Lobotomy by Any Other Name

Commentary by Peter R. Breggin, M.D.

On August 4, 2003 the Los Angeles Times published a story by Benedict Carey on the “New Psychosurgery” being conducted at medical centers at Harvard University and Brown. The syndicated report was republished around the country as recently as October 2003. The potential patients were identified as individuals suffering from intractable depression and obsessive compulsive disorder (OCD).

The psychosurgeons are attempting to recover from one of the more serious blows dealt to their aspirations in the past two decades. In June 2002 a landmark malpractice suit was brought against another national medical center where a surgeon was performing very similar psychosurgery (Zimmerman v. Cleveland Clinic). The victim of the combined capsulotomy and cingulotomy was a 58-year-old woman. After the surgery, she was rendered mute and robotic. Two doctors from the Harvard project testified on behalf of the surgeon and I testified as a psychiatric expert on behalf of the patient. After hearing both sides of the controversy, the jury awarded $7.5 million to the injured patient and the psychosurgery project at the Cleveland Clinic was shut down.

The surgery is not new and the story made the same discredited claims that have been offered for lobotomy since the 1940s. The two forms of psychosurgery that are being promoted — cingulotomy and capsulotomy — are the same techniques used in combination in the Cleveland Clinic malpractice case.

Cingulotomy was first performed in 1948 and capsulotomy in 1949 during the first great wave of lobotomy. These surgical interventions interrupt and destroy large bundles of nerve connections in the brain (white matter). These nerve connections include pathways to and from the frontal lobes. As a result, innumerable brains cells (neurons in gray matter) die throughout various portions of the brain. Much of the cell death occurs in the adjacent frontal lobes of the brain — the seat of all higher human functions. This is the scientific definition of lobotomy. The inevitable result is widespread damage to the high mental functions, including judgment, insight, future planning, social awareness, and creativity.

Exactly this kind of psychosurgery fell out of favor decades ago because it causes severe damage to the mental and emotional processes. In the early 1970s, a second wave of psychosurgery began with cingulotomy as the most common operation. I worked as a psychiatric consultant with the U. S. Congress to form the psychosurgery commission which ultimately declared all psychosurgical operations experimental and unfit for routine clinical use. In a trial in which I testified as an expert in 1973 in Michigan (Kaimowitz v. Department of Mental Health), a three-judge panel declared the same psychosurgery too damaging to the brain, mind, and personality to be permitted in state facilities. This precedent-setting case has never been challenged in the courts. Most psychosurgery projects around the country, including cingulotomy and capsulotomy, were stopped. Harvard and Brown are the only two that have been identified as remaining in North America.

I have personally evaluated five cingulotomy psychosurgery cases performed at Harvard. These individuals lost memory and reasoning functions, were flatted emotionally, and became unable to relate in a caring manner to other people. Four became legally incompetent.

There is no mystery about how the surgery “works.” It produces intellectual and emotional blunting. The doctors rate this apathetic state as an improvement. Patients who submit to this surgery are never told how damaging it will be to their most basic human processes.

The psychosurgery performed at Harvard and Brown is the same old lobotomy that was rejected by science, medicine, and the public decades ago. Damaging the brain is not a solution to human psychological suffering.