Re: lobotomy may soon be performed without the patient's consent @ Dundee & Cardiff

[Guest guest]

" he demonstrates with a cake knife how he used to sever

or core out part of the frontal lobes of his patients to break the

nerve " circuits " believed responsible for mental illness. "

That's like removing someone's eyes, who has Glaucoma because the eyes

are 'responsible' for the blindness.......these people are mad.

[Guest guest]

" he demonstrates with a cake knife how he used to sever

or core out part of the frontal lobes of his patients to break the

nerve " circuits " believed responsible for mental illness. "

That's like removing someone's eyes, who has Glaucoma because the eyes

are 'responsible' for the blindness.......these people are mad.

[Guest guest]

" he demonstrates with a cake knife how he used to sever

or core out part of the frontal lobes of his patients to break the

nerve " circuits " believed responsible for mental illness. "

That's like removing someone's eyes, who has Glaucoma because the eyes

are 'responsible' for the blindness.......these people are mad.

[Guest guest]

" he demonstrates with a cake knife how he used to sever

or core out part of the frontal lobes of his patients to break the

nerve " circuits " believed responsible for mental illness. "

That's like removing someone's eyes, who has Glaucoma because the eyes

are 'responsible' for the blindness.......these people are mad.

[Guest guest]

Bryce,

Is there any url or email address associated with this

information?

It is easy to believe, but some people like proof.

john

--- bryce_j_j <jeremy.bryce@...> wrote:

>

>

>

>

> The lobotomy is deemed one of the worst crimes in

> medical history.

> But a modern form of it is still practised in

> Britain - and may soon

> be performed without the patient's consent. By

> Toomey and

> Young

>

>

>

>

> The flashbacks come late at night. First comes the

> recollection of

> intense physical pain, as if the bones in his arms

> are being snapped

> like twigs. Then he hears the voice of the

> neurosurgeon applying an

> electric current to metal pins implanted in the

> tissue of his

> brain. " How do you feel, ? " the surgeon Arthur

> E Wall asks,

> while peering into Hutchinson's eyes to see if

> his pupils have

> yet dilated with fear.

>

> When Hutchinson swears at the surgeon, Wall

> administers another

> electric shock to nerve centres located in the

> hypothalamus at the

> centre of his patient's brain. At this, Hutchinson's

> pupils dilate

> and he screams: " You're going to kill me, you

> bastard! " Hutchinson's

> medical records, written by Wall over 30 years ago,

> confirm that his

> patient " felt funny - as if he was dying " . But as he

> screamed,

> Hutchinson recalls Wall leaning in close to his face

> and

> leering: " And I thought you were a bit of a tough

> guy. "

>

>

>

> His next recollection is of Wall giving orders for

> surgical

> implements to be passed. Hutchinson feels the metal

> pins inserted

> through nylon balls lodged in cavities bored into

> the front of his

> skull being replaced by thicker electrodes he says

> felt like " broom

> handles " . " After that I started, I start to feel

> warm all over and

> quickly feel as if I have fallen into a vat of

> molten metal, as if I

> am, quite literally, frying, " says Hutchinson,

> tellingly confusing

> tenses as he describes the brain surgery he

> underwent in 1974 yet

> still relives up to a dozen times a day and in

> frequent nightmares.

>

> Throughout the surgery, Hutchinson was kept

> conscious; his head held

> in a brace, his hands and feet strapped to the

> operating table.

> Hutchinson, a 27-year-old father of three at the

> time of the

> operation, says he had not given his written consent

> to the

> operation being performed; neither had his wife -

> his next of kin.

> Instead his mother, an alcoholic, had been visited

> at home, in the

> late evening, after she had been drinking, and had

> been asked to

> sign the form. " My mother thought doctors were

> gods, " Hutchinson

> says. " She'd have signed anything they asked. "

>

> Hutchinson's excruciatingly detailed recollections

> are a rare

> testimony of someone still lucid and intensely angry

> about a type of

> brain surgery to which he was subjected - he

> contends illegally -

> commonly referred to as a lobotomy. In strict

> medical terms, a

> lobotomy - or leucotomy, as the procedure became

> known in this

> country - involved the removal of part of the

> frontal lobes of the

> brain or the severing of neural fibres connecting

> the frontal lobes

> to the limbic system - the part of the brain

> concerned with

> emotional response and functions not under conscious

> control.

>

> From the mid-1930s until the early 1960s this form

> of " psychosurgery " was heralded as a miracle cure

> for the mentally

> ill, before psychotherapy came into vogue and drugs

> to treat many

> mental-health problems became widely available. It

> was pioneered by

> a maverick Portuguese neurologist, Egas Moniz, who

> was awarded the

> Nobel prize in 1949 for developing and promoting the

> procedure.

> Lobotomies were seen as the solution to a wide range

> of mental

> disorders ranging from profound depression,

> schizophrenia and

> advanced neurosyphilis to mild retardation, at a

> time when half of

> all hospital beds in many countries were occupied by

> the mentally

> ill, and mental institutions were often places of

> humiliation and

> horror.

>

> At the height of its popularity in the 1940s and

> 50s, particularly

> in the US, some of the most enthusiastic proponents

> of the procedure

> promoted it as a way of controlling large numbers of

> those

> considered society's worst misfits, including

> communists and

> homosexuals. Neurologists, not just in the US but in

> Japan, Britain

> and elsewhere, carried out variations of the

> procedure on tens of

> thousands of patients - an estimated 50,000 in the

> UK alone.

>

> Little attention was paid to what happened to those

> subjected to

> lobotomies after surgery. F Kennedy's

> temperamental sister

> Rose, who underwent the operation at the age of 23,

> for instance,

> spent the next 60 years of her life out of sight in

> a mental

> institution. Francis Farmer, the rebellious

> Hollywood actress and

> political activist whose outspoken behaviour was

> also " cured " by a

> lobotomy, quickly drifted into oblivion and ended

> her days as a

> hotel clerk.

>

> But as the number of lives wrecked by such surgery

> became more

> widely known, its effect was gradually exposed -

> most famously in

> Milos Forman's 1975 film, One Flew over the Cuckoo's

> Nest. But also

> earlier, in the 1958 play Suddenly Last Summer, by

> Tennessee

> . A close friend of , whose sister

> Rose was

> lobotomised as a teenager, recalls how the

> playwright talked of his

> sister as " fragile and gentle " , someone hurt by " the

> harshness of

> life " .

>

> " Things alarmed Miss Rose that would not even be

> noticed by someone

> less sensitive. She was just awakening to sexuality

> and knew almost

> nothing about it… Rose came home from school one day

> and said the

> nuns were using altar candles for self-abuse. She

> told mother this, "

> the playwright once confided to his biographer

> Dotson Rader. To the

> siblings' mother, known even to her children as

> " Miss " , human

> sexuality was " the great unmentionable " . She

> promptly took her

> daughter to the doctor, demanding the " filth " be cut

> out of her

> brain: " Cut it away! Miss ordered. " Make it

> clean! " " And he

> did, " recalled the playwright, who said his mother

> never showed any

> remorse about reducing her daughter to a human

> vegetable.

>

> Some now consider such practices to be among the

> most egregious

> medical crimes of the last century and have called

> for Moniz, who

> was later shot in the back by a dissatisfied

> patient, to be

> posthumously stripped of his Nobel prize. The Nobel

> Foundation rules

> this out, maintaining that all of its awards can be

> justified within

> the historical context that they are given.

>

> By the time Hutchinson had his operation in 1974,

> the scale on which

> psychosurgery was being performed was drastically

> reduced, with more

> and more mental disorders being treated with drugs

> and

> psychotherapy. Crude frontal lobotomies, of the type

> Moniz promoted,

> had been phased out. Surgery became targeted at more

> specific parts

> of the brain as the neurobiology of emotion became

> better

> understood. The surgery performed by Wall on

> Hutchinson's

> hypothalamus, for instance, was intended to curb his

> aggression.

>

> Since then, psychosurgery has become even more

> refined, the parts of

> the brain targeted and destroyed to control

> behaviour ever smaller.

> Though the name lobotomy persists, the medical

> profession now refers

> to any such procedure as NMD (neurosurgery for

> mental disorder). But

> Britain is now one of the few countries where this

> sort of surgery

> is still permitted. Even here it is only performed

> for persistent

> severe depression and anxiety and

> obsessive-compulsive disorder

> (OCD) in two places: University Hospital of Wales in

> Cardiff, and

> Ninewells hospital, Dundee. Patients must consent to

> the surgery and

> ethical and clinical standards committees subject

> each case to rigid

> scrutiny before it goes ahead.

>

> If the worst excesses are in the past, the type of

> surgery now

> conducted so controlled and the numbers to whom it

> is given severely

> limited, some might argue that the subject of

> lobotomies,

> psychosurgery, NMD - call it what you will - is only

> of historical

> interest. They would be wrong.

>

> In the coming month, parliament is expected to

> finally debate

> another hotly contested piece of proposed

> legislation: the draft

> Mental Health Bill (2004), which many mental-health

> experts fear

> will reduce safeguards for the mentally ill. One

> provision of the

> bill is a little-noticed clause that, if passed onto

> the statute

> books, would allow doctors to perform NMD without a

> patient's

> consent if they were considered so mentally ill they

> were incapable

> of giving it.

>

>

> No matter how refined these latest NMD techniques

> are, nor how

> vociferously neurosurgeons who practise it argue it

> is nowadays

> employed only as a last resort, its outcome is often

> unpredictable.

> Since it is irreversible, some believe it should be

> banned. At the

> very least it should only be conducted on those able

> to give their

> informed consent, argue campaigners such as the

> mental-health

> charity Mind and the Mental Health Alliance, which

> includes such

> bodies as the Royal College of Nursing, the Royal

> College of

> Psychiatrists, the Law Society and dozens of other

> organisations in

> the field of mental health.

>

> With many of those who have undergone such surgery

> unable to speak

> for themselves and few of those subjected to the

> cruder forms of

> surgery still alive, Hutchinson's is the rare

> voice of

> experience. His story serves as a chilling

> reinforcement of the

> adage that a society be judged by the way it treats

> its most

> vulnerable. With the government proposing

> legislation that many

> believe would turn the clock back on the way we

> treat the mentally

> ill, what does that say about modern Britain?

>

>

>

>

>

>

>

>

>

>

>

> As Hutchinson sits talking in the cramped living

> room of his small

> terrace house in Leeds, he frequently stretches out

> his arms to hug

> his two-year-old grandson, one of 17 grandchildren.

> While the boy

> giggles with delight, Hutchinson, 59, talks a little

> of his own

> childhood. He recalls how his mother would often

> lock him, the

> middle of three brothers, in a coal shed overnight.

> " Glass were all

> broken. I'd have to sleep in coal sack, night after

> night. It went

> on for years, " he says. But he prefers not to dwell

> on it. " That's

> all done now, in the past. "

>

> On his own admission, Hutchinson grew into a

> troubled youngster.

> Though he channelled his aggression into amateur

> boxing and other

> sports, he was, he admits, " always in trouble as a

> lad " and would

> often get into fights. After a spate of joyriding

> cars as a

> teenager, he was sent to a series of borstal

> schools, then remand

> homes. Eventually he found work as a welder, married

> and had three

> children. When he was 27, however, he suffered a

> nervous breakdown.

> After being admitted to a psychiatric hospital, he

> was given ECT

> (electroconvulsive therapy) and prescribed strong

> sedatives. His

> psychiatrist then recommended that he undergo

> psychosurgery.

>

> According to Hutchinson, the psychiatrist tried to

> persuade him such

> surgery was necessary to curb his aggressive

> tendencies after asking

> him how he would feel if Hutchinson were ever to

> kill one of his own

> children. " I'd never harmed any of my children. I

> never would. But

> when he put it like that, I was scared. " Still,

> Hutchinson was

> considered incapable of giving consent, as ?he was

> so heavily

> sedated. At first his wife agreed to the operation.

> But after seeing

> the sizable holes that had been drilled into her

> husband's skull in

> preparation for the second part of the operation a

> week later, she

> withdrew her consent. It was then that his mother

> was approached.

>

> In a 1976 TV documentary on the same operation as

> Hutchinson

> underwent, being performed on a mother-of-five

> called Margaret

> Chapman, the neurosurgeon Wall, who has since died,

> describes the

> operation as " quite simple, really " . He then

> casually admits

> knowledge of psychiatry is " something you pick up as

> you go along " .

> But far from curing Hutchinson's aggression, which

> he describes

> as " within his control " before the operation, the

> surgery he

> underwent left him so traumatised that he walked out

> on his first

> wife, Ruth, who had recently given birth to twins,

> fearing he might

> do his children harm. He subsequently attempted to

> physically attack

> the psychiatrist who had referred him to Wall, and

> several years

> later tried to commit suicide. Though he eventually

> resumed work and

> remarried, he has suffered vivid flashbacks of the

> operation ever

> since, and in recent years has been diagnosed as

> suffering from post-

> traumatic stress disorder.

>

> However troubling Hutchinson's story is, it is by no

> means the

> result of the most cavalier practitioner of

> psychosurgery in this

> country. The neurosurgeon reputed to have been

> Britain's most

> prolific lobotomist was the former president of the

> Society of

> British Neurological Surgeons (SBNS), Sir Wylie

> McKissock, based at

> Atkinson Morley's hospital in Wimbledon in the late

> 1940s and 50s.

> McKissock is described by those who knew him as a

> taciturn and

> difficult man, much feared by his junior staff. He

> rarely spoke to

> or met patients before or after surgery. Instead, at

> weekends, he

> made regular tours of nursing homes and mental

> hospitals along the

> Sussex coast. With the aid of a theatre sister, he

> would perform,

> for cash, up to 10 a day of the crude frontal

> lobotomies pioneered

> by Moniz. McKissock is understood to have performed

> around 2,000

> such operations.

>

> Few records exist of the reasons they were performed

> or their

> outcome; but a 1949 study of 300 of McKissock's

> lobotomy patients

> recorded that 16 had died as a direct or indirect

> result of the

> operation. It is impossible, therefore, to assess

> how many of these

> operations were performed needlessly. But the

> experience of those

> such as Hutchinson, and the accounts of relatives of

> others who

> underwent earlier forms of psychosurgery, attest to

> it having been

> performed for flimsy reasons and to disastrous

> effect by some

> British surgeons, just as it was in the US.

>

>

>

>

>

>

>

>

>

> One such case is that of Shaw, whose brother

> , a 69-

> year-old retired painter and decorator from

> Liverpool, describes

> as " a very, very clever lad " when he was younger.

> " He was very good

> at art. He loved to draw cartoons. Our father was a

> sign writer and

> he sent some of Ron's cartoons to a London newspaper

> when we were

> still teenagers, " recalls of his elder

> brother. " They wanted

> Ron to draw more and were going to pay him quite

> well. But he

> suffered with his nerves. He never did it. "

>

> When was in his early teens, his brother

> remembers he started

> coming home from school crying and would often wake

> up screaming in

> the night. The boy was admitted to hospital and

> given ECT. It failed

> to help. " Years later, we discovered, through

> another boy who was at

> school with Ron, that there was a teacher who used

> to regularly take

> my brother into a back room to cane him. Who knows

> what else he did

> to him in that room. I believe now that it was this

> bullying that

> caused my brother to behave the way he did. "

>

> When he was 17, volunteered to join the army,

> but within a

> year was discharged with a knee injury. In 1955,

> when was

> stationed in the Far East, completing his national

> service, his

> brother was admitted to Rainhill hospital in the St

> Helens district

> of Liverpool and a frontal lobotomy was performed.

> " I knew nothing

> about it. When I came back from the Far East, my

> brother was

> destroyed. He did not talk for two years. Eventually

> he started to

> speak, but he was never the same again. He was never

> able to work.

> My parents spent the rest of their lives looking

> after him. Their

> lives were ruined too. After they died he lived

> alone, though I took

> him out as much as I could. "

>

> Shaw died last year. His partially skeletal

> body was found in

> a field months later. His brother believes he was

> trying to walk to

> the Marble Church in Holywell, which had always

> fascinated him, when

> he stopped for a rest and died of natural causes.

> His body had been

> run over by a tractor after his death and his

> remains were

> surrounded by diaries he kept of his daily

> activities. " I'd been

> driving all over the country looking for him for

> months. Then the

> police called, saying they'd found a body with holes

> drilled in the

> front of his skull and I knew it was Ron, " says

> , his voice

> cracking. " It's unforgivable what was done to him. "

>

>

>

> Supporters of modern-day psychosurgery, or NMD,

> argue it has moved

> light years from the notorious excesses of such

> early practices. Yet

> even the crudest operations, they stress, were

> effective in

> alleviating the mental suffering of some patients.

> One former

> president of Ireland's Royal College of Surgeons,

> who is believed to

> be one of the few surviving neurosurgeons to have

> carried out the

> conventional frontal lobotomy on a regular basis,

> sits sipping a gin

> and tonic as he demonstrates with a cake knife how

> he used to sever

> or core out part of the frontal lobes of his

> patients to break the

> nerve " circuits " believed responsible for mental

> illness. He carried

> out two operations every Saturday morning, at the

> request of the

> Irish Department of Health, for nearly 10 years

> until 1960.

>

> Immaculately dressed in a tweed suit, he recalls how

> the operation

> helped one vet obsessed with a fear of constipation

> who ate fruit

> constantly and spent all day in the toilet. After

> the operation he

> was able to return to work. He also talks of

> performing lobotomies

> on more than 20 priests with perceived personality

> disorders. But,

> he says, in his experience the surgery did more to

> help those who

> were returned to closed orders rather than allowed

> to return to the

> community. Lobotomies, he says, did little to help

> those with

> schizophrenia, neurosyphilis or personality

> disorders other than

> obsessive-compulsive disorder and severe depression.

>

>

>

> Those forms of NMD still being conducted in this

> country today are

> targeted at the treatment of severe depression,

> severe anxiety and

> OCD. These procedures, which involve minute

> destructive lesions in

> parts of the frontal lobe or limbic system, are

> known as

> cingulotomies - the cingulum being the part of the

> frontal lobe

> associated with OCD - and capsulotomies, which

> involve making

> lesions in the capsules: the dense nerve-fibre

> pathway connecting

> part of the frontal lobe with the limbic structure.

> Neurosurgeons at

> Ninewells hospital in Dundee, for instance, carried

> out 34 NMD

> operations between 1990 and 2001. In the past year

> the hospital has

> conducted five such operations on patients it

> describes as " among

> the most severely ill and disabled who come into

> contact with any

> branch of the medical professions " . Surgeons at the

> University

> Hospital of Wales in Cardiff have conducted 56 NMD

> operations in the

> past decade. It was there that the former child

> singing star Lena

> Zavaroni, who suffered from anorexia, underwent such

> surgery in 1999

> for severe depression. Though the operation seemed

> to have been a

> success, she died of pneumonia less than a month

> later. According to

> Simpson, consultant neurosurgeon at Cardiff,

> the operations

> his team have conducted have led to a " marked

> improvement " in

> roughly half of those being treated for severe

> depression and

> OCD. " NMD is not a panacea, " Simpson agrees. " It is

> carefully

> regulated and only offered to patients for whom all

> other treatments

> have failed… But in the patients for whom it works

> well, whose

> suffering has been indescribable, it transforms

> their lives. "

>

>

>

>

>

>

>

>

>

> Some believe the way ahead lies in other forms of

> brain surgery,

> such as deep brain stimulation with implantable

> electrodes, as are

> increasingly used to treat Parkinson's disease. This

> they believe

> could offer an alternative to the ablative

> operations that have been

> used to date in psychosurgery. The introduction of

> modified stem

> cells into certain parts of the brain has also

> already had

> experimental success in treating some neurological

> conditions and

> holds out hope for combating psychiatric disease.

> But it is the

> irreversible nature of the NMD still practised that

> concerns

> opponents. That this type of surgery could be

> carried out without a

> patient's consent, according to the proposed

> legislation, they

> reject outright. Under the current Mental Health Act

> of 1983, three

> independent people, one a doctor, has to certify

> that any patient

> undergoing psychosurgery understands the treatment

> and consents to

> it. The draft mental-health bill under consideration

> has broadly the

> same safeguards for those capable of giving consent.

> The main

> difference is that it allows for treatment to be

> given without the

> patient's consent, at the request of doctors and on

> an order of the

> High Court, providing three conditions are met. The

> first is if it

> can be verified that a patient does not have the

> capacity to

> consent. The second is if there is no reasonable

> prospect of them

> regaining this capacity, and the third is if they

> are " unlikely to

> resist treatment " .

>

> According to Brook, former chief executive

> of the mental-

> health charity Mind, one of the biggest concerns of

> those who work

> in mental health is that no leading study has

> properly assessed the

> effect of psychosurgery on an individual's

> personality or sought the

> views of those undergoing such treatment. " Because

> of its hazards

> and the lack of clear evidence for the treatment's

> benefit, or basis

> for predicting success in the individual concerned,

> we believe it

> should never be given to someone who doesn't have

> the capacity to

> consent to it, " says Brook.

>

> Doctors at Ninewells hospital in Dundee argue that

> the lack of a

> randomised control trial to support NMD applies

> equally to a range

> of " cutting edge " medical and surgical procedures.

> Simpson

> says that although he appreciates there may be an

> " understandable

> fear of returning to the bad old days of lobotomy " ,

> he believes it

> is " not unreasonable in certain circumstances and

> with adequate

> legal safeguards " to perform NMD without a patient's

> consent. " The

> issue of consent is sensitive and crucially

> important, " warns

> Simpson, adding that " the more you open it up in

> this way, the more

> crucial it becomes to have adequate legal

> safeguards " .

>

> But , who is behind moves to launch

> a legal

> campaign in the US to have Moniz's Nobel prize

> revoked, believes

> that there are even wider issues at stake. 's

> own grandmother

> was left to languish in a psychiatric institution

> for 20 years after

> undergoing a lobotomy. As a result, the medical

> librarian ?from

> Levittown, New York state, founded an organisation

> called

> Psychosurgery.org, dedicated to the " surgical

> casualties " of such

> procedures. " There are a lot of important lessons to

> be learnt from

> what happened to our family members, " says .

>

> Many families of those suffering from Alzheimer's

> disease, she

> stresses, are now clamouring to have experimental

> brain surgery

> performed on them. " But there is a real ethical

> question about

> whether you can really do these kind of things to

> someone who is by

> definition having problems making decisions. I

> really hope people

> will take into consideration the amount of damage

> that was done in

> the past when they attempt to push forward with such

> treatments, "

> concludes.

>

>

>

>

>

>

>

>

>

> Hutchinson has recently tried to sue his local

> health

> authority for medical malpractice, but has had to

> give up because

> his surgery was carried out so long ago that the

> statute of

> limitations on such a claim has expired. West

> Yorkshire police are

> now investigating if there is a criminal case to

> answer over a lack

> of proper legal consent having been obtained.

>

> Such thoughts are far from his mind, however, as

> Hutchinson drives

> me back to the train station in Leeds, warning me

> that he might have

> to pull over to the side of the road at any moment

> because his

> lobotomy has also left ?him with narcolepsy.

> Throughout the journey,

> he talks affectionately about his brood of

> grandchildren. But by the

> time we reach the station, he has lapsed into

> melancholia and tears

> well in his eyes as he talks about how his own

> children's lives were

> damaged when he abandoned them after his operation.

>

> " If nothing else, I want people to understand what

> these bastards

> did to me, and thousands of others, so nothing like

> this is ever

> allowed to happen again, " he says, clutching the

> steering wheel

> until his knuckles go white. " What they did was not

> treatment - it

> was torture. "

>

> Young is consultant neurosurgeon at the

> Beaumont hospital in

> Dublin

>

> THE ORIGINS OF MIND-ALTERING SURGERY

>

>

> Egas Moniz could have afforded to rest on his

> laurels by the time he

> attended the Second World Congress of Neurology in

> London in 1935.

> The 61-year-old professor of neurology, and dean of

> Lisbon's Medical

> School, had already gained an international

> reputation for

> pioneering cerebral angiography - a radiological

> technique for

> mapping brain vessels. But Moniz was disappointed

> that this had not

> won him the Nobel prize. So when he heard two Yale

> neurologists

> speak at the London congress about experimental

> brain research on

> two chimpanzees called Clyde and Becky, observing

> how Becky's temper

> tantrums subsided after surgery, he would go on to

> pioneer - and

> relentlessly promote - a procedure that eventually

> won him the

> coveted Nobel prize.

>

> The procedure was the lobotomy. Back in Lisbon he

> ordered that a

> human brain be brought to him from a morgue, and

> thrusted a pen

> through the cortex several times until he was

> satisfied he knew the

> approximate angle and depth that would best detach

> the frontal

> lobes. He performed the operation on a former

> prostitute, who

> afterwards was unable to give her age or say where

> she was. She was

> returned to an asylum, never to be seen by him

> again.

>

>

>

> Moniz nonetheless considered this a " clinical cure "

> and continued

> operating. The procedure was greeted with enthusiasm

> by the medical

> profession and went on to be practised in many

> countries. After

> Moniz won the Nobel prize in 1949, the lobotomy's

> popularity

> increased. But today many believe the procedure is

> barbaric, and are

> campaigning for him to be stripped of the award.

>

> The Nobel Foundation contends that Moniz's prize

> should be judged in

> the historical context of a period when there was

> widespread despair

> about mental-health treatment. In the 1930s and 40s,

> patients were

> often beaten, choked, spat on and humiliated by

> attendants in state

> hospitals, where the average duration of confinement

> was 10 years.

> Cost was also a factor. In the mid-1930s a lobotomy

> cost $250 in the

> US, compared with tens of thousands of dollars to

> keep a patient

> incarcerated. The drawback of the operation - that

> it robbed

> patients of their personality traits - was

> considered a small price

> for emptying hospital beds.

>

> If Moniz brought the lobotomy fame, then the US

> physician Walter

> Freeman brought it infamy. A tireless

> self-publicist, he would

> perform his variation of Moniz's operation - the

> " ice pick "

> lobotomy - before an enthralled audience. This

> involved driving an

> ice-pick-like instrument through the roof of the eye

> and sweeping it

> across the frontal lobe to scramble neural

> connections. Freeman once

> boasted he was " as good as Sinatra " in getting

> young people to

> faint at the sight of what he did. One of his

> patients,

> Dulley, was 12 when he was lobotomised because his

> stepmother said

> he was sullen and refused to bathe.

>

> It was not until the mid-1950s, with the advent of

> antipsychotic and

> pacifying drugs such as chlorpromazine, that the

> lobotomy began to

> fall out of favour.

>

> The role of psychosurgery came under greater

> scrutiny in the 1960s

> and 70s, when social unrest led some sociobiologists

> to consider it

> a tool for addressing violence and

> " psycho-civilising " society

> through the use of implantable brain electrodes.

>

> Despite growing unease, more refined procedures such

> as

> cingulotomies were developed and the modern era of

> psychosurgery was

> born. Such procedures remain controversial and have

> been banned in

> Germany, Japan and a number of US states. They are

> still practised

> in the UK, Finland, India, Sweden, Belgium and

> Spain.

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Bryce,

Is there any url or email address associated with this

information?

It is easy to believe, but some people like proof.

john

--- bryce_j_j <jeremy.bryce@...> wrote:

>

>

>

>

> The lobotomy is deemed one of the worst crimes in

> medical history.

> But a modern form of it is still practised in

> Britain - and may soon

> be performed without the patient's consent. By

> Toomey and

> Young

>

>

>

>

> The flashbacks come late at night. First comes the

> recollection of

> intense physical pain, as if the bones in his arms

> are being snapped

> like twigs. Then he hears the voice of the

> neurosurgeon applying an

> electric current to metal pins implanted in the

> tissue of his

> brain. " How do you feel, ? " the surgeon Arthur

> E Wall asks,

> while peering into Hutchinson's eyes to see if

> his pupils have

> yet dilated with fear.

>

> When Hutchinson swears at the surgeon, Wall

> administers another

> electric shock to nerve centres located in the

> hypothalamus at the

> centre of his patient's brain. At this, Hutchinson's

> pupils dilate

> and he screams: " You're going to kill me, you

> bastard! " Hutchinson's

> medical records, written by Wall over 30 years ago,

> confirm that his

> patient " felt funny - as if he was dying " . But as he

> screamed,

> Hutchinson recalls Wall leaning in close to his face

> and

> leering: " And I thought you were a bit of a tough

> guy. "

>

>

>

> His next recollection is of Wall giving orders for

> surgical

> implements to be passed. Hutchinson feels the metal

> pins inserted

> through nylon balls lodged in cavities bored into

> the front of his

> skull being replaced by thicker electrodes he says

> felt like " broom

> handles " . " After that I started, I start to feel

> warm all over and

> quickly feel as if I have fallen into a vat of

> molten metal, as if I

> am, quite literally, frying, " says Hutchinson,

> tellingly confusing

> tenses as he describes the brain surgery he

> underwent in 1974 yet

> still relives up to a dozen times a day and in

> frequent nightmares.

>

> Throughout the surgery, Hutchinson was kept

> conscious; his head held

> in a brace, his hands and feet strapped to the

> operating table.

> Hutchinson, a 27-year-old father of three at the

> time of the

> operation, says he had not given his written consent

> to the

> operation being performed; neither had his wife -

> his next of kin.

> Instead his mother, an alcoholic, had been visited

> at home, in the

> late evening, after she had been drinking, and had

> been asked to

> sign the form. " My mother thought doctors were

> gods, " Hutchinson

> says. " She'd have signed anything they asked. "

>

> Hutchinson's excruciatingly detailed recollections

> are a rare

> testimony of someone still lucid and intensely angry

> about a type of

> brain surgery to which he was subjected - he

> contends illegally -

> commonly referred to as a lobotomy. In strict

> medical terms, a

> lobotomy - or leucotomy, as the procedure became

> known in this

> country - involved the removal of part of the

> frontal lobes of the

> brain or the severing of neural fibres connecting

> the frontal lobes

> to the limbic system - the part of the brain

> concerned with

> emotional response and functions not under conscious

> control.

>

> From the mid-1930s until the early 1960s this form

> of " psychosurgery " was heralded as a miracle cure

> for the mentally

> ill, before psychotherapy came into vogue and drugs

> to treat many

> mental-health problems became widely available. It

> was pioneered by

> a maverick Portuguese neurologist, Egas Moniz, who

> was awarded the

> Nobel prize in 1949 for developing and promoting the

> procedure.

> Lobotomies were seen as the solution to a wide range

> of mental

> disorders ranging from profound depression,

> schizophrenia and

> advanced neurosyphilis to mild retardation, at a

> time when half of

> all hospital beds in many countries were occupied by

> the mentally

> ill, and mental institutions were often places of

> humiliation and

> horror.

>

> At the height of its popularity in the 1940s and

> 50s, particularly

> in the US, some of the most enthusiastic proponents

> of the procedure

> promoted it as a way of controlling large numbers of

> those

> considered society's worst misfits, including

> communists and

> homosexuals. Neurologists, not just in the US but in

> Japan, Britain

> and elsewhere, carried out variations of the

> procedure on tens of

> thousands of patients - an estimated 50,000 in the

> UK alone.

>

> Little attention was paid to what happened to those

> subjected to

> lobotomies after surgery. F Kennedy's

> temperamental sister

> Rose, who underwent the operation at the age of 23,

> for instance,

> spent the next 60 years of her life out of sight in

> a mental

> institution. Francis Farmer, the rebellious

> Hollywood actress and

> political activist whose outspoken behaviour was

> also " cured " by a

> lobotomy, quickly drifted into oblivion and ended

> her days as a

> hotel clerk.

>

> But as the number of lives wrecked by such surgery

> became more

> widely known, its effect was gradually exposed -

> most famously in

> Milos Forman's 1975 film, One Flew over the Cuckoo's

> Nest. But also

> earlier, in the 1958 play Suddenly Last Summer, by

> Tennessee

> . A close friend of , whose sister

> Rose was

> lobotomised as a teenager, recalls how the

> playwright talked of his

> sister as " fragile and gentle " , someone hurt by " the

> harshness of

> life " .

>

> " Things alarmed Miss Rose that would not even be

> noticed by someone

> less sensitive. She was just awakening to sexuality

> and knew almost

> nothing about it… Rose came home from school one day

> and said the

> nuns were using altar candles for self-abuse. She

> told mother this, "

> the playwright once confided to his biographer

> Dotson Rader. To the

> siblings' mother, known even to her children as

> " Miss " , human

> sexuality was " the great unmentionable " . She

> promptly took her

> daughter to the doctor, demanding the " filth " be cut

> out of her

> brain: " Cut it away! Miss ordered. " Make it

> clean! " " And he

> did, " recalled the playwright, who said his mother

> never showed any

> remorse about reducing her daughter to a human

> vegetable.

>

> Some now consider such practices to be among the

> most egregious

> medical crimes of the last century and have called

> for Moniz, who

> was later shot in the back by a dissatisfied

> patient, to be

> posthumously stripped of his Nobel prize. The Nobel

> Foundation rules

> this out, maintaining that all of its awards can be

> justified within

> the historical context that they are given.

>

> By the time Hutchinson had his operation in 1974,

> the scale on which

> psychosurgery was being performed was drastically

> reduced, with more

> and more mental disorders being treated with drugs

> and

> psychotherapy. Crude frontal lobotomies, of the type

> Moniz promoted,

> had been phased out. Surgery became targeted at more

> specific parts

> of the brain as the neurobiology of emotion became

> better

> understood. The surgery performed by Wall on

> Hutchinson's

> hypothalamus, for instance, was intended to curb his

> aggression.

>

> Since then, psychosurgery has become even more

> refined, the parts of

> the brain targeted and destroyed to control

> behaviour ever smaller.

> Though the name lobotomy persists, the medical

> profession now refers

> to any such procedure as NMD (neurosurgery for

> mental disorder). But

> Britain is now one of the few countries where this

> sort of surgery

> is still permitted. Even here it is only performed

> for persistent

> severe depression and anxiety and

> obsessive-compulsive disorder

> (OCD) in two places: University Hospital of Wales in

> Cardiff, and

> Ninewells hospital, Dundee. Patients must consent to

> the surgery and

> ethical and clinical standards committees subject

> each case to rigid

> scrutiny before it goes ahead.

>

> If the worst excesses are in the past, the type of

> surgery now

> conducted so controlled and the numbers to whom it

> is given severely

> limited, some might argue that the subject of

> lobotomies,

> psychosurgery, NMD - call it what you will - is only

> of historical

> interest. They would be wrong.

>

> In the coming month, parliament is expected to

> finally debate

> another hotly contested piece of proposed

> legislation: the draft

> Mental Health Bill (2004), which many mental-health

> experts fear

> will reduce safeguards for the mentally ill. One

> provision of the

> bill is a little-noticed clause that, if passed onto

> the statute

> books, would allow doctors to perform NMD without a

> patient's

> consent if they were considered so mentally ill they

> were incapable

> of giving it.

>

>

> No matter how refined these latest NMD techniques

> are, nor how

> vociferously neurosurgeons who practise it argue it

> is nowadays

> employed only as a last resort, its outcome is often

> unpredictable.

> Since it is irreversible, some believe it should be

> banned. At the

> very least it should only be conducted on those able

> to give their

> informed consent, argue campaigners such as the

> mental-health

> charity Mind and the Mental Health Alliance, which

> includes such

> bodies as the Royal College of Nursing, the Royal

> College of

> Psychiatrists, the Law Society and dozens of other

> organisations in

> the field of mental health.

>

> With many of those who have undergone such surgery

> unable to speak

> for themselves and few of those subjected to the

> cruder forms of

> surgery still alive, Hutchinson's is the rare

> voice of

> experience. His story serves as a chilling

> reinforcement of the

> adage that a society be judged by the way it treats

> its most

> vulnerable. With the government proposing

> legislation that many

> believe would turn the clock back on the way we

> treat the mentally

> ill, what does that say about modern Britain?

>

>

>

>

>

>

>

>

>

>

>

> As Hutchinson sits talking in the cramped living

> room of his small

> terrace house in Leeds, he frequently stretches out

> his arms to hug

> his two-year-old grandson, one of 17 grandchildren.

> While the boy

> giggles with delight, Hutchinson, 59, talks a little

> of his own

> childhood. He recalls how his mother would often

> lock him, the

> middle of three brothers, in a coal shed overnight.

> " Glass were all

> broken. I'd have to sleep in coal sack, night after

> night. It went

> on for years, " he says. But he prefers not to dwell

> on it. " That's

> all done now, in the past. "

>

> On his own admission, Hutchinson grew into a

> troubled youngster.

> Though he channelled his aggression into amateur

> boxing and other

> sports, he was, he admits, " always in trouble as a

> lad " and would

> often get into fights. After a spate of joyriding

> cars as a

> teenager, he was sent to a series of borstal

> schools, then remand

> homes. Eventually he found work as a welder, married

> and had three

> children. When he was 27, however, he suffered a

> nervous breakdown.

> After being admitted to a psychiatric hospital, he

> was given ECT

> (electroconvulsive therapy) and prescribed strong

> sedatives. His

> psychiatrist then recommended that he undergo

> psychosurgery.

>

> According to Hutchinson, the psychiatrist tried to

> persuade him such

> surgery was necessary to curb his aggressive

> tendencies after asking

> him how he would feel if Hutchinson were ever to

> kill one of his own

> children. " I'd never harmed any of my children. I

> never would. But

> when he put it like that, I was scared. " Still,

> Hutchinson was

> considered incapable of giving consent, as ?he was

> so heavily

> sedated. At first his wife agreed to the operation.

> But after seeing

> the sizable holes that had been drilled into her

> husband's skull in

> preparation for the second part of the operation a

> week later, she

> withdrew her consent. It was then that his mother

> was approached.

>

> In a 1976 TV documentary on the same operation as

> Hutchinson

> underwent, being performed on a mother-of-five

> called Margaret

> Chapman, the neurosurgeon Wall, who has since died,

> describes the

> operation as " quite simple, really " . He then

> casually admits

> knowledge of psychiatry is " something you pick up as

> you go along " .

> But far from curing Hutchinson's aggression, which

> he describes

> as " within his control " before the operation, the

> surgery he

> underwent left him so traumatised that he walked out

> on his first

> wife, Ruth, who had recently given birth to twins,

> fearing he might

> do his children harm. He subsequently attempted to

> physically attack

> the psychiatrist who had referred him to Wall, and

> several years

> later tried to commit suicide. Though he eventually

> resumed work and

> remarried, he has suffered vivid flashbacks of the

> operation ever

> since, and in recent years has been diagnosed as

> suffering from post-

> traumatic stress disorder.

>

> However troubling Hutchinson's story is, it is by no

> means the

> result of the most cavalier practitioner of

> psychosurgery in this

> country. The neurosurgeon reputed to have been

> Britain's most

> prolific lobotomist was the former president of the

> Society of

> British Neurological Surgeons (SBNS), Sir Wylie

> McKissock, based at

> Atkinson Morley's hospital in Wimbledon in the late

> 1940s and 50s.

> McKissock is described by those who knew him as a

> taciturn and

> difficult man, much feared by his junior staff. He

> rarely spoke to

> or met patients before or after surgery. Instead, at

> weekends, he

> made regular tours of nursing homes and mental

> hospitals along the

> Sussex coast. With the aid of a theatre sister, he

> would perform,

> for cash, up to 10 a day of the crude frontal

> lobotomies pioneered

> by Moniz. McKissock is understood to have performed

> around 2,000

> such operations.

>

> Few records exist of the reasons they were performed

> or their

> outcome; but a 1949 study of 300 of McKissock's

> lobotomy patients

> recorded that 16 had died as a direct or indirect

> result of the

> operation. It is impossible, therefore, to assess

> how many of these

> operations were performed needlessly. But the

> experience of those

> such as Hutchinson, and the accounts of relatives of

> others who

> underwent earlier forms of psychosurgery, attest to

> it having been

> performed for flimsy reasons and to disastrous

> effect by some

> British surgeons, just as it was in the US.

>

>

>

>

>

>

>

>

>

> One such case is that of Shaw, whose brother

> , a 69-

> year-old retired painter and decorator from

> Liverpool, describes

> as " a very, very clever lad " when he was younger.

> " He was very good

> at art. He loved to draw cartoons. Our father was a

> sign writer and

> he sent some of Ron's cartoons to a London newspaper

> when we were

> still teenagers, " recalls of his elder

> brother. " They wanted

> Ron to draw more and were going to pay him quite

> well. But he

> suffered with his nerves. He never did it. "

>

> When was in his early teens, his brother

> remembers he started

> coming home from school crying and would often wake

> up screaming in

> the night. The boy was admitted to hospital and

> given ECT. It failed

> to help. " Years later, we discovered, through

> another boy who was at

> school with Ron, that there was a teacher who used

> to regularly take

> my brother into a back room to cane him. Who knows

> what else he did

> to him in that room. I believe now that it was this

> bullying that

> caused my brother to behave the way he did. "

>

> When he was 17, volunteered to join the army,

> but within a

> year was discharged with a knee injury. In 1955,

> when was

> stationed in the Far East, completing his national

> service, his

> brother was admitted to Rainhill hospital in the St

> Helens district

> of Liverpool and a frontal lobotomy was performed.

> " I knew nothing

> about it. When I came back from the Far East, my

> brother was

> destroyed. He did not talk for two years. Eventually

> he started to

> speak, but he was never the same again. He was never

> able to work.

> My parents spent the rest of their lives looking

> after him. Their

> lives were ruined too. After they died he lived

> alone, though I took

> him out as much as I could. "

>

> Shaw died last year. His partially skeletal

> body was found in

> a field months later. His brother believes he was

> trying to walk to

> the Marble Church in Holywell, which had always

> fascinated him, when

> he stopped for a rest and died of natural causes.

> His body had been

> run over by a tractor after his death and his

> remains were

> surrounded by diaries he kept of his daily

> activities. " I'd been

> driving all over the country looking for him for

> months. Then the

> police called, saying they'd found a body with holes

> drilled in the

> front of his skull and I knew it was Ron, " says

> , his voice

> cracking. " It's unforgivable what was done to him. "

>

>

>

> Supporters of modern-day psychosurgery, or NMD,

> argue it has moved

> light years from the notorious excesses of such

> early practices. Yet

> even the crudest operations, they stress, were

> effective in

> alleviating the mental suffering of some patients.

> One former

> president of Ireland's Royal College of Surgeons,

> who is believed to

> be one of the few surviving neurosurgeons to have

> carried out the

> conventional frontal lobotomy on a regular basis,

> sits sipping a gin

> and tonic as he demonstrates with a cake knife how

> he used to sever

> or core out part of the frontal lobes of his

> patients to break the

> nerve " circuits " believed responsible for mental

> illness. He carried

> out two operations every Saturday morning, at the

> request of the

> Irish Department of Health, for nearly 10 years

> until 1960.

>

> Immaculately dressed in a tweed suit, he recalls how

> the operation

> helped one vet obsessed with a fear of constipation

> who ate fruit

> constantly and spent all day in the toilet. After

> the operation he

> was able to return to work. He also talks of

> performing lobotomies

> on more than 20 priests with perceived personality

> disorders. But,

> he says, in his experience the surgery did more to

> help those who

> were returned to closed orders rather than allowed

> to return to the

> community. Lobotomies, he says, did little to help

> those with

> schizophrenia, neurosyphilis or personality

> disorders other than

> obsessive-compulsive disorder and severe depression.

>

>

>

> Those forms of NMD still being conducted in this

> country today are

> targeted at the treatment of severe depression,

> severe anxiety and

> OCD. These procedures, which involve minute

> destructive lesions in

> parts of the frontal lobe or limbic system, are

> known as

> cingulotomies - the cingulum being the part of the

> frontal lobe

> associated with OCD - and capsulotomies, which

> involve making

> lesions in the capsules: the dense nerve-fibre

> pathway connecting

> part of the frontal lobe with the limbic structure.

> Neurosurgeons at

> Ninewells hospital in Dundee, for instance, carried

> out 34 NMD

> operations between 1990 and 2001. In the past year

> the hospital has

> conducted five such operations on patients it

> describes as " among

> the most severely ill and disabled who come into

> contact with any

> branch of the medical professions " . Surgeons at the

> University

> Hospital of Wales in Cardiff have conducted 56 NMD

> operations in the

> past decade. It was there that the former child

> singing star Lena

> Zavaroni, who suffered from anorexia, underwent such

> surgery in 1999

> for severe depression. Though the operation seemed

> to have been a

> success, she died of pneumonia less than a month

> later. According to

> Simpson, consultant neurosurgeon at Cardiff,

> the operations

> his team have conducted have led to a " marked

> improvement " in

> roughly half of those being treated for severe

> depression and

> OCD. " NMD is not a panacea, " Simpson agrees. " It is

> carefully

> regulated and only offered to patients for whom all

> other treatments

> have failed… But in the patients for whom it works

> well, whose

> suffering has been indescribable, it transforms

> their lives. "

>

>

>

>

>

>

>

>

>

> Some believe the way ahead lies in other forms of

> brain surgery,

> such as deep brain stimulation with implantable

> electrodes, as are

> increasingly used to treat Parkinson's disease. This

> they believe

> could offer an alternative to the ablative

> operations that have been

> used to date in psychosurgery. The introduction of

> modified stem

> cells into certain parts of the brain has also

> already had

> experimental success in treating some neurological

> conditions and

> holds out hope for combating psychiatric disease.

> But it is the

> irreversible nature of the NMD still practised that

> concerns

> opponents. That this type of surgery could be

> carried out without a

> patient's consent, according to the proposed

> legislation, they

> reject outright. Under the current Mental Health Act

> of 1983, three

> independent people, one a doctor, has to certify

> that any patient

> undergoing psychosurgery understands the treatment

> and consents to

> it. The draft mental-health bill under consideration

> has broadly the

> same safeguards for those capable of giving consent.

> The main

> difference is that it allows for treatment to be

> given without the

> patient's consent, at the request of doctors and on

> an order of the

> High Court, providing three conditions are met. The

> first is if it

> can be verified that a patient does not have the

> capacity to

> consent. The second is if there is no reasonable

> prospect of them

> regaining this capacity, and the third is if they

> are " unlikely to

> resist treatment " .

>

> According to Brook, former chief executive

> of the mental-

> health charity Mind, one of the biggest concerns of

> those who work

> in mental health is that no leading study has

> properly assessed the

> effect of psychosurgery on an individual's

> personality or sought the

> views of those undergoing such treatment. " Because

> of its hazards

> and the lack of clear evidence for the treatment's

> benefit, or basis

> for predicting success in the individual concerned,

> we believe it

> should never be given to someone who doesn't have

> the capacity to

> consent to it, " says Brook.

>

> Doctors at Ninewells hospital in Dundee argue that

> the lack of a

> randomised control trial to support NMD applies

> equally to a range

> of " cutting edge " medical and surgical procedures.

> Simpson

> says that although he appreciates there may be an

> " understandable

> fear of returning to the bad old days of lobotomy " ,

> he believes it

> is " not unreasonable in certain circumstances and

> with adequate

> legal safeguards " to perform NMD without a patient's

> consent. " The

> issue of consent is sensitive and crucially

> important, " warns

> Simpson, adding that " the more you open it up in

> this way, the more

> crucial it becomes to have adequate legal

> safeguards " .

>

> But , who is behind moves to launch

> a legal

> campaign in the US to have Moniz's Nobel prize

> revoked, believes

> that there are even wider issues at stake. 's

> own grandmother

> was left to languish in a psychiatric institution

> for 20 years after

> undergoing a lobotomy. As a result, the medical

> librarian ?from

> Levittown, New York state, founded an organisation

> called

> Psychosurgery.org, dedicated to the " surgical

> casualties " of such

> procedures. " There are a lot of important lessons to

> be learnt from

> what happened to our family members, " says .

>

> Many families of those suffering from Alzheimer's

> disease, she

> stresses, are now clamouring to have experimental

> brain surgery

> performed on them. " But there is a real ethical

> question about

> whether you can really do these kind of things to

> someone who is by

> definition having problems making decisions. I

> really hope people

> will take into consideration the amount of damage

> that was done in

> the past when they attempt to push forward with such

> treatments, "

> concludes.

>

>

>

>

>

>

>

>

>

> Hutchinson has recently tried to sue his local

> health

> authority for medical malpractice, but has had to

> give up because

> his surgery was carried out so long ago that the

> statute of

> limitations on such a claim has expired. West

> Yorkshire police are

> now investigating if there is a criminal case to

> answer over a lack

> of proper legal consent having been obtained.

>

> Such thoughts are far from his mind, however, as

> Hutchinson drives

> me back to the train station in Leeds, warning me

> that he might have

> to pull over to the side of the road at any moment

> because his

> lobotomy has also left ?him with narcolepsy.

> Throughout the journey,

> he talks affectionately about his brood of

> grandchildren. But by the

> time we reach the station, he has lapsed into

> melancholia and tears

> well in his eyes as he talks about how his own

> children's lives were

> damaged when he abandoned them after his operation.

>

> " If nothing else, I want people to understand what

> these bastards

> did to me, and thousands of others, so nothing like

> this is ever

> allowed to happen again, " he says, clutching the

> steering wheel

> until his knuckles go white. " What they did was not

> treatment - it

> was torture. "

>

> Young is consultant neurosurgeon at the

> Beaumont hospital in

> Dublin

>

> THE ORIGINS OF MIND-ALTERING SURGERY

>

>

> Egas Moniz could have afforded to rest on his

> laurels by the time he

> attended the Second World Congress of Neurology in

> London in 1935.

> The 61-year-old professor of neurology, and dean of

> Lisbon's Medical

> School, had already gained an international

> reputation for

> pioneering cerebral angiography - a radiological

> technique for

> mapping brain vessels. But Moniz was disappointed

> that this had not

> won him the Nobel prize. So when he heard two Yale

> neurologists

> speak at the London congress about experimental

> brain research on

> two chimpanzees called Clyde and Becky, observing

> how Becky's temper

> tantrums subsided after surgery, he would go on to

> pioneer - and

> relentlessly promote - a procedure that eventually

> won him the

> coveted Nobel prize.

>

> The procedure was the lobotomy. Back in Lisbon he

> ordered that a

> human brain be brought to him from a morgue, and

> thrusted a pen

> through the cortex several times until he was

> satisfied he knew the

> approximate angle and depth that would best detach

> the frontal

> lobes. He performed the operation on a former

> prostitute, who

> afterwards was unable to give her age or say where

> she was. She was

> returned to an asylum, never to be seen by him

> again.

>

>

>

> Moniz nonetheless considered this a " clinical cure "

> and continued

> operating. The procedure was greeted with enthusiasm

> by the medical

> profession and went on to be practised in many

> countries. After

> Moniz won the Nobel prize in 1949, the lobotomy's

> popularity

> increased. But today many believe the procedure is

> barbaric, and are

> campaigning for him to be stripped of the award.

>

> The Nobel Foundation contends that Moniz's prize

> should be judged in

> the historical context of a period when there was

> widespread despair

> about mental-health treatment. In the 1930s and 40s,

> patients were

> often beaten, choked, spat on and humiliated by

> attendants in state

> hospitals, where the average duration of confinement

> was 10 years.

> Cost was also a factor. In the mid-1930s a lobotomy

> cost $250 in the

> US, compared with tens of thousands of dollars to

> keep a patient

> incarcerated. The drawback of the operation - that

> it robbed

> patients of their personality traits - was

> considered a small price

> for emptying hospital beds.

>

> If Moniz brought the lobotomy fame, then the US

> physician Walter

> Freeman brought it infamy. A tireless

> self-publicist, he would

> perform his variation of Moniz's operation - the

> " ice pick "

> lobotomy - before an enthralled audience. This

> involved driving an

> ice-pick-like instrument through the roof of the eye

> and sweeping it

> across the frontal lobe to scramble neural

> connections. Freeman once

> boasted he was " as good as Sinatra " in getting

> young people to

> faint at the sight of what he did. One of his

> patients,

> Dulley, was 12 when he was lobotomised because his

> stepmother said

> he was sullen and refused to bathe.

>

> It was not until the mid-1950s, with the advent of

> antipsychotic and

> pacifying drugs such as chlorpromazine, that the

> lobotomy began to

> fall out of favour.

>

> The role of psychosurgery came under greater

> scrutiny in the 1960s

> and 70s, when social unrest led some sociobiologists

> to consider it

> a tool for addressing violence and

> " psycho-civilising " society

> through the use of implantable brain electrodes.

>

> Despite growing unease, more refined procedures such

> as

> cingulotomies were developed and the modern era of

> psychosurgery was

> born. Such procedures remain controversial and have

> been banned in

> Germany, Japan and a number of US states. They are

> still practised

> in the UK, Finland, India, Sweden, Belgium and

> Spain.

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Bryce,

Is there any url or email address associated with this

information?

It is easy to believe, but some people like proof.

john

--- bryce_j_j <jeremy.bryce@...> wrote:

>

>

>

>

> The lobotomy is deemed one of the worst crimes in

> medical history.

> But a modern form of it is still practised in

> Britain - and may soon

> be performed without the patient's consent. By

> Toomey and

> Young

>

>

>

>

> The flashbacks come late at night. First comes the

> recollection of

> intense physical pain, as if the bones in his arms

> are being snapped

> like twigs. Then he hears the voice of the

> neurosurgeon applying an

> electric current to metal pins implanted in the

> tissue of his

> brain. " How do you feel, ? " the surgeon Arthur

> E Wall asks,

> while peering into Hutchinson's eyes to see if

> his pupils have

> yet dilated with fear.

>

> When Hutchinson swears at the surgeon, Wall

> administers another

> electric shock to nerve centres located in the

> hypothalamus at the

> centre of his patient's brain. At this, Hutchinson's

> pupils dilate

> and he screams: " You're going to kill me, you

> bastard! " Hutchinson's

> medical records, written by Wall over 30 years ago,

> confirm that his

> patient " felt funny - as if he was dying " . But as he

> screamed,

> Hutchinson recalls Wall leaning in close to his face

> and

> leering: " And I thought you were a bit of a tough

> guy. "

>

>

>

> His next recollection is of Wall giving orders for

> surgical

> implements to be passed. Hutchinson feels the metal

> pins inserted

> through nylon balls lodged in cavities bored into

> the front of his

> skull being replaced by thicker electrodes he says

> felt like " broom

> handles " . " After that I started, I start to feel

> warm all over and

> quickly feel as if I have fallen into a vat of

> molten metal, as if I

> am, quite literally, frying, " says Hutchinson,

> tellingly confusing

> tenses as he describes the brain surgery he

> underwent in 1974 yet

> still relives up to a dozen times a day and in

> frequent nightmares.

>

> Throughout the surgery, Hutchinson was kept

> conscious; his head held

> in a brace, his hands and feet strapped to the

> operating table.

> Hutchinson, a 27-year-old father of three at the

> time of the

> operation, says he had not given his written consent

> to the

> operation being performed; neither had his wife -

> his next of kin.

> Instead his mother, an alcoholic, had been visited

> at home, in the

> late evening, after she had been drinking, and had

> been asked to

> sign the form. " My mother thought doctors were

> gods, " Hutchinson

> says. " She'd have signed anything they asked. "

>

> Hutchinson's excruciatingly detailed recollections

> are a rare

> testimony of someone still lucid and intensely angry

> about a type of

> brain surgery to which he was subjected - he

> contends illegally -

> commonly referred to as a lobotomy. In strict

> medical terms, a

> lobotomy - or leucotomy, as the procedure became

> known in this

> country - involved the removal of part of the

> frontal lobes of the

> brain or the severing of neural fibres connecting

> the frontal lobes

> to the limbic system - the part of the brain

> concerned with

> emotional response and functions not under conscious

> control.

>

> From the mid-1930s until the early 1960s this form

> of " psychosurgery " was heralded as a miracle cure

> for the mentally

> ill, before psychotherapy came into vogue and drugs

> to treat many

> mental-health problems became widely available. It

> was pioneered by

> a maverick Portuguese neurologist, Egas Moniz, who

> was awarded the

> Nobel prize in 1949 for developing and promoting the

> procedure.

> Lobotomies were seen as the solution to a wide range

> of mental

> disorders ranging from profound depression,

> schizophrenia and

> advanced neurosyphilis to mild retardation, at a

> time when half of

> all hospital beds in many countries were occupied by

> the mentally

> ill, and mental institutions were often places of

> humiliation and

> horror.

>

> At the height of its popularity in the 1940s and

> 50s, particularly

> in the US, some of the most enthusiastic proponents

> of the procedure

> promoted it as a way of controlling large numbers of

> those

> considered society's worst misfits, including

> communists and

> homosexuals. Neurologists, not just in the US but in

> Japan, Britain

> and elsewhere, carried out variations of the

> procedure on tens of

> thousands of patients - an estimated 50,000 in the

> UK alone.

>

> Little attention was paid to what happened to those

> subjected to

> lobotomies after surgery. F Kennedy's

> temperamental sister

> Rose, who underwent the operation at the age of 23,

> for instance,

> spent the next 60 years of her life out of sight in

> a mental

> institution. Francis Farmer, the rebellious

> Hollywood actress and

> political activist whose outspoken behaviour was

> also " cured " by a

> lobotomy, quickly drifted into oblivion and ended

> her days as a

> hotel clerk.

>

> But as the number of lives wrecked by such surgery

> became more

> widely known, its effect was gradually exposed -

> most famously in

> Milos Forman's 1975 film, One Flew over the Cuckoo's

> Nest. But also

> earlier, in the 1958 play Suddenly Last Summer, by

> Tennessee

> . A close friend of , whose sister

> Rose was

> lobotomised as a teenager, recalls how the

> playwright talked of his

> sister as " fragile and gentle " , someone hurt by " the

> harshness of

> life " .

>

> " Things alarmed Miss Rose that would not even be

> noticed by someone

> less sensitive. She was just awakening to sexuality

> and knew almost

> nothing about it… Rose came home from school one day

> and said the

> nuns were using altar candles for self-abuse. She

> told mother this, "

> the playwright once confided to his biographer

> Dotson Rader. To the

> siblings' mother, known even to her children as

> " Miss " , human

> sexuality was " the great unmentionable " . She

> promptly took her

> daughter to the doctor, demanding the " filth " be cut

> out of her

> brain: " Cut it away! Miss ordered. " Make it

> clean! " " And he

> did, " recalled the playwright, who said his mother

> never showed any

> remorse about reducing her daughter to a human

> vegetable.

>

> Some now consider such practices to be among the

> most egregious

> medical crimes of the last century and have called

> for Moniz, who

> was later shot in the back by a dissatisfied

> patient, to be

> posthumously stripped of his Nobel prize. The Nobel

> Foundation rules

> this out, maintaining that all of its awards can be

> justified within

> the historical context that they are given.

>

> By the time Hutchinson had his operation in 1974,

> the scale on which

> psychosurgery was being performed was drastically

> reduced, with more

> and more mental disorders being treated with drugs

> and

> psychotherapy. Crude frontal lobotomies, of the type

> Moniz promoted,

> had been phased out. Surgery became targeted at more

> specific parts

> of the brain as the neurobiology of emotion became

> better

> understood. The surgery performed by Wall on

> Hutchinson's

> hypothalamus, for instance, was intended to curb his

> aggression.

>

> Since then, psychosurgery has become even more

> refined, the parts of

> the brain targeted and destroyed to control

> behaviour ever smaller.

> Though the name lobotomy persists, the medical

> profession now refers

> to any such procedure as NMD (neurosurgery for

> mental disorder). But

> Britain is now one of the few countries where this

> sort of surgery

> is still permitted. Even here it is only performed

> for persistent

> severe depression and anxiety and

> obsessive-compulsive disorder

> (OCD) in two places: University Hospital of Wales in

> Cardiff, and

> Ninewells hospital, Dundee. Patients must consent to

> the surgery and

> ethical and clinical standards committees subject

> each case to rigid

> scrutiny before it goes ahead.

>

> If the worst excesses are in the past, the type of

> surgery now

> conducted so controlled and the numbers to whom it

> is given severely

> limited, some might argue that the subject of

> lobotomies,

> psychosurgery, NMD - call it what you will - is only

> of historical

> interest. They would be wrong.

>

> In the coming month, parliament is expected to

> finally debate

> another hotly contested piece of proposed

> legislation: the draft

> Mental Health Bill (2004), which many mental-health

> experts fear

> will reduce safeguards for the mentally ill. One

> provision of the

> bill is a little-noticed clause that, if passed onto

> the statute

> books, would allow doctors to perform NMD without a

> patient's

> consent if they were considered so mentally ill they

> were incapable

> of giving it.

>

>

> No matter how refined these latest NMD techniques

> are, nor how

> vociferously neurosurgeons who practise it argue it

> is nowadays

> employed only as a last resort, its outcome is often

> unpredictable.

> Since it is irreversible, some believe it should be

> banned. At the

> very least it should only be conducted on those able

> to give their

> informed consent, argue campaigners such as the

> mental-health

> charity Mind and the Mental Health Alliance, which

> includes such

> bodies as the Royal College of Nursing, the Royal

> College of

> Psychiatrists, the Law Society and dozens of other

> organisations in

> the field of mental health.

>

> With many of those who have undergone such surgery

> unable to speak

> for themselves and few of those subjected to the

> cruder forms of

> surgery still alive, Hutchinson's is the rare

> voice of

> experience. His story serves as a chilling

> reinforcement of the

> adage that a society be judged by the way it treats

> its most

> vulnerable. With the government proposing

> legislation that many

> believe would turn the clock back on the way we

> treat the mentally

> ill, what does that say about modern Britain?

>

>

>

>

>

>

>

>

>

>

>

> As Hutchinson sits talking in the cramped living

> room of his small

> terrace house in Leeds, he frequently stretches out

> his arms to hug

> his two-year-old grandson, one of 17 grandchildren.

> While the boy

> giggles with delight, Hutchinson, 59, talks a little

> of his own

> childhood. He recalls how his mother would often

> lock him, the

> middle of three brothers, in a coal shed overnight.

> " Glass were all

> broken. I'd have to sleep in coal sack, night after

> night. It went

> on for years, " he says. But he prefers not to dwell

> on it. " That's

> all done now, in the past. "

>

> On his own admission, Hutchinson grew into a

> troubled youngster.

> Though he channelled his aggression into amateur

> boxing and other

> sports, he was, he admits, " always in trouble as a

> lad " and would

> often get into fights. After a spate of joyriding

> cars as a

> teenager, he was sent to a series of borstal

> schools, then remand

> homes. Eventually he found work as a welder, married

> and had three

> children. When he was 27, however, he suffered a

> nervous breakdown.

> After being admitted to a psychiatric hospital, he

> was given ECT

> (electroconvulsive therapy) and prescribed strong

> sedatives. His

> psychiatrist then recommended that he undergo

> psychosurgery.

>

> According to Hutchinson, the psychiatrist tried to

> persuade him such

> surgery was necessary to curb his aggressive

> tendencies after asking

> him how he would feel if Hutchinson were ever to

> kill one of his own

> children. " I'd never harmed any of my children. I

> never would. But

> when he put it like that, I was scared. " Still,

> Hutchinson was

> considered incapable of giving consent, as ?he was

> so heavily

> sedated. At first his wife agreed to the operation.

> But after seeing

> the sizable holes that had been drilled into her

> husband's skull in

> preparation for the second part of the operation a

> week later, she

> withdrew her consent. It was then that his mother

> was approached.

>

> In a 1976 TV documentary on the same operation as

> Hutchinson

> underwent, being performed on a mother-of-five

> called Margaret

> Chapman, the neurosurgeon Wall, who has since died,

> describes the

> operation as " quite simple, really " . He then

> casually admits

> knowledge of psychiatry is " something you pick up as

> you go along " .

> But far from curing Hutchinson's aggression, which

> he describes

> as " within his control " before the operation, the

> surgery he

> underwent left him so traumatised that he walked out

> on his first

> wife, Ruth, who had recently given birth to twins,

> fearing he might

> do his children harm. He subsequently attempted to

> physically attack

> the psychiatrist who had referred him to Wall, and

> several years

> later tried to commit suicide. Though he eventually

> resumed work and

> remarried, he has suffered vivid flashbacks of the

> operation ever

> since, and in recent years has been diagnosed as

> suffering from post-

> traumatic stress disorder.

>

> However troubling Hutchinson's story is, it is by no

> means the

> result of the most cavalier practitioner of

> psychosurgery in this

> country. The neurosurgeon reputed to have been

> Britain's most

> prolific lobotomist was the former president of the

> Society of

> British Neurological Surgeons (SBNS), Sir Wylie

> McKissock, based at

> Atkinson Morley's hospital in Wimbledon in the late

> 1940s and 50s.

> McKissock is described by those who knew him as a

> taciturn and

> difficult man, much feared by his junior staff. He

> rarely spoke to

> or met patients before or after surgery. Instead, at

> weekends, he

> made regular tours of nursing homes and mental

> hospitals along the

> Sussex coast. With the aid of a theatre sister, he

> would perform,

> for cash, up to 10 a day of the crude frontal

> lobotomies pioneered

> by Moniz. McKissock is understood to have performed

> around 2,000

> such operations.

>

> Few records exist of the reasons they were performed

> or their

> outcome; but a 1949 study of 300 of McKissock's

> lobotomy patients

> recorded that 16 had died as a direct or indirect

> result of the

> operation. It is impossible, therefore, to assess

> how many of these

> operations were performed needlessly. But the

> experience of those

> such as Hutchinson, and the accounts of relatives of

> others who

> underwent earlier forms of psychosurgery, attest to

> it having been

> performed for flimsy reasons and to disastrous

> effect by some

> British surgeons, just as it was in the US.

>

>

>

>

>

>

>

>

>

> One such case is that of Shaw, whose brother

> , a 69-

> year-old retired painter and decorator from

> Liverpool, describes

> as " a very, very clever lad " when he was younger.

> " He was very good

> at art. He loved to draw cartoons. Our father was a

> sign writer and

> he sent some of Ron's cartoons to a London newspaper

> when we were

> still teenagers, " recalls of his elder

> brother. " They wanted

> Ron to draw more and were going to pay him quite

> well. But he

> suffered with his nerves. He never did it. "

>

> When was in his early teens, his brother

> remembers he started

> coming home from school crying and would often wake

> up screaming in

> the night. The boy was admitted to hospital and

> given ECT. It failed

> to help. " Years later, we discovered, through

> another boy who was at

> school with Ron, that there was a teacher who used

> to regularly take

> my brother into a back room to cane him. Who knows

> what else he did

> to him in that room. I believe now that it was this

> bullying that

> caused my brother to behave the way he did. "

>

> When he was 17, volunteered to join the army,

> but within a

> year was discharged with a knee injury. In 1955,

> when was

> stationed in the Far East, completing his national

> service, his

> brother was admitted to Rainhill hospital in the St

> Helens district

> of Liverpool and a frontal lobotomy was performed.

> " I knew nothing

> about it. When I came back from the Far East, my

> brother was

> destroyed. He did not talk for two years. Eventually

> he started to

> speak, but he was never the same again. He was never

> able to work.

> My parents spent the rest of their lives looking

> after him. Their

> lives were ruined too. After they died he lived

> alone, though I took

> him out as much as I could. "

>

> Shaw died last year. His partially skeletal

> body was found in

> a field months later. His brother believes he was

> trying to walk to

> the Marble Church in Holywell, which had always

> fascinated him, when

> he stopped for a rest and died of natural causes.

> His body had been

> run over by a tractor after his death and his

> remains were

> surrounded by diaries he kept of his daily

> activities. " I'd been

> driving all over the country looking for him for

> months. Then the

> police called, saying they'd found a body with holes

> drilled in the

> front of his skull and I knew it was Ron, " says

> , his voice

> cracking. " It's unforgivable what was done to him. "

>

>

>

> Supporters of modern-day psychosurgery, or NMD,

> argue it has moved

> light years from the notorious excesses of such

> early practices. Yet

> even the crudest operations, they stress, were

> effective in

> alleviating the mental suffering of some patients.

> One former

> president of Ireland's Royal College of Surgeons,

> who is believed to

> be one of the few surviving neurosurgeons to have

> carried out the

> conventional frontal lobotomy on a regular basis,

> sits sipping a gin

> and tonic as he demonstrates with a cake knife how

> he used to sever

> or core out part of the frontal lobes of his

> patients to break the

> nerve " circuits " believed responsible for mental

> illness. He carried

> out two operations every Saturday morning, at the

> request of the

> Irish Department of Health, for nearly 10 years

> until 1960.

>

> Immaculately dressed in a tweed suit, he recalls how

> the operation

> helped one vet obsessed with a fear of constipation

> who ate fruit

> constantly and spent all day in the toilet. After

> the operation he

> was able to return to work. He also talks of

> performing lobotomies

> on more than 20 priests with perceived personality

> disorders. But,

> he says, in his experience the surgery did more to

> help those who

> were returned to closed orders rather than allowed

> to return to the

> community. Lobotomies, he says, did little to help

> those with

> schizophrenia, neurosyphilis or personality

> disorders other than

> obsessive-compulsive disorder and severe depression.

>

>

>

> Those forms of NMD still being conducted in this

> country today are

> targeted at the treatment of severe depression,

> severe anxiety and

> OCD. These procedures, which involve minute

> destructive lesions in

> parts of the frontal lobe or limbic system, are

> known as

> cingulotomies - the cingulum being the part of the

> frontal lobe

> associated with OCD - and capsulotomies, which

> involve making

> lesions in the capsules: the dense nerve-fibre

> pathway connecting

> part of the frontal lobe with the limbic structure.

> Neurosurgeons at

> Ninewells hospital in Dundee, for instance, carried

> out 34 NMD

> operations between 1990 and 2001. In the past year

> the hospital has

> conducted five such operations on patients it

> describes as " among

> the most severely ill and disabled who come into

> contact with any

> branch of the medical professions " . Surgeons at the

> University

> Hospital of Wales in Cardiff have conducted 56 NMD

> operations in the

> past decade. It was there that the former child

> singing star Lena

> Zavaroni, who suffered from anorexia, underwent such

> surgery in 1999

> for severe depression. Though the operation seemed

> to have been a

> success, she died of pneumonia less than a month

> later. According to

> Simpson, consultant neurosurgeon at Cardiff,

> the operations

> his team have conducted have led to a " marked

> improvement " in

> roughly half of those being treated for severe

> depression and

> OCD. " NMD is not a panacea, " Simpson agrees. " It is

> carefully

> regulated and only offered to patients for whom all

> other treatments

> have failed… But in the patients for whom it works

> well, whose

> suffering has been indescribable, it transforms

> their lives. "

>

>

>

>

>

>

>

>

>

> Some believe the way ahead lies in other forms of

> brain surgery,

> such as deep brain stimulation with implantable

> electrodes, as are

> increasingly used to treat Parkinson's disease. This

> they believe

> could offer an alternative to the ablative

> operations that have been

> used to date in psychosurgery. The introduction of

> modified stem

> cells into certain parts of the brain has also

> already had

> experimental success in treating some neurological

> conditions and

> holds out hope for combating psychiatric disease.

> But it is the

> irreversible nature of the NMD still practised that

> concerns

> opponents. That this type of surgery could be

> carried out without a

> patient's consent, according to the proposed

> legislation, they

> reject outright. Under the current Mental Health Act

> of 1983, three

> independent people, one a doctor, has to certify

> that any patient

> undergoing psychosurgery understands the treatment

> and consents to

> it. The draft mental-health bill under consideration

> has broadly the

> same safeguards for those capable of giving consent.

> The main

> difference is that it allows for treatment to be

> given without the

> patient's consent, at the request of doctors and on

> an order of the

> High Court, providing three conditions are met. The

> first is if it

> can be verified that a patient does not have the

> capacity to

> consent. The second is if there is no reasonable

> prospect of them

> regaining this capacity, and the third is if they

> are " unlikely to

> resist treatment " .

>

> According to Brook, former chief executive

> of the mental-

> health charity Mind, one of the biggest concerns of

> those who work

> in mental health is that no leading study has

> properly assessed the

> effect of psychosurgery on an individual's

> personality or sought the

> views of those undergoing such treatment. " Because

> of its hazards

> and the lack of clear evidence for the treatment's

> benefit, or basis

> for predicting success in the individual concerned,

> we believe it

> should never be given to someone who doesn't have

> the capacity to

> consent to it, " says Brook.

>

> Doctors at Ninewells hospital in Dundee argue that

> the lack of a

> randomised control trial to support NMD applies

> equally to a range

> of " cutting edge " medical and surgical procedures.

> Simpson

> says that although he appreciates there may be an

> " understandable

> fear of returning to the bad old days of lobotomy " ,

> he believes it

> is " not unreasonable in certain circumstances and

> with adequate

> legal safeguards " to perform NMD without a patient's

> consent. " The

> issue of consent is sensitive and crucially

> important, " warns

> Simpson, adding that " the more you open it up in

> this way, the more

> crucial it becomes to have adequate legal

> safeguards " .

>

> But , who is behind moves to launch

> a legal

> campaign in the US to have Moniz's Nobel prize

> revoked, believes

> that there are even wider issues at stake. 's

> own grandmother

> was left to languish in a psychiatric institution

> for 20 years after

> undergoing a lobotomy. As a result, the medical

> librarian ?from

> Levittown, New York state, founded an organisation

> called

> Psychosurgery.org, dedicated to the " surgical

> casualties " of such

> procedures. " There are a lot of important lessons to

> be learnt from

> what happened to our family members, " says .

>

> Many families of those suffering from Alzheimer's

> disease, she

> stresses, are now clamouring to have experimental

> brain surgery

> performed on them. " But there is a real ethical

> question about

> whether you can really do these kind of things to

> someone who is by

> definition having problems making decisions. I

> really hope people

> will take into consideration the amount of damage

> that was done in

> the past when they attempt to push forward with such

> treatments, "

> concludes.

>

>

>

>

>

>

>

>

>

> Hutchinson has recently tried to sue his local

> health

> authority for medical malpractice, but has had to

> give up because

> his surgery was carried out so long ago that the

> statute of

> limitations on such a claim has expired. West

> Yorkshire police are

> now investigating if there is a criminal case to

> answer over a lack

> of proper legal consent having been obtained.

>

> Such thoughts are far from his mind, however, as

> Hutchinson drives

> me back to the train station in Leeds, warning me

> that he might have

> to pull over to the side of the road at any moment

> because his

> lobotomy has also left ?him with narcolepsy.

> Throughout the journey,

> he talks affectionately about his brood of

> grandchildren. But by the

> time we reach the station, he has lapsed into

> melancholia and tears

> well in his eyes as he talks about how his own

> children's lives were

> damaged when he abandoned them after his operation.

>

> " If nothing else, I want people to understand what

> these bastards

> did to me, and thousands of others, so nothing like

> this is ever

> allowed to happen again, " he says, clutching the

> steering wheel

> until his knuckles go white. " What they did was not

> treatment - it

> was torture. "

>

> Young is consultant neurosurgeon at the

> Beaumont hospital in

> Dublin

>

> THE ORIGINS OF MIND-ALTERING SURGERY

>

>

> Egas Moniz could have afforded to rest on his

> laurels by the time he

> attended the Second World Congress of Neurology in

> London in 1935.

> The 61-year-old professor of neurology, and dean of

> Lisbon's Medical

> School, had already gained an international

> reputation for

> pioneering cerebral angiography - a radiological

> technique for

> mapping brain vessels. But Moniz was disappointed

> that this had not

> won him the Nobel prize. So when he heard two Yale

> neurologists

> speak at the London congress about experimental

> brain research on

> two chimpanzees called Clyde and Becky, observing

> how Becky's temper

> tantrums subsided after surgery, he would go on to

> pioneer - and

> relentlessly promote - a procedure that eventually

> won him the

> coveted Nobel prize.

>

> The procedure was the lobotomy. Back in Lisbon he

> ordered that a

> human brain be brought to him from a morgue, and

> thrusted a pen

> through the cortex several times until he was

> satisfied he knew the

> approximate angle and depth that would best detach

> the frontal

> lobes. He performed the operation on a former

> prostitute, who

> afterwards was unable to give her age or say where

> she was. She was

> returned to an asylum, never to be seen by him

> again.

>

>

>

> Moniz nonetheless considered this a " clinical cure "

> and continued

> operating. The procedure was greeted with enthusiasm

> by the medical

> profession and went on to be practised in many

> countries. After

> Moniz won the Nobel prize in 1949, the lobotomy's

> popularity

> increased. But today many believe the procedure is

> barbaric, and are

> campaigning for him to be stripped of the award.

>

> The Nobel Foundation contends that Moniz's prize

> should be judged in

> the historical context of a period when there was

> widespread despair

> about mental-health treatment. In the 1930s and 40s,

> patients were

> often beaten, choked, spat on and humiliated by

> attendants in state

> hospitals, where the average duration of confinement

> was 10 years.

> Cost was also a factor. In the mid-1930s a lobotomy

> cost $250 in the

> US, compared with tens of thousands of dollars to

> keep a patient

> incarcerated. The drawback of the operation - that

> it robbed

> patients of their personality traits - was

> considered a small price

> for emptying hospital beds.

>

> If Moniz brought the lobotomy fame, then the US

> physician Walter

> Freeman brought it infamy. A tireless

> self-publicist, he would

> perform his variation of Moniz's operation - the

> " ice pick "

> lobotomy - before an enthralled audience. This

> involved driving an

> ice-pick-like instrument through the roof of the eye

> and sweeping it

> across the frontal lobe to scramble neural

> connections. Freeman once

> boasted he was " as good as Sinatra " in getting

> young people to

> faint at the sight of what he did. One of his

> patients,

> Dulley, was 12 when he was lobotomised because his

> stepmother said

> he was sullen and refused to bathe.

>

> It was not until the mid-1950s, with the advent of

> antipsychotic and

> pacifying drugs such as chlorpromazine, that the

> lobotomy began to

> fall out of favour.

>

> The role of psychosurgery came under greater

> scrutiny in the 1960s

> and 70s, when social unrest led some sociobiologists

> to consider it

> a tool for addressing violence and

> " psycho-civilising " society

> through the use of implantable brain electrodes.

>

> Despite growing unease, more refined procedures such

> as

> cingulotomies were developed and the modern era of

> psychosurgery was

> born. Such procedures remain controversial and have

> been banned in

> Germany, Japan and a number of US states. They are

> still practised

> in the UK, Finland, India, Sweden, Belgium and

> Spain.

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

Bryce,

Is there any url or email address associated with this

information?

It is easy to believe, but some people like proof.

john

--- bryce_j_j <jeremy.bryce@...> wrote:

>

>

>

>

> The lobotomy is deemed one of the worst crimes in

> medical history.

> But a modern form of it is still practised in

> Britain - and may soon

> be performed without the patient's consent. By

> Toomey and

> Young

>

>

>

>

> The flashbacks come late at night. First comes the

> recollection of

> intense physical pain, as if the bones in his arms

> are being snapped

> like twigs. Then he hears the voice of the

> neurosurgeon applying an

> electric current to metal pins implanted in the

> tissue of his

> brain. " How do you feel, ? " the surgeon Arthur

> E Wall asks,

> while peering into Hutchinson's eyes to see if

> his pupils have

> yet dilated with fear.

>

> When Hutchinson swears at the surgeon, Wall

> administers another

> electric shock to nerve centres located in the

> hypothalamus at the

> centre of his patient's brain. At this, Hutchinson's

> pupils dilate

> and he screams: " You're going to kill me, you

> bastard! " Hutchinson's

> medical records, written by Wall over 30 years ago,

> confirm that his

> patient " felt funny - as if he was dying " . But as he

> screamed,

> Hutchinson recalls Wall leaning in close to his face

> and

> leering: " And I thought you were a bit of a tough

> guy. "

>

>

>

> His next recollection is of Wall giving orders for

> surgical

> implements to be passed. Hutchinson feels the metal

> pins inserted

> through nylon balls lodged in cavities bored into

> the front of his

> skull being replaced by thicker electrodes he says

> felt like " broom

> handles " . " After that I started, I start to feel

> warm all over and

> quickly feel as if I have fallen into a vat of

> molten metal, as if I

> am, quite literally, frying, " says Hutchinson,

> tellingly confusing

> tenses as he describes the brain surgery he

> underwent in 1974 yet

> still relives up to a dozen times a day and in

> frequent nightmares.

>

> Throughout the surgery, Hutchinson was kept

> conscious; his head held

> in a brace, his hands and feet strapped to the

> operating table.

> Hutchinson, a 27-year-old father of three at the

> time of the

> operation, says he had not given his written consent

> to the

> operation being performed; neither had his wife -

> his next of kin.

> Instead his mother, an alcoholic, had been visited

> at home, in the

> late evening, after she had been drinking, and had

> been asked to

> sign the form. " My mother thought doctors were

> gods, " Hutchinson

> says. " She'd have signed anything they asked. "

>

> Hutchinson's excruciatingly detailed recollections

> are a rare

> testimony of someone still lucid and intensely angry

> about a type of

> brain surgery to which he was subjected - he

> contends illegally -

> commonly referred to as a lobotomy. In strict

> medical terms, a

> lobotomy - or leucotomy, as the procedure became

> known in this

> country - involved the removal of part of the

> frontal lobes of the

> brain or the severing of neural fibres connecting

> the frontal lobes

> to the limbic system - the part of the brain

> concerned with

> emotional response and functions not under conscious

> control.

>

> From the mid-1930s until the early 1960s this form

> of " psychosurgery " was heralded as a miracle cure

> for the mentally

> ill, before psychotherapy came into vogue and drugs

> to treat many

> mental-health problems became widely available. It

> was pioneered by

> a maverick Portuguese neurologist, Egas Moniz, who

> was awarded the

> Nobel prize in 1949 for developing and promoting the

> procedure.

> Lobotomies were seen as the solution to a wide range

> of mental

> disorders ranging from profound depression,

> schizophrenia and

> advanced neurosyphilis to mild retardation, at a

> time when half of

> all hospital beds in many countries were occupied by

> the mentally

> ill, and mental institutions were often places of

> humiliation and

> horror.

>

> At the height of its popularity in the 1940s and

> 50s, particularly

> in the US, some of the most enthusiastic proponents

> of the procedure

> promoted it as a way of controlling large numbers of

> those

> considered society's worst misfits, including

> communists and

> homosexuals. Neurologists, not just in the US but in

> Japan, Britain

> and elsewhere, carried out variations of the

> procedure on tens of

> thousands of patients - an estimated 50,000 in the

> UK alone.

>

> Little attention was paid to what happened to those

> subjected to

> lobotomies after surgery. F Kennedy's

> temperamental sister

> Rose, who underwent the operation at the age of 23,

> for instance,

> spent the next 60 years of her life out of sight in

> a mental

> institution. Francis Farmer, the rebellious

> Hollywood actress and

> political activist whose outspoken behaviour was

> also " cured " by a

> lobotomy, quickly drifted into oblivion and ended

> her days as a

> hotel clerk.

>

> But as the number of lives wrecked by such surgery

> became more

> widely known, its effect was gradually exposed -

> most famously in

> Milos Forman's 1975 film, One Flew over the Cuckoo's

> Nest. But also

> earlier, in the 1958 play Suddenly Last Summer, by

> Tennessee

> . A close friend of , whose sister

> Rose was

> lobotomised as a teenager, recalls how the

> playwright talked of his

> sister as " fragile and gentle " , someone hurt by " the

> harshness of

> life " .

>

> " Things alarmed Miss Rose that would not even be

> noticed by someone

> less sensitive. She was just awakening to sexuality

> and knew almost

> nothing about it… Rose came home from school one day

> and said the

> nuns were using altar candles for self-abuse. She

> told mother this, "

> the playwright once confided to his biographer

> Dotson Rader. To the

> siblings' mother, known even to her children as

> " Miss " , human

> sexuality was " the great unmentionable " . She

> promptly took her

> daughter to the doctor, demanding the " filth " be cut

> out of her

> brain: " Cut it away! Miss ordered. " Make it

> clean! " " And he

> did, " recalled the playwright, who said his mother

> never showed any

> remorse about reducing her daughter to a human

> vegetable.

>

> Some now consider such practices to be among the

> most egregious

> medical crimes of the last century and have called

> for Moniz, who

> was later shot in the back by a dissatisfied

> patient, to be

> posthumously stripped of his Nobel prize. The Nobel

> Foundation rules

> this out, maintaining that all of its awards can be

> justified within

> the historical context that they are given.

>

> By the time Hutchinson had his operation in 1974,

> the scale on which

> psychosurgery was being performed was drastically

> reduced, with more

> and more mental disorders being treated with drugs

> and

> psychotherapy. Crude frontal lobotomies, of the type

> Moniz promoted,

> had been phased out. Surgery became targeted at more

> specific parts

> of the brain as the neurobiology of emotion became

> better

> understood. The surgery performed by Wall on

> Hutchinson's

> hypothalamus, for instance, was intended to curb his

> aggression.

>

> Since then, psychosurgery has become even more

> refined, the parts of

> the brain targeted and destroyed to control

> behaviour ever smaller.

> Though the name lobotomy persists, the medical

> profession now refers

> to any such procedure as NMD (neurosurgery for

> mental disorder). But

> Britain is now one of the few countries where this

> sort of surgery

> is still permitted. Even here it is only performed

> for persistent

> severe depression and anxiety and

> obsessive-compulsive disorder

> (OCD) in two places: University Hospital of Wales in

> Cardiff, and

> Ninewells hospital, Dundee. Patients must consent to

> the surgery and

> ethical and clinical standards committees subject

> each case to rigid

> scrutiny before it goes ahead.

>

> If the worst excesses are in the past, the type of

> surgery now

> conducted so controlled and the numbers to whom it

> is given severely

> limited, some might argue that the subject of

> lobotomies,

> psychosurgery, NMD - call it what you will - is only

> of historical

> interest. They would be wrong.

>

> In the coming month, parliament is expected to

> finally debate

> another hotly contested piece of proposed

> legislation: the draft

> Mental Health Bill (2004), which many mental-health

> experts fear

> will reduce safeguards for the mentally ill. One

> provision of the

> bill is a little-noticed clause that, if passed onto

> the statute

> books, would allow doctors to perform NMD without a

> patient's

> consent if they were considered so mentally ill they

> were incapable

> of giving it.

>

>

> No matter how refined these latest NMD techniques

> are, nor how

> vociferously neurosurgeons who practise it argue it

> is nowadays

> employed only as a last resort, its outcome is often

> unpredictable.

> Since it is irreversible, some believe it should be

> banned. At the

> very least it should only be conducted on those able

> to give their

> informed consent, argue campaigners such as the

> mental-health

> charity Mind and the Mental Health Alliance, which

> includes such

> bodies as the Royal College of Nursing, the Royal

> College of

> Psychiatrists, the Law Society and dozens of other

> organisations in

> the field of mental health.

>

> With many of those who have undergone such surgery

> unable to speak

> for themselves and few of those subjected to the

> cruder forms of

> surgery still alive, Hutchinson's is the rare

> voice of

> experience. His story serves as a chilling

> reinforcement of the

> adage that a society be judged by the way it treats

> its most

> vulnerable. With the government proposing

> legislation that many

> believe would turn the clock back on the way we

> treat the mentally

> ill, what does that say about modern Britain?

>

>

>

>

>

>

>

>

>

>

>

> As Hutchinson sits talking in the cramped living

> room of his small

> terrace house in Leeds, he frequently stretches out

> his arms to hug

> his two-year-old grandson, one of 17 grandchildren.

> While the boy

> giggles with delight, Hutchinson, 59, talks a little

> of his own

> childhood. He recalls how his mother would often

> lock him, the

> middle of three brothers, in a coal shed overnight.

> " Glass were all

> broken. I'd have to sleep in coal sack, night after

> night. It went

> on for years, " he says. But he prefers not to dwell

> on it. " That's

> all done now, in the past. "

>

> On his own admission, Hutchinson grew into a

> troubled youngster.

> Though he channelled his aggression into amateur

> boxing and other

> sports, he was, he admits, " always in trouble as a

> lad " and would

> often get into fights. After a spate of joyriding

> cars as a

> teenager, he was sent to a series of borstal

> schools, then remand

> homes. Eventually he found work as a welder, married

> and had three

> children. When he was 27, however, he suffered a

> nervous breakdown.

> After being admitted to a psychiatric hospital, he

> was given ECT

> (electroconvulsive therapy) and prescribed strong

> sedatives. His

> psychiatrist then recommended that he undergo

> psychosurgery.

>

> According to Hutchinson, the psychiatrist tried to

> persuade him such

> surgery was necessary to curb his aggressive

> tendencies after asking

> him how he would feel if Hutchinson were ever to

> kill one of his own

> children. " I'd never harmed any of my children. I

> never would. But

> when he put it like that, I was scared. " Still,

> Hutchinson was

> considered incapable of giving consent, as ?he was

> so heavily

> sedated. At first his wife agreed to the operation.

> But after seeing

> the sizable holes that had been drilled into her

> husband's skull in

> preparation for the second part of the operation a

> week later, she

> withdrew her consent. It was then that his mother

> was approached.

>

> In a 1976 TV documentary on the same operation as

> Hutchinson

> underwent, being performed on a mother-of-five

> called Margaret

> Chapman, the neurosurgeon Wall, who has since died,

> describes the

> operation as " quite simple, really " . He then

> casually admits

> knowledge of psychiatry is " something you pick up as

> you go along " .

> But far from curing Hutchinson's aggression, which

> he describes

> as " within his control " before the operation, the

> surgery he

> underwent left him so traumatised that he walked out

> on his first

> wife, Ruth, who had recently given birth to twins,

> fearing he might

> do his children harm. He subsequently attempted to

> physically attack

> the psychiatrist who had referred him to Wall, and

> several years

> later tried to commit suicide. Though he eventually

> resumed work and

> remarried, he has suffered vivid flashbacks of the

> operation ever

> since, and in recent years has been diagnosed as

> suffering from post-

> traumatic stress disorder.

>

> However troubling Hutchinson's story is, it is by no

> means the

> result of the most cavalier practitioner of

> psychosurgery in this

> country. The neurosurgeon reputed to have been

> Britain's most

> prolific lobotomist was the former president of the

> Society of

> British Neurological Surgeons (SBNS), Sir Wylie

> McKissock, based at

> Atkinson Morley's hospital in Wimbledon in the late

> 1940s and 50s.

> McKissock is described by those who knew him as a

> taciturn and

> difficult man, much feared by his junior staff. He

> rarely spoke to

> or met patients before or after surgery. Instead, at

> weekends, he

> made regular tours of nursing homes and mental

> hospitals along the

> Sussex coast. With the aid of a theatre sister, he

> would perform,

> for cash, up to 10 a day of the crude frontal

> lobotomies pioneered

> by Moniz. McKissock is understood to have performed

> around 2,000

> such operations.

>

> Few records exist of the reasons they were performed

> or their

> outcome; but a 1949 study of 300 of McKissock's

> lobotomy patients

> recorded that 16 had died as a direct or indirect

> result of the

> operation. It is impossible, therefore, to assess

> how many of these

> operations were performed needlessly. But the

> experience of those

> such as Hutchinson, and the accounts of relatives of

> others who

> underwent earlier forms of psychosurgery, attest to

> it having been

> performed for flimsy reasons and to disastrous

> effect by some

> British surgeons, just as it was in the US.

>

>

>

>

>

>

>

>

>

> One such case is that of Shaw, whose brother

> , a 69-

> year-old retired painter and decorator from

> Liverpool, describes

> as " a very, very clever lad " when he was younger.

> " He was very good

> at art. He loved to draw cartoons. Our father was a

> sign writer and

> he sent some of Ron's cartoons to a London newspaper

> when we were

> still teenagers, " recalls of his elder

> brother. " They wanted

> Ron to draw more and were going to pay him quite

> well. But he

> suffered with his nerves. He never did it. "

>

> When was in his early teens, his brother

> remembers he started

> coming home from school crying and would often wake

> up screaming in

> the night. The boy was admitted to hospital and

> given ECT. It failed

> to help. " Years later, we discovered, through

> another boy who was at

> school with Ron, that there was a teacher who used

> to regularly take

> my brother into a back room to cane him. Who knows

> what else he did

> to him in that room. I believe now that it was this

> bullying that

> caused my brother to behave the way he did. "

>

> When he was 17, volunteered to join the army,

> but within a

> year was discharged with a knee injury. In 1955,

> when was

> stationed in the Far East, completing his national

> service, his

> brother was admitted to Rainhill hospital in the St

> Helens district

> of Liverpool and a frontal lobotomy was performed.

> " I knew nothing

> about it. When I came back from the Far East, my

> brother was

> destroyed. He did not talk for two years. Eventually

> he started to

> speak, but he was never the same again. He was never

> able to work.

> My parents spent the rest of their lives looking

> after him. Their

> lives were ruined too. After they died he lived

> alone, though I took

> him out as much as I could. "

>

> Shaw died last year. His partially skeletal

> body was found in

> a field months later. His brother believes he was

> trying to walk to

> the Marble Church in Holywell, which had always

> fascinated him, when

> he stopped for a rest and died of natural causes.

> His body had been

> run over by a tractor after his death and his

> remains were

> surrounded by diaries he kept of his daily

> activities. " I'd been

> driving all over the country looking for him for

> months. Then the

> police called, saying they'd found a body with holes

> drilled in the

> front of his skull and I knew it was Ron, " says

> , his voice

> cracking. " It's unforgivable what was done to him. "

>

>

>

> Supporters of modern-day psychosurgery, or NMD,

> argue it has moved

> light years from the notorious excesses of such

> early practices. Yet

> even the crudest operations, they stress, were

> effective in

> alleviating the mental suffering of some patients.

> One former

> president of Ireland's Royal College of Surgeons,

> who is believed to

> be one of the few surviving neurosurgeons to have

> carried out the

> conventional frontal lobotomy on a regular basis,

> sits sipping a gin

> and tonic as he demonstrates with a cake knife how

> he used to sever

> or core out part of the frontal lobes of his

> patients to break the

> nerve " circuits " believed responsible for mental

> illness. He carried

> out two operations every Saturday morning, at the

> request of the

> Irish Department of Health, for nearly 10 years

> until 1960.

>

> Immaculately dressed in a tweed suit, he recalls how

> the operation

> helped one vet obsessed with a fear of constipation

> who ate fruit

> constantly and spent all day in the toilet. After

> the operation he

> was able to return to work. He also talks of

> performing lobotomies

> on more than 20 priests with perceived personality

> disorders. But,

> he says, in his experience the surgery did more to

> help those who

> were returned to closed orders rather than allowed

> to return to the

> community. Lobotomies, he says, did little to help

> those with

> schizophrenia, neurosyphilis or personality

> disorders other than

> obsessive-compulsive disorder and severe depression.

>

>

>

> Those forms of NMD still being conducted in this

> country today are

> targeted at the treatment of severe depression,

> severe anxiety and

> OCD. These procedures, which involve minute

> destructive lesions in

> parts of the frontal lobe or limbic system, are

> known as

> cingulotomies - the cingulum being the part of the

> frontal lobe

> associated with OCD - and capsulotomies, which

> involve making

> lesions in the capsules: the dense nerve-fibre

> pathway connecting

> part of the frontal lobe with the limbic structure.

> Neurosurgeons at

> Ninewells hospital in Dundee, for instance, carried

> out 34 NMD

> operations between 1990 and 2001. In the past year

> the hospital has

> conducted five such operations on patients it

> describes as " among

> the most severely ill and disabled who come into

> contact with any

> branch of the medical professions " . Surgeons at the

> University

> Hospital of Wales in Cardiff have conducted 56 NMD

> operations in the

> past decade. It was there that the former child

> singing star Lena

> Zavaroni, who suffered from anorexia, underwent such

> surgery in 1999

> for severe depression. Though the operation seemed

> to have been a

> success, she died of pneumonia less than a month

> later. According to

> Simpson, consultant neurosurgeon at Cardiff,

> the operations

> his team have conducted have led to a " marked

> improvement " in

> roughly half of those being treated for severe

> depression and

> OCD. " NMD is not a panacea, " Simpson agrees. " It is

> carefully

> regulated and only offered to patients for whom all

> other treatments

> have failed… But in the patients for whom it works

> well, whose

> suffering has been indescribable, it transforms

> their lives. "

>

>

>

>

>

>

>

>

>

> Some believe the way ahead lies in other forms of

> brain surgery,

> such as deep brain stimulation with implantable

> electrodes, as are

> increasingly used to treat Parkinson's disease. This

> they believe

> could offer an alternative to the ablative

> operations that have been

> used to date in psychosurgery. The introduction of

> modified stem

> cells into certain parts of the brain has also

> already had

> experimental success in treating some neurological

> conditions and

> holds out hope for combating psychiatric disease.

> But it is the

> irreversible nature of the NMD still practised that

> concerns

> opponents. That this type of surgery could be

> carried out without a

> patient's consent, according to the proposed

> legislation, they

> reject outright. Under the current Mental Health Act

> of 1983, three

> independent people, one a doctor, has to certify

> that any patient

> undergoing psychosurgery understands the treatment

> and consents to

> it. The draft mental-health bill under consideration

> has broadly the

> same safeguards for those capable of giving consent.

> The main

> difference is that it allows for treatment to be

> given without the

> patient's consent, at the request of doctors and on

> an order of the

> High Court, providing three conditions are met. The

> first is if it

> can be verified that a patient does not have the

> capacity to

> consent. The second is if there is no reasonable

> prospect of them

> regaining this capacity, and the third is if they

> are " unlikely to

> resist treatment " .

>

> According to Brook, former chief executive

> of the mental-

> health charity Mind, one of the biggest concerns of

> those who work

> in mental health is that no leading study has

> properly assessed the

> effect of psychosurgery on an individual's

> personality or sought the

> views of those undergoing such treatment. " Because

> of its hazards

> and the lack of clear evidence for the treatment's

> benefit, or basis

> for predicting success in the individual concerned,

> we believe it

> should never be given to someone who doesn't have

> the capacity to

> consent to it, " says Brook.

>

> Doctors at Ninewells hospital in Dundee argue that

> the lack of a

> randomised control trial to support NMD applies

> equally to a range

> of " cutting edge " medical and surgical procedures.

> Simpson

> says that although he appreciates there may be an

> " understandable

> fear of returning to the bad old days of lobotomy " ,

> he believes it

> is " not unreasonable in certain circumstances and

> with adequate

> legal safeguards " to perform NMD without a patient's

> consent. " The

> issue of consent is sensitive and crucially

> important, " warns

> Simpson, adding that " the more you open it up in

> this way, the more

> crucial it becomes to have adequate legal

> safeguards " .

>

> But , who is behind moves to launch

> a legal

> campaign in the US to have Moniz's Nobel prize

> revoked, believes

> that there are even wider issues at stake. 's

> own grandmother

> was left to languish in a psychiatric institution

> for 20 years after

> undergoing a lobotomy. As a result, the medical

> librarian ?from

> Levittown, New York state, founded an organisation

> called

> Psychosurgery.org, dedicated to the " surgical

> casualties " of such

> procedures. " There are a lot of important lessons to

> be learnt from

> what happened to our family members, " says .

>

> Many families of those suffering from Alzheimer's

> disease, she

> stresses, are now clamouring to have experimental

> brain surgery

> performed on them. " But there is a real ethical

> question about

> whether you can really do these kind of things to

> someone who is by

> definition having problems making decisions. I

> really hope people

> will take into consideration the amount of damage

> that was done in

> the past when they attempt to push forward with such

> treatments, "

> concludes.

>

>

>

>

>

>

>

>

>

> Hutchinson has recently tried to sue his local

> health

> authority for medical malpractice, but has had to

> give up because

> his surgery was carried out so long ago that the

> statute of

> limitations on such a claim has expired. West

> Yorkshire police are

> now investigating if there is a criminal case to

> answer over a lack

> of proper legal consent having been obtained.

>

> Such thoughts are far from his mind, however, as

> Hutchinson drives

> me back to the train station in Leeds, warning me

> that he might have

> to pull over to the side of the road at any moment

> because his

> lobotomy has also left ?him with narcolepsy.

> Throughout the journey,

> he talks affectionately about his brood of

> grandchildren. But by the

> time we reach the station, he has lapsed into

> melancholia and tears

> well in his eyes as he talks about how his own

> children's lives were

> damaged when he abandoned them after his operation.

>

> " If nothing else, I want people to understand what

> these bastards

> did to me, and thousands of others, so nothing like

> this is ever

> allowed to happen again, " he says, clutching the

> steering wheel

> until his knuckles go white. " What they did was not

> treatment - it

> was torture. "

>

> Young is consultant neurosurgeon at the

> Beaumont hospital in

> Dublin

>

> THE ORIGINS OF MIND-ALTERING SURGERY

>

>

> Egas Moniz could have afforded to rest on his

> laurels by the time he

> attended the Second World Congress of Neurology in

> London in 1935.

> The 61-year-old professor of neurology, and dean of

> Lisbon's Medical

> School, had already gained an international

> reputation for

> pioneering cerebral angiography - a radiological

> technique for

> mapping brain vessels. But Moniz was disappointed

> that this had not

> won him the Nobel prize. So when he heard two Yale

> neurologists

> speak at the London congress about experimental

> brain research on

> two chimpanzees called Clyde and Becky, observing

> how Becky's temper

> tantrums subsided after surgery, he would go on to

> pioneer - and

> relentlessly promote - a procedure that eventually

> won him the

> coveted Nobel prize.

>

> The procedure was the lobotomy. Back in Lisbon he

> ordered that a

> human brain be brought to him from a morgue, and

> thrusted a pen

> through the cortex several times until he was

> satisfied he knew the

> approximate angle and depth that would best detach

> the frontal

> lobes. He performed the operation on a former

> prostitute, who

> afterwards was unable to give her age or say where

> she was. She was

> returned to an asylum, never to be seen by him

> again.

>

>

>

> Moniz nonetheless considered this a " clinical cure "

> and continued

> operating. The procedure was greeted with enthusiasm

> by the medical

> profession and went on to be practised in many

> countries. After

> Moniz won the Nobel prize in 1949, the lobotomy's

> popularity

> increased. But today many believe the procedure is

> barbaric, and are

> campaigning for him to be stripped of the award.

>

> The Nobel Foundation contends that Moniz's prize

> should be judged in

> the historical context of a period when there was

> widespread despair

> about mental-health treatment. In the 1930s and 40s,

> patients were

> often beaten, choked, spat on and humiliated by

> attendants in state

> hospitals, where the average duration of confinement

> was 10 years.

> Cost was also a factor. In the mid-1930s a lobotomy

> cost $250 in the

> US, compared with tens of thousands of dollars to

> keep a patient

> incarcerated. The drawback of the operation - that

> it robbed

> patients of their personality traits - was

> considered a small price

> for emptying hospital beds.

>

> If Moniz brought the lobotomy fame, then the US

> physician Walter

> Freeman brought it infamy. A tireless

> self-publicist, he would

> perform his variation of Moniz's operation - the

> " ice pick "

> lobotomy - before an enthralled audience. This

> involved driving an

> ice-pick-like instrument through the roof of the eye

> and sweeping it

> across the frontal lobe to scramble neural

> connections. Freeman once

> boasted he was " as good as Sinatra " in getting

> young people to

> faint at the sight of what he did. One of his

> patients,

> Dulley, was 12 when he was lobotomised because his

> stepmother said

> he was sullen and refused to bathe.

>

> It was not until the mid-1950s, with the advent of

> antipsychotic and

> pacifying drugs such as chlorpromazine, that the

> lobotomy began to

> fall out of favour.

>

> The role of psychosurgery came under greater

> scrutiny in the 1960s

> and 70s, when social unrest led some sociobiologists

> to consider it

> a tool for addressing violence and

> " psycho-civilising " society

> through the use of implantable brain electrodes.

>

> Despite growing unease, more refined procedures such

> as

> cingulotomies were developed and the modern era of

> psychosurgery was

> born. Such procedures remain controversial and have

> been banned in

> Germany, Japan and a number of US states. They are

> still practised

> in the UK, Finland, India, Sweden, Belgium and

> Spain.

>

>

>

>

>

>

>

>

>

>

>

[Guest guest]

http://www.timesonline.co.uk/article/0,,2099-2034199,00.html

The Sunday Times Magazine

Copyright 2006 Times Newspapers Ltd.

>

> >

> >

> >

> >

> > The lobotomy is deemed one of the worst crimes in

> > medical history.

> > But a modern form of it is still practised in

> > Britain - and may soon

> > be performed without the patient's consent. By

> > Toomey and

> > Young

> >

> >

> >

> >

> > The flashbacks come late at night. First comes the

> > recollection of

> > intense physical pain, as if the bones in his arms

> > are being snapped

> > like twigs. Then he hears the voice of the

> > neurosurgeon applying an

> > electric current to metal pins implanted in the

> > tissue of his

> > brain. " How do you feel, ? " the surgeon Arthur

> > E Wall asks,

> > while peering into Hutchinson's eyes to see if

> > his pupils have

> > yet dilated with fear.

> >

> > When Hutchinson swears at the surgeon, Wall

> > administers another

> > electric shock to nerve centres located in the

> > hypothalamus at the

> > centre of his patient's brain. At this, Hutchinson's

> > pupils dilate

> > and he screams: " You're going to kill me, you

> > bastard! " Hutchinson's

> > medical records, written by Wall over 30 years ago,

> > confirm that his

> > patient " felt funny - as if he was dying " . But as he

> > screamed,

> > Hutchinson recalls Wall leaning in close to his face

> > and

> > leering: " And I thought you were a bit of a tough

> > guy. "

> >

> >

> >

> > His next recollection is of Wall giving orders for

> > surgical

> > implements to be passed. Hutchinson feels the metal

> > pins inserted

> > through nylon balls lodged in cavities bored into

> > the front of his

> > skull being replaced by thicker electrodes he says

> > felt like " broom

> > handles " . " After that I started, I start to feel

> > warm all over and

> > quickly feel as if I have fallen into a vat of

> > molten metal, as if I

> > am, quite literally, frying, " says Hutchinson,

> > tellingly confusing

> > tenses as he describes the brain surgery he

> > underwent in 1974 yet

> > still relives up to a dozen times a day and in

> > frequent nightmares.

> >

> > Throughout the surgery, Hutchinson was kept

> > conscious; his head held

> > in a brace, his hands and feet strapped to the

> > operating table.

> > Hutchinson, a 27-year-old father of three at the

> > time of the

> > operation, says he had not given his written consent

> > to the

> > operation being performed; neither had his wife -

> > his next of kin.

> > Instead his mother, an alcoholic, had been visited

> > at home, in the

> > late evening, after she had been drinking, and had

> > been asked to

> > sign the form. " My mother thought doctors were

> > gods, " Hutchinson

> > says. " She'd have signed anything they asked. "

> >

> > Hutchinson's excruciatingly detailed recollections

> > are a rare

> > testimony of someone still lucid and intensely angry

> > about a type of

> > brain surgery to which he was subjected - he

> > contends illegally -

> > commonly referred to as a lobotomy. In strict

> > medical terms, a

> > lobotomy - or leucotomy, as the procedure became

> > known in this

> > country - involved the removal of part of the

> > frontal lobes of the

> > brain or the severing of neural fibres connecting

> > the frontal lobes

> > to the limbic system - the part of the brain

> > concerned with

> > emotional response and functions not under conscious

> > control.

> >

> > From the mid-1930s until the early 1960s this form

> > of " psychosurgery " was heralded as a miracle cure

> > for the mentally

> > ill, before psychotherapy came into vogue and drugs

> > to treat many

> > mental-health problems became widely available. It

> > was pioneered by

> > a maverick Portuguese neurologist, Egas Moniz, who

> > was awarded the

> > Nobel prize in 1949 for developing and promoting the

> > procedure.

> > Lobotomies were seen as the solution to a wide range

> > of mental

> > disorders ranging from profound depression,

> > schizophrenia and

> > advanced neurosyphilis to mild retardation, at a

> > time when half of

> > all hospital beds in many countries were occupied by

> > the mentally

> > ill, and mental institutions were often places of

> > humiliation and

> > horror.

> >

> > At the height of its popularity in the 1940s and

> > 50s, particularly

> > in the US, some of the most enthusiastic proponents

> > of the procedure

> > promoted it as a way of controlling large numbers of

> > those

> > considered society's worst misfits, including

> > communists and

> > homosexuals. Neurologists, not just in the US but in

> > Japan, Britain

> > and elsewhere, carried out variations of the

> > procedure on tens of

> > thousands of patients - an estimated 50,000 in the

> > UK alone.

> >

> > Little attention was paid to what happened to those

> > subjected to

> > lobotomies after surgery. F Kennedy's

> > temperamental sister

> > Rose, who underwent the operation at the age of 23,

> > for instance,

> > spent the next 60 years of her life out of sight in

> > a mental

> > institution. Francis Farmer, the rebellious

> > Hollywood actress and

> > political activist whose outspoken behaviour was

> > also " cured " by a

> > lobotomy, quickly drifted into oblivion and ended

> > her days as a

> > hotel clerk.

> >

> > But as the number of lives wrecked by such surgery

> > became more

> > widely known, its effect was gradually exposed -

> > most famously in

> > Milos Forman's 1975 film, One Flew over the Cuckoo's

> > Nest. But also

> > earlier, in the 1958 play Suddenly Last Summer, by

> > Tennessee

> > . A close friend of , whose sister

> > Rose was

> > lobotomised as a teenager, recalls how the

> > playwright talked of his

> > sister as " fragile and gentle " , someone hurt by " the

> > harshness of

> > life " .

> >

> > " Things alarmed Miss Rose that would not even be

> > noticed by someone

> > less sensitive. She was just awakening to sexuality

> > and knew almost

> > nothing about it… Rose came home from school one day

> > and said the

> > nuns were using altar candles for self-abuse. She

> > told mother this, "

> > the playwright once confided to his biographer

> > Dotson Rader. To the

> > siblings' mother, known even to her children as

> > " Miss " , human

> > sexuality was " the great unmentionable " . She

> > promptly took her

> > daughter to the doctor, demanding the " filth " be cut

> > out of her

> > brain: " Cut it away! Miss ordered. " Make it

> > clean! " " And he

> > did, " recalled the playwright, who said his mother

> > never showed any

> > remorse about reducing her daughter to a human

> > vegetable.

> >

> > Some now consider such practices to be among the

> > most egregious

> > medical crimes of the last century and have called

> > for Moniz, who

> > was later shot in the back by a dissatisfied

> > patient, to be

> > posthumously stripped of his Nobel prize. The Nobel

> > Foundation rules

> > this out, maintaining that all of its awards can be

> > justified within

> > the historical context that they are given.

> >

> > By the time Hutchinson had his operation in 1974,

> > the scale on which

> > psychosurgery was being performed was drastically

> > reduced, with more

> > and more mental disorders being treated with drugs

> > and

> > psychotherapy. Crude frontal lobotomies, of the type

> > Moniz promoted,

> > had been phased out. Surgery became targeted at more

> > specific parts

> > of the brain as the neurobiology of emotion became

> > better

> > understood. The surgery performed by Wall on

> > Hutchinson's

> > hypothalamus, for instance, was intended to curb his

> > aggression.

> >

> > Since then, psychosurgery has become even more

> > refined, the parts of

> > the brain targeted and destroyed to control

> > behaviour ever smaller.

> > Though the name lobotomy persists, the medical

> > profession now refers

> > to any such procedure as NMD (neurosurgery for

> > mental disorder). But

> > Britain is now one of the few countries where this

> > sort of surgery

> > is still permitted. Even here it is only performed

> > for persistent

> > severe depression and anxiety and

> > obsessive-compulsive disorder

> > (OCD) in two places: University Hospital of Wales in

> > Cardiff, and

> > Ninewells hospital, Dundee. Patients must consent to

> > the surgery and

> > ethical and clinical standards committees subject

> > each case to rigid

> > scrutiny before it goes ahead.

> >

> > If the worst excesses are in the past, the type of

> > surgery now

> > conducted so controlled and the numbers to whom it

> > is given severely

> > limited, some might argue that the subject of

> > lobotomies,

> > psychosurgery, NMD - call it what you will - is only

> > of historical

> > interest. They would be wrong.

> >

> > In the coming month, parliament is expected to

> > finally debate

> > another hotly contested piece of proposed

> > legislation: the draft

> > Mental Health Bill (2004), which many mental-health

> > experts fear

> > will reduce safeguards for the mentally ill. One

> > provision of the

> > bill is a little-noticed clause that, if passed onto

> > the statute

> > books, would allow doctors to perform NMD without a

> > patient's

> > consent if they were considered so mentally ill they

> > were incapable

> > of giving it.

> >

> >

> > No matter how refined these latest NMD techniques

> > are, nor how

> > vociferously neurosurgeons who practise it argue it

> > is nowadays

> > employed only as a last resort, its outcome is often

> > unpredictable.

> > Since it is irreversible, some believe it should be

> > banned. At the

> > very least it should only be conducted on those able

> > to give their

> > informed consent, argue campaigners such as the

> > mental-health

> > charity Mind and the Mental Health Alliance, which

> > includes such

> > bodies as the Royal College of Nursing, the Royal

> > College of

> > Psychiatrists, the Law Society and dozens of other

> > organisations in

> > the field of mental health.

> >

> > With many of those who have undergone such surgery

> > unable to speak

> > for themselves and few of those subjected to the

> > cruder forms of

> > surgery still alive, Hutchinson's is the rare

> > voice of

> > experience. His story serves as a chilling

> > reinforcement of the

> > adage that a society be judged by the way it treats

> > its most

> > vulnerable. With the government proposing

> > legislation that many

> > believe would turn the clock back on the way we

> > treat the mentally

> > ill, what does that say about modern Britain?

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > As Hutchinson sits talking in the cramped living

> > room of his small

> > terrace house in Leeds, he frequently stretches out

> > his arms to hug

> > his two-year-old grandson, one of 17 grandchildren.

> > While the boy

> > giggles with delight, Hutchinson, 59, talks a little

> > of his own

> > childhood. He recalls how his mother would often

> > lock him, the

> > middle of three brothers, in a coal shed overnight.

> > " Glass were all

> > broken. I'd have to sleep in coal sack, night after

> > night. It went

> > on for years, " he says. But he prefers not to dwell

> > on it. " That's

> > all done now, in the past. "

> >

> > On his own admission, Hutchinson grew into a

> > troubled youngster.

> > Though he channelled his aggression into amateur

> > boxing and other

> > sports, he was, he admits, " always in trouble as a

> > lad " and would

> > often get into fights. After a spate of joyriding

> > cars as a

> > teenager, he was sent to a series of borstal

> > schools, then remand

> > homes. Eventually he found work as a welder, married

> > and had three

> > children. When he was 27, however, he suffered a

> > nervous breakdown.

> > After being admitted to a psychiatric hospital, he

> > was given ECT

> > (electroconvulsive therapy) and prescribed strong

> > sedatives. His

> > psychiatrist then recommended that he undergo

> > psychosurgery.

> >

> > According to Hutchinson, the psychiatrist tried to

> > persuade him such

> > surgery was necessary to curb his aggressive

> > tendencies after asking

> > him how he would feel if Hutchinson were ever to

> > kill one of his own

> > children. " I'd never harmed any of my children. I

> > never would. But

> > when he put it like that, I was scared. " Still,

> > Hutchinson was

> > considered incapable of giving consent, as ?he was

> > so heavily

> > sedated. At first his wife agreed to the operation.

> > But after seeing

> > the sizable holes that had been drilled into her

> > husband's skull in

> > preparation for the second part of the operation a

> > week later, she

> > withdrew her consent. It was then that his mother

> > was approached.

> >

> > In a 1976 TV documentary on the same operation as

> > Hutchinson

> > underwent, being performed on a mother-of-five

> > called Margaret

> > Chapman, the neurosurgeon Wall, who has since died,

> > describes the

> > operation as " quite simple, really " . He then

> > casually admits

> > knowledge of psychiatry is " something you pick up as

> > you go along " .

> > But far from curing Hutchinson's aggression, which

> > he describes

> > as " within his control " before the operation, the

> > surgery he

> > underwent left him so traumatised that he walked out

> > on his first

> > wife, Ruth, who had recently given birth to twins,

> > fearing he might

> > do his children harm. He subsequently attempted to

> > physically attack

> > the psychiatrist who had referred him to Wall, and

> > several years

> > later tried to commit suicide. Though he eventually

> > resumed work and

> > remarried, he has suffered vivid flashbacks of the

> > operation ever

> > since, and in recent years has been diagnosed as

> > suffering from post-

> > traumatic stress disorder.

> >

> > However troubling Hutchinson's story is, it is by no

> > means the

> > result of the most cavalier practitioner of

> > psychosurgery in this

> > country. The neurosurgeon reputed to have been

> > Britain's most

> > prolific lobotomist was the former president of the

> > Society of

> > British Neurological Surgeons (SBNS), Sir Wylie

> > McKissock, based at

> > Atkinson Morley's hospital in Wimbledon in the late

> > 1940s and 50s.

> > McKissock is described by those who knew him as a

> > taciturn and

> > difficult man, much feared by his junior staff. He

> > rarely spoke to

> > or met patients before or after surgery. Instead, at

> > weekends, he

> > made regular tours of nursing homes and mental

> > hospitals along the

> > Sussex coast. With the aid of a theatre sister, he

> > would perform,

> > for cash, up to 10 a day of the crude frontal

> > lobotomies pioneered

> > by Moniz. McKissock is understood to have performed

> > around 2,000

> > such operations.

> >

> > Few records exist of the reasons they were performed

> > or their

> > outcome; but a 1949 study of 300 of McKissock's

> > lobotomy patients

> > recorded that 16 had died as a direct or indirect

> > result of the

> > operation. It is impossible, therefore, to assess

> > how many of these

> > operations were performed needlessly. But the

> > experience of those

> > such as Hutchinson, and the accounts of relatives of

> > others who

> > underwent earlier forms of psychosurgery, attest to

> > it having been

> > performed for flimsy reasons and to disastrous

> > effect by some

> > British surgeons, just as it was in the US.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > One such case is that of Shaw, whose brother

> > , a 69-

> > year-old retired painter and decorator from

> > Liverpool, describes

> > as " a very, very clever lad " when he was younger.

> > " He was very good

> > at art. He loved to draw cartoons. Our father was a

> > sign writer and

> > he sent some of Ron's cartoons to a London newspaper

> > when we were

> > still teenagers, " recalls of his elder

> > brother. " They wanted

> > Ron to draw more and were going to pay him quite

> > well. But he

> > suffered with his nerves. He never did it. "

> >

> > When was in his early teens, his brother

> > remembers he started

> > coming home from school crying and would often wake

> > up screaming in

> > the night. The boy was admitted to hospital and

> > given ECT. It failed

> > to help. " Years later, we discovered, through

> > another boy who was at

> > school with Ron, that there was a teacher who used

> > to regularly take

> > my brother into a back room to cane him. Who knows

> > what else he did

> > to him in that room. I believe now that it was this

> > bullying that

> > caused my brother to behave the way he did. "

> >

> > When he was 17, volunteered to join the army,

> > but within a

> > year was discharged with a knee injury. In 1955,

> > when was

> > stationed in the Far East, completing his national

> > service, his

> > brother was admitted to Rainhill hospital in the St

> > Helens district

> > of Liverpool and a frontal lobotomy was performed.

> > " I knew nothing

> > about it. When I came back from the Far East, my

> > brother was

> > destroyed. He did not talk for two years. Eventually

> > he started to

> > speak, but he was never the same again. He was never

> > able to work.

> > My parents spent the rest of their lives looking

> > after him. Their

> > lives were ruined too. After they died he lived

> > alone, though I took

> > him out as much as I could. "

> >

> > Shaw died last year. His partially skeletal

> > body was found in

> > a field months later. His brother believes he was

> > trying to walk to

> > the Marble Church in Holywell, which had always

> > fascinated him, when

> > he stopped for a rest and died of natural causes.

> > His body had been

> > run over by a tractor after his death and his

> > remains were

> > surrounded by diaries he kept of his daily

> > activities. " I'd been

> > driving all over the country looking for him for

> > months. Then the

> > police called, saying they'd found a body with holes

> > drilled in the

> > front of his skull and I knew it was Ron, " says

> > , his voice

> > cracking. " It's unforgivable what was done to him. "

> >

> >

> >

> > Supporters of modern-day psychosurgery, or NMD,

> > argue it has moved

> > light years from the notorious excesses of such

> > early practices. Yet

> > even the crudest operations, they stress, were

> > effective in

> > alleviating the mental suffering of some patients.

> > One former

> > president of Ireland's Royal College of Surgeons,

> > who is believed to

> > be one of the few surviving neurosurgeons to have

> > carried out the

> > conventional frontal lobotomy on a regular basis,

> > sits sipping a gin

> > and tonic as he demonstrates with a cake knife how

> > he used to sever

> > or core out part of the frontal lobes of his

> > patients to break the

> > nerve " circuits " believed responsible for mental

> > illness. He carried

> > out two operations every Saturday morning, at the

> > request of the

> > Irish Department of Health, for nearly 10 years

> > until 1960.

> >

> > Immaculately dressed in a tweed suit, he recalls how

> > the operation

> > helped one vet obsessed with a fear of constipation

> > who ate fruit

> > constantly and spent all day in the toilet. After

> > the operation he

> > was able to return to work. He also talks of

> > performing lobotomies

> > on more than 20 priests with perceived personality

> > disorders. But,

> > he says, in his experience the surgery did more to

> > help those who

> > were returned to closed orders rather than allowed

> > to return to the

> > community. Lobotomies, he says, did little to help

> > those with

> > schizophrenia, neurosyphilis or personality

> > disorders other than

> > obsessive-compulsive disorder and severe depression.

> >

> >

> >

> > Those forms of NMD still being conducted in this

> > country today are

> > targeted at the treatment of severe depression,

> > severe anxiety and

> > OCD. These procedures, which involve minute

> > destructive lesions in

> > parts of the frontal lobe or limbic system, are

> > known as

> > cingulotomies - the cingulum being the part of the

> > frontal lobe

> > associated with OCD - and capsulotomies, which

> > involve making

> > lesions in the capsules: the dense nerve-fibre

> > pathway connecting

> > part of the frontal lobe with the limbic structure.

> > Neurosurgeons at

> > Ninewells hospital in Dundee, for instance, carried

> > out 34 NMD

> > operations between 1990 and 2001. In the past year

> > the hospital has

> > conducted five such operations on patients it

> > describes as " among

> > the most severely ill and disabled who come into

> > contact with any

> > branch of the medical professions " . Surgeons at the

> > University

> > Hospital of Wales in Cardiff have conducted 56 NMD

> > operations in the

> > past decade. It was there that the former child

> > singing star Lena

> > Zavaroni, who suffered from anorexia, underwent such

> > surgery in 1999

> > for severe depression. Though the operation seemed

> > to have been a

> > success, she died of pneumonia less than a month

> > later. According to

> > Simpson, consultant neurosurgeon at Cardiff,

> > the operations

> > his team have conducted have led to a " marked

> > improvement " in

> > roughly half of those being treated for severe

> > depression and

> > OCD. " NMD is not a panacea, " Simpson agrees. " It is

> > carefully

> > regulated and only offered to patients for whom all

> > other treatments

> > have failed… But in the patients for whom it works

> > well, whose

> > suffering has been indescribable, it transforms

> > their lives. "

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Some believe the way ahead lies in other forms of

> > brain surgery,

> > such as deep brain stimulation with implantable

> > electrodes, as are

> > increasingly used to treat Parkinson's disease. This

> > they believe

> > could offer an alternative to the ablative

> > operations that have been

> > used to date in psychosurgery. The introduction of

> > modified stem

> > cells into certain parts of the brain has also

> > already had

> > experimental success in treating some neurological

> > conditions and

> > holds out hope for combating psychiatric disease.

> > But it is the

> > irreversible nature of the NMD still practised that

> > concerns

> > opponents. That this type of surgery could be

> > carried out without a

> > patient's consent, according to the proposed

> > legislation, they

> > reject outright. Under the current Mental Health Act

> > of 1983, three

> > independent people, one a doctor, has to certify

> > that any patient

> > undergoing psychosurgery understands the treatment

> > and consents to

> > it. The draft mental-health bill under consideration

> > has broadly the

> > same safeguards for those capable of giving consent.

> > The main

> > difference is that it allows for treatment to be

> > given without the

> > patient's consent, at the request of doctors and on

> > an order of the

> > High Court, providing three conditions are met. The

> > first is if it

> > can be verified that a patient does not have the

> > capacity to

> > consent. The second is if there is no reasonable

> > prospect of them

> > regaining this capacity, and the third is if they

> > are " unlikely to

> > resist treatment " .

> >

> > According to Brook, former chief executive

> > of the mental-

> > health charity Mind, one of the biggest concerns of

> > those who work

> > in mental health is that no leading study has

> > properly assessed the

> > effect of psychosurgery on an individual's

> > personality or sought the

> > views of those undergoing such treatment. " Because

> > of its hazards

> > and the lack of clear evidence for the treatment's

> > benefit, or basis

> > for predicting success in the individual concerned,

> > we believe it

> > should never be given to someone who doesn't have

> > the capacity to

> > consent to it, " says Brook.

> >

> > Doctors at Ninewells hospital in Dundee argue that

> > the lack of a

> > randomised control trial to support NMD applies

> > equally to a range

> > of " cutting edge " medical and surgical procedures.

> > Simpson

> > says that although he appreciates there may be an

> > " understandable

> > fear of returning to the bad old days of lobotomy " ,

> > he believes it

> > is " not unreasonable in certain circumstances and

> > with adequate

> > legal safeguards " to perform NMD without a patient's

> > consent. " The

> > issue of consent is sensitive and crucially

> > important, " warns

> > Simpson, adding that " the more you open it up in

> > this way, the more

> > crucial it becomes to have adequate legal

> > safeguards " .

> >

> > But , who is behind moves to launch

> > a legal

> > campaign in the US to have Moniz's Nobel prize

> > revoked, believes

> > that there are even wider issues at stake. 's

> > own grandmother

> > was left to languish in a psychiatric institution

> > for 20 years after

> > undergoing a lobotomy. As a result, the medical

> > librarian ?from

> > Levittown, New York state, founded an organisation

> > called

> > Psychosurgery.org, dedicated to the " surgical

> > casualties " of such

> > procedures. " There are a lot of important lessons to

> > be learnt from

> > what happened to our family members, " says .

> >

> > Many families of those suffering from Alzheimer's

> > disease, she

> > stresses, are now clamouring to have experimental

> > brain surgery

> > performed on them. " But there is a real ethical

> > question about

> > whether you can really do these kind of things to

> > someone who is by

> > definition having problems making decisions. I

> > really hope people

> > will take into consideration the amount of damage

> > that was done in

> > the past when they attempt to push forward with such

> > treatments, "

> > concludes.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Hutchinson has recently tried to sue his local

> > health

> > authority for medical malpractice, but has had to

> > give up because

> > his surgery was carried out so long ago that the

> > statute of

> > limitations on such a claim has expired. West

> > Yorkshire police are

> > now investigating if there is a criminal case to

> > answer over a lack

> > of proper legal consent having been obtained.

> >

> > Such thoughts are far from his mind, however, as

> > Hutchinson drives

> > me back to the train station in Leeds, warning me

> > that he might have

> > to pull over to the side of the road at any moment

> > because his

> > lobotomy has also left ?him with narcolepsy.

> > Throughout the journey,

> > he talks affectionately about his brood of

> > grandchildren. But by the

> > time we reach the station, he has lapsed into

> > melancholia and tears

> > well in his eyes as he talks about how his own

> > children's lives were

> > damaged when he abandoned them after his operation.

> >

> > " If nothing else, I want people to understand what

> > these bastards

> > did to me, and thousands of others, so nothing like

> > this is ever

> > allowed to happen again, " he says, clutching the

> > steering wheel

> > until his knuckles go white. " What they did was not

> > treatment - it

> > was torture. "

> >

> > Young is consultant neurosurgeon at the

> > Beaumont hospital in

> > Dublin

> >

> > THE ORIGINS OF MIND-ALTERING SURGERY

> >

> >

> > Egas Moniz could have afforded to rest on his

> > laurels by the time he

> > attended the Second World Congress of Neurology in

> > London in 1935.

> > The 61-year-old professor of neurology, and dean of

> > Lisbon's Medical

> > School, had already gained an international

> > reputation for

> > pioneering cerebral angiography - a radiological

> > technique for

> > mapping brain vessels. But Moniz was disappointed

> > that this had not

> > won him the Nobel prize. So when he heard two Yale

> > neurologists

> > speak at the London congress about experimental

> > brain research on

> > two chimpanzees called Clyde and Becky, observing

> > how Becky's temper

> > tantrums subsided after surgery, he would go on to

> > pioneer - and

> > relentlessly promote - a procedure that eventually

> > won him the

> > coveted Nobel prize.

> >

> > The procedure was the lobotomy. Back in Lisbon he

> > ordered that a

> > human brain be brought to him from a morgue, and

> > thrusted a pen

> > through the cortex several times until he was

> > satisfied he knew the

> > approximate angle and depth that would best detach

> > the frontal

> > lobes. He performed the operation on a former

> > prostitute, who

> > afterwards was unable to give her age or say where

> > she was. She was

> > returned to an asylum, never to be seen by him

> > again.

> >

> >

> >

> > Moniz nonetheless considered this a " clinical cure "

> > and continued

> > operating. The procedure was greeted with enthusiasm

> > by the medical

> > profession and went on to be practised in many

> > countries. After

> > Moniz won the Nobel prize in 1949, the lobotomy's

> > popularity

> > increased. But today many believe the procedure is

> > barbaric, and are

> > campaigning for him to be stripped of the award.

> >

> > The Nobel Foundation contends that Moniz's prize

> > should be judged in

> > the historical context of a period when there was

> > widespread despair

> > about mental-health treatment. In the 1930s and 40s,

> > patients were

> > often beaten, choked, spat on and humiliated by

> > attendants in state

> > hospitals, where the average duration of confinement

> > was 10 years.

> > Cost was also a factor. In the mid-1930s a lobotomy

> > cost $250 in the

> > US, compared with tens of thousands of dollars to

> > keep a patient

> > incarcerated. The drawback of the operation - that

> > it robbed

> > patients of their personality traits - was

> > considered a small price

> > for emptying hospital beds.

> >

> > If Moniz brought the lobotomy fame, then the US

> > physician Walter

> > Freeman brought it infamy. A tireless

> > self-publicist, he would

> > perform his variation of Moniz's operation - the

> > " ice pick "

> > lobotomy - before an enthralled audience. This

> > involved driving an

> > ice-pick-like instrument through the roof of the eye

> > and sweeping it

> > across the frontal lobe to scramble neural

> > connections. Freeman once

> > boasted he was " as good as Sinatra " in getting

> > young people to

> > faint at the sight of what he did. One of his

> > patients,

> > Dulley, was 12 when he was lobotomised because his

> > stepmother said

> > he was sullen and refused to bathe.

> >

> > It was not until the mid-1950s, with the advent of

> > antipsychotic and

> > pacifying drugs such as chlorpromazine, that the

> > lobotomy began to

> > fall out of favour.

> >

> > The role of psychosurgery came under greater

> > scrutiny in the 1960s

> > and 70s, when social unrest led some sociobiologists

> > to consider it

> > a tool for addressing violence and

> > " psycho-civilising " society

> > through the use of implantable brain electrodes.

> >

> > Despite growing unease, more refined procedures such

> > as

> > cingulotomies were developed and the modern era of

> > psychosurgery was

> > born. Such procedures remain controversial and have

> > been banned in

> > Germany, Japan and a number of US states. They are

> > still practised

> > in the UK, Finland, India, Sweden, Belgium and

> > Spain.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

http://www.timesonline.co.uk/article/0,,2099-2034199,00.html

The Sunday Times Magazine

Copyright 2006 Times Newspapers Ltd.

>

> >

> >

> >

> >

> > The lobotomy is deemed one of the worst crimes in

> > medical history.

> > But a modern form of it is still practised in

> > Britain - and may soon

> > be performed without the patient's consent. By

> > Toomey and

> > Young

> >

> >

> >

> >

> > The flashbacks come late at night. First comes the

> > recollection of

> > intense physical pain, as if the bones in his arms

> > are being snapped

> > like twigs. Then he hears the voice of the

> > neurosurgeon applying an

> > electric current to metal pins implanted in the

> > tissue of his

> > brain. " How do you feel, ? " the surgeon Arthur

> > E Wall asks,

> > while peering into Hutchinson's eyes to see if

> > his pupils have

> > yet dilated with fear.

> >

> > When Hutchinson swears at the surgeon, Wall

> > administers another

> > electric shock to nerve centres located in the

> > hypothalamus at the

> > centre of his patient's brain. At this, Hutchinson's

> > pupils dilate

> > and he screams: " You're going to kill me, you

> > bastard! " Hutchinson's

> > medical records, written by Wall over 30 years ago,

> > confirm that his

> > patient " felt funny - as if he was dying " . But as he

> > screamed,

> > Hutchinson recalls Wall leaning in close to his face

> > and

> > leering: " And I thought you were a bit of a tough

> > guy. "

> >

> >

> >

> > His next recollection is of Wall giving orders for

> > surgical

> > implements to be passed. Hutchinson feels the metal

> > pins inserted

> > through nylon balls lodged in cavities bored into

> > the front of his

> > skull being replaced by thicker electrodes he says

> > felt like " broom

> > handles " . " After that I started, I start to feel

> > warm all over and

> > quickly feel as if I have fallen into a vat of

> > molten metal, as if I

> > am, quite literally, frying, " says Hutchinson,

> > tellingly confusing

> > tenses as he describes the brain surgery he

> > underwent in 1974 yet

> > still relives up to a dozen times a day and in

> > frequent nightmares.

> >

> > Throughout the surgery, Hutchinson was kept

> > conscious; his head held

> > in a brace, his hands and feet strapped to the

> > operating table.

> > Hutchinson, a 27-year-old father of three at the

> > time of the

> > operation, says he had not given his written consent

> > to the

> > operation being performed; neither had his wife -

> > his next of kin.

> > Instead his mother, an alcoholic, had been visited

> > at home, in the

> > late evening, after she had been drinking, and had

> > been asked to

> > sign the form. " My mother thought doctors were

> > gods, " Hutchinson

> > says. " She'd have signed anything they asked. "

> >

> > Hutchinson's excruciatingly detailed recollections

> > are a rare

> > testimony of someone still lucid and intensely angry

> > about a type of

> > brain surgery to which he was subjected - he

> > contends illegally -

> > commonly referred to as a lobotomy. In strict

> > medical terms, a

> > lobotomy - or leucotomy, as the procedure became

> > known in this

> > country - involved the removal of part of the

> > frontal lobes of the

> > brain or the severing of neural fibres connecting

> > the frontal lobes

> > to the limbic system - the part of the brain

> > concerned with

> > emotional response and functions not under conscious

> > control.

> >

> > From the mid-1930s until the early 1960s this form

> > of " psychosurgery " was heralded as a miracle cure

> > for the mentally

> > ill, before psychotherapy came into vogue and drugs

> > to treat many

> > mental-health problems became widely available. It

> > was pioneered by

> > a maverick Portuguese neurologist, Egas Moniz, who

> > was awarded the

> > Nobel prize in 1949 for developing and promoting the

> > procedure.

> > Lobotomies were seen as the solution to a wide range

> > of mental

> > disorders ranging from profound depression,

> > schizophrenia and

> > advanced neurosyphilis to mild retardation, at a

> > time when half of

> > all hospital beds in many countries were occupied by

> > the mentally

> > ill, and mental institutions were often places of

> > humiliation and

> > horror.

> >

> > At the height of its popularity in the 1940s and

> > 50s, particularly

> > in the US, some of the most enthusiastic proponents

> > of the procedure

> > promoted it as a way of controlling large numbers of

> > those

> > considered society's worst misfits, including

> > communists and

> > homosexuals. Neurologists, not just in the US but in

> > Japan, Britain

> > and elsewhere, carried out variations of the

> > procedure on tens of

> > thousands of patients - an estimated 50,000 in the

> > UK alone.

> >

> > Little attention was paid to what happened to those

> > subjected to

> > lobotomies after surgery. F Kennedy's

> > temperamental sister

> > Rose, who underwent the operation at the age of 23,

> > for instance,

> > spent the next 60 years of her life out of sight in

> > a mental

> > institution. Francis Farmer, the rebellious

> > Hollywood actress and

> > political activist whose outspoken behaviour was

> > also " cured " by a

> > lobotomy, quickly drifted into oblivion and ended

> > her days as a

> > hotel clerk.

> >

> > But as the number of lives wrecked by such surgery

> > became more

> > widely known, its effect was gradually exposed -

> > most famously in

> > Milos Forman's 1975 film, One Flew over the Cuckoo's

> > Nest. But also

> > earlier, in the 1958 play Suddenly Last Summer, by

> > Tennessee

> > . A close friend of , whose sister

> > Rose was

> > lobotomised as a teenager, recalls how the

> > playwright talked of his

> > sister as " fragile and gentle " , someone hurt by " the

> > harshness of

> > life " .

> >

> > " Things alarmed Miss Rose that would not even be

> > noticed by someone

> > less sensitive. She was just awakening to sexuality

> > and knew almost

> > nothing about it… Rose came home from school one day

> > and said the

> > nuns were using altar candles for self-abuse. She

> > told mother this, "

> > the playwright once confided to his biographer

> > Dotson Rader. To the

> > siblings' mother, known even to her children as

> > " Miss " , human

> > sexuality was " the great unmentionable " . She

> > promptly took her

> > daughter to the doctor, demanding the " filth " be cut

> > out of her

> > brain: " Cut it away! Miss ordered. " Make it

> > clean! " " And he

> > did, " recalled the playwright, who said his mother

> > never showed any

> > remorse about reducing her daughter to a human

> > vegetable.

> >

> > Some now consider such practices to be among the

> > most egregious

> > medical crimes of the last century and have called

> > for Moniz, who

> > was later shot in the back by a dissatisfied

> > patient, to be

> > posthumously stripped of his Nobel prize. The Nobel

> > Foundation rules

> > this out, maintaining that all of its awards can be

> > justified within

> > the historical context that they are given.

> >

> > By the time Hutchinson had his operation in 1974,

> > the scale on which

> > psychosurgery was being performed was drastically

> > reduced, with more

> > and more mental disorders being treated with drugs

> > and

> > psychotherapy. Crude frontal lobotomies, of the type

> > Moniz promoted,

> > had been phased out. Surgery became targeted at more

> > specific parts

> > of the brain as the neurobiology of emotion became

> > better

> > understood. The surgery performed by Wall on

> > Hutchinson's

> > hypothalamus, for instance, was intended to curb his

> > aggression.

> >

> > Since then, psychosurgery has become even more

> > refined, the parts of

> > the brain targeted and destroyed to control

> > behaviour ever smaller.

> > Though the name lobotomy persists, the medical

> > profession now refers

> > to any such procedure as NMD (neurosurgery for

> > mental disorder). But

> > Britain is now one of the few countries where this

> > sort of surgery

> > is still permitted. Even here it is only performed

> > for persistent

> > severe depression and anxiety and

> > obsessive-compulsive disorder

> > (OCD) in two places: University Hospital of Wales in

> > Cardiff, and

> > Ninewells hospital, Dundee. Patients must consent to

> > the surgery and

> > ethical and clinical standards committees subject

> > each case to rigid

> > scrutiny before it goes ahead.

> >

> > If the worst excesses are in the past, the type of

> > surgery now

> > conducted so controlled and the numbers to whom it

> > is given severely

> > limited, some might argue that the subject of

> > lobotomies,

> > psychosurgery, NMD - call it what you will - is only

> > of historical

> > interest. They would be wrong.

> >

> > In the coming month, parliament is expected to

> > finally debate

> > another hotly contested piece of proposed

> > legislation: the draft

> > Mental Health Bill (2004), which many mental-health

> > experts fear

> > will reduce safeguards for the mentally ill. One

> > provision of the

> > bill is a little-noticed clause that, if passed onto

> > the statute

> > books, would allow doctors to perform NMD without a

> > patient's

> > consent if they were considered so mentally ill they

> > were incapable

> > of giving it.

> >

> >

> > No matter how refined these latest NMD techniques

> > are, nor how

> > vociferously neurosurgeons who practise it argue it

> > is nowadays

> > employed only as a last resort, its outcome is often

> > unpredictable.

> > Since it is irreversible, some believe it should be

> > banned. At the

> > very least it should only be conducted on those able

> > to give their

> > informed consent, argue campaigners such as the

> > mental-health

> > charity Mind and the Mental Health Alliance, which

> > includes such

> > bodies as the Royal College of Nursing, the Royal

> > College of

> > Psychiatrists, the Law Society and dozens of other

> > organisations in

> > the field of mental health.

> >

> > With many of those who have undergone such surgery

> > unable to speak

> > for themselves and few of those subjected to the

> > cruder forms of

> > surgery still alive, Hutchinson's is the rare

> > voice of

> > experience. His story serves as a chilling

> > reinforcement of the

> > adage that a society be judged by the way it treats

> > its most

> > vulnerable. With the government proposing

> > legislation that many

> > believe would turn the clock back on the way we

> > treat the mentally

> > ill, what does that say about modern Britain?

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > As Hutchinson sits talking in the cramped living

> > room of his small

> > terrace house in Leeds, he frequently stretches out

> > his arms to hug

> > his two-year-old grandson, one of 17 grandchildren.

> > While the boy

> > giggles with delight, Hutchinson, 59, talks a little

> > of his own

> > childhood. He recalls how his mother would often

> > lock him, the

> > middle of three brothers, in a coal shed overnight.

> > " Glass were all

> > broken. I'd have to sleep in coal sack, night after

> > night. It went

> > on for years, " he says. But he prefers not to dwell

> > on it. " That's

> > all done now, in the past. "

> >

> > On his own admission, Hutchinson grew into a

> > troubled youngster.

> > Though he channelled his aggression into amateur

> > boxing and other

> > sports, he was, he admits, " always in trouble as a

> > lad " and would

> > often get into fights. After a spate of joyriding

> > cars as a

> > teenager, he was sent to a series of borstal

> > schools, then remand

> > homes. Eventually he found work as a welder, married

> > and had three

> > children. When he was 27, however, he suffered a

> > nervous breakdown.

> > After being admitted to a psychiatric hospital, he

> > was given ECT

> > (electroconvulsive therapy) and prescribed strong

> > sedatives. His

> > psychiatrist then recommended that he undergo

> > psychosurgery.

> >

> > According to Hutchinson, the psychiatrist tried to

> > persuade him such

> > surgery was necessary to curb his aggressive

> > tendencies after asking

> > him how he would feel if Hutchinson were ever to

> > kill one of his own

> > children. " I'd never harmed any of my children. I

> > never would. But

> > when he put it like that, I was scared. " Still,

> > Hutchinson was

> > considered incapable of giving consent, as ?he was

> > so heavily

> > sedated. At first his wife agreed to the operation.

> > But after seeing

> > the sizable holes that had been drilled into her

> > husband's skull in

> > preparation for the second part of the operation a

> > week later, she

> > withdrew her consent. It was then that his mother

> > was approached.

> >

> > In a 1976 TV documentary on the same operation as

> > Hutchinson

> > underwent, being performed on a mother-of-five

> > called Margaret

> > Chapman, the neurosurgeon Wall, who has since died,

> > describes the

> > operation as " quite simple, really " . He then

> > casually admits

> > knowledge of psychiatry is " something you pick up as

> > you go along " .

> > But far from curing Hutchinson's aggression, which

> > he describes

> > as " within his control " before the operation, the

> > surgery he

> > underwent left him so traumatised that he walked out

> > on his first

> > wife, Ruth, who had recently given birth to twins,

> > fearing he might

> > do his children harm. He subsequently attempted to

> > physically attack

> > the psychiatrist who had referred him to Wall, and

> > several years

> > later tried to commit suicide. Though he eventually

> > resumed work and

> > remarried, he has suffered vivid flashbacks of the

> > operation ever

> > since, and in recent years has been diagnosed as

> > suffering from post-

> > traumatic stress disorder.

> >

> > However troubling Hutchinson's story is, it is by no

> > means the

> > result of the most cavalier practitioner of

> > psychosurgery in this

> > country. The neurosurgeon reputed to have been

> > Britain's most

> > prolific lobotomist was the former president of the

> > Society of

> > British Neurological Surgeons (SBNS), Sir Wylie

> > McKissock, based at

> > Atkinson Morley's hospital in Wimbledon in the late

> > 1940s and 50s.

> > McKissock is described by those who knew him as a

> > taciturn and

> > difficult man, much feared by his junior staff. He

> > rarely spoke to

> > or met patients before or after surgery. Instead, at

> > weekends, he

> > made regular tours of nursing homes and mental

> > hospitals along the

> > Sussex coast. With the aid of a theatre sister, he

> > would perform,

> > for cash, up to 10 a day of the crude frontal

> > lobotomies pioneered

> > by Moniz. McKissock is understood to have performed

> > around 2,000

> > such operations.

> >

> > Few records exist of the reasons they were performed

> > or their

> > outcome; but a 1949 study of 300 of McKissock's

> > lobotomy patients

> > recorded that 16 had died as a direct or indirect

> > result of the

> > operation. It is impossible, therefore, to assess

> > how many of these

> > operations were performed needlessly. But the

> > experience of those

> > such as Hutchinson, and the accounts of relatives of

> > others who

> > underwent earlier forms of psychosurgery, attest to

> > it having been

> > performed for flimsy reasons and to disastrous

> > effect by some

> > British surgeons, just as it was in the US.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > One such case is that of Shaw, whose brother

> > , a 69-

> > year-old retired painter and decorator from

> > Liverpool, describes

> > as " a very, very clever lad " when he was younger.

> > " He was very good

> > at art. He loved to draw cartoons. Our father was a

> > sign writer and

> > he sent some of Ron's cartoons to a London newspaper

> > when we were

> > still teenagers, " recalls of his elder

> > brother. " They wanted

> > Ron to draw more and were going to pay him quite

> > well. But he

> > suffered with his nerves. He never did it. "

> >

> > When was in his early teens, his brother

> > remembers he started

> > coming home from school crying and would often wake

> > up screaming in

> > the night. The boy was admitted to hospital and

> > given ECT. It failed

> > to help. " Years later, we discovered, through

> > another boy who was at

> > school with Ron, that there was a teacher who used

> > to regularly take

> > my brother into a back room to cane him. Who knows

> > what else he did

> > to him in that room. I believe now that it was this

> > bullying that

> > caused my brother to behave the way he did. "

> >

> > When he was 17, volunteered to join the army,

> > but within a

> > year was discharged with a knee injury. In 1955,

> > when was

> > stationed in the Far East, completing his national

> > service, his

> > brother was admitted to Rainhill hospital in the St

> > Helens district

> > of Liverpool and a frontal lobotomy was performed.

> > " I knew nothing

> > about it. When I came back from the Far East, my

> > brother was

> > destroyed. He did not talk for two years. Eventually

> > he started to

> > speak, but he was never the same again. He was never

> > able to work.

> > My parents spent the rest of their lives looking

> > after him. Their

> > lives were ruined too. After they died he lived

> > alone, though I took

> > him out as much as I could. "

> >

> > Shaw died last year. His partially skeletal

> > body was found in

> > a field months later. His brother believes he was

> > trying to walk to

> > the Marble Church in Holywell, which had always

> > fascinated him, when

> > he stopped for a rest and died of natural causes.

> > His body had been

> > run over by a tractor after his death and his

> > remains were

> > surrounded by diaries he kept of his daily

> > activities. " I'd been

> > driving all over the country looking for him for

> > months. Then the

> > police called, saying they'd found a body with holes

> > drilled in the

> > front of his skull and I knew it was Ron, " says

> > , his voice

> > cracking. " It's unforgivable what was done to him. "

> >

> >

> >

> > Supporters of modern-day psychosurgery, or NMD,

> > argue it has moved

> > light years from the notorious excesses of such

> > early practices. Yet

> > even the crudest operations, they stress, were

> > effective in

> > alleviating the mental suffering of some patients.

> > One former

> > president of Ireland's Royal College of Surgeons,

> > who is believed to

> > be one of the few surviving neurosurgeons to have

> > carried out the

> > conventional frontal lobotomy on a regular basis,

> > sits sipping a gin

> > and tonic as he demonstrates with a cake knife how

> > he used to sever

> > or core out part of the frontal lobes of his

> > patients to break the

> > nerve " circuits " believed responsible for mental

> > illness. He carried

> > out two operations every Saturday morning, at the

> > request of the

> > Irish Department of Health, for nearly 10 years

> > until 1960.

> >

> > Immaculately dressed in a tweed suit, he recalls how

> > the operation

> > helped one vet obsessed with a fear of constipation

> > who ate fruit

> > constantly and spent all day in the toilet. After

> > the operation he

> > was able to return to work. He also talks of

> > performing lobotomies

> > on more than 20 priests with perceived personality

> > disorders. But,

> > he says, in his experience the surgery did more to

> > help those who

> > were returned to closed orders rather than allowed

> > to return to the

> > community. Lobotomies, he says, did little to help

> > those with

> > schizophrenia, neurosyphilis or personality

> > disorders other than

> > obsessive-compulsive disorder and severe depression.

> >

> >

> >

> > Those forms of NMD still being conducted in this

> > country today are

> > targeted at the treatment of severe depression,

> > severe anxiety and

> > OCD. These procedures, which involve minute

> > destructive lesions in

> > parts of the frontal lobe or limbic system, are

> > known as

> > cingulotomies - the cingulum being the part of the

> > frontal lobe

> > associated with OCD - and capsulotomies, which

> > involve making

> > lesions in the capsules: the dense nerve-fibre

> > pathway connecting

> > part of the frontal lobe with the limbic structure.

> > Neurosurgeons at

> > Ninewells hospital in Dundee, for instance, carried

> > out 34 NMD

> > operations between 1990 and 2001. In the past year

> > the hospital has

> > conducted five such operations on patients it

> > describes as " among

> > the most severely ill and disabled who come into

> > contact with any

> > branch of the medical professions " . Surgeons at the

> > University

> > Hospital of Wales in Cardiff have conducted 56 NMD

> > operations in the

> > past decade. It was there that the former child

> > singing star Lena

> > Zavaroni, who suffered from anorexia, underwent such

> > surgery in 1999

> > for severe depression. Though the operation seemed

> > to have been a

> > success, she died of pneumonia less than a month

> > later. According to

> > Simpson, consultant neurosurgeon at Cardiff,

> > the operations

> > his team have conducted have led to a " marked

> > improvement " in

> > roughly half of those being treated for severe

> > depression and

> > OCD. " NMD is not a panacea, " Simpson agrees. " It is

> > carefully

> > regulated and only offered to patients for whom all

> > other treatments

> > have failed… But in the patients for whom it works

> > well, whose

> > suffering has been indescribable, it transforms

> > their lives. "

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Some believe the way ahead lies in other forms of

> > brain surgery,

> > such as deep brain stimulation with implantable

> > electrodes, as are

> > increasingly used to treat Parkinson's disease. This

> > they believe

> > could offer an alternative to the ablative

> > operations that have been

> > used to date in psychosurgery. The introduction of

> > modified stem

> > cells into certain parts of the brain has also

> > already had

> > experimental success in treating some neurological

> > conditions and

> > holds out hope for combating psychiatric disease.

> > But it is the

> > irreversible nature of the NMD still practised that

> > concerns

> > opponents. That this type of surgery could be

> > carried out without a

> > patient's consent, according to the proposed

> > legislation, they

> > reject outright. Under the current Mental Health Act

> > of 1983, three

> > independent people, one a doctor, has to certify

> > that any patient

> > undergoing psychosurgery understands the treatment

> > and consents to

> > it. The draft mental-health bill under consideration

> > has broadly the

> > same safeguards for those capable of giving consent.

> > The main

> > difference is that it allows for treatment to be

> > given without the

> > patient's consent, at the request of doctors and on

> > an order of the

> > High Court, providing three conditions are met. The

> > first is if it

> > can be verified that a patient does not have the

> > capacity to

> > consent. The second is if there is no reasonable

> > prospect of them

> > regaining this capacity, and the third is if they

> > are " unlikely to

> > resist treatment " .

> >

> > According to Brook, former chief executive

> > of the mental-

> > health charity Mind, one of the biggest concerns of

> > those who work

> > in mental health is that no leading study has

> > properly assessed the

> > effect of psychosurgery on an individual's

> > personality or sought the

> > views of those undergoing such treatment. " Because

> > of its hazards

> > and the lack of clear evidence for the treatment's

> > benefit, or basis

> > for predicting success in the individual concerned,

> > we believe it

> > should never be given to someone who doesn't have

> > the capacity to

> > consent to it, " says Brook.

> >

> > Doctors at Ninewells hospital in Dundee argue that

> > the lack of a

> > randomised control trial to support NMD applies

> > equally to a range

> > of " cutting edge " medical and surgical procedures.

> > Simpson

> > says that although he appreciates there may be an

> > " understandable

> > fear of returning to the bad old days of lobotomy " ,

> > he believes it

> > is " not unreasonable in certain circumstances and

> > with adequate

> > legal safeguards " to perform NMD without a patient's

> > consent. " The

> > issue of consent is sensitive and crucially

> > important, " warns

> > Simpson, adding that " the more you open it up in

> > this way, the more

> > crucial it becomes to have adequate legal

> > safeguards " .

> >

> > But , who is behind moves to launch

> > a legal

> > campaign in the US to have Moniz's Nobel prize

> > revoked, believes

> > that there are even wider issues at stake. 's

> > own grandmother

> > was left to languish in a psychiatric institution

> > for 20 years after

> > undergoing a lobotomy. As a result, the medical

> > librarian ?from

> > Levittown, New York state, founded an organisation

> > called

> > Psychosurgery.org, dedicated to the " surgical

> > casualties " of such

> > procedures. " There are a lot of important lessons to

> > be learnt from

> > what happened to our family members, " says .

> >

> > Many families of those suffering from Alzheimer's

> > disease, she

> > stresses, are now clamouring to have experimental

> > brain surgery

> > performed on them. " But there is a real ethical

> > question about

> > whether you can really do these kind of things to

> > someone who is by

> > definition having problems making decisions. I

> > really hope people

> > will take into consideration the amount of damage

> > that was done in

> > the past when they attempt to push forward with such

> > treatments, "

> > concludes.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Hutchinson has recently tried to sue his local

> > health

> > authority for medical malpractice, but has had to

> > give up because

> > his surgery was carried out so long ago that the

> > statute of

> > limitations on such a claim has expired. West

> > Yorkshire police are

> > now investigating if there is a criminal case to

> > answer over a lack

> > of proper legal consent having been obtained.

> >

> > Such thoughts are far from his mind, however, as

> > Hutchinson drives

> > me back to the train station in Leeds, warning me

> > that he might have

> > to pull over to the side of the road at any moment

> > because his

> > lobotomy has also left ?him with narcolepsy.

> > Throughout the journey,

> > he talks affectionately about his brood of

> > grandchildren. But by the

> > time we reach the station, he has lapsed into

> > melancholia and tears

> > well in his eyes as he talks about how his own

> > children's lives were

> > damaged when he abandoned them after his operation.

> >

> > " If nothing else, I want people to understand what

> > these bastards

> > did to me, and thousands of others, so nothing like

> > this is ever

> > allowed to happen again, " he says, clutching the

> > steering wheel

> > until his knuckles go white. " What they did was not

> > treatment - it

> > was torture. "

> >

> > Young is consultant neurosurgeon at the

> > Beaumont hospital in

> > Dublin

> >

> > THE ORIGINS OF MIND-ALTERING SURGERY

> >

> >

> > Egas Moniz could have afforded to rest on his

> > laurels by the time he

> > attended the Second World Congress of Neurology in

> > London in 1935.

> > The 61-year-old professor of neurology, and dean of

> > Lisbon's Medical

> > School, had already gained an international

> > reputation for

> > pioneering cerebral angiography - a radiological

> > technique for

> > mapping brain vessels. But Moniz was disappointed

> > that this had not

> > won him the Nobel prize. So when he heard two Yale

> > neurologists

> > speak at the London congress about experimental

> > brain research on

> > two chimpanzees called Clyde and Becky, observing

> > how Becky's temper

> > tantrums subsided after surgery, he would go on to

> > pioneer - and

> > relentlessly promote - a procedure that eventually

> > won him the

> > coveted Nobel prize.

> >

> > The procedure was the lobotomy. Back in Lisbon he

> > ordered that a

> > human brain be brought to him from a morgue, and

> > thrusted a pen

> > through the cortex several times until he was

> > satisfied he knew the

> > approximate angle and depth that would best detach

> > the frontal

> > lobes. He performed the operation on a former

> > prostitute, who

> > afterwards was unable to give her age or say where

> > she was. She was

> > returned to an asylum, never to be seen by him

> > again.

> >

> >

> >

> > Moniz nonetheless considered this a " clinical cure "

> > and continued

> > operating. The procedure was greeted with enthusiasm

> > by the medical

> > profession and went on to be practised in many

> > countries. After

> > Moniz won the Nobel prize in 1949, the lobotomy's

> > popularity

> > increased. But today many believe the procedure is

> > barbaric, and are

> > campaigning for him to be stripped of the award.

> >

> > The Nobel Foundation contends that Moniz's prize

> > should be judged in

> > the historical context of a period when there was

> > widespread despair

> > about mental-health treatment. In the 1930s and 40s,

> > patients were

> > often beaten, choked, spat on and humiliated by

> > attendants in state

> > hospitals, where the average duration of confinement

> > was 10 years.

> > Cost was also a factor. In the mid-1930s a lobotomy

> > cost $250 in the

> > US, compared with tens of thousands of dollars to

> > keep a patient

> > incarcerated. The drawback of the operation - that

> > it robbed

> > patients of their personality traits - was

> > considered a small price

> > for emptying hospital beds.

> >

> > If Moniz brought the lobotomy fame, then the US

> > physician Walter

> > Freeman brought it infamy. A tireless

> > self-publicist, he would

> > perform his variation of Moniz's operation - the

> > " ice pick "

> > lobotomy - before an enthralled audience. This

> > involved driving an

> > ice-pick-like instrument through the roof of the eye

> > and sweeping it

> > across the frontal lobe to scramble neural

> > connections. Freeman once

> > boasted he was " as good as Sinatra " in getting

> > young people to

> > faint at the sight of what he did. One of his

> > patients,

> > Dulley, was 12 when he was lobotomised because his

> > stepmother said

> > he was sullen and refused to bathe.

> >

> > It was not until the mid-1950s, with the advent of

> > antipsychotic and

> > pacifying drugs such as chlorpromazine, that the

> > lobotomy began to

> > fall out of favour.

> >

> > The role of psychosurgery came under greater

> > scrutiny in the 1960s

> > and 70s, when social unrest led some sociobiologists

> > to consider it

> > a tool for addressing violence and

> > " psycho-civilising " society

> > through the use of implantable brain electrodes.

> >

> > Despite growing unease, more refined procedures such

> > as

> > cingulotomies were developed and the modern era of

> > psychosurgery was

> > born. Such procedures remain controversial and have

> > been banned in

> > Germany, Japan and a number of US states. They are

> > still practised

> > in the UK, Finland, India, Sweden, Belgium and

> > Spain.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

http://www.timesonline.co.uk/article/0,,2099-2034199,00.html

The Sunday Times Magazine

Copyright 2006 Times Newspapers Ltd.

>

> >

> >

> >

> >

> > The lobotomy is deemed one of the worst crimes in

> > medical history.

> > But a modern form of it is still practised in

> > Britain - and may soon

> > be performed without the patient's consent. By

> > Toomey and

> > Young

> >

> >

> >

> >

> > The flashbacks come late at night. First comes the

> > recollection of

> > intense physical pain, as if the bones in his arms

> > are being snapped

> > like twigs. Then he hears the voice of the

> > neurosurgeon applying an

> > electric current to metal pins implanted in the

> > tissue of his

> > brain. " How do you feel, ? " the surgeon Arthur

> > E Wall asks,

> > while peering into Hutchinson's eyes to see if

> > his pupils have

> > yet dilated with fear.

> >

> > When Hutchinson swears at the surgeon, Wall

> > administers another

> > electric shock to nerve centres located in the

> > hypothalamus at the

> > centre of his patient's brain. At this, Hutchinson's

> > pupils dilate

> > and he screams: " You're going to kill me, you

> > bastard! " Hutchinson's

> > medical records, written by Wall over 30 years ago,

> > confirm that his

> > patient " felt funny - as if he was dying " . But as he

> > screamed,

> > Hutchinson recalls Wall leaning in close to his face

> > and

> > leering: " And I thought you were a bit of a tough

> > guy. "

> >

> >

> >

> > His next recollection is of Wall giving orders for

> > surgical

> > implements to be passed. Hutchinson feels the metal

> > pins inserted

> > through nylon balls lodged in cavities bored into

> > the front of his

> > skull being replaced by thicker electrodes he says

> > felt like " broom

> > handles " . " After that I started, I start to feel

> > warm all over and

> > quickly feel as if I have fallen into a vat of

> > molten metal, as if I

> > am, quite literally, frying, " says Hutchinson,

> > tellingly confusing

> > tenses as he describes the brain surgery he

> > underwent in 1974 yet

> > still relives up to a dozen times a day and in

> > frequent nightmares.

> >

> > Throughout the surgery, Hutchinson was kept

> > conscious; his head held

> > in a brace, his hands and feet strapped to the

> > operating table.

> > Hutchinson, a 27-year-old father of three at the

> > time of the

> > operation, says he had not given his written consent

> > to the

> > operation being performed; neither had his wife -

> > his next of kin.

> > Instead his mother, an alcoholic, had been visited

> > at home, in the

> > late evening, after she had been drinking, and had

> > been asked to

> > sign the form. " My mother thought doctors were

> > gods, " Hutchinson

> > says. " She'd have signed anything they asked. "

> >

> > Hutchinson's excruciatingly detailed recollections

> > are a rare

> > testimony of someone still lucid and intensely angry

> > about a type of

> > brain surgery to which he was subjected - he

> > contends illegally -

> > commonly referred to as a lobotomy. In strict

> > medical terms, a

> > lobotomy - or leucotomy, as the procedure became

> > known in this

> > country - involved the removal of part of the

> > frontal lobes of the

> > brain or the severing of neural fibres connecting

> > the frontal lobes

> > to the limbic system - the part of the brain

> > concerned with

> > emotional response and functions not under conscious

> > control.

> >

> > From the mid-1930s until the early 1960s this form

> > of " psychosurgery " was heralded as a miracle cure

> > for the mentally

> > ill, before psychotherapy came into vogue and drugs

> > to treat many

> > mental-health problems became widely available. It

> > was pioneered by

> > a maverick Portuguese neurologist, Egas Moniz, who

> > was awarded the

> > Nobel prize in 1949 for developing and promoting the

> > procedure.

> > Lobotomies were seen as the solution to a wide range

> > of mental

> > disorders ranging from profound depression,

> > schizophrenia and

> > advanced neurosyphilis to mild retardation, at a

> > time when half of

> > all hospital beds in many countries were occupied by

> > the mentally

> > ill, and mental institutions were often places of

> > humiliation and

> > horror.

> >

> > At the height of its popularity in the 1940s and

> > 50s, particularly

> > in the US, some of the most enthusiastic proponents

> > of the procedure

> > promoted it as a way of controlling large numbers of

> > those

> > considered society's worst misfits, including

> > communists and

> > homosexuals. Neurologists, not just in the US but in

> > Japan, Britain

> > and elsewhere, carried out variations of the

> > procedure on tens of

> > thousands of patients - an estimated 50,000 in the

> > UK alone.

> >

> > Little attention was paid to what happened to those

> > subjected to

> > lobotomies after surgery. F Kennedy's

> > temperamental sister

> > Rose, who underwent the operation at the age of 23,

> > for instance,

> > spent the next 60 years of her life out of sight in

> > a mental

> > institution. Francis Farmer, the rebellious

> > Hollywood actress and

> > political activist whose outspoken behaviour was

> > also " cured " by a

> > lobotomy, quickly drifted into oblivion and ended

> > her days as a

> > hotel clerk.

> >

> > But as the number of lives wrecked by such surgery

> > became more

> > widely known, its effect was gradually exposed -

> > most famously in

> > Milos Forman's 1975 film, One Flew over the Cuckoo's

> > Nest. But also

> > earlier, in the 1958 play Suddenly Last Summer, by

> > Tennessee

> > . A close friend of , whose sister

> > Rose was

> > lobotomised as a teenager, recalls how the

> > playwright talked of his

> > sister as " fragile and gentle " , someone hurt by " the

> > harshness of

> > life " .

> >

> > " Things alarmed Miss Rose that would not even be

> > noticed by someone

> > less sensitive. She was just awakening to sexuality

> > and knew almost

> > nothing about it… Rose came home from school one day

> > and said the

> > nuns were using altar candles for self-abuse. She

> > told mother this, "

> > the playwright once confided to his biographer

> > Dotson Rader. To the

> > siblings' mother, known even to her children as

> > " Miss " , human

> > sexuality was " the great unmentionable " . She

> > promptly took her

> > daughter to the doctor, demanding the " filth " be cut

> > out of her

> > brain: " Cut it away! Miss ordered. " Make it

> > clean! " " And he

> > did, " recalled the playwright, who said his mother

> > never showed any

> > remorse about reducing her daughter to a human

> > vegetable.

> >

> > Some now consider such practices to be among the

> > most egregious

> > medical crimes of the last century and have called

> > for Moniz, who

> > was later shot in the back by a dissatisfied

> > patient, to be

> > posthumously stripped of his Nobel prize. The Nobel

> > Foundation rules

> > this out, maintaining that all of its awards can be

> > justified within

> > the historical context that they are given.

> >

> > By the time Hutchinson had his operation in 1974,

> > the scale on which

> > psychosurgery was being performed was drastically

> > reduced, with more

> > and more mental disorders being treated with drugs

> > and

> > psychotherapy. Crude frontal lobotomies, of the type

> > Moniz promoted,

> > had been phased out. Surgery became targeted at more

> > specific parts

> > of the brain as the neurobiology of emotion became

> > better

> > understood. The surgery performed by Wall on

> > Hutchinson's

> > hypothalamus, for instance, was intended to curb his

> > aggression.

> >

> > Since then, psychosurgery has become even more

> > refined, the parts of

> > the brain targeted and destroyed to control

> > behaviour ever smaller.

> > Though the name lobotomy persists, the medical

> > profession now refers

> > to any such procedure as NMD (neurosurgery for

> > mental disorder). But

> > Britain is now one of the few countries where this

> > sort of surgery

> > is still permitted. Even here it is only performed

> > for persistent

> > severe depression and anxiety and

> > obsessive-compulsive disorder

> > (OCD) in two places: University Hospital of Wales in

> > Cardiff, and

> > Ninewells hospital, Dundee. Patients must consent to

> > the surgery and

> > ethical and clinical standards committees subject

> > each case to rigid

> > scrutiny before it goes ahead.

> >

> > If the worst excesses are in the past, the type of

> > surgery now

> > conducted so controlled and the numbers to whom it

> > is given severely

> > limited, some might argue that the subject of

> > lobotomies,

> > psychosurgery, NMD - call it what you will - is only

> > of historical

> > interest. They would be wrong.

> >

> > In the coming month, parliament is expected to

> > finally debate

> > another hotly contested piece of proposed

> > legislation: the draft

> > Mental Health Bill (2004), which many mental-health

> > experts fear

> > will reduce safeguards for the mentally ill. One

> > provision of the

> > bill is a little-noticed clause that, if passed onto

> > the statute

> > books, would allow doctors to perform NMD without a

> > patient's

> > consent if they were considered so mentally ill they

> > were incapable

> > of giving it.

> >

> >

> > No matter how refined these latest NMD techniques

> > are, nor how

> > vociferously neurosurgeons who practise it argue it

> > is nowadays

> > employed only as a last resort, its outcome is often

> > unpredictable.

> > Since it is irreversible, some believe it should be

> > banned. At the

> > very least it should only be conducted on those able

> > to give their

> > informed consent, argue campaigners such as the

> > mental-health

> > charity Mind and the Mental Health Alliance, which

> > includes such

> > bodies as the Royal College of Nursing, the Royal

> > College of

> > Psychiatrists, the Law Society and dozens of other

> > organisations in

> > the field of mental health.

> >

> > With many of those who have undergone such surgery

> > unable to speak

> > for themselves and few of those subjected to the

> > cruder forms of

> > surgery still alive, Hutchinson's is the rare

> > voice of

> > experience. His story serves as a chilling

> > reinforcement of the

> > adage that a society be judged by the way it treats

> > its most

> > vulnerable. With the government proposing

> > legislation that many

> > believe would turn the clock back on the way we

> > treat the mentally

> > ill, what does that say about modern Britain?

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > As Hutchinson sits talking in the cramped living

> > room of his small

> > terrace house in Leeds, he frequently stretches out

> > his arms to hug

> > his two-year-old grandson, one of 17 grandchildren.

> > While the boy

> > giggles with delight, Hutchinson, 59, talks a little

> > of his own

> > childhood. He recalls how his mother would often

> > lock him, the

> > middle of three brothers, in a coal shed overnight.

> > " Glass were all

> > broken. I'd have to sleep in coal sack, night after

> > night. It went

> > on for years, " he says. But he prefers not to dwell

> > on it. " That's

> > all done now, in the past. "

> >

> > On his own admission, Hutchinson grew into a

> > troubled youngster.

> > Though he channelled his aggression into amateur

> > boxing and other

> > sports, he was, he admits, " always in trouble as a

> > lad " and would

> > often get into fights. After a spate of joyriding

> > cars as a

> > teenager, he was sent to a series of borstal

> > schools, then remand

> > homes. Eventually he found work as a welder, married

> > and had three

> > children. When he was 27, however, he suffered a

> > nervous breakdown.

> > After being admitted to a psychiatric hospital, he

> > was given ECT

> > (electroconvulsive therapy) and prescribed strong

> > sedatives. His

> > psychiatrist then recommended that he undergo

> > psychosurgery.

> >

> > According to Hutchinson, the psychiatrist tried to

> > persuade him such

> > surgery was necessary to curb his aggressive

> > tendencies after asking

> > him how he would feel if Hutchinson were ever to

> > kill one of his own

> > children. " I'd never harmed any of my children. I

> > never would. But

> > when he put it like that, I was scared. " Still,

> > Hutchinson was

> > considered incapable of giving consent, as ?he was

> > so heavily

> > sedated. At first his wife agreed to the operation.

> > But after seeing

> > the sizable holes that had been drilled into her

> > husband's skull in

> > preparation for the second part of the operation a

> > week later, she

> > withdrew her consent. It was then that his mother

> > was approached.

> >

> > In a 1976 TV documentary on the same operation as

> > Hutchinson

> > underwent, being performed on a mother-of-five

> > called Margaret

> > Chapman, the neurosurgeon Wall, who has since died,

> > describes the

> > operation as " quite simple, really " . He then

> > casually admits

> > knowledge of psychiatry is " something you pick up as

> > you go along " .

> > But far from curing Hutchinson's aggression, which

> > he describes

> > as " within his control " before the operation, the

> > surgery he

> > underwent left him so traumatised that he walked out

> > on his first

> > wife, Ruth, who had recently given birth to twins,

> > fearing he might

> > do his children harm. He subsequently attempted to

> > physically attack

> > the psychiatrist who had referred him to Wall, and

> > several years

> > later tried to commit suicide. Though he eventually

> > resumed work and

> > remarried, he has suffered vivid flashbacks of the

> > operation ever

> > since, and in recent years has been diagnosed as

> > suffering from post-

> > traumatic stress disorder.

> >

> > However troubling Hutchinson's story is, it is by no

> > means the

> > result of the most cavalier practitioner of

> > psychosurgery in this

> > country. The neurosurgeon reputed to have been

> > Britain's most

> > prolific lobotomist was the former president of the

> > Society of

> > British Neurological Surgeons (SBNS), Sir Wylie

> > McKissock, based at

> > Atkinson Morley's hospital in Wimbledon in the late

> > 1940s and 50s.

> > McKissock is described by those who knew him as a

> > taciturn and

> > difficult man, much feared by his junior staff. He

> > rarely spoke to

> > or met patients before or after surgery. Instead, at

> > weekends, he

> > made regular tours of nursing homes and mental

> > hospitals along the

> > Sussex coast. With the aid of a theatre sister, he

> > would perform,

> > for cash, up to 10 a day of the crude frontal

> > lobotomies pioneered

> > by Moniz. McKissock is understood to have performed

> > around 2,000

> > such operations.

> >

> > Few records exist of the reasons they were performed

> > or their

> > outcome; but a 1949 study of 300 of McKissock's

> > lobotomy patients

> > recorded that 16 had died as a direct or indirect

> > result of the

> > operation. It is impossible, therefore, to assess

> > how many of these

> > operations were performed needlessly. But the

> > experience of those

> > such as Hutchinson, and the accounts of relatives of

> > others who

> > underwent earlier forms of psychosurgery, attest to

> > it having been

> > performed for flimsy reasons and to disastrous

> > effect by some

> > British surgeons, just as it was in the US.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > One such case is that of Shaw, whose brother

> > , a 69-

> > year-old retired painter and decorator from

> > Liverpool, describes

> > as " a very, very clever lad " when he was younger.

> > " He was very good

> > at art. He loved to draw cartoons. Our father was a

> > sign writer and

> > he sent some of Ron's cartoons to a London newspaper

> > when we were

> > still teenagers, " recalls of his elder

> > brother. " They wanted

> > Ron to draw more and were going to pay him quite

> > well. But he

> > suffered with his nerves. He never did it. "

> >

> > When was in his early teens, his brother

> > remembers he started

> > coming home from school crying and would often wake

> > up screaming in

> > the night. The boy was admitted to hospital and

> > given ECT. It failed

> > to help. " Years later, we discovered, through

> > another boy who was at

> > school with Ron, that there was a teacher who used

> > to regularly take

> > my brother into a back room to cane him. Who knows

> > what else he did

> > to him in that room. I believe now that it was this

> > bullying that

> > caused my brother to behave the way he did. "

> >

> > When he was 17, volunteered to join the army,

> > but within a

> > year was discharged with a knee injury. In 1955,

> > when was

> > stationed in the Far East, completing his national

> > service, his

> > brother was admitted to Rainhill hospital in the St

> > Helens district

> > of Liverpool and a frontal lobotomy was performed.

> > " I knew nothing

> > about it. When I came back from the Far East, my

> > brother was

> > destroyed. He did not talk for two years. Eventually

> > he started to

> > speak, but he was never the same again. He was never

> > able to work.

> > My parents spent the rest of their lives looking

> > after him. Their

> > lives were ruined too. After they died he lived

> > alone, though I took

> > him out as much as I could. "

> >

> > Shaw died last year. His partially skeletal

> > body was found in

> > a field months later. His brother believes he was

> > trying to walk to

> > the Marble Church in Holywell, which had always

> > fascinated him, when

> > he stopped for a rest and died of natural causes.

> > His body had been

> > run over by a tractor after his death and his

> > remains were

> > surrounded by diaries he kept of his daily

> > activities. " I'd been

> > driving all over the country looking for him for

> > months. Then the

> > police called, saying they'd found a body with holes

> > drilled in the

> > front of his skull and I knew it was Ron, " says

> > , his voice

> > cracking. " It's unforgivable what was done to him. "

> >

> >

> >

> > Supporters of modern-day psychosurgery, or NMD,

> > argue it has moved

> > light years from the notorious excesses of such

> > early practices. Yet

> > even the crudest operations, they stress, were

> > effective in

> > alleviating the mental suffering of some patients.

> > One former

> > president of Ireland's Royal College of Surgeons,

> > who is believed to

> > be one of the few surviving neurosurgeons to have

> > carried out the

> > conventional frontal lobotomy on a regular basis,

> > sits sipping a gin

> > and tonic as he demonstrates with a cake knife how

> > he used to sever

> > or core out part of the frontal lobes of his

> > patients to break the

> > nerve " circuits " believed responsible for mental

> > illness. He carried

> > out two operations every Saturday morning, at the

> > request of the

> > Irish Department of Health, for nearly 10 years

> > until 1960.

> >

> > Immaculately dressed in a tweed suit, he recalls how

> > the operation

> > helped one vet obsessed with a fear of constipation

> > who ate fruit

> > constantly and spent all day in the toilet. After

> > the operation he

> > was able to return to work. He also talks of

> > performing lobotomies

> > on more than 20 priests with perceived personality

> > disorders. But,

> > he says, in his experience the surgery did more to

> > help those who

> > were returned to closed orders rather than allowed

> > to return to the

> > community. Lobotomies, he says, did little to help

> > those with

> > schizophrenia, neurosyphilis or personality

> > disorders other than

> > obsessive-compulsive disorder and severe depression.

> >

> >

> >

> > Those forms of NMD still being conducted in this

> > country today are

> > targeted at the treatment of severe depression,

> > severe anxiety and

> > OCD. These procedures, which involve minute

> > destructive lesions in

> > parts of the frontal lobe or limbic system, are

> > known as

> > cingulotomies - the cingulum being the part of the

> > frontal lobe

> > associated with OCD - and capsulotomies, which

> > involve making

> > lesions in the capsules: the dense nerve-fibre

> > pathway connecting

> > part of the frontal lobe with the limbic structure.

> > Neurosurgeons at

> > Ninewells hospital in Dundee, for instance, carried

> > out 34 NMD

> > operations between 1990 and 2001. In the past year

> > the hospital has

> > conducted five such operations on patients it

> > describes as " among

> > the most severely ill and disabled who come into

> > contact with any

> > branch of the medical professions " . Surgeons at the

> > University

> > Hospital of Wales in Cardiff have conducted 56 NMD

> > operations in the

> > past decade. It was there that the former child

> > singing star Lena

> > Zavaroni, who suffered from anorexia, underwent such

> > surgery in 1999

> > for severe depression. Though the operation seemed

> > to have been a

> > success, she died of pneumonia less than a month

> > later. According to

> > Simpson, consultant neurosurgeon at Cardiff,

> > the operations

> > his team have conducted have led to a " marked

> > improvement " in

> > roughly half of those being treated for severe

> > depression and

> > OCD. " NMD is not a panacea, " Simpson agrees. " It is

> > carefully

> > regulated and only offered to patients for whom all

> > other treatments

> > have failed… But in the patients for whom it works

> > well, whose

> > suffering has been indescribable, it transforms

> > their lives. "

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Some believe the way ahead lies in other forms of

> > brain surgery,

> > such as deep brain stimulation with implantable

> > electrodes, as are

> > increasingly used to treat Parkinson's disease. This

> > they believe

> > could offer an alternative to the ablative

> > operations that have been

> > used to date in psychosurgery. The introduction of

> > modified stem

> > cells into certain parts of the brain has also

> > already had

> > experimental success in treating some neurological

> > conditions and

> > holds out hope for combating psychiatric disease.

> > But it is the

> > irreversible nature of the NMD still practised that

> > concerns

> > opponents. That this type of surgery could be

> > carried out without a

> > patient's consent, according to the proposed

> > legislation, they

> > reject outright. Under the current Mental Health Act

> > of 1983, three

> > independent people, one a doctor, has to certify

> > that any patient

> > undergoing psychosurgery understands the treatment

> > and consents to

> > it. The draft mental-health bill under consideration

> > has broadly the

> > same safeguards for those capable of giving consent.

> > The main

> > difference is that it allows for treatment to be

> > given without the

> > patient's consent, at the request of doctors and on

> > an order of the

> > High Court, providing three conditions are met. The

> > first is if it

> > can be verified that a patient does not have the

> > capacity to

> > consent. The second is if there is no reasonable

> > prospect of them

> > regaining this capacity, and the third is if they

> > are " unlikely to

> > resist treatment " .

> >

> > According to Brook, former chief executive

> > of the mental-

> > health charity Mind, one of the biggest concerns of

> > those who work

> > in mental health is that no leading study has

> > properly assessed the

> > effect of psychosurgery on an individual's

> > personality or sought the

> > views of those undergoing such treatment. " Because

> > of its hazards

> > and the lack of clear evidence for the treatment's

> > benefit, or basis

> > for predicting success in the individual concerned,

> > we believe it

> > should never be given to someone who doesn't have

> > the capacity to

> > consent to it, " says Brook.

> >

> > Doctors at Ninewells hospital in Dundee argue that

> > the lack of a

> > randomised control trial to support NMD applies

> > equally to a range

> > of " cutting edge " medical and surgical procedures.

> > Simpson

> > says that although he appreciates there may be an

> > " understandable

> > fear of returning to the bad old days of lobotomy " ,

> > he believes it

> > is " not unreasonable in certain circumstances and

> > with adequate

> > legal safeguards " to perform NMD without a patient's

> > consent. " The

> > issue of consent is sensitive and crucially

> > important, " warns

> > Simpson, adding that " the more you open it up in

> > this way, the more

> > crucial it becomes to have adequate legal

> > safeguards " .

> >

> > But , who is behind moves to launch

> > a legal

> > campaign in the US to have Moniz's Nobel prize

> > revoked, believes

> > that there are even wider issues at stake. 's

> > own grandmother

> > was left to languish in a psychiatric institution

> > for 20 years after

> > undergoing a lobotomy. As a result, the medical

> > librarian ?from

> > Levittown, New York state, founded an organisation

> > called

> > Psychosurgery.org, dedicated to the " surgical

> > casualties " of such

> > procedures. " There are a lot of important lessons to

> > be learnt from

> > what happened to our family members, " says .

> >

> > Many families of those suffering from Alzheimer's

> > disease, she

> > stresses, are now clamouring to have experimental

> > brain surgery

> > performed on them. " But there is a real ethical

> > question about

> > whether you can really do these kind of things to

> > someone who is by

> > definition having problems making decisions. I

> > really hope people

> > will take into consideration the amount of damage

> > that was done in

> > the past when they attempt to push forward with such

> > treatments, "

> > concludes.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Hutchinson has recently tried to sue his local

> > health

> > authority for medical malpractice, but has had to

> > give up because

> > his surgery was carried out so long ago that the

> > statute of

> > limitations on such a claim has expired. West

> > Yorkshire police are

> > now investigating if there is a criminal case to

> > answer over a lack

> > of proper legal consent having been obtained.

> >

> > Such thoughts are far from his mind, however, as

> > Hutchinson drives

> > me back to the train station in Leeds, warning me

> > that he might have

> > to pull over to the side of the road at any moment

> > because his

> > lobotomy has also left ?him with narcolepsy.

> > Throughout the journey,

> > he talks affectionately about his brood of

> > grandchildren. But by the

> > time we reach the station, he has lapsed into

> > melancholia and tears

> > well in his eyes as he talks about how his own

> > children's lives were

> > damaged when he abandoned them after his operation.

> >

> > " If nothing else, I want people to understand what

> > these bastards

> > did to me, and thousands of others, so nothing like

> > this is ever

> > allowed to happen again, " he says, clutching the

> > steering wheel

> > until his knuckles go white. " What they did was not

> > treatment - it

> > was torture. "

> >

> > Young is consultant neurosurgeon at the

> > Beaumont hospital in

> > Dublin

> >

> > THE ORIGINS OF MIND-ALTERING SURGERY

> >

> >

> > Egas Moniz could have afforded to rest on his

> > laurels by the time he

> > attended the Second World Congress of Neurology in

> > London in 1935.

> > The 61-year-old professor of neurology, and dean of

> > Lisbon's Medical

> > School, had already gained an international

> > reputation for

> > pioneering cerebral angiography - a radiological

> > technique for

> > mapping brain vessels. But Moniz was disappointed

> > that this had not

> > won him the Nobel prize. So when he heard two Yale

> > neurologists

> > speak at the London congress about experimental

> > brain research on

> > two chimpanzees called Clyde and Becky, observing

> > how Becky's temper

> > tantrums subsided after surgery, he would go on to

> > pioneer - and

> > relentlessly promote - a procedure that eventually

> > won him the

> > coveted Nobel prize.

> >

> > The procedure was the lobotomy. Back in Lisbon he

> > ordered that a

> > human brain be brought to him from a morgue, and

> > thrusted a pen

> > through the cortex several times until he was

> > satisfied he knew the

> > approximate angle and depth that would best detach

> > the frontal

> > lobes. He performed the operation on a former

> > prostitute, who

> > afterwards was unable to give her age or say where

> > she was. She was

> > returned to an asylum, never to be seen by him

> > again.

> >

> >

> >

> > Moniz nonetheless considered this a " clinical cure "

> > and continued

> > operating. The procedure was greeted with enthusiasm

> > by the medical

> > profession and went on to be practised in many

> > countries. After

> > Moniz won the Nobel prize in 1949, the lobotomy's

> > popularity

> > increased. But today many believe the procedure is

> > barbaric, and are

> > campaigning for him to be stripped of the award.

> >

> > The Nobel Foundation contends that Moniz's prize

> > should be judged in

> > the historical context of a period when there was

> > widespread despair

> > about mental-health treatment. In the 1930s and 40s,

> > patients were

> > often beaten, choked, spat on and humiliated by

> > attendants in state

> > hospitals, where the average duration of confinement

> > was 10 years.

> > Cost was also a factor. In the mid-1930s a lobotomy

> > cost $250 in the

> > US, compared with tens of thousands of dollars to

> > keep a patient

> > incarcerated. The drawback of the operation - that

> > it robbed

> > patients of their personality traits - was

> > considered a small price

> > for emptying hospital beds.

> >

> > If Moniz brought the lobotomy fame, then the US

> > physician Walter

> > Freeman brought it infamy. A tireless

> > self-publicist, he would

> > perform his variation of Moniz's operation - the

> > " ice pick "

> > lobotomy - before an enthralled audience. This

> > involved driving an

> > ice-pick-like instrument through the roof of the eye

> > and sweeping it

> > across the frontal lobe to scramble neural

> > connections. Freeman once

> > boasted he was " as good as Sinatra " in getting

> > young people to

> > faint at the sight of what he did. One of his

> > patients,

> > Dulley, was 12 when he was lobotomised because his

> > stepmother said

> > he was sullen and refused to bathe.

> >

> > It was not until the mid-1950s, with the advent of

> > antipsychotic and

> > pacifying drugs such as chlorpromazine, that the

> > lobotomy began to

> > fall out of favour.

> >

> > The role of psychosurgery came under greater

> > scrutiny in the 1960s

> > and 70s, when social unrest led some sociobiologists

> > to consider it

> > a tool for addressing violence and

> > " psycho-civilising " society

> > through the use of implantable brain electrodes.

> >

> > Despite growing unease, more refined procedures such

> > as

> > cingulotomies were developed and the modern era of

> > psychosurgery was

> > born. Such procedures remain controversial and have

> > been banned in

> > Germany, Japan and a number of US states. They are

> > still practised

> > in the UK, Finland, India, Sweden, Belgium and

> > Spain.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

http://www.timesonline.co.uk/article/0,,2099-2034199,00.html

The Sunday Times Magazine

Copyright 2006 Times Newspapers Ltd.

>

> >

> >

> >

> >

> > The lobotomy is deemed one of the worst crimes in

> > medical history.

> > But a modern form of it is still practised in

> > Britain - and may soon

> > be performed without the patient's consent. By

> > Toomey and

> > Young

> >

> >

> >

> >

> > The flashbacks come late at night. First comes the

> > recollection of

> > intense physical pain, as if the bones in his arms

> > are being snapped

> > like twigs. Then he hears the voice of the

> > neurosurgeon applying an

> > electric current to metal pins implanted in the

> > tissue of his

> > brain. " How do you feel, ? " the surgeon Arthur

> > E Wall asks,

> > while peering into Hutchinson's eyes to see if

> > his pupils have

> > yet dilated with fear.

> >

> > When Hutchinson swears at the surgeon, Wall

> > administers another

> > electric shock to nerve centres located in the

> > hypothalamus at the

> > centre of his patient's brain. At this, Hutchinson's

> > pupils dilate

> > and he screams: " You're going to kill me, you

> > bastard! " Hutchinson's

> > medical records, written by Wall over 30 years ago,

> > confirm that his

> > patient " felt funny - as if he was dying " . But as he

> > screamed,

> > Hutchinson recalls Wall leaning in close to his face

> > and

> > leering: " And I thought you were a bit of a tough

> > guy. "

> >

> >

> >

> > His next recollection is of Wall giving orders for

> > surgical

> > implements to be passed. Hutchinson feels the metal

> > pins inserted

> > through nylon balls lodged in cavities bored into

> > the front of his

> > skull being replaced by thicker electrodes he says

> > felt like " broom

> > handles " . " After that I started, I start to feel

> > warm all over and

> > quickly feel as if I have fallen into a vat of

> > molten metal, as if I

> > am, quite literally, frying, " says Hutchinson,

> > tellingly confusing

> > tenses as he describes the brain surgery he

> > underwent in 1974 yet

> > still relives up to a dozen times a day and in

> > frequent nightmares.

> >

> > Throughout the surgery, Hutchinson was kept

> > conscious; his head held

> > in a brace, his hands and feet strapped to the

> > operating table.

> > Hutchinson, a 27-year-old father of three at the

> > time of the

> > operation, says he had not given his written consent

> > to the

> > operation being performed; neither had his wife -

> > his next of kin.

> > Instead his mother, an alcoholic, had been visited

> > at home, in the

> > late evening, after she had been drinking, and had

> > been asked to

> > sign the form. " My mother thought doctors were

> > gods, " Hutchinson

> > says. " She'd have signed anything they asked. "

> >

> > Hutchinson's excruciatingly detailed recollections

> > are a rare

> > testimony of someone still lucid and intensely angry

> > about a type of

> > brain surgery to which he was subjected - he

> > contends illegally -

> > commonly referred to as a lobotomy. In strict

> > medical terms, a

> > lobotomy - or leucotomy, as the procedure became

> > known in this

> > country - involved the removal of part of the

> > frontal lobes of the

> > brain or the severing of neural fibres connecting

> > the frontal lobes

> > to the limbic system - the part of the brain

> > concerned with

> > emotional response and functions not under conscious

> > control.

> >

> > From the mid-1930s until the early 1960s this form

> > of " psychosurgery " was heralded as a miracle cure

> > for the mentally

> > ill, before psychotherapy came into vogue and drugs

> > to treat many

> > mental-health problems became widely available. It

> > was pioneered by

> > a maverick Portuguese neurologist, Egas Moniz, who

> > was awarded the

> > Nobel prize in 1949 for developing and promoting the

> > procedure.

> > Lobotomies were seen as the solution to a wide range

> > of mental

> > disorders ranging from profound depression,

> > schizophrenia and

> > advanced neurosyphilis to mild retardation, at a

> > time when half of

> > all hospital beds in many countries were occupied by

> > the mentally

> > ill, and mental institutions were often places of

> > humiliation and

> > horror.

> >

> > At the height of its popularity in the 1940s and

> > 50s, particularly

> > in the US, some of the most enthusiastic proponents

> > of the procedure

> > promoted it as a way of controlling large numbers of

> > those

> > considered society's worst misfits, including

> > communists and

> > homosexuals. Neurologists, not just in the US but in

> > Japan, Britain

> > and elsewhere, carried out variations of the

> > procedure on tens of

> > thousands of patients - an estimated 50,000 in the

> > UK alone.

> >

> > Little attention was paid to what happened to those

> > subjected to

> > lobotomies after surgery. F Kennedy's

> > temperamental sister

> > Rose, who underwent the operation at the age of 23,

> > for instance,

> > spent the next 60 years of her life out of sight in

> > a mental

> > institution. Francis Farmer, the rebellious

> > Hollywood actress and

> > political activist whose outspoken behaviour was

> > also " cured " by a

> > lobotomy, quickly drifted into oblivion and ended

> > her days as a

> > hotel clerk.

> >

> > But as the number of lives wrecked by such surgery

> > became more

> > widely known, its effect was gradually exposed -

> > most famously in

> > Milos Forman's 1975 film, One Flew over the Cuckoo's

> > Nest. But also

> > earlier, in the 1958 play Suddenly Last Summer, by

> > Tennessee

> > . A close friend of , whose sister

> > Rose was

> > lobotomised as a teenager, recalls how the

> > playwright talked of his

> > sister as " fragile and gentle " , someone hurt by " the

> > harshness of

> > life " .

> >

> > " Things alarmed Miss Rose that would not even be

> > noticed by someone

> > less sensitive. She was just awakening to sexuality

> > and knew almost

> > nothing about it… Rose came home from school one day

> > and said the

> > nuns were using altar candles for self-abuse. She

> > told mother this, "

> > the playwright once confided to his biographer

> > Dotson Rader. To the

> > siblings' mother, known even to her children as

> > " Miss " , human

> > sexuality was " the great unmentionable " . She

> > promptly took her

> > daughter to the doctor, demanding the " filth " be cut

> > out of her

> > brain: " Cut it away! Miss ordered. " Make it

> > clean! " " And he

> > did, " recalled the playwright, who said his mother

> > never showed any

> > remorse about reducing her daughter to a human

> > vegetable.

> >

> > Some now consider such practices to be among the

> > most egregious

> > medical crimes of the last century and have called

> > for Moniz, who

> > was later shot in the back by a dissatisfied

> > patient, to be

> > posthumously stripped of his Nobel prize. The Nobel

> > Foundation rules

> > this out, maintaining that all of its awards can be

> > justified within

> > the historical context that they are given.

> >

> > By the time Hutchinson had his operation in 1974,

> > the scale on which

> > psychosurgery was being performed was drastically

> > reduced, with more

> > and more mental disorders being treated with drugs

> > and

> > psychotherapy. Crude frontal lobotomies, of the type

> > Moniz promoted,

> > had been phased out. Surgery became targeted at more

> > specific parts

> > of the brain as the neurobiology of emotion became

> > better

> > understood. The surgery performed by Wall on

> > Hutchinson's

> > hypothalamus, for instance, was intended to curb his

> > aggression.

> >

> > Since then, psychosurgery has become even more

> > refined, the parts of

> > the brain targeted and destroyed to control

> > behaviour ever smaller.

> > Though the name lobotomy persists, the medical

> > profession now refers

> > to any such procedure as NMD (neurosurgery for

> > mental disorder). But

> > Britain is now one of the few countries where this

> > sort of surgery

> > is still permitted. Even here it is only performed

> > for persistent

> > severe depression and anxiety and

> > obsessive-compulsive disorder

> > (OCD) in two places: University Hospital of Wales in

> > Cardiff, and

> > Ninewells hospital, Dundee. Patients must consent to

> > the surgery and

> > ethical and clinical standards committees subject

> > each case to rigid

> > scrutiny before it goes ahead.

> >

> > If the worst excesses are in the past, the type of

> > surgery now

> > conducted so controlled and the numbers to whom it

> > is given severely

> > limited, some might argue that the subject of

> > lobotomies,

> > psychosurgery, NMD - call it what you will - is only

> > of historical

> > interest. They would be wrong.

> >

> > In the coming month, parliament is expected to

> > finally debate

> > another hotly contested piece of proposed

> > legislation: the draft

> > Mental Health Bill (2004), which many mental-health

> > experts fear

> > will reduce safeguards for the mentally ill. One

> > provision of the

> > bill is a little-noticed clause that, if passed onto

> > the statute

> > books, would allow doctors to perform NMD without a

> > patient's

> > consent if they were considered so mentally ill they

> > were incapable

> > of giving it.

> >

> >

> > No matter how refined these latest NMD techniques

> > are, nor how

> > vociferously neurosurgeons who practise it argue it

> > is nowadays

> > employed only as a last resort, its outcome is often

> > unpredictable.

> > Since it is irreversible, some believe it should be

> > banned. At the

> > very least it should only be conducted on those able

> > to give their

> > informed consent, argue campaigners such as the

> > mental-health

> > charity Mind and the Mental Health Alliance, which

> > includes such

> > bodies as the Royal College of Nursing, the Royal

> > College of

> > Psychiatrists, the Law Society and dozens of other

> > organisations in

> > the field of mental health.

> >

> > With many of those who have undergone such surgery

> > unable to speak

> > for themselves and few of those subjected to the

> > cruder forms of

> > surgery still alive, Hutchinson's is the rare

> > voice of

> > experience. His story serves as a chilling

> > reinforcement of the

> > adage that a society be judged by the way it treats

> > its most

> > vulnerable. With the government proposing

> > legislation that many

> > believe would turn the clock back on the way we

> > treat the mentally

> > ill, what does that say about modern Britain?

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > As Hutchinson sits talking in the cramped living

> > room of his small

> > terrace house in Leeds, he frequently stretches out

> > his arms to hug

> > his two-year-old grandson, one of 17 grandchildren.

> > While the boy

> > giggles with delight, Hutchinson, 59, talks a little

> > of his own

> > childhood. He recalls how his mother would often

> > lock him, the

> > middle of three brothers, in a coal shed overnight.

> > " Glass were all

> > broken. I'd have to sleep in coal sack, night after

> > night. It went

> > on for years, " he says. But he prefers not to dwell

> > on it. " That's

> > all done now, in the past. "

> >

> > On his own admission, Hutchinson grew into a

> > troubled youngster.

> > Though he channelled his aggression into amateur

> > boxing and other

> > sports, he was, he admits, " always in trouble as a

> > lad " and would

> > often get into fights. After a spate of joyriding

> > cars as a

> > teenager, he was sent to a series of borstal

> > schools, then remand

> > homes. Eventually he found work as a welder, married

> > and had three

> > children. When he was 27, however, he suffered a

> > nervous breakdown.

> > After being admitted to a psychiatric hospital, he

> > was given ECT

> > (electroconvulsive therapy) and prescribed strong

> > sedatives. His

> > psychiatrist then recommended that he undergo

> > psychosurgery.

> >

> > According to Hutchinson, the psychiatrist tried to

> > persuade him such

> > surgery was necessary to curb his aggressive

> > tendencies after asking

> > him how he would feel if Hutchinson were ever to

> > kill one of his own

> > children. " I'd never harmed any of my children. I

> > never would. But

> > when he put it like that, I was scared. " Still,

> > Hutchinson was

> > considered incapable of giving consent, as ?he was

> > so heavily

> > sedated. At first his wife agreed to the operation.

> > But after seeing

> > the sizable holes that had been drilled into her

> > husband's skull in

> > preparation for the second part of the operation a

> > week later, she

> > withdrew her consent. It was then that his mother

> > was approached.

> >

> > In a 1976 TV documentary on the same operation as

> > Hutchinson

> > underwent, being performed on a mother-of-five

> > called Margaret

> > Chapman, the neurosurgeon Wall, who has since died,

> > describes the

> > operation as " quite simple, really " . He then

> > casually admits

> > knowledge of psychiatry is " something you pick up as

> > you go along " .

> > But far from curing Hutchinson's aggression, which

> > he describes

> > as " within his control " before the operation, the

> > surgery he

> > underwent left him so traumatised that he walked out

> > on his first

> > wife, Ruth, who had recently given birth to twins,

> > fearing he might

> > do his children harm. He subsequently attempted to

> > physically attack

> > the psychiatrist who had referred him to Wall, and

> > several years

> > later tried to commit suicide. Though he eventually

> > resumed work and

> > remarried, he has suffered vivid flashbacks of the

> > operation ever

> > since, and in recent years has been diagnosed as

> > suffering from post-

> > traumatic stress disorder.

> >

> > However troubling Hutchinson's story is, it is by no

> > means the

> > result of the most cavalier practitioner of

> > psychosurgery in this

> > country. The neurosurgeon reputed to have been

> > Britain's most

> > prolific lobotomist was the former president of the

> > Society of

> > British Neurological Surgeons (SBNS), Sir Wylie

> > McKissock, based at

> > Atkinson Morley's hospital in Wimbledon in the late

> > 1940s and 50s.

> > McKissock is described by those who knew him as a

> > taciturn and

> > difficult man, much feared by his junior staff. He

> > rarely spoke to

> > or met patients before or after surgery. Instead, at

> > weekends, he

> > made regular tours of nursing homes and mental

> > hospitals along the

> > Sussex coast. With the aid of a theatre sister, he

> > would perform,

> > for cash, up to 10 a day of the crude frontal

> > lobotomies pioneered

> > by Moniz. McKissock is understood to have performed

> > around 2,000

> > such operations.

> >

> > Few records exist of the reasons they were performed

> > or their

> > outcome; but a 1949 study of 300 of McKissock's

> > lobotomy patients

> > recorded that 16 had died as a direct or indirect

> > result of the

> > operation. It is impossible, therefore, to assess

> > how many of these

> > operations were performed needlessly. But the

> > experience of those

> > such as Hutchinson, and the accounts of relatives of

> > others who

> > underwent earlier forms of psychosurgery, attest to

> > it having been

> > performed for flimsy reasons and to disastrous

> > effect by some

> > British surgeons, just as it was in the US.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > One such case is that of Shaw, whose brother

> > , a 69-

> > year-old retired painter and decorator from

> > Liverpool, describes

> > as " a very, very clever lad " when he was younger.

> > " He was very good

> > at art. He loved to draw cartoons. Our father was a

> > sign writer and

> > he sent some of Ron's cartoons to a London newspaper

> > when we were

> > still teenagers, " recalls of his elder

> > brother. " They wanted

> > Ron to draw more and were going to pay him quite

> > well. But he

> > suffered with his nerves. He never did it. "

> >

> > When was in his early teens, his brother

> > remembers he started

> > coming home from school crying and would often wake

> > up screaming in

> > the night. The boy was admitted to hospital and

> > given ECT. It failed

> > to help. " Years later, we discovered, through

> > another boy who was at

> > school with Ron, that there was a teacher who used

> > to regularly take

> > my brother into a back room to cane him. Who knows

> > what else he did

> > to him in that room. I believe now that it was this

> > bullying that

> > caused my brother to behave the way he did. "

> >

> > When he was 17, volunteered to join the army,

> > but within a

> > year was discharged with a knee injury. In 1955,

> > when was

> > stationed in the Far East, completing his national

> > service, his

> > brother was admitted to Rainhill hospital in the St

> > Helens district

> > of Liverpool and a frontal lobotomy was performed.

> > " I knew nothing

> > about it. When I came back from the Far East, my

> > brother was

> > destroyed. He did not talk for two years. Eventually

> > he started to

> > speak, but he was never the same again. He was never

> > able to work.

> > My parents spent the rest of their lives looking

> > after him. Their

> > lives were ruined too. After they died he lived

> > alone, though I took

> > him out as much as I could. "

> >

> > Shaw died last year. His partially skeletal

> > body was found in

> > a field months later. His brother believes he was

> > trying to walk to

> > the Marble Church in Holywell, which had always

> > fascinated him, when

> > he stopped for a rest and died of natural causes.

> > His body had been

> > run over by a tractor after his death and his

> > remains were

> > surrounded by diaries he kept of his daily

> > activities. " I'd been

> > driving all over the country looking for him for

> > months. Then the

> > police called, saying they'd found a body with holes

> > drilled in the

> > front of his skull and I knew it was Ron, " says

> > , his voice

> > cracking. " It's unforgivable what was done to him. "

> >

> >

> >

> > Supporters of modern-day psychosurgery, or NMD,

> > argue it has moved

> > light years from the notorious excesses of such

> > early practices. Yet

> > even the crudest operations, they stress, were

> > effective in

> > alleviating the mental suffering of some patients.

> > One former

> > president of Ireland's Royal College of Surgeons,

> > who is believed to

> > be one of the few surviving neurosurgeons to have

> > carried out the

> > conventional frontal lobotomy on a regular basis,

> > sits sipping a gin

> > and tonic as he demonstrates with a cake knife how

> > he used to sever

> > or core out part of the frontal lobes of his

> > patients to break the

> > nerve " circuits " believed responsible for mental

> > illness. He carried

> > out two operations every Saturday morning, at the

> > request of the

> > Irish Department of Health, for nearly 10 years

> > until 1960.

> >

> > Immaculately dressed in a tweed suit, he recalls how

> > the operation

> > helped one vet obsessed with a fear of constipation

> > who ate fruit

> > constantly and spent all day in the toilet. After

> > the operation he

> > was able to return to work. He also talks of

> > performing lobotomies

> > on more than 20 priests with perceived personality

> > disorders. But,

> > he says, in his experience the surgery did more to

> > help those who

> > were returned to closed orders rather than allowed

> > to return to the

> > community. Lobotomies, he says, did little to help

> > those with

> > schizophrenia, neurosyphilis or personality

> > disorders other than

> > obsessive-compulsive disorder and severe depression.

> >

> >

> >

> > Those forms of NMD still being conducted in this

> > country today are

> > targeted at the treatment of severe depression,

> > severe anxiety and

> > OCD. These procedures, which involve minute

> > destructive lesions in

> > parts of the frontal lobe or limbic system, are

> > known as

> > cingulotomies - the cingulum being the part of the

> > frontal lobe

> > associated with OCD - and capsulotomies, which

> > involve making

> > lesions in the capsules: the dense nerve-fibre

> > pathway connecting

> > part of the frontal lobe with the limbic structure.

> > Neurosurgeons at

> > Ninewells hospital in Dundee, for instance, carried

> > out 34 NMD

> > operations between 1990 and 2001. In the past year

> > the hospital has

> > conducted five such operations on patients it

> > describes as " among

> > the most severely ill and disabled who come into

> > contact with any

> > branch of the medical professions " . Surgeons at the

> > University

> > Hospital of Wales in Cardiff have conducted 56 NMD

> > operations in the

> > past decade. It was there that the former child

> > singing star Lena

> > Zavaroni, who suffered from anorexia, underwent such

> > surgery in 1999

> > for severe depression. Though the operation seemed

> > to have been a

> > success, she died of pneumonia less than a month

> > later. According to

> > Simpson, consultant neurosurgeon at Cardiff,

> > the operations

> > his team have conducted have led to a " marked

> > improvement " in

> > roughly half of those being treated for severe

> > depression and

> > OCD. " NMD is not a panacea, " Simpson agrees. " It is

> > carefully

> > regulated and only offered to patients for whom all

> > other treatments

> > have failed… But in the patients for whom it works

> > well, whose

> > suffering has been indescribable, it transforms

> > their lives. "

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Some believe the way ahead lies in other forms of

> > brain surgery,

> > such as deep brain stimulation with implantable

> > electrodes, as are

> > increasingly used to treat Parkinson's disease. This

> > they believe

> > could offer an alternative to the ablative

> > operations that have been

> > used to date in psychosurgery. The introduction of

> > modified stem

> > cells into certain parts of the brain has also

> > already had

> > experimental success in treating some neurological

> > conditions and

> > holds out hope for combating psychiatric disease.

> > But it is the

> > irreversible nature of the NMD still practised that

> > concerns

> > opponents. That this type of surgery could be

> > carried out without a

> > patient's consent, according to the proposed

> > legislation, they

> > reject outright. Under the current Mental Health Act

> > of 1983, three

> > independent people, one a doctor, has to certify

> > that any patient

> > undergoing psychosurgery understands the treatment

> > and consents to

> > it. The draft mental-health bill under consideration

> > has broadly the

> > same safeguards for those capable of giving consent.

> > The main

> > difference is that it allows for treatment to be

> > given without the

> > patient's consent, at the request of doctors and on

> > an order of the

> > High Court, providing three conditions are met. The

> > first is if it

> > can be verified that a patient does not have the

> > capacity to

> > consent. The second is if there is no reasonable

> > prospect of them

> > regaining this capacity, and the third is if they

> > are " unlikely to

> > resist treatment " .

> >

> > According to Brook, former chief executive

> > of the mental-

> > health charity Mind, one of the biggest concerns of

> > those who work

> > in mental health is that no leading study has

> > properly assessed the

> > effect of psychosurgery on an individual's

> > personality or sought the

> > views of those undergoing such treatment. " Because

> > of its hazards

> > and the lack of clear evidence for the treatment's

> > benefit, or basis

> > for predicting success in the individual concerned,

> > we believe it

> > should never be given to someone who doesn't have

> > the capacity to

> > consent to it, " says Brook.

> >

> > Doctors at Ninewells hospital in Dundee argue that

> > the lack of a

> > randomised control trial to support NMD applies

> > equally to a range

> > of " cutting edge " medical and surgical procedures.

> > Simpson

> > says that although he appreciates there may be an

> > " understandable

> > fear of returning to the bad old days of lobotomy " ,

> > he believes it

> > is " not unreasonable in certain circumstances and

> > with adequate

> > legal safeguards " to perform NMD without a patient's

> > consent. " The

> > issue of consent is sensitive and crucially

> > important, " warns

> > Simpson, adding that " the more you open it up in

> > this way, the more

> > crucial it becomes to have adequate legal

> > safeguards " .

> >

> > But , who is behind moves to launch

> > a legal

> > campaign in the US to have Moniz's Nobel prize

> > revoked, believes

> > that there are even wider issues at stake. 's

> > own grandmother

> > was left to languish in a psychiatric institution

> > for 20 years after

> > undergoing a lobotomy. As a result, the medical

> > librarian ?from

> > Levittown, New York state, founded an organisation

> > called

> > Psychosurgery.org, dedicated to the " surgical

> > casualties " of such

> > procedures. " There are a lot of important lessons to

> > be learnt from

> > what happened to our family members, " says .

> >

> > Many families of those suffering from Alzheimer's

> > disease, she

> > stresses, are now clamouring to have experimental

> > brain surgery

> > performed on them. " But there is a real ethical

> > question about

> > whether you can really do these kind of things to

> > someone who is by

> > definition having problems making decisions. I

> > really hope people

> > will take into consideration the amount of damage

> > that was done in

> > the past when they attempt to push forward with such

> > treatments, "

> > concludes.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Hutchinson has recently tried to sue his local

> > health

> > authority for medical malpractice, but has had to

> > give up because

> > his surgery was carried out so long ago that the

> > statute of

> > limitations on such a claim has expired. West

> > Yorkshire police are

> > now investigating if there is a criminal case to

> > answer over a lack

> > of proper legal consent having been obtained.

> >

> > Such thoughts are far from his mind, however, as

> > Hutchinson drives

> > me back to the train station in Leeds, warning me

> > that he might have

> > to pull over to the side of the road at any moment

> > because his

> > lobotomy has also left ?him with narcolepsy.

> > Throughout the journey,

> > he talks affectionately about his brood of

> > grandchildren. But by the

> > time we reach the station, he has lapsed into

> > melancholia and tears

> > well in his eyes as he talks about how his own

> > children's lives were

> > damaged when he abandoned them after his operation.

> >

> > " If nothing else, I want people to understand what

> > these bastards

> > did to me, and thousands of others, so nothing like

> > this is ever

> > allowed to happen again, " he says, clutching the

> > steering wheel

> > until his knuckles go white. " What they did was not

> > treatment - it

> > was torture. "

> >

> > Young is consultant neurosurgeon at the

> > Beaumont hospital in

> > Dublin

> >

> > THE ORIGINS OF MIND-ALTERING SURGERY

> >

> >

> > Egas Moniz could have afforded to rest on his

> > laurels by the time he

> > attended the Second World Congress of Neurology in

> > London in 1935.

> > The 61-year-old professor of neurology, and dean of

> > Lisbon's Medical

> > School, had already gained an international

> > reputation for

> > pioneering cerebral angiography - a radiological

> > technique for

> > mapping brain vessels. But Moniz was disappointed

> > that this had not

> > won him the Nobel prize. So when he heard two Yale

> > neurologists

> > speak at the London congress about experimental

> > brain research on

> > two chimpanzees called Clyde and Becky, observing

> > how Becky's temper

> > tantrums subsided after surgery, he would go on to

> > pioneer - and

> > relentlessly promote - a procedure that eventually

> > won him the

> > coveted Nobel prize.

> >

> > The procedure was the lobotomy. Back in Lisbon he

> > ordered that a

> > human brain be brought to him from a morgue, and

> > thrusted a pen

> > through the cortex several times until he was

> > satisfied he knew the

> > approximate angle and depth that would best detach

> > the frontal

> > lobes. He performed the operation on a former

> > prostitute, who

> > afterwards was unable to give her age or say where

> > she was. She was

> > returned to an asylum, never to be seen by him

> > again.

> >

> >

> >

> > Moniz nonetheless considered this a " clinical cure "

> > and continued

> > operating. The procedure was greeted with enthusiasm

> > by the medical

> > profession and went on to be practised in many

> > countries. After

> > Moniz won the Nobel prize in 1949, the lobotomy's

> > popularity

> > increased. But today many believe the procedure is

> > barbaric, and are

> > campaigning for him to be stripped of the award.

> >

> > The Nobel Foundation contends that Moniz's prize

> > should be judged in

> > the historical context of a period when there was

> > widespread despair

> > about mental-health treatment. In the 1930s and 40s,

> > patients were

> > often beaten, choked, spat on and humiliated by

> > attendants in state

> > hospitals, where the average duration of confinement

> > was 10 years.

> > Cost was also a factor. In the mid-1930s a lobotomy

> > cost $250 in the

> > US, compared with tens of thousands of dollars to

> > keep a patient

> > incarcerated. The drawback of the operation - that

> > it robbed

> > patients of their personality traits - was

> > considered a small price

> > for emptying hospital beds.

> >

> > If Moniz brought the lobotomy fame, then the US

> > physician Walter

> > Freeman brought it infamy. A tireless

> > self-publicist, he would

> > perform his variation of Moniz's operation - the

> > " ice pick "

> > lobotomy - before an enthralled audience. This

> > involved driving an

> > ice-pick-like instrument through the roof of the eye

> > and sweeping it

> > across the frontal lobe to scramble neural

> > connections. Freeman once

> > boasted he was " as good as Sinatra " in getting

> > young people to

> > faint at the sight of what he did. One of his

> > patients,

> > Dulley, was 12 when he was lobotomised because his

> > stepmother said

> > he was sullen and refused to bathe.

> >

> > It was not until the mid-1950s, with the advent of

> > antipsychotic and

> > pacifying drugs such as chlorpromazine, that the

> > lobotomy began to

> > fall out of favour.

> >

> > The role of psychosurgery came under greater

> > scrutiny in the 1960s

> > and 70s, when social unrest led some sociobiologists

> > to consider it

> > a tool for addressing violence and

> > " psycho-civilising " society

> > through the use of implantable brain electrodes.

> >

> > Despite growing unease, more refined procedures such

> > as

> > cingulotomies were developed and the modern era of

> > psychosurgery was

> > born. Such procedures remain controversial and have

> > been banned in

> > Germany, Japan and a number of US states. They are

> > still practised

> > in the UK, Finland, India, Sweden, Belgium and

> > Spain.

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >