Thursday, July 14, 2005

Lobotomy Revisited

The age of lobotomy was not the golden age of psychiatry.

In The New England Journal Dr Lerner reviews the medical historical literature on lobotomy and writes that with time comes more perspective on this now-defunct practice. In particular, he examines the career of Dr Walter Freeman, the chief US proponent of lobotomy, whose Nobel Prize is the target of a recent campaign to have it revoked.

Although the notion of cutting brain tissue in order to make people submissive is repugnant from our modern perspective, the ability to discharge psychiatric patients even to a limited existence at home was perceived as a therapeutic triumph in the 1940s and 1950s...

But whereas Freeman's later excesses raise obvious red flags, his earlier efforts on behalf of a population of very ill patients pose a more complicated question. To what degree should physicians and researchers "push the envelope" in search of an effective remedy? Here the history of lobotomy offers a somewhat surprising answer. Lobotomy was not, as it was long considered, an aberrant and cruel therapy promulgated by fringe practitioners. Rather, it exemplified a common characteristic of medical practice, in which doctors and patients have often felt the need to "do something" in the face of seemingly hopeless situations. In such cases, some patients have inevitably served as guinea pigs. Radical cancer surgery, artificial-heart implantation, and the early organ transplantations come to mind. Sometimes, the interventions are the first step toward a successful remedy; in other instances, they prove worthless.

There's not much really at stake in the decision of whether to rescind Freeman's Nobel Prize--he practiced by the now-substandard ethical standards of his day, and nobody plans to model a career after his. The broader lesson is that the next time a wonder cure emerges, the medical profession and society at large ought to take our time and involve many people with a multitude of perspectives into the ethical decisionmaking about how to apply it, because we've seen wonder cures morph into monstrosities. Luckily, this is a lesson we've mostly learned.


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