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Electroconvulsive therapy (was first developed around 1938) and lobotomy (first performed on humans in the 1890s). Electroconvulsive therapy is still a legitimate treatment for severe depression.
The Lobotomy
Perhaps the lobotomy (the removal of parts of the brain) is the most controversial of treatments that have been developed over the past two centuries for mania and depression. And what is even more bizarre is the results that lobotomies have produced. Here, we'll look at the accident that sparked the revolution in psychosurgery and its development over the past hundred years as a viable form of therapy...
The explosives accident that sparked it all...
Lobotomy AccidentPhineas Gage was a mild-tempered man from Vermont, USA, earning an honest living as a foreman during the construction of America's railroads in 1848. All was fine until an explosive charge was accidentally detonated, sending a 3-foot long rod of metal into one end of Gage's head and out of the other. The penetration, from a cheek to the top of his head, inevitably went through his brain. Gage was lucky to have survived this accidental lobotomy with the loss of an eye, and most of his cognitive abilities such as memory remained in tact, but a strange personality change occurred: Phineas became almost childish in his behavior, unwilling to listen to others and often using obscenities.
What had happened?
The part of Phineas' brain that had been destroyed by his experience was the orbitofrontal cortex the part which has been attributed to animal/human emotions. Could removing this part of the brain actually benefit people with overly-strong emotions, and help those suffering anxiety and depression?
Later lobotomists would find out...
The experiments begin...
Phineas Gage's change in personality meant that he was virtually unemployable, and reports claimed that he ended up as a sight at a circus. His legacy lived on, however, and Gage's revelations about the function of the orbitofrontal cortex lead to important and even more fascinating research over the next century:
1935: Becky the Chimp
Jacobsen, Wolfe & Jackson put the lobotomy to the test on a chimpanzee called Becky. In removing the frontal lobe of her brain, they managed to make her immune to any distress that she would normally endure when she made mistakes. When made to take a test in a chamber, instead of being upset as she would have been previously, she behaved cheerfully.
London's Second International Congress of Neurology
The congress of summer, 1935 brought together the cream of the world of neurology. Among the attendees were Antonio Moniz, a Portugese neuropsychiatrist, his admirer-to-be, Walter Freeman; and Fulton, whose lobectomy of animals (the removal of the frontal lobes of the brain) stunned the visitors. After a demonstration and great deal of debate of Fulton's discoveries, Moniz suggested the application of the lobectomy to humans. The crowd was shocked, but by September of the same year, Moniz had attempted the operation on a woman patient from an asylum. The woman's mental faculties were damaged after the operation, but the paranoia that she had previously from was lessened. Moniz later published his findings, attempting to present his operations in a positive light, and again gained the interest of the 1935 conference attendee, Walter Freeman, who would continue his work into later years.
More on Moniz: Did you know?
Away from his life in revolutionizing the world of lobotomy, Antonio Moniz enjoyed quite an influence in world politics. He helped end World War I in signing the Treaty of Versailles and served as an ambassador, but was eventually rewarded for his neurological achievements in 1949, with an award of the Nobel Peace Prize.
Moniz was eventually shot and murdered by one of his lobotomy patients.
Freeman was a US neurologist who was keen to experiment with lobotomies, and after reading Moniz's findings, was encouraged to collaborate with a surgeon colleague who was qualified to operate on patients, James Watts. The woman they operated on, an American with severe depression, underwent the surgery (her last concern being of her hair being cut off), and awoke carefree. Although side-effects of bad communication became apparent a week later, they soon disappeared and the woman appeared cured.
Post-War Lobotomy
It was after the Second World War that a real need to treat new victims of war-related disorders such as shell-shock and severe depression became apparent. Lobotomies grew in popularity, and by 1955, tens of thousands of people had undergone the operation.
Modern Lobotomy
Despite the risks and adverse effects that were witnessed in previous patients, lobotomies remain a valid, if rare, form of treatment today. Instead of removing parts of the brain as Phineas had endured, the first lobotomies used alcohol to sever the fibers that linked the frontal lobe to the rest of the brain. Today, lobotomies are used often to treat epilepsy, and those such as the amygdalotomy use drills to create a hole in the head.
Electroshock Therapy
A Brief History of Electroshock Therapy (ECT)
Almost everyone who I know who has undergone electroshock therapy and every doctor associated with mental illness treatment seems to know the same horrible story of Ugo Cerletti, the Italian psychiatrist, who in 1938 came up with the idea for treating human beings with electroshock therapy. Cerletti was observing the barbaric act of slaughterhouse pigs being electrocuted into unconsciousness to make it less difficult for workers to slit their throats and thought that it could be applied to the treatment of mental illnesses in human beings. It’s not too pleasant of an image to think about while you’re laying on a gurney about to go into the operating room for your first treatment.
The concept of having electricity pass through your brain is daunting enough to frighten even the most educated of people. The reputation of electroshock - - also referred to as electroconvulsive therapy or ECT by proponents - - has suffered. Not more than a year after Cerletti got his brilliant idea, the New York State Psychiatric Institute introduced ECT into the United States.
For the next thirty years, hundred of thousands of patients of all ages, received electroshock treatments for every type of “disorder” including depression, mania, schizophrenia and even homosexuality and truancy.
But by the end of the 1960s, electroshock had almost vanished from the psychiatric scene. The film “One Flew Over the Cuckoo’s Nest” was released in 1975. Jack Nicholson played the unforgettable character who is given unwanted and unnecessary electroshock treatments and his fellow patients on the ward were portrayed as lobotomized-looking, hollowed-out souls who had trouble recognizing friends and family. Their capacity for speech and language had been damaged and they often ended up needing to be institutionalized. "Cuckoo’s Nest" played a major role in discrediting ECT.
It was the great leap in creating psychotropic medications, especially antidepressants, which were able to do what electroshock therapy was supposed to do but even more efficiently, that slowed down the use of ECT. Soon, ECT was “put on hold” - - it was performed less frequently. These new psychotropic medications were not nearly as barbaric as jolting a patient with an electrical current and inducing a grand-mal seizure.
The Procedure of ECT
ECT is usually administered to patients in a series of treatments, ranging from six to twelve treatments over a two week period. Most of these patients have had no success on antidepressants or mood stabilizing medications.
The patient’s heart rate is monitored throughout the procedure, which actually lasts no more than ten minutes in the operating room. He receives an IV of an anesthetic (i.e. Brevital) in his arm and usually is asked to count (I was asked to count backwards) until he becomes unconscious. Then an IV of succinylcholine is put in the arm (relaxing the muscles to prevent broken bones and cracked vertebrae), a rubber block is inserted in the mouth to prevent biting on the tongue, a mask is placed over the mouth so the brain is not deprived of oxygen and conducting jelly is rubbed on the temples and electrodes connected. The doctor presses a button and electric current shoots through the brain, causing a grand-mal seizure for 20 seconds. Usually, the patient wakes up in about 30 minutes. I remember waking up completely confused and not knowing where I was or what had happened. My jaw ached, my limbs were sore and I had a horrible headache, almost as if I had downed a Margarita too quickly!
Different 50 Years Ago
Patients in the 1950’s sometimes received more than 100 treatments. The amount of electricity used was also greater, and the waveform and the stimulus was different. Anesthetics and muscle relaxants were not used (patients were shackled to the gurney but there were still broken bones and vertebrae) and they were not closely monitored. ECT today is different than it was fifty years ago. How ECT works, with minimal damage to the patient, has a lot to do with how it is currently administered. There are two advances that have improved the procedure. The first is nondominant unilateral ECT, which is the use of electrodes only to the right side of the patient’s head (as opposed to bilateral), protecting the left side of the brain, the site of language and auditory memory. The other advance has been the introduction of brief-pulse stimulus - - a quick jolt of electricity instead of a steady stream, making it less likely that the patient will later suffer serious problems with memory.
Side Effects of Electroshock Therapy
It is well established and documented that memory impairment is the worst side effect and is the one most frequently cited by patients. Most ECT specialists say that memory loss is transient and concerns principally the time immediately after electroshock treatment. The other most common side effects are headaches, nausea, confusion and muscle ache or soreness. Over the course of ECT, patients may have difficulty remembering newly learned information. Some patients report memory loss for events that occurred during the day, weeks, and months preceding ECT. I have memory loss from the period six months before my first treatment through the period ending six months after my last treatment (a total of thirty months). Most of these memories return, but some patients have reported longer-lasting problems with recall of some of these memories and some patients have claimed they have “permanent brain damage.” I still am unable to recall all my memories and the events from this period. Researchers have yet to find evidence that ECT damages the brain. They have established that the amount of electricity which actually enters the brain is much lower in intensity and shorter in duration than that which would be necessary to damage the brain. But there are cases of patients who have reported improved memory ability following ECT because of its ability to remove the amnesia that is sometimes associated with severe depression.