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Psychosurgery doesn't stop at ice breakers

Currently in theaters, films Mountain reminds us of this movement from another time, lobotomy. Director Rick Alverson invited the audience to follow in the footsteps of the character played by Jeff Goldblum, arousing Dr. Walter Jackson Freeman.

The street film follows the journey of a neurologist, who penetrated the United States "Lobotomobile" -When baptized posteriori vehicles, armed with ice breakers, in the 1950s and 1960s. The true prophet lobotomy, he claims more than 3,500.

From a medical point of view, lobotomy is a neurosurgical operation that consists of releasing the frontal lobe from the entire brain by cutting off the neurons attached to it.

Freeman popularized certain techniques, which passed just above the eye: transorbital lobotomy. Practiced in this way, the operation only takes a few minutes.

If today appears as one of the worst drugs in monstrosity, the procedure at that time was presented as progress.

Nobel who is shy

Every year in December, the month of the Nobel Prize ceremony, articles are published about the worst controversy in the history of the award. Always think "Shame Nobel" accepted in 1949 by Egas Moniz, inventor of lobotomy in 1935.

Portuguese neuroscientists, who are also inventors of brain angiography, are considered a precursor: lobotomy is the first attempt to treat patients who have hitherto been limited to isolation, especially psychotics.

Neurosurgeon Marc Lévêque has dedicated a book for psychosurgery (surgery to treat mental disorders) entitled Soul surgery. He concluded the situation well: "This year, 1935, what else did we finally offer to all seriously ill patients? Lifelong detention, bromide stupidity or even shock therapy such as coma by hypoglycemia – the famous Sakel drugs – or drug-induced epilepsy, Cardiazol … "

Lobotomy, allows to calm the state of psychotic agitation and hence patients to switch from lifetime hospitalization to home again.

But as is often the case in medicine, when the technique seems to work and there is no therapeutic alternative, it is overused – because at that time there were only a few control institutions. Many children are considered too nervous to undergo surgery.

A safer alternative

The main problem arises quickly: the sequel to the lobotomy is sometimes terrible and irreversible. From the start, criticism was made of techniques that were considered too crude, which had serious neuropsychological effects and caused personality changes.

Urinary incontinence, egocentrism, indifference, patient puerility and a dramatic decrease in IQ: very severe post-lobotomy syndrome.

"We replace psychosis with mental disabilities," worry later Dr. Hoffman, head psychiatrist from service veterans in the United States.

One of the most famous people doing lobotomy was Rosemary Kennedy, JFK's older sister. When he was 23 years old by Dr. Freeman because of behavior problems, he spent the rest of his life in an institution.

Even the inventor of the procedure recognizes the limits. At the International Psychosurgery Conference in Lisbon in 1948, Moniz stated: "I don't know what will happen to brain leukotomy [l’autre nom de la lobotomie, ndlr] as a treatment. Maybe sooner or later it will be replaced with a better and safer method. "

Indeed this is what happened, a few years later. The neuroleptic discovery will ring a bell lobotomy. In 1951, French surgeon Henri Laborit identified the first of them, chlorpromazine, to be effective in treating psychosis.

This discovery would deserve the Nobel Prize: neuroleptics would revolutionize psychiatry, just as antibiotics had changed the management of infectious diseases.

This moment in psychiatric history, which is characterized by the emergence of neuroleptics as an alternative to lobotomy, is well illustrated by this film. Shutter Island. Film Mountain also at this time: finally the arrival of the drug makes the lobotomy obsolete.

Freeman, however, continued operations until 1967, when a patient who had lobotomized for the third time died of intracranial bleeding. Lobotomists are then barred from exercising and this technique is gradually banned in most American states.

Come back gracefully

Psychosurgical stories can stop there. It must be said that in addition to its derivatives, lobotomy touches the taboo of the anatomical approach to psychology. However, the discipline made a big comeback in the 1980s-1990s, with the development of deep brain stimulation.

This technique, used for the first time at the University of Grenoble Hospital in 1987, was almost miraculously effective in certain patients suffering from Parkinson's disease.

This method consists of implanting electrodes in the brain sending weak electrical stimulation. The indications today extend to certain psychiatric disorders such as severe OCD, and why not tomorrow for resistant depression.

In the United States, operations such as cingulotomy are sometimes performed for treatment-resistant OCD after an MRI score.

Similarly, electroconvulsive therapy – better known as electroconvulsive therapy – the time that is condemned to abuse it, now returns to mercy. Practiced in good condition and for good reasons, this gives impressive results, especially in the case of resistant depression.

New neuromodulation techniques, such as repetitive transcranial magnetic stimulation, also intervene directly in the brain, but without being invasive.

By becoming more precise and more ethical, neurosurgery can have a bright future ahead of it. "The future in this area looks rather attractive to sick people, noted Dr. Marc Lévêque. It is still necessary to remain vigilant, so as not to sink into the excesses of the first-generation psychological surgery. "

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