PSYCHOSURGERY

Wires exiting through the scalp.
Wires exiting through the scalp.
Image Source Welcome Images (L0072639) (CC Licence 4)

Introduction

This subject has cropped up before on our website - please see our articles on the Epsom Hospital Cluster and Dr Henry Rapoport Rollin.

The crude and facile argument for psychosurgery was that patients were in a hopeless mental state and that there was nothing else to be tried. This case was, of course, made by some doctors who treated mental patients and it stemmed from a belief that psychiatric illnesses were caused by specific brain lesions.

This particular article has been provoked by the story of Josef Hassid, who was diagnosed with schizophrenia, so we should first look at what schizophrenia is understood to be in today's terms.

Schizophrenia

The NHS Choices website explains how schizophrenia can manifest itself and the possible causes of the condition, but there seems to be no single cause: it is more likely to be a combination of causes. Violence is not an automatic outcome and schizophrenia is not what we glibly think of as a 'split personality'; the sufferer may experience hallucinations (such as 'hearing voices'), delusions, changes in behaviour and thoughts and social withdrawal. Today patients are treated by a variety of methods, which can encompass antipsychotic medicines, counselling, psychiatric help, social workers and therapies of different kinds. In other words, the treatment is a 'package' tailored to the specific patient's condition and the objective is successful management of the illness, which is dependent on the patient's co-operation with the treatment regime. There is no cure as yet.

A variant illness is known as schizoaffective disorder, which is said to combine elements of schizophrenia with elements of bipolar disorder (formerly called manic depression). An example of this is the Australian pianist David Helfgott, whose story was depicted in the film 'Shine'. There are some parallels between Helfgott and Hassid, in that they were both child prodigies who undertook their formal musical studies in England, but Helfgott survived many years of therapy and hospitalisation and is still performing today.

Treatment of Polish refugees

Dr George Bram was at Long Grove Hospital for at least part of Hassid's time there and he had an interesting history as a psychiatrist who treated many Polish refugees with mental illnesses, such as shell-shock, who had been in the Allied Armed Forces and could not return to Poland. The book 'Reason and Passion: A celebration of the Work of Hanna Segal' says that conditions at Long Grove were generally appalling, especially for the Poles who spoke no English. Bram had been appointed to care for these patients and wanted to get them out of there into better surroundings. Along with the psychoanalyst Hanna Segal, herself a Polish refugee, he established a rehabilitation centre. Bram eventually moved on to Mabledon Hospital, Dartford, where he treated Polish patients, but increasingly found his facilities encroached upon by overspill cases from other departments. Mabledon ultimately went the way of the Epsom Cluster and was demolished, with various organisations constantly wrangling over what should be done with the site.

The lobotomists in Britain

Barnwood House Hospital in Gloucester was a private facility and in 1939 it formed an alliance with the Burden Neurological Institute near Bristol. Basically, Barnwood provided the guinea pigs and Burden administered experimental treatment, such as electroconvulsive therapy (ECT) and the lobotomy. The first lobotomies of this joint enterprise were performed with a paper knife and Barnwood subsequently engaged Wylie McKissock to carry out the procedure.

Sir Wylie McKissock (1906-94) was an enthusiastic and prolific lobotomist, who set up the neurosurgical unit at the Atkinson Morley Hospital (then in Wimbledon but latterly relocated to St George's Hospital, Tooting). He and other neurosurgeons would travel to various hospitals which did not have resident neurosurgeons and perform the operation in little more than a few minutes. McKissock's lobotomy activities tend to be omitted or glossed over in obituaries.

Neurosurgeon Geoffrey Cureton Knight (1906-94) was initially an advocate of the lobotomy in cases of intractable mental illness, but he refined the techniques and came up with a procedure called Stereotactic Subcaudate Tractotomy (SST) which, simplistically, involves the implantation of temporarily radioactive seeds to destroy small portions of the brain. Such operations were still going on into the 1990s, primarily in cases of depression and Obsessive Compulsive Disorder (OCD), but, again, a range of side effects had been observed.

On the subject of side-effects, a sad case was reported in the Chester Chronicle of 17 January 2017. According to the newspaper, Mrs Kathleen Wheatley had as a young woman suffered from severe anxiety and, following ECT treatment, she underwent a lobotomy in 1979. The operation apparently caused her thyroid gland to become overactive and her weight ballooned. After years of dieting and exercise Mrs Wheatley had a gastric band operation which, in turn, caused her to develop an ulcer. Ultimately she suffered a cardiac arrest and sepsis and died in 2015. The coroner's verdict was that her death was 'due to natural causes in combination with the effects of obesity likely caused by a lobotomy and the complications of necessary surgical treatment'.

Closer to home, Netherne Hospital at Hooley was founded in 1905 to alleviate overcrowding at Brookwood Asylum; it had always operated a fairly enlightened treatment regime, but also suffered from the same problems as the establishments in the Epsom Cluster, being used as a war hospital, taking displaced patients from other places and generally becoming overstretched. In 1942 neurosurgeon Eric Radley-Smith performed 50 lobotomies at Netherne, with mixed results, as was usually the case. It is, however, very clear from the numerous accounts of the 'lobotomy era' that quite often the post-operative monitoring was fairly superficial, one of the objectives in many facilities being to quieten down violent or difficult patients for the benefit of hard-pressed staff.

Radley-Smith was also a pioneer of the hypophysectomy, which entails removal of the pituitary gland and is still performed today. In this instance the underlying scientific justification is on a firm basis, in that it is a viable treatment for tumours: however, there can be various side effects and complications.

Eliot Slater CBE (1904-83) was a distinguished and influential psychiatrist, who was clinical director of Sutton Emergency Hospital (Belmont) for many years, but he was also an advocate of the lobotomy. He wrote in the British Medical Journal of 9 June 1951 as follows.
'Practically all workers with an extensive experience are agreed that the main significance of leucotomy is that it is the most certain measure we have for reducing anxiety and tension which have existed for a long time. Much of the earlier work on the damage to the personality resulting from leucotomy is now of historical interest only'. Slater went on to say that the techniques had been refined and that most leucotomies did not involve such extensive invasion of the brain as in the past. He then said, 'The modern and more limited operations are enough to bring the needed relief to a wide range of patients, even though there are still some whose symptoms are so severe that something more will be required'.
Later in the article he sought to explain why
'many patients, especially in the schizophrenic group fail to improve because of the severity of their mental illness'.
He said,
'The operation may bring about a greater social accessibility but reveal an unsuspected degree of deterioration of personality and flattening of emotional responsiveness. Such defects in these cases should be attributed to their true cause, the sequelae of the schizophrenic process, and not in the absence of evidence laid to the discredit of the operation'.
The article on Slater in the Oxford Dictionary of National Biography makes no mention of leucotomies.

William Sargant (1907-88) was more controversial than Slater and was also at Sutton Emergency Hospital during the Second World War. Sargant sometimes felt thwarted there, since it was under the jurisdiction of the London County Council, whose advisers were required to approve every 'unusual procedure', particularly the lobotomy, and often didn't approve. So, Sargant got round this by sending patients to McKissock at St George's. Subsequently he was in charge of psychological medicine at St Thomas' Hospital in London, where his treatment regimes involved ECT, deep sleep therapy, insulin shock therapy, methedrine (methamphetamine) and other drugs, often in large doses - many patients were subjected to some or all of the treatments at the same time and often without a patient's informed consent. (Main sources: Wikipedia, supported by comprehensive inline citations; 'Visionary or Disaster; a perspective on William Sargant' by Dr Nick Read)

William Walters Sargant, identity card, 1947.
William Walters Sargant, identity card, 1947.
Image Source Welcome Images (L0028434) (CC Licence 4)

In recent years the actress Celia Imrie has talked about her experiences as a teenaged anorexic, as a result of which, in the mid-1960s,weighing just over 4 stone, she was admitted to St Thomas' under the care of Sargant. She has sometimes said that she cannot remember what treatment she received, but in other interviews (e.g. 'The Daily Mail' of 18 October 2011) there is mention of ECT and insulin coma therapy. In any event she regards the whole experience as 'ghastly' and has described Sargant as 'brusque and cold' with 'dark, hard, evil eyes' ('The Daily Mail', 04 April 2011).

Psychosurgery now

Psychosurgery is rarely practised today and is very much a last resort requiring informed consent. The Mental Health Act 1983 introduced the consent requirement and also provided that an independent panel, including a psychiatrist, must establish that the patient does indeed consent. The modern term for psychosurgery is NMD (Neurosurgery for Mental Disorder). The current position is simply explained in a booklet issued by Mind, the mental health charity.

Mind stresses that NMD today, which is very rare and is not performed in England at all (the two centres for such an operation are in Scotland and Wales), is not a lobotomy, although to a layperson it sounds somewhat similar. In broad terms, incisions are made in the head and parts of the brain are destroyed by electric current. However, the fact that such surgery is so rare indicates that alternative options are preferred if at all possible.

In September 1999 the singer Lena Zavaroni, formerly a child star, underwent a surgical procedure ('not a lobotomy') in Cardiff. She had consented and the legal requirements of the Mental Health Act 1983 were complied with. Lena had struggled with eating disorders - broadly, what we call anorexia - and mental issues for much of her life and this was said to be a last resort option for her as an alternative to suicide. Latterly she lived on state benefits and her weight was just over four stone. It seemed for a short while as if the operation might have worked, but three weeks later Lena died of bronchial pneumonia. No direct causal link was established between the surgery and the pneumonia, but the surgeon said that she was simply too weak to fight off the infection. Lena was just short of her 35th birthday and had battled with anorexia for 22 years.

Lena Zavaroni in Madurodam, The Netherlands.
Lena Zavaroni in Madurodam, The Netherlands.
Image Source Nationaal Archief, Den Haag, via wikimedia

Postscript

It must be emphasised that most of the doctors and institutions mentioned above did many good things and should not be viewed exclusively in the light of lobotomy work. The Burden Neurological Institute, for example, introduced the drug Epanutin (Phenytoin/Dilantin) in the UK as a treatment for certain types of epileptic seizure; McKissock performed surgery on war casualties with brain injuries and Sargant treated shell-shocked soldiers.

The lobotomy was born out of desperation at a time when there was nothing else to be done about patients with very severe mental illnesses, but the 'system' was abused, particularly in the USA. Howard Dully was just twelve years old when he was subjected to a transorbital lobotomy by the now infamous Dr Walter Freeman, who diagnosed the lad as schizophrenic. In truth, Howard was difficult and troubled, but his step-mother found him uncontrollable and he was mistreated. Other doctors perceived his behaviour as fairly typical for someone of his age who was unhappy at home, but the gung-ho ice-pick wielder, Dr Freeman, was the answer to Mrs Dully's problem, it seems. After the operation Howard spent a long time in various institutions and descended into alcoholism but, miraculously, he embarked on a journey to find out what had happened to him and why and gradually clawed his way out of the pit and made something of his life.


Howard's Journey
A YouTube video clip

Linda Jackson © May, 2017