Diagnosis and Treatment

Diagnosis of a need for psychosurgery is based on observation of symptoms
supporting abnormal psychological behavior. Examples are extremes of aggression,
anxiety, obsession, or compulsiveness as well as psychoses other
than schizophrenia. The exclusion of schizophrenics, except for those having
marked anxiety and tension, is based on data supporting poor responses
by schizophrenics to lobotomy and other leucotomies. Surveys have shown
that good surgical outcomes were only obtained in 18 percent of schizophrenics
who underwent lobotomy, as compared with 50 percent of depressives.
Psychosurgery’s unfavorable record between 1935 and 1965, and its postoperative
irreversibility, speak to the need for careful study before suggesting
such brain surgery. In addition, many members of the medical community
believe that the choice of psychosurgery should be based on the longtermnature
of symptoms untreatable by other means, as well as a severe risk
of suicide. Before psychosurgery is attempted, other methods must be exhausted,
such as repeated ECT, prolonged psychoanalysis, and aggressive
pharmaceutical treatments with antipsychotic drugs. Some sources suggest,
as criteria for choosing psychosurgery, the persistence of symptoms for
more than ten years of treatment under conditions where all possible
nonsurgical methodology has been exhausted after its aggressive use. Others
believe it inhumane to require a decade of illness before allowing the
possibility of a cure.
Symptom severity is another hugely important criterion for psychosurgery.
Examples of this are the complete inability to work at a job or carry out
household chores, as well as long-term and severe endogenous depression.
It is also suggested that patients who have strong psychological support from
their families and stable environments are the best candidates. Careful assessment
of patient symptoms, handicaps, and problems should always be
carried out. Formal rating scales, personality assessment via school and work
records, and information coming from close relatives or friends are also
viewed as crucial.
The use of psychosurgery is limited to a very small number of patients not
helped by existing chemotherapeutic or psychoanalytical methodology. It is
fortunate that a wide variety of new techniques have made psychosurgery capable
of destroying smaller and smaller targets. As knowledge of the brain
and its functioning increases, it appears possible that modern psychosurgery
may yet prove to be useful where other methods fail.
Sources for Further Study
Feigenbaum, Ernes. Stereotactic Cingulotomy as a Means of Psychosurgery. Rockville,
Md.: U.S. Department of Health and Human Services, Public
Health Service, 1985. A useful description of one of the newer psychosurgical
methods.
Fulton, John F. Frontal Lobotomy and Affective Behavior: A Neuropsychological
Analysis. New York: W. W. Norton, 1951. A prominent member of the
American medical profession contemporary with António Egas Moniz
and Pedro A. Lima discusses human and animal lobotomy. Fulton is
strongly for lobotomy and lauds its achievements and prospects. The
book has good references and illustrations.
Lader, Malcolm H., and Reginald Herrington. Biological Treatments in Psychiatry.
2d ed. New York: Oxford University Press, 1996. Covers the human
brain, mental illness and principles of its treatment, neuropharmacology,
psychosurgery, and ECT. Contains a good bibliography.
Rodgers, Joann Ellison. Psychosurgery: Damaging the Brain to Save the Mind.
New York: HarperCollins, 1992. Covers psychosurgery in healing the
chronically mentally ill. Describes methods which destroy only a few
brain cells and their efficacy compared to drugs. Examines moral and
medical pros and cons.
Turner, Eric A. Surgery of the Mind. Birmingham, England: Carmen Press,
1982. Answers questions regarding the ethics of carrying out psychosurgery,
its consequences, and its justifications. Topics include the brain,
its function and operation, selection and management of lobotomy patients,
various types of psychosurgery, and follow-up of five hundred
psychosurgeries.
Valenstein, Elliot S. Great and Desperate Cures: The Rise and Decline of Psychosurgery
and Other Radical Treatments for Mental Illness. New York: Basic
Books, 1986. Well-thought-out history of psychosurgery. Includes theories
of mentation leading to psychosurgery, methodology of its great proponents,
and reasons for its replacement and limited use. Illustrated.
__________, ed. The Psychosurgery Debate: Scientific, Legal, and Ethical Perspectives.
New York:W. F. Freeman, 1980. Includes an overview of the history,
rationale for, and extent of psychosurgery; patient selection; evaluation
of methods used; description of legal and ethical issues; and an extensive
bibliography.
Sanford S. Singer
See also: Anxiety Disorders; Bipolar Disorder; Brain Structure; Depression;
Madness: Historical Concepts; Schizophrenia: Background, Types, and Symptoms;
Schizophrenia: Theoretical Explanations.