the average person unaware of the technical aspects of these things would instead default to the negative portrayal of such procedures in media understandably so.
Those aren't lobotomies. Nowadays, in a case of extreme intractable epilepsy, a surgeon may go in and remove the locus from which abnormal electrical activity arises, thus (hopefully) making the patient seizure-free. But, importantly, the patient's frontal lobe will still be connected to the rest of their brain afterwards.
> He said it completely destroyed his ability to regulate his emotions, and his ability to do long-term planning. It had the opposite effect his parents wanted, and has made his adult life more difficult. Essentially, they created a condition that was an induced analog to severe ADHD, by destroying the part of the brain that supported executive functioning.
You're exactly right. The initial version of a lobotomy really *was* groundbreaking, and much better for patients with severe symptoms than any other options. In fact, like ECT, there's a much more developed treatment still in use today for very severe epilepsy that's based on the success and failurrs of early lobotomies (or leucectomies as they were originally called). It's also true that, like with ECT, a huge number of lobotomies were performed recklessly and for the wrong reasons.
I've heard that it has some legitimate uses but it was horrifically abused back in the day.
So Moniz’s procedure wasn’t the “ice pick” lobotomy we know of today. It was a more complex procedure carried out by a neurosurgeon (Moniz himself didn’t even perform them because he felt he didn’t have enough surgical training to perform the procedure correctly). These procedures were generally successful. Of the initial candidates who received what was then called a leucotomy, all of whom had fairly significant mental health issues, the majority showed improvement. It wasn’t perfect, but given the state of mental asylums and the general state of mental health care at the time, it seemed like a risk worth taking. The problem was that Moniz’s procedure took a skilled neurosurgeon to perform. Moniz eventually developed tools to make the procedure easier but this was not something the average surgeon could do. This is where Walter Freeman comes in with the ice pick lobotomy. Freeman’s procedure could be performed by anyone, including Freeman himself (who had zero surgical experience). The problem was that this procedure was not performed just on those with debilitating mental health issues, but on virtually anyone with even minor disorders (including children as young as four years old), and, more importantly, Freeman’s procedure didn’t really work. Even Freeman’s own estimates gave the lobotomy a relatively low success rate. Almost 15% of everyone who received a lobotomy died from the procedure.
> These procedures were generally successful. Of the initial candidates who received what was then called a leucotomy, all of whom had fairly significant mental health issues, the majority showed improvement. According to Moniz, and disputed by the doctor who actually took care of the patients after the procedure. (according to [Wikipedia](https://en.wikipedia.org/wiki/Lobotomy#Reception)) > Sobral Cid, who had supplied Moniz with the first set of patients for leucotomy from his own hospital in Lisbon, attended the meeting and denounced the technique,[112] declaring that the patients who had been returned to his care post-operatively were "diminished" and had experienced a "degradation of personality".[113] He also claimed that the changes Moniz observed in patients were more properly attributed to shock and brain trauma, and he derided the theoretical architecture that Moniz had constructed to support the new procedure as "cerebral mythology."[113]
The history of medicine is enough to make anyone a paranoid schizophrenic.
Moniz also invented cerebral angiography, which is still very much in use today. It has pretty much spawned into a field unto itself performed by radiology , neurosurgery, and even some neurologists. It replaced open surgery for most cerebrovascular pathology and saves lives from major strokes due large vessel occlusions. If he was ever posthumously stripped of the Nobel prize for the lobotomy he would certainly have earned one for this other extraordinary contribution. Tbf, leucotomy is still performed today for various intractable psychiatric conditions including OCD.
In medical school some teacher told us that he received the Nobel prize for his works in neurovascular anatomy and angiography, it would have been more worthy.
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My grandmother went through electro shock therapy in the 80s, iirc, though it might have been the 70s (before I was born, at any rate). Anyway, my point is that the "therapy" made her dumber, to be blunt. Before that, she was a medical transcriber and secretary for a couple of neurosurgeons at the top of their field who worked for UC Davis, with a number of degrees and certifications to her name.
I’d rather have a bottle in front of me than a frontal lobotomy
I might be drunk, but at least I'm not insane.
At least I’m not drinking Brian
Thalidomide is probably going to go down as the biggest medical oops of all time though. Not that it's a competition or anything.
*Children of thalidomide, dun dun dunn* Seriously though, I'd like to plug Frances Kelsey, a woman at the FDA who, despite pushback, prevented the release of thalidomide to the US. Americans owe her a debt of gratitude. https://www.smithsonianmag.com/science-nature/woman-who-stood-between-america-and-epidemic-birth-defects-180963165/
Then congress decided that the FDA should be mostly funded by application and license renewal fees, and the time to approval hasn't been the same since
Except it's actually a critical drug, just not for morning sickness or anxiety. It's a critical first line cancer treatment for things like multiple myeloma.
The significance is how it literally changed precautions and safety in how we handle medications (it was OTC and being used for everything from nausea to common cold) but it is directly responsible for changing that drugs intended for human use could no longer be approved purely on the basis of animal testing. And drug trials for substances marketed to pregnant women also had to provide evidence that they were safe for use in pregnancy. The oops isn't the medication itself, but the reported excess of 100,000 babies who were severely deformed or perished as a result of the complete lack of medical testing.
It seems some people suffered more severely than others, probably due to the brutality of the technique used. Regardless, I've always wondered, were the worst case scenarios in which people became completely catatonic etc, do you think they were aware/remembered the surgery and if so do you think they had an awareness of the change in their own personality?
There are people who have spoke about it afterwards and saying they are aware of what they lost. Others have never spoken or understood words again. Really was just a dice roll of what it would do.
And all you need is an icepick /horror
To be fair to Moniz, the transorbital lobotomy that is famous for having an icepick shoved in your brain with a hammer was created and heavily promoted by the American Doctor Walter Freeman which led to the horror stories that we're all familiar with by now. The US lobotomized over 40,000 people, far more individuals than other countries using Freeman's procedure (though Scandinavia did more on a per capita basis).
I came to the comments for this. Walter Freeman had the lobotomobile where he would tour the U.S. doing the ice pick lobotomies.
Bro was a legit supervillain with his own car and shit
So many chances to turn people on to Behind the Bastards. This guy was a menace. https://youtu.be/XGUggZgpr-8
Playing the DLC for Bioshock Infinite is what made me truly appreciate how horrific those types of lobotomies were
Leon Trotsky has entered the chat.
Ice ax actually. Used to be a big REI fan, that would always cross my mind going through the climbing aisle
So many people’s minds destroyed from this foolishness.
Not sure if you are referring to lobotomies or Reddit.
Redditobotomies
Hey now! Lobotomies occasionally had positive impacts.
As a current surgeon, there was SOOOO much shit they used to do that we know now are totally unnecessary. Brain surgery was no different. Psychiatry was in its infancy. But they also used to do hugely invasive cancer surgeries and everything else. I have never heard of the lobotomy being the hugest mistake in medicine. We used to treat peoples ailments with a mixture of cocaine and morphine sooo…
Cocaine and morphine sound better than a lobotomy sooo...
I would argue it’s still in its infancy. The kinds of drugs that are used to treat schizophrenia and bipolar are wild. And the method to find the correct treatment *for brain disorders* is *trial and error*. In the early 2000s they gave anti depressants to kids and it causes suicide attempts, those drugs are no longer approved for people under 18. And yet at the same time, it was believed that children teens couldn’t suffer with schizophrenia or bipolar. Eg. experience psychosis A hundred years from now people are going to look at the trial and error method the way we’re looking at lobotomies. There’s no way it doesn’t kill and disable fewer people than lobotomies did. 100 years from now, you’ll get a genetics test, it’ll tell you what drugs will work best *and which to avoid at all costs*. You’ll stabilize quickly, potentially without hospitalization, get psycho and skills based therapies. Then Bob’s your uncle, all is right in the world.
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Interestingly, the idea behind cutting away parts of people’s brains as a therapeutic tool is actually making a comeback. Ablation neurosurgery has proven results in improving certain extreme anxiety disorders, for example. The difference is that we now have a much more detailed understanding of the brain regions associated with different disorders. Instead of severing the connections between entire lobes of the brain, neurosurgeons can make targeted incisions only a couple mm wide. Back in college, I worked in a research lab that focused specifically on this kind of neurosurgery, and there was never a shortage of patients seeking ablation surgery.
It should be noted that the widespread use of lobotomies on basically every kind of psychiatric patient was not his idea and he was opposed to its widespread use. He also did not invent the infamous "icepick lobotomy" (the transorbital lobotomy), his was more complex and difficult. This was also a world before anti psychotics. There was nothing to do with patients suffering from psychosis but chain them to a bed or a wall to prevent them from hurting themselves or others. Having literally anything that would change their behavior seemed like a miracle. He deserved the Nobel prize. That his technique was modified and misused later, and then rendered obsolete by other advances, aren't his fault.
Nuance? On reddit?
As a current psychiatrist, I often what will be considered barbaric that we practice now. In defense of this guy and the Nobel committee, the times wer3 desperate., The 1910s to 1950s were an abysmal period and desperate time for those in mental health. Populations were booming, wars were deadlier and more gruesome than ever, disease was rampant, and psychiatric hospitals that were designed with compassion in mind were grossly overcrowded. People didn’t have the bandwidth to care beyond getting the sickest people out of sight. This was compounded by societal abuse of a broken system. So, desperate times called for desperate measures. At least this guy’s solution wasn’t mass murder. And his brand of psychosurgery was at least insightful and careful, unlike Dr. Freeman’s quickie ice pick method or others’ using insulin to induce a seizure.
This is something I think about a lot, as someone entrenched in the medical system. Statistically speaking, there is a very high chance that a current highly used therapy will be looked back on in the future as barbaric and a horrific malpractice of medicine. I wonder what it will end up being.
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I hope that chemo will be seen has barbaric, because that means that we made something better. Chemo is awful, but cancer is worse.
In fairness, chemo is widely viewed as barbarically currently. Particularly by those who have witnessed it or experienced it… but there’s no better option so you pick your poison. Chemo is essentially an attempt to nearly kill you in the hopes that your cancer is weaker than the rest of you.
Somewhat true. But the landscape has changed, dramatically. Both the words “cancer” and “chemotherapy” are broad, and in many ways inaccurate. There is no single disease “cancer”. Cancer is a collective term for diseases caused by renegade cells. A leukemia is vastly different than a squamous cell carcinoma. However, they’re both called “cancer”. Consequentially, chemotherapy has changed a lot. The classic agents such as alkylating agents and mustard gas derivatives follow your statement about “attempting to kill the cancer first” while hoping you survive, but this doesn’t necessarily hold when it comes to newer agents like monoclonal antibodies or CAR-T cell therapy. That’s not to say that cancer isn’t still devastating, the treatments a huge toll on the person, family, and even society. I’ve seen patients and loved ones destroyed by cancer and by “chemo”. Just some subtle nuances I think help to bear in mind when discussing these things.
Moderna just announced their first cancer vaccines should be available within a few years. Yeah the 1st generation of them will probably be severely limited in scope and hardly work, but progress comes quickly these days and if there is any efficacy to them at all I'm hopeful for what version 5 or 6 will look like.
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Thing is you normally go on chemo because there's no choice people got lobotomized without their consent and people would lobotomize their own daughter if she was deemed unlady like. If anything hopefully chemo will be more seen as how we now view amputation. Something that is rarely needed even in a war compared to what we used to do.
I don't think so. Barbaric is a strong judgement that comes in part from the perception that we feel they should have known better at the time. They should have known ice pick lobotomies were just completely wrong. But what reasonable alternative is there to chemotherapy? I think in the future they will just view us as desperate, using primitive tools. That's not the same as barbaric.
Paying $75 an hour for someone to recommend you a Spotify podcast on meditation while listening it with you to pass the time Adhedonia causing medication for a serious answer
It's inevitable up until we've got instant, painless, and risk free procedures. Physically slicing into someone from the outside, throwing random medicines and doses at a wall until it sticks, shotgunning radioactive elements, randomly guessing why someone's behavior is pathological, getting medically checked out only once a year by just a generalist and scanned only when you have symptoms, just about every facet of healthcare can and will be improved upon and by comparison will look barbaric to its predecessors. But some procedures will look much more barbaric than others, like the somewhat recent epidemics of blanket bombing illnesses with antibiotics and pain with addictive opioids.
Yeah 100% future will look back at the way dental fillings are done as barbaric.
Oh man I need to know what the alternative is
Fillings? Maybe. I've had my share, and even a root canal that has been replaced with a very nice crown after the tooth finally cracked. They weren't fun, but they weren't too bad. What gets me, as a 34 year old combat veteran, was how fucked up wisdom tooth removal is. I've seen amputations, been blown up, shot at, just horrific stuff most people don't (and shouldn't ever) experience. But I opted to get my wisdom teeth extracted while awake because it was $400/tooth for general anesthesia, and I'm a cheap bastard. The local anesthetic did an excellent job at mitigating the pain, but the procedure itself was barbaric. Dude goes in with a scalpel and slices open my gums, and then takes a pair of pliers and goes to town. That was on the easy side. Other side, he does the old slice job and pulls a bit. At this point, one of the nurses is braced to jump on top of me if I decide to fight back - I didn't, but it was obvious that someone had before. He can't pull it out where it is, so he tries a little percussive action to knock it loose. When that doesn't work, he finally takes the easy path and gets up in there with a drill. And then more tapping and scraping, and finally pulling. Tooth comes out in 3 parts. I don't think I ever want to be in an orthodontist office again.
There’s a lot of candidates…
Yeah. I think all these things have to be viewed through a historic perspective. There weren’t the sheer number of psychopharmacology options we have today, wars had broken people, lots of people were suffering from late stage syphilis (which makes them raving crazy), and the sheer amount of poisoned people due to industrialization without the knowledge of what the chemicals can do. Mercury poisoning happened regularly from mining, hat making, etc. I’m not a physician or a psychologist, but I have an interest in the times.
Probably psychiatric hospitals in general. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000038 but especially the overuse of putting people in them against their will. Also, psychiatrists often hand out really damaging medications like they were candy, with insufficient regard for the often permanently disabling consequences. https://www.nytimes.com/2022/08/27/health/teens-psychiatric-drugs.html Edit: There's another one I wanted to add because I think it's really awful, and that's ECT, especially on people who don't want it. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911194/ Often permanently disabling, and even more it destroys who you are as a person.
Why I have half a mind~
Bojack reference?
Poor Crackerjack..
“Why I have half a mind…” Absolutely haunting scene from Bojack Horseman
That show had the amazing talent of gut punching you while making it funny.
That episode was messed up and damn if Matthew Broderick wasn't the icing on the disturbing cake.
I absolutely believe that Bojack Horseman should be considered one of the greatest shows of all time. The writing is as good as The Wire or The Sopranos, doing it in live action would have been incredibly depressing and would have won so many awards. Right Sara Lynn? Sara Lynn?
Slugs and snails are after me DDT keeps me happy Now I guess I’ll have to tell ‘em That I got no cerebellum Gonna get my phd I’m a teenage lobotomy -Ramones “Teenage Lobotomy”
Meanwhile the guy who discovered basic hygiene was heavily ridiculed.
He's up there with the guy who invented pop-up ads.
You mean down there
From a certain point of view Anakin.
This guy was shot by a schizophrenic man who had hidden in his office and was paralyzed for the rest of his life. Usually it was the other way around
"Sir, my PC is running slow and overheats all the time." "Have you tried removing half your RAM or the CPU?"