Unkind Cuts

Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness

by Elliot S. Valenstein
Basic Books, 338 pp., $19.95

This is the book which for some length of time I have been awaiting. Not without trepidation, having lived through those lamentable years that made up what the author calls “the rise and decline of psychosurgery.” Professor Valenstein deals particularly with the mutilating brain operation known as a leucotomy—or, in the US, lobotomy—which was performed on tens of thousands of people before its decline in popularity during the 1950s. Most of the principals who developed this procedure were known to me and although I was little more than a disapproving onlooker, I was never an active protestor, I regret to say.

As Professor Valenstein points out in his scholarly account, the operation of leucotomy did not appear upon the psychiatric scene unheralded. The failure of conservative measures to alleviate the symptoms and behavior of a large and captive population of psychotics encouraged the introduction of procedures some of which were reckless, drastic, traumatic, and crude. As in frustration one kicks or thumps into action a faulty radio, the alienist resorted to measures that in every sense of the word were shocking. During the first thirty years of this century dangerous methods inducing states of hypoglycemia, smothering, suffocation, hypothermia, electroshock, or convulsant drug-intoxication were deliberately employed in cases where mental illness was intractable, distressing, or socially unacceptable. The author quotes the apt remarks of my friend the late Dr. Maurice Partridge.

Bizarre illnesses may require bizarre treatment, and in psychiatry they often get it. They show so often a stubbornness and resistiveness to treatment, they expose so clearly the ignorance of their pathology and aetiology that they arouse aggressive reactions in the baffled and frustrated therapist.

Disapproving of long-winded metaphysical attempts to solve the intrapsychic conflicts of the insane as practiced by analysts, those who were in charge of psychotic patients resorted either to desperate and ill-considered steps or else to studied inactivity.

Those of us whose professional lives had been devoted to helping vicitms of structural disease of the brain were horrified by these somatic treatments, which seemed to create the very problems we were trying to cure. A grim homeopathy, indeed. But, strange to say and reluctant to admit, occasionally such violent interventions seemed to work; or, at any rate, distressing symptoms lessened or even disappeared. No obvious explanation was available or even sought. Res ipsa loquitor, as lawyers say.

Neurological sensitivities had in fact already been blunted by the apparent success during the 1920s of treating cases of general paresis by a malaria-induced fever. Such patients had traditionally come within the province of neurologists and not that of psychiatrists or alienists. A few neurologists, like the distinguished Foster Kennedy, even welcomed the advent of insulin coma in schizophrenia as an offset to Freudian analysis. In his preface to the American edition of Sakel’s monograph on insulin shock therapy, he had written, in 1938, that the scholarship of his time was being “blown away by a new wind” and that “we shall not again be content …

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