What is Psychosurgery?

Psychosurgery is a very rare set of surgeries which used to be extremely common in the treatment of mental disorders. Most people associate this with some form of lobotomy, though not all surgeries are of this type. It is true that the majority of psychosurgery methods were lobotomies, usually disrupting and permanently damaging brain tissue in the frontal lobe in the hopes of curing psychiatric conditions. Such procedures are rare at present, though in a few places in the world they may still be performed.

Generally, neurosurgeons who perform surgeries on the spine and brain performed frontal and other types of lobotomies. The first of these types of psychosurgeries were documented in the 19th century, with evidence of earlier employment of them in a variety of cultures. Gradually, techniques like the ice pick lobotomy, which could be performed under local anesthesia, gained acceptance. In particular, Dr. Walter Freeman, in America, lectured, traveled, and performed this type of psychosurgery through much of the United States.

The method of psychosurgery that Freeman evolved used an ice pick. This was hammered into the brain’s frontal lobe. This certainly caused irreparable brain damage in numerous cases. Such brain damage might give the appearance of an improved mental status, and what it especially might do was promote calmer behavior in a person, due to reduced brain function. There is plenty of evidence it did not cure many mental illnesses and there were people who underwent more than one lobotomy to try to address existing symptoms.

The brutality of Freeman’s methods and his callousness in the face of treating human beings seems obvious now, but during the middle part of the 20th century, his ideas became widely accepted in the medical community, resulting in numerous lobotomies being performed. Critics were few in number though there were some. Some estimate that during Freeman’s acceptance by other doctors, roughly 50,000 Americans had lobotomies, and they were performed in many other countries too. In psychiatric treatment, changes in therapeutic approach moved away from Freeman's and other similar methods and have swung toward drug and talk therapy, which tend to be both less dangerous and more likely to cure patients.

This does not mean that psychosurgery is completely gone. There are still some centers that perform certain types of lobotomies. One type that is less damaging to the brain has been suggested as potentially useful in the treatment of resistant obsessive-compulsive disorder (OCD) and possibly bipolar disorder. A few other surgeries like brain stimulation are also considered psychosurgical, but they do not carry the same taint of early methods of lobotomy, and work on minimizing brain damage instead of producing it.

Unlike in the mid-20th century, any form of psychosurgery performed today in a free country would be a treatment of last resort, when all other treatments had been tried. Any psychosurgery would need absolute consent of the patient too, which was not the case in earlier days. Neurosurgeons and psychiatrists alike often view the employment of psychosurgery in the 20th century as a matter of embarrassment: a step back in medicine instead of step forward toward more rational and improved patient care.