Lobotomy to TMS: How Science Evolved To Treat Mental Disorders Ethically

Psychosurgery is an umbrella term to refer to different types of surgical interventions that aim to alter a person’s behavior, thoughts, and mood. One of the more famous types of psychosurgery is lobotomy. It’s a surgical treatment wherein a hole is drilled into a person’s skull. The procedure’s primary purpose is to cut brain nerve fibers connecting the frontal lobe to other parts of the brain. 

It rose to fame in the early 1930s and continued being practiced until the later parts of the 1950s. When Egas Moniz of Portugal bagged a Nobel Prize for introducing lobotomy to the rest of the world, Walter Freeman Jr., the father of the well-known consciousness researcher Walter Freeman III, already started performing lobotomies throughout the United States. 

1941, Freeman performed the procedure on John F. Kennedy’s 23-year old sister, Rosemary Kennedy. Because lobotomy involved inserting a sharp instrument into the skull-drilled holes to destroy the frontal lobe tissues, it left Rosemary severely disabled. As a consequence, she needed special care all throughout her life.

Freeman and his Lobotomobile

Despite what happened to Rosemary Kennedy, Freeman continued performing lobotomies. Later on, he even invented another procedure called ‘transorbital lobotomy.’ This time, an ice pick slipped past a person’s eyeball, thrusting the same through the back of their eye socket before swishing it to and from the brain. After this discovery, he drove all over Canada and the U.S. onboard his station wagon called the ‘Lobotomobile’ to perform more than 20 transorbital lobotomies per day. 

Most of his patients were elderly and women from the mental hospital. He usually knocks them out through electroshock therapy. Unfortunately, three patients died immediately after the operation. Despite this, Freeman still kept practicing lobotomies until he performed such a procedure on a total of 5,000 people. He only stopped when one of his patients in 1967 died from a cerebral hemorrhage. 

Is it a successful practice?

Even before Freeman died, he still insisted that his procedure is a success because it helped many people deal with their mental health issues. However, Edward Shorter, a world-renowned medical historian, challenged Freeman’s definition of success. According to him, Freeman defined success in the sense that lobotomy stopped his patients from being agitated. But, unfortunately, this doesn’t mean they’re cured because although they were discharged from the mental facility, they were rendered incapacitated to function normally, Shorter said. He also added that most of Freeman’s patients lacked energy and were demobilized permanently.  

The stigma of Lobotomy

John Fulton announced in 1952 that the lobotomy era had already ended. However, it was also only at this time that Freeman’s credentials were scrutinized. Unlike Moniz, Freeman is not a licensed neurologist but a physicist. Five thousand lobotomies later, Freeman’s methods were questioned for being unreliable and unethical. In addition, they found out that there was blatant maltreatment of marginalized patients like the mentally ill, elderly, and women.

It was also revealed that informed consent was blatantly disregarded for most patients who underwent surgery and were forcefully dragged to the operating table. Thankfully, because these issues were brought to light, the new generation of scientists and neurologists learned from the mistakes of the past. 

They used the same to develop less invasive and more ethical methods in treating mental disorders. Besides that, they now perform psychosurgery with ethical concern, care, and knowledge. Apart from that, lobotomies are now considered the last resort when pharmacological interventions, clinical therapy, and other treatments repeatedly fail. 

What is Transcranial Magnetic Stimulation (TMS) Therapy?

One of the therapies and treatments that developed after thorough researches is TMS or Transcranial magnetic stimulation. It’s a noninvasive brain stimulation treatment that utilizes electromagnetic pulses to activate nerve cells. Its primary purpose is to manage the symptoms of mental health and neurological disorders. And because it also utilizes repetitive electrical impulses, this treatment is also known as repetitive transcranial magnetic stimulation or TMS. 

TMS is far from the highly invasive psychosurgeries of the past, but it serves the same purpose — to treat the depressive mental condition. The Food and Drug Authority (FDA) gave this treatment a go by approving it in 2008 to help patients who don’t get a positive response to psychotherapy and antidepressant medication. Aside from these conditions, several studies showed how TMS helps address Parkinson’s disease and anxiety. 

How does TMS work?

TMS is a method administered by a TMS physician or TMS technician. You don’t need to get admitted to undergo this procedure. If ever you’re doing it in a hospital, you don’t need to stay there overnight. When you’re about to start the procedure, they’ll need you to remove all magnet-sensitive items you’re wearing, like jewelry. And as you go through the process, you can expect to do the following:

  • The TMS physician or technician will ask you to wear protective earplugs to lessen the sounds you’ll hear from the magnetic impulses. You will also be asked to sit in a chair and remain in a comfortable position. Since they won’t administer general anesthesia, you will be wide awake during the entire treatment. 
  • On your first treatment session, the TMS physician or technician will take measurements of your head to see where to position the magnetic coil properly. Other measurements will also be taken so they can personalize the TMS machine settings. 
  • The coil will be placed above your brain’s frontal part. Afterwhich, treatment will commence. 
  • Expect to hear a clicking sound — this means that magnetic impulses are being released. You can also expect to hear a knocking or tapping sensation under the magnetic coil.

The entire session will only last for 30 minutes to an hour. After that, you can already drive home and perform your usual activities. You need to repeat these sessions five times per week for at least 4 to 6 weeks. Your attending doctor will determine how long your treatment should last after evaluating your specific condition and responses. 

Takeaway

Lobotomy may have been an unethical and questionable procedure to address mental health issues. However, its birth and practice became a lesson for the succeeding generation of neurologists and researchers. It started with depriving the marginalized patients of a chance to say no, and it ended with a more ethical, noninvasive, scientific, and more effective method of treating mental disorders. With these, we can say that science evolved along with morality and conscience.

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