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A Science Odyssey
People and Discoveries
photo Moniz develops lobotomy for mental illness

Photo: Lobotomy operation

Antônio Egas Moniz (1874-1955) of Portugal was an ambitious and multitalented person -- a neurologist, political figure, and man of letters. By the 1930s he was already known for his successful refinement of techniques enabling doctors to visualize blood vessels in the brain by using radioactive tracers. He had hoped and perhaps expected to receive the Nobel Prize for this work, and was disappointed when he realized he would not.

In 1935 at an international neurology conference he saw a presentation on the frontal lobes of the brain and the effects of removing them from chimpanzees. Moniz later claimed he had been thinking about similar methods before the conference, but it went into scientific mythology that the calm behavior of the presenter's formerly temperamental chimp had inspired him to develop the lobotomy to treat mental illness.

Moniz had an idea that some forms of mental illness were caused by an abnormal sort of stickiness in nerve cells, causing neural impulses to get stuck and the patient to repeatedly experience the same pathological ideas. There was no empiric evidence for his theory, but Moniz pressed on. If the nerve fibers causing these morbidly fixed ideas could be destroyed, the patient might improve. In November 1935, he and his assistants made the first attempts at this type of psychosurgery. First they gave a series of alcohol injections to the frontal lobe (through holes drilled in the skull). After seven patients, they switched to cutting the lobe with a wire. Nothing was removed; connections were just severed.

In 1936 Moniz published the very positive results of his first 20 operations on patients who had suffered from anxiety, depression, and schizophrenia. Though his follow-up was mainly within the first few days of surgery and his determination of "improvement" rather subjective, his publication was well received. It seemed to offer evidence of the benefits of psychosurgery. For example, Moniz's first patient was less agitated and less overtly paranoid than she had been before, although she was also more apathetic and in fact duller than Moniz had hoped. She had a few physical side effects such as nausea and disorientation, but overall struck Moniz as much improved. In the 1930s diagnoses of serious mental illness were increasing, and yet knowledge of its causes or how to treat it was not. Doctors were sometimes willing to try anything to help their most desperately ill patients. This terrible need for treatment cleared the path for widespread acceptance of such radical treatments as shock therapy and lobotomy.

In the United States, neurology professor Walter Freeman threw himself into lobotomy practice and promotion with an unmatched fervor. Within a year of reading Moniz's publication, he and an assistant had performed 20 lobotomies. They wrote, "In all our patients there was a . . . common denominator of worry, apprehension, anxiety, insomnia and nervous tension, and in all of them these particular symptoms have been relieved to a greater or lesser extent." They also claimed that disorientation, confusion, phobias, hallucinations and delusions had been relieved or erased entirely in some patients. But they also noted, "Every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality." In 1942 they published an influential book promoting the practice. In the United States the number of lobotomies performed per year went from 100 in 1946 to 5,000 in 1949. That year Moniz won the Nobel Prize in physiology/medicine for his contribution.

The popularity of the procedure declined drastically in the 1950s and beyond. Evidence of serious side effects mounted with long-term studies. The use of newly developed Thorazine, the first nonsedating tranquilizer, reduced the perceived need for most lobotomies.

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