Between 1935 and 1970, tens of thousands of people worldwide underwent brain operations due to psychiatric indication that were intended to positively influence their mental state and behaviour. The majority of these psychosurgical procedures were prefrontal lobotomies. Developed in 1935, the procedure initially met with fierce opposition, but was introduced in numerous countries in the following decade, and was employed up until the late 1960s. This article investigates why psychosurgery was widely accepted after World War II. It examines the effects (...) it was hoped psychosurgical intervention would have, the undesired outcomes in which the method could potentially result, and the significance these outcomes were given. The analysis of scientific articles of the period as well as one case study show that the goal of the operation was, first and foremost, to help the mentally ill adapt to the social order inside and outside the mental institution. After initial criticism, changes in personality, severe physical side-effects and death were accepted in order to reach this goal. Thus, with psychosurgical intervention the social adjustment of patients, also in their own interest, was rated higher than physical and psychic integrity. This widely held view shows that after World War II a post-bourgeoise order of the subject dominated, according to which an individual was to adapt and to function in the interests of the collective. According to the assumption, the triumph of lobotomy was related to the development of a new conception of the self that made possible a broad implementation of the procedure and that was consolidated through psychosurgery. (shrink)

Dr. Jonson, Professor of Medical Ethics at the University of California, San Francisco, was a member of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and is currently a member of the President's Commission for the Study of Ethical Problems in Medicine and in Biomedical and Behavioral Research. Mr. Yesley practices law in Santa Fe, New Mexico, and was the staff director of the National Commission. This article is reprinted from Medicolegal News with permission (...) from the American Society of Law and Medicine, © 1980. (shrink)

Who was truly capable of experiencing pain? In this article, I explore ideas about the distribution of bodily sensitivity in patients from the early nineteenth century to 1965 in Anglo-American societies. While certain patients were regarded as “truly hurting,” other patients’ distress could be disparaged or not even registered as being “real pain.” Such judgments had major effects on regimes of pain-alleviation. Indeed, it took until the late twentieth century for the routine underestimation of the sufferings of certain groups of (...) people to be deemed scandalous. Often the categorizations were contradictory. For instance, the humble status of workers and immigrants meant that they were said to be insensitive to noxious stimuli; the profound inferiority of these same patients meant that they were especially likely to respond with “exaggerated” sensitivity. How did physicians hold such positions simultaneously? Pain-assignation claimed to be based on natural hierarchical schemas, but the great Chain of Feeling was more fluid than it seemed. (shrink)

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal (...) research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a cure of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction. (shrink)

ArgumentIn the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more “scientific” understanding and (...) better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable. (shrink)

All recent memory theories of hippocampal function have incorporated the idea that the hippocampus is required to process items only of some qualitatively specifiahle kind, and is not required to process items of some complementary set. In contrast, it is now proposed that the hippocampus is needed to process stimuli of all kinds, but only when there is a need to associate those stimuli with other events that are temporally discontiguous. In order to form or use temporally discontiguous associations, it (...) is essential to maintain some memory of the first component until the second component has occurred. When the temporal gap to he spanned is small, and the number of items to be temporarily retained is low, a limited-capacity, short-term store is sufficient to allow associations to be formed. Such a store is presumed to operate in parallel with the hippocampus in normal animals. Hippocampal damage disrupts a much higher-capacity store that has a slower decay rate, and so leaves animals with only a very limited ability to form temporally discontiguous associations. Hippocampal damage, however, is not held to affect the long-term storage of associations of any kind, if they can be formed. Analyses of both new and existing data are presented to show that by classifying tasks in terms of the need to use a temporary memory store to retain temporally discontiguous information one can cut right across existing classifications as well as achieve a better fit to the data. The hippocampus thus seems best described as a high-capacity, intermediate-term memory store. (shrink)

A preliminary attempt is made to analyze the intraspecihc aggressive behavior of mammals in terms of specific neural circuitry. The results of stimulation, lesion, and recording studies of aggressive behavior in cats and rats are reviewed and analyzed in terms of three hypothetical motivational systems: offense, defense, and submission. A critical distinction, derived from ethological theory, is made between motivating stimuli that simultaneously activate functional groupings of motor patterning mechanisms, and releasing and directing stimuli that are necessary for the activation (...) of discrete motor patterning mechanisms. It is suggested that motivating stimuli activate pathways that converge upon sets of homogeneous neurons, called motivational mechanisms, whose activity determines the motivational state of the animal. A defense motivational mechanism is hypothesized to be located in the midbrain central gray. In addition to tactile, auditory, and visual inputs from the paleospinothalamic tract, lateral lemniscus, and (perhaps) from the pretectum, it may receive inputs from a major forebrain pathway whose functional significance is not yet understood. A submission motivational mechanism is also thought to be located in the central gray. In addition to inputs for defense, it is thought to receive a necessary input from a "consociate (social familiarity cue) modulator" located in the ventromedial hypothalamus, which can switch behavior from defense to submission. The location of the hypothetical offense motivational mechanism is not known, although the pathways by which it is activated are traced in some detail. (shrink)