The lobotomy, also known as leucotomy, was a procedure developed in the 1930s in an attempt to treat severe psychiatric illness. In the first procedures, small holes were drilled into the skull and ethanol was injected into part of the brain to functionally sever the frontal lobes (which generally control more executive functions, such as personality, motivation, and attention) from the rest of the brain
Even without sufficient medical trials, the mechanics of the procedure continued to evolve, and in the mid-1940s, lobotomies became routine office procedures. Doctors would stick an icepick into the brain through the top of the eye socket. Roughly 40,000 Americans were “treated” with this procedure, with a significant amount of associated death and morbidity.
Given the rather gruesome nature of the procedure and the clear lack of evidence for its success, many countries eventually banned the practice altogether.
With improvements in localization provided by high-resolution imaging (e.g. MRI scans) and brain wave studies, teams of neurosurgeons and neurologists are now able to target and remove small regions of the brain to significantly improve seizure control while causing minimal secondary damage. Promising results have led to a rise in the lobotomy-like procedure. According to the Nationwide Inpatient Sample, roughly 6,500 lobectomies and partial lobectomies were performed in the United States between 1990 and 2008. In one subset of epilepsy patients, seizure control was achieved in up to 75% of patients treated with surgery and medications compared to 0% in patients treated with only medications.
2. Electroshock Therapy
Now more commonly referred to as electroconvulsive therapy (or ECT), electroshock therapy was developed as a treatment for psychiatric conditions in the 1930s. It was shown to be very effective in improving mental illness, especially severe depression. At its height in the 1940s and 50s, it was estimated that approximately one-third of patients hospitalized with affective disorders (e.g bipolar, depression, anxiety) had undergone the treatment.
Unfortunately, it was also associated with significant memory disturbances and confusion, and prior to the use of anesthetics was known to cause bodily harm, including bone fractures and dislocations. Improvement in techniques and the use of anesthetics to prevent the contorting movements of the seizure helped mitigate these problems.
Despite these improvements, however, public perception of ECT was exceedingly negative. In the popular novel and movie, One Flew Over the Cuckoo’s Nest, Big Nurse (Nurse Ratched), used it as a tool to terrorize and control the patients in her ward; in Sylvia Plath’s The Bell Jar, the protagonist’s first psychiatrist punishes her with ECT, although later she is treated successfully with ECT in a more controlled environment. The negative public perception, combined with the rise of antidepressant use from the 1950s onwards, led to a significant decrease in the use of ECT.
Over the past 20 or so years, however, ECT has had a resurgence due to its effectiveness in patients with severe depression that do not respond to medication alone. It is estimated that roughly 100,000 Americans receive ECT per year in the United States, and it is considered to be the gold standard treatment for severe depression.
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