Talk:Psychosurgery

From Wikipedia, the free encyclopedia

Contents

[edit] "Lobotomy"

This is quite good! I have two questions: 1. why no mention of the common or garden name lobotomy? Even if the name is entirely incorrect, it's the one people know (I myself didn't come across 'leucotomy' until I was reading some pop-neurology a few years ago). 2. why the scare quotes around 'scientific'? I think the line between science and pseudo-science deserves a sentence of explanation here, not dismissal with a scare quote - hell, Moniz got a Nobel Prize. MichaelTinkler


1. lobotomy is a term in its own right for a surgical incision into the lobe of any organ so to use it here would be incorrect.
2. scare quotes because survival rates were initially very poor (7 out of 20 isn't science it is slaughter) and the acceptance of a technique on that basis is desperation. But it had, for the time, an edge that could be called scientific without that being the correct phrase. Nobel prizes are not a indicator of correctness - they have been handed out for research subsequently proved wrong. -- TwoOneTwo


The likely reason that 'lobotomy' has not been used in the article is that it is a term for a procedure that is no longer practiced (and hasn't been for decades). Even though most people are familiar with the term, to call all neurosurgical procedures for mental disorder 'lobotomies' is fundamentally incorrect. The term 'psychosurgery' is arguably outdated as well, since one cannot perform surgery on the 'psyche'. It was coined by Egas Moniz in 1937 and has unfortunately remained in common usage. In 1976, the World Health Organisation defined 'psychosurgery' as, "the selective surgical removal or destruction…of neural pathways…with a view to influencing behaviour". A similar description was offered by Chorover (1974): "selective destruction of areas of the brain for the primary purpose of altering thoughts, emotional reactions, personality characteristics of social response patterns". The most appropriate term for such procedures is Neurosurgery for Mental Disorder (NMD), which has been defined by the UK Royal College of Psychiatrists as, "a surgical procedure for the destruction of brain tissue for the purposes of alleviating specific mental disorders carried out by a stereotactic or other method capable of making an accurate placement of the lesion."

I should also add that although Moniz received his Nobel Prize for the development of leucotomy for psychosis, he was also responsible for the the development of cerebral arteriography.

--DChristmas 11:27, 2 February 2006 (UTC)

Chorover, S. L. (1974) Science, 184, 669.

Freeman, C., Crossley, D. & Eccleston, D. (2000) Neurosurgery for mental disorder. Report from the Neurosurgery Working Group of the Royal College of Psychiatrists. London: Royal College of Psychiatrists.

The problem with the term neurosurgery for mental disorder (NMD) is that it remains rather a British term and is less commonly used in the US, where even doctors who are involved with psychosurgery still use the term psychosurgery. For example, doctors at Galveston, Texas, recently published an article called "Psychosurgery for Self-Injurious Behavior in Tourette's Disorder"; and the psychosurgery team at Harvard University/Massachusetts General Hospital have a webpage entitled "Psychosurgery". Even in Britain the term NMD isn't used by everyone. For example, although the Mental Health Act Commission replaced psychosurgery with NMD in 1997, the Joint Parliamentary Committee on the Draft Mental Health Bill last year used the term psychosurgery, not NMD. I think, for the time being at least, psychosurgery remains the most widely used and understood term, and most appropriate as the title for this article (with perhaps a note on terminology?)Staug73 18:02, 12 February 2006 (UTC)
I have to agree with you regarding the transatlantic differences in terminology, and it may be a difficult obstacle to overcome when the US undoubtedly outnumbers the UK in terms of readership of Wikipedia. It is probably worthy of a page in itself to attempt to describe the evolution of different terms! Perhaps, as you suggest, a note on terminology would help to clarify such issues. The Draft Mental Health Bill does indeed refer to psychosurgery under 'Type A' treatments, and the flaws in that Bill certainly don't help to inform the debate on mental health treatments such as NMD/ psychosurgery. -- --DChristmas 17:00, 19 February 2006 (UTC)

[edit] Psychosurgery today

I thought psychosurgery was, in a very few cases, still performed today for very severe OCD. There's also the history of surgery for epilepsy, though that's not really psychosurgery I suppose. --Robert Merkel

Cingulotomy is still performed, whereby the cingulate gyrus is ablated in some way. It remains fairly rare - see [1] -- FP <talk><edits> 20:47, May 15, 2005 (UTC)
Deep brain stimulation and stereotactic ablation is becoming more common by the day, and is by many believed to be a "coming star" in the next decade or so.--Lipothymia 20:59, 20 March 2006 (UTC)

Also notably, it has recently been tested by the chinese in drug addiction, by removing the areas that would normally perceive pleasure and well-being, roughly speaking. Other countries are considering following suit, as there is a very high success rate, with success defined as the patient not using illicit drugs again. I'd like someone who knows more about it to chime in. Zuiram 23:29, 22 October 2006 (UTC)

It has been used in both Russia and China to treat addiction, but both countries have abandoned these programmes. I will put something in the present day section. In the meantime you can read something about it here (China) and here (Russia)Staug73 12:39, 1 November 2006 (UTC)

This is from a western point of view. I just read of a Dr in China claiming to have done near 1000, one thousand "mostly for schizophrenia". wall street journal http://online.wsj.com/article/SB119393867164279313.html?mod=googlenews_wsj —Preceding unsigned comment added by Mark v1.0 (talk • contribs) 05:09, 4 November 2007 (UTC)

[edit] General comments

This article seems to be a bit disorganised. In particular the paragraph:

The initial criteria for treatment were quite steep, only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, depression with risk of suicide and incapacitating obsessive-compulsive disorder were the main symptoms treated. The original leucotomy was a crude operation and the practice was soon developed into a more exact, stereotactic procedure where only very small lesions were placed in the brain.

This seems out of sequence as the next paragraph goes on to talk about "icepick lobotomy", the very opposite of stereotactic surgery. Also I think the "initial criteria" given look like the current criteria for surgery but I don't know enough about this subject to know if they were also the initial critera. Cosgrove and Raunch in their excellent article do not really go into the early indications. Certainly the criteria widened to include many conditions during the heydays of its use.

The other thing that doesn't come across clearly in this article is that the use declined after the introduction of effective treatments but a very small number of people still have psychosurgery performed on them for intractable psychiatric conditions. The current indications for psychosurgery should be listed.

If anyone is looking after this please have a go at fixing it. --CloudSurfer 09:44, 14 Sep 2004 (UTC)

[edit] Request for more info

As someone who is both curious and horrified by this kind of thing, I would like to know (a) why it was theorised that severing the prefrontal cortex from the rest of the brain would have any effect (b) what effect it was supposed to have and (c) what effect it actually had, apart from death in some cases. What does psychosurgery actually achieve? Presumably it alters the mood, but how, and to what extent? Were the thousands who were lobotomised able to lead relatively normal lives thereafter? (I assume it would be hard to distinguish the results of lobotomy from the 'noise' of the patient's original illness, however). Ashley Pomeroy 21:51, 19 Nov 2004 (UTC)

  • I second that, this article is majorly useless for anyone wanting to learn, perfect for someone who loves gossip. --Kintaro 15:33, 15 May 2005 (UTC)

It was theorized that the nerves connecting the frontal lobe to the thatlamic region were defective and by severing them the defective thoughts could be removed, thus allowing new, healthy nerves to regenrate in their place.

[edit] NPOV?

Now, I confess I'm not an expert in these things (medicine, science), but I think the article's tone isn't very neutral. It actually took me three reads of this article to figure out that lobotomy may have had any effect besides severe impairment. Putting things in context, mentioning the effects of the operation, and some more useful links might be in order. -- 193.166.89.77

It seems this article has had problems for a while, as expressed above. I guess I'll give it an overhaul in the next few days, if nobody else will. -- FP <talk><edits> 20:47, May 15, 2005 (UTC)

[edit] POV?

The article is definitely judgemental of psychic surgery, which isn't even what it is about. -- 66.32.73.120

This article is not about about psychic surgery and there is no basis to make the assumption it is representing psychosurgery falsely as psychic surgery Rotovia (talk) 00:09, 6 March 2008 (UTC)

[edit] Does this really need a mention

This term should not be confused with the allegedly fraudulent, sleight-of-hand practice of psychic surgery.

This term should not be confused with the practice of psychic surgery. would do just fine. --Kintaro 15:33, 15 May 2005 (UTC)

[edit] Ancient trepanning

"[Trepanning]<nowiki> may have been done in an attempt to allow the brain to expand in the case of increased brain fluid pressure, for example after head injuries; several documented cases of healed wounds indicate that such crude surgery could be survived back then." The fact that the wounds healed, indicating the surgery was survived, is documented and IMHO should be added to the article. I'm less sure about the claim that trepanning may have been attempted to address brain fluid pressure; can we get citation for that theory? -- ~~~~

I very much doubt that as well -- it's more likely it's about releasing spirits. Actually, I'm not even sure that the paragraphs on trepanning even belong on this page. They don't really fit with the definition of psychosurgery. Actually, I don't think the surgery referred to at the bottom of the page does either. Psychosurgery is really about smashing up the frontal lobe and its variations Limegreen 04:36, 15 July 2005 (UTC)

[edit] ETS/Psychosurgery

Can anybody verify that Endoscopic thoracic sympathectomy is in fact 'psychosurgery'? To me this article seems a real misnomer. While I understand that 'lobotomy' from a scientific perspective means the removal of a lobe, in common use it means the surgery described on this page. Thus, I think this page should be re-named 'Lobotomy', with some mention of psychosurgery. It should then have a See Also section referring people to Neurosurgery, ETS, trepanning etc. Any comments?? Limegreen 00:16, 20 July 2005 (UTC)

The largest and most famous ETS clinic in Eurpoe, the Privatix clinic in Finland and Italy, headed by Timo Telaranta, president of the International Symposium on Sympathetic Surgery, is dedicated almost exclusively to using the procedure to treat psychiatric disorders. They have psychosurgery patients numbering in the thousands. They have repeatedly published significant psychiatric effects from the surgery, and those documents are referenced in the article. I think psychosurgery is a fine title for the article, as a reader who is interested in surgeries that affect the personality will find an excellent resource here, rather than having to click around several articles. 69.228.47.7 01:15, 9 August 2005 (UTC)


Psychosurgery is indeed a good title for the article, but I think that Endoscopic thoracic sympathectomy (ETS) doesn't belong here. Every definition of psychosurgery that I have been able to find refers to surgery on the brain for the treatment of mental disorder.
ETS isn't surgery on the brain. It involves the spinal cord, not the brain. Normally it is done in an attempt to control sweaty hands, facial blushing and things like that. Yes, surgeons in Finland have started operating on people with social phobia but that doesn't make it psychosurgery if psychosurgery is defined as an operation on the brain.
Egas Moniz, who is generally credited with the invention of psychosurgery although a few operations had been done previously by other people, coined the terms psychosurgery and leucotomy. And modern operations are still called psychosurgery http://neurosurgery.mgh.harvard.edu/Functional/psysurg.htm
So it seems to be a good title that covers everything from the earliest operations to those being done today. As well as in the USA, psychosurgery is still used on a small number of people every year in the UK, and some other countries as well, although in other countries it is no longer used. Incidentally psychiatrists in Britain are now trying to get people to use the name NMD - neurosurgery for mental disorder. And to further confuse things, they sometimes call operations cingulotomies or capsulotomies etc which just refers to the bit of the brain they are aiming for and is still psychosurgery.
The term lobotomy was coined by Walter Freeman in the USA who thought that it was a better way of describing the operation than Moniz's term leucotomy. The name "lobotomy" became popular in the US, whilst "leucotomy" remained in favour in Europe. The problem with "lobotomy" is that is has come to be associated with just one type of operation, Walter Freeman's transorbital, or "ice-pick", lobotomy so people say that it stopped being used in the 1970s, whilst of course psychosurgery has continued this day.Staug73 19:08, 27 January 2006 (UTC)

[edit] "lobectomy"

According to Wikipedia, "lobectomy" redirects to Pneumonectomy, which defines it as the removal of one lobe of the lung. This article defines it as removal of one lobe [of the brain]. Does lobectomy simply mean removal of a lobe? If so, Pneumonectomy is incorrect and this article is in need of clarification. Which is correct?

Lobectomy = removal of a lobe, whether of lung, liver or brain. It may need to be a disambig. JFW | T@lk 07:45, 17 November 2005 (UTC)

[edit] Anorexic patients lobotomized

Added the fact that psychosurgery is practiced in anorexic patients. Phrase “Lobotomy is no longer used as a treatment for schizophrenia” deleted because it is still practiced for schizophrenic patients, in Mexico for sure (and probably in other countries as well). —Cesar Tort 18:43, 6 April 2006 (UTC)

[edit] Present day

I think the sentence It may be a treatment of last resort for (...) anorexic patients in Chile, the United States, Sweden and Mexico needs revision, or at least a citation!

Psychosurgery is certainly used in the treatment of anorexia in Mexico [2]. Chile - I have found an article from about 15 years ago [3]. I thought though the current use of psychosurgery in the USA was limited to the treatment of OCD and depression, and in Sweden OCD, depression and anxiety.Staug73 08:58, 18 June 2006 (UTC)

I removed this phrase about pain "In the case of people suffering chronic pain, the surgery does not act on the perception of pain" as the Baer study is about OCD not pain.Staug73 12:50, 26 October 2006 (UTC)

[edit] Proposed merge: Lobotomy and Psychosurgery

These two pages have very little difference between them in content; the Psychosurgery page has no real discussion of surgeries other than other than Lobotomy. The latter is the more familiar concept, so it seems the right page to merge into. --Ogdred 22:28, 9 September 2006 (UTC)

Lobotomy has redirected for over to years to this page until 2 days ago [4]. I'm inclined to agree that it should probably be the other way round. --Limegreen 23:12, 9 September 2006 (UTC)
I would suggest they not be merged, but that this one be cleaned up.Trilobitealive 03:12, 23 December 2006 (UTC)
Disagree. Psychosurgery is a neologism that lacks precision, and is moreover behefted with considerable stigma. What is discussed in this article is neurosurgical procedures for psychiatric disorders, whereas psychosurgery in reality also entails other therapeutic modalities, e.g. surgical procedures for cosmetic/psychological reasons. I propose that this article should briefly enlist the different procedures done for psychiatric/psychological reasons, with links to each and every procedure listed. A move to lobotomy would firstly be simply wrong (as lobotomy simply means removing a lobe of any organ, could also be removing part of the lung for instance), and even more bias to the article itself. --88.250.10.109 10:41, 20 February 2007 (UTC)

[edit] Phineas Gage

I altered the part about Phineas Gage. It read:

"The effects were comparable to a surgical lobotomy."

The effects of the accident to Mr.Gage's personality were not comparable to a surgical lobotomy. The effects were documented as:

"Gage was fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom), manifesting but little deference for his fellows, impatient of restraint or advice when it conflicts with his desires, at times pertinaciously obstinate, yet capricious and vacillating, devising many plans of future operations, which are no sooner arranged than they are abandoned in turn for others appearing more feasible. A child in his intellectual capacity and manifestations, he has the animal passions of a strong man. "

I doubt that the frontal lobe lobotomy would have been so successful if it had these effects on the patients.