Why is a lobotomy done? Lobotomy as a method of treatment of mental and narcological diseases

Lobotomy is a surgical method for the treatment of mental illness, the meaning of which is to disconnect or destroy the connections of one of the parts of the brain of the head with the rest of its sections. As a rule, the concept of "lobotomy" by itself means the separation of any of the frontal parts from the rest of the brain. This is a neurosurgical operation that this moment not used, that is, it is already history.

This method of treatment was developed in those years when there were no effective drugs with which to cure schizophrenia, mental behavior disorders with hallucinations and delusions, when psychiatric patients were a significant threat to the lives of other people. After the creation of Aminazin(a drug class of antipsychotics) lobotomy has become an unclaimed treatment. But there are a lot of terrible stories and legends around this concept, which are still being retold in our time. What kind of terrible treatment is this, who created it and first used it, what consequences this operation had, you will learn by reading this article.

History of lobotomy

The founder of this type of surgical intervention is Dr. Egas Monitz(Moniz) from Portugal. In 1934, at one of the meetings of neurologists, he became very interested in one of the experiments of his colleagues, which cut out the frontal part of a rather irritable and aggressive monkey named Becky. Due to the removal of this brain part, the monkey became controllable and quiet.

Egash proposed to conduct this experiment on humans. It's just that at that time there were no effective medications that could cope with the aggression and arousal of mentally ill patients. These people were isolated in psychiatric hospitals, they were dressed straitjackets(which was not always safe for medical workers) were placed in empty wards with soft padding on the walls so that patients could not harm others or themselves.

What is lobotomy: general concepts

By and large, there was no treatment as such, patients were “closed” in mental hospitals, from where it was almost impossible to return to a full life. Because the doctors fought over the development effective way treatment for these people. And so Egas Moniz suggested break one of the frontal parts the human brain, since it is the frontal parts that are responsible for the mental adequacy of people's behavior.

Some time after the congress of doctors in 1936, under the leadership of Egas, the surgeon Almeida Lima performed a lobotomy on a person, the first in the world. Two holes were drilled in the skull of a woman who suffered from paranoia, through which alcohol was injected, which destroyed part of the brain of the frontal lobe. The operation was called leucotomy (translated from the Greek language λευκός - white, since the substance of the brain of the head has White color, and τομή - cut). That is, nothing was removed from the cranial cavity. The patient's condition improved and, inspired by the success, doctors began to introduce this method of treatment.

Subsequently, Egas Moniz improved this operation. A special surgical instrument - leucotom, which cut the brain tissue with a loop of wire. Of the 20 people who were subjected to lobotomy, 7 began to feel better, another 7 had an insignificant result, and 6 had no effect at all. Not good positive results did not stop Egash, and he continued to use this method of treatment, and in 1949 he was even awarded the Nobel Prize for his contribution to the treatment of complex mental disorders.

The idea of ​​Moniz was very quickly and actively picked up in the USA. Neurosurgeon James Watts, with psychiatrist and neurologist Walter Freeman, began performing a lobotomy, which also required drilling holes in the skull, and, accordingly, was not available to most psychiatric clinics (since a special doctor, a neurosurgeon, was needed for this). Freeman set himself the task of simplifying the lobotomy so that each psychiatrist could independently perform this operation. And after a while, he suggested an operation called a transorbital lobotomy.

What is a transorbital lobotomy?

This surgical intervention was performed without drilling holes in the skull. Access to the brain carried out with the help of the eye.

Since the brain tissue of the head is not sensitive to pain, Walter Freeman proposed this intervention. without anesthesia, under electric shock to bring the whole procedure even closer to conventional mental hospitals.

As time went on, Walter Freeman performed one lobotomy after another, very quickly the number of operations reached the figure of 3,500 people. Walter talked about the "positive" effect of these operations, but did not go into much detail. In fact, the results were not so encouraging. Most of the patients, although they did not become so aggressive, lost their mental capabilities, fell into a stupor, and began to urinate under themselves.

Freeman directly called these phenomena surgically reproduced childhood, believing that it is in this way that the brain of the human head passes to a younger mental time. He probably thought that in the future all lost skills would develop anew, “growing up” would happen again. It is for this reason that he proposed to treat these patients as naughty children. But, unfortunately, the lost skills were not restored again, most people remained crippled for the rest of their lives.

Nowadays, physicians are obliged to first inform the patient about what will be done, how big risk and possible complications, and only then carry out complex mental or physical treatment. A sick person is obliged to understand the risk, make an appropriate decision and sign the necessary papers. However, in the days of the lobotomy, sick people did not have these rights, and informed consent was not treated very carefully. In fact, doctors could do whatever they wanted.

Freeman said that a mentally ill person cannot give consent to a lobotomy, because he is not able to realize all the benefits from it. But simply, in this way, the doctor did not give up. If he could not get consent from the patient, then he turned to his relatives in the hope that they would give consent. What is much worse, when the patient had already agreed, but changed his mind at the last second, the doctor still performed the operation, even when it was necessary to “turn off” the person.

In most cases, the patient had to agree to the operation against his will: surgeons or family members decided for the patients, who probably did not want to harm, but were irresponsible about the treatment.

Consequences after a lobotomy

We can safely say that there were very rare cases when a lobotomy treated a mental illness, while not causing damage to human health. Most often, many results of a lobotomy were pretty bad. What complications appeared after performing a lobotomy? Let's consider:

Apparently, not all the time the elimination of mental disorders with the help of lobotomy could be compared with other "effects" of these operations. And, by and large, lobotomy did not always cure psychiatric diseases either. Based on statistics, for one third of the operated people, the operation was useless, for another third it was accompanied by significant complications, and only another third of patients received a definite therapeutic result.

When was the lobotomy operation cancelled?

Not all neurosurgeons supported this method of treatment. Thoughts have often been expressed about increased morbidity of these procedures about the inappropriateness of this method of treatment. Relatives of patients who were returned to those operated on in the state of "vegetables" began to write complaints and petitions for this inhumane method of treatment to be banned.

The only thing that most doctors agreed on was that lobotomy could only be used in those situations if none of the methods of treatment existing at that time (including electric shock, insulin therapy) showed any positive effect, and the person was very aggressive and could harm others or yourself.

But at the same time, lobotomy gradually began to gain momentum and carried out even in the most banal situations. For example, one child at the age of 12 was lobotomized because of his bad behavior and disobedience. And this is not just one example. The abuse of such a surgical method of therapy as lobotomy, unfortunately, has been noted more than once.

The decline of lobotomy falls on the 50s of the last century. In the Soviet Union, after studying the effectiveness of lobotomy treatment of 400 patients in 1950, a decree was issued by the Ministry of Health about an official ban on this method of treatment. In some countries, like Norway, America, France, England, India, Belgium, Spain, Finland and some others, lobotomy was performed until the 80s of the 20th century. There is no exact date for the ban on these terrible operations.

After investigating some cases of lobotomy, in 1977 the National Committee for the Protection of Man from Behavioral and Biomedical Research concluded that only in some situations this operation is justified, and, by and large, absolutely ineffective. And over time, this treatment has sunk into oblivion. An important role in this was played by the fact that in 1950 the neuroleptic Chlorpromazine (Aminazine) was created for the first time in the world. When it began to be used in psychiatric practice, it became a big breakthrough in treatment. And after that, there was no need for a lobotomy, since it was now possible to reduce the phenomena of psychosis with the help of conventional injections.

Modern methods of treatment

Neurosurgical treatments for mental disorders were not limited to lobotomy. After the prohibition of this cruel method of treatment developed more gentle, For example:

• limbic leukotomy;
• capsulotomy;
• anterior cingulotomy.

The meaning of which lies in the partial violation of well-defined parts of the brain. But even these methods are resorted to only in cases of resistant types of mental disorders, if no other modern methods of treatment have absolutely no effect.

That is, summing up all of the above, we can say that a lobotomy is quite barbaric treatment mental illness, which is now history. Destruction of parts of the brain with tools only to normalize mental state hasn't been done for a long time. Science has found much more effective and humane ways to treat mental disorders.

Previously, doctors with the help of lobotomy tried to heal patients with poor mental health. Today, this method seems ridiculous, and the word “lobotomy” is more often used as a joke. It has long been clear that the technique does not work, but it is completely incomprehensible how they tried to treat something in this way.

1 Lobotomy Inventor Wins Nobel Prize

These days, lobotomy is considered a clear failure of psychiatry, but in the past, the procedure was performed on any occasion. The method was developed by the Portuguese doctor Egas Moniz, who was the first to perform an operation called prefrontal leucotomy. He introduced a loop into the brain and caused minor damage to parts of the brain with rotational movements. So Moniz treated schizophrenia - he realized that patients after surgery are much easier to manage.

Later, another doctor named Walter Freeman "improved" the method - he began to operate through the upper wall of the orbit. It was clearly faster. We know this procedure today under the name of transorbital lobotomy. In 1949, Moniz received the Nobel Prize for his discovery, and the apparently untested procedure gained universal confidence. Now it can be carried out legally. Soon, thousands of patients around the world were lobotomized. Exclusively for medicinal purposes, of course.

Relatives of some lobotomy victims have petitioned the Nobel Committee to cancel the award because the procedure caused irreparable harm. The committee categorically refused to consider the requests and wrote a rebuttal, where it explained in detail how the committee's decision was justified. The members of the committee considered the lobotomy best method treatment for schizophrenia: it works, it's ahead of its time, after all, so why should the award for it be considered a mistake?

It should be noted that there were no precedents: the Nobel Committee has never canceled the award, and probably never will, because it is contrary to its policy. So Egas Moniz will remain in history as a brilliant doctor.

2. Many people thought lobotomy was the best alternative.

You may be wondering: how did the practice of poking a person in the eye with a tool that looks like a small ice pick become so popular? But the goal of the doctors was good: to help people suffering from schizophrenia and other severe mental illnesses. The doctors who advocated the lobotomy were unaware of all the risks of brain surgery. They didn't see what they were doing, but the reason for the operation was valid: psychiatric hospitals were a terrible place for patients, and the procedure could help them lead a sort of normal life.

The problem is that at that time there were no drugs that could calm the violent patient for a long time. A seriously mentally ill person could cause severe harm to himself or others, so that drastic measures were sometimes required. Patients often had to be put in straitjackets and placed in a separate room with padded walls. Under such conditions, violence was commonplace. The treatment was difficult and cruel, and without effective way treatment for schizophrenics and other patients, there was no hope of ever leaving the hospital.

Lobotomy seemed like a way out of a terrible situation for both patients and doctors. It’s a pity that it ended up not being a way out, but a dead end.

3. Patient monitoring

Moniz was the first to use the lobotomy. Freeman made her popular. But at the same time, the pioneers of lobotomy did not approve of each other's methods. Moniz believed that the Freeman method (transorbital lobotomy) was not the most responsible way to do brain surgery. Freeman pierced the brains of patients for their own good with too much enthusiasm. But the Moniz method also had many shortcomings.

Moniz did not follow the further fate of his patients. He didn't even have enough evidence to draw conclusions. Strange, isn't it? He also performed operations on the brain using a new method, which had never been tested anywhere before!

Moniz treated patients and monitored their behavior for only a few days after breaking the connections in their heads. Many believe that the criteria for determining whether the patient has actually become normal was biased: the doctor really wanted the result to be positive. To be clear: Moniz found improvement in most of his patients because that is what he wanted to find. Freeman, although he practiced a perhaps more barbaric method, worked with patients after the operation. He did not abandon them until his death.

4. Surgically induced childhood

Freeman coined a term for people who have recently undergone a lobotomy: surgically induced childhood. He believed that the lack of normal mental abilities in patients, distraction, stupor and other characteristic consequences of a lobotomy occur because the patient regresses - returns to a younger mental age. But at the same time, Freeman did not assume that damage could be done to the individual. Most likely, he believed that the patient would eventually “grow up” again: re-growing up would pass quickly and eventually lead to a full recovery. And he offered to treat the sick (even adults) in the same way as naughty children would be treated.

He even suggested that parents spank their adult daughter if she misbehaved, and later give her ice cream and a kiss. The regressive patterns of behavior that often manifested in patients after lobotomy disappeared over time in only a few: as a rule, the person remained mentally and emotionally paralyzed for the rest of his life.

Many patients could not control urination. They really behaved like very naughty children: they were instantly aroused by various stimuli, showed attention deficit disorder and uncontrollable outbursts of anger.

5. Informed consent

These days, physicians must first inform the patient of what will be done, what the risks and possible complications are, and only then begin complex physical or mental treatment. The patient, being of sound mind, must realize the risk, make a decision and sign the documents.

But in the days of the lobotomy, patients had no such rights, and informed consent was treated casually. In fact, the surgeons did whatever they wanted.

Freeman believed that a mentally ill patient could not give consent to a lobotomy, since he was not able to understand all its benefits. But the doctor did not give up so easily. If he could not get consent from the patient, he went to relatives in the hope that they would give consent. Even worse, if the patient had already agreed, but changed his mind at the last minute, the doctor would still perform the operation, even if it was necessary to “turn off” the patient.

In many cases, people had to agree to a lobotomy against their will: they were decided by doctors or family members who, perhaps, did not want to harm and did not want to, but treated the treatment irresponsibly.

6 Lobotomy Destroyed Human Lives

Most often, a lobotomy either turned a person into a vegetable, or made him more obedient, passive and easily controlled, and often also less intelligent. Many physicians saw this as "progress" because they didn't know how to deal with difficult patients. If the lobotomy did not kill the patient, then doctors considered all irreparable brain damage as side effects of treatment.

Many people who asked for an appeal against Moniz Nobel Prize, complained that they or their relatives were not only not cured, but irreparable damage was done that forever made them not who they were. There was a case when one pregnant woman was lobotomized due to headaches alone, and she never became the same: for the rest of her life she remained at the level of a small child, unable to eat or take care of herself on her own.

Another example: a boy named Howard Dully got a lobotomy at the request of his stepmother - she did not like that Howard was a difficult child. Freeman strongly recommended this method as a way to change personality. And the boy spent his life losing himself forever.

7. Surgical theater

It is believed that Freeman was too happy to be able to legally perform a transorbital lobotomy on all patients indiscriminately. He not only did not consider it necessary to properly inform the patient about the risks and the procedure, but also boasted of his success in front of agitated people. Freeman often completed the procedure in ten minutes, which is short for a complex brain operation, even if it were the most rewarding operation in the world. Unfortunately, the doctor himself did not think so.

He once performed 25 lobotomies in a day. It was he who first guessed to “humanely” use electric shock to perform operations while patients were unconscious. Worse, sometimes Freeman performed lobotomies on both hemispheres of the brain just to show off. It is impossible to say exactly how many people he ruined the lives of.

8 Chemical Lobotomy

Today, lobotomy is considered an absurd barbaric procedure. But quite recently it was practiced everywhere, without even understanding what they were doing. I would like to believe that the lobotomy has disappeared forever, because the doctors finally understood what they were doing. But in reality, it has simply been superseded by more effective treatments.

Of all the doctors, only Freeman adored the lobotomy. Other doctors did not like this procedure, but they resorted to it when they thought that there was nothing else left. But time passed, and the operation was replaced by psychotropic drugs. There was a medicine called chlorpromazine, which at first was called "chemical lobotomy."

People were afraid that chlorpromazine could also permanently change the personality. But the drug clearly didn't turn patients into mindless children who can't even control basic bodily functions. And soon lobotomy as a medical practice was abandoned for good.

From Wikipedia, the free encyclopedia

The term is also used leucotomy(from other Greek. λευκός - white And τομή - incision).

After prefrontal lobotomy, the patient was diagnosed with frontal lobe syndrome (ICD-10 code F07) for life.

History of lobotomy in the West

Lobotomy was developed in 1935 by the Portuguese Egas Moniz. He hypothesized that the intersection of afferent and efferent fibers in the frontal lobe could be effective in the treatment of mental disorders. The first operation was carried out in 1936. Since, due to gout, Moniz could not perform it himself, the operation was performed by professor of neurosurgery Almeida Lima (port. Almeida Lima) under his supervision. Moniz called the operation "leukotomy", because the frontal parts themselves were not damaged, but only the white matter of the neuronal connections that connected the frontal parts to other parts of the brain cut through. This procedure was advertised as a means of salvation in hopeless situations.

The lobotomy procedure consisted of the following: a loop was inserted into the brain with the help of a conductor, and the brain tissue was damaged by rotational movements. After performing about a hundred such operations and conducting a follow-up observation of patients, which consisted in a subjective assessment of the mental state, Moniz reported the success of this operation and began to popularize it. So, in 1936, he published the results of surgical treatment of 20 of his first patients: 7 of them recovered, 7 improved, while 6 showed no positive dynamics.

In fact, Egas Moniz observed only a few patients, and most of them were never seen after the operation. Although the quality of research was criticized in the scientific audience, E. Moniz wrote hundreds of articles and books about lobotomy. Immediately after Moniz's announcement of his discovery, critical statements from the scientific community followed: for example, S. Cid argued that the changes observed by Monish in patients after surgery should be compared with the consequences of a brain injury and that, in essence, these changes represent personality degradation . Paul Courbon noted that mutilation of an organ cannot improve its function and that the brain damage caused by lobotomy entails the risk of subsequent development of meningitis, epilepsy, and brain abscesses. Despite this, Moniz's message led to rapid adoption of the procedure on an experimental basis by individual clinicians in Brazil, Cuba, Italy, Romania, and the United States.

In 1949, Egas Moniz was awarded the Nobel Prize in Physiology or Medicine "for his discovery of the therapeutic effects of leucotomy in certain mental illness».

The first studies of lobotomy led to positive results, however, as it turned out later, they were carried out without strictly following the methodology. It is difficult to assess the positive results of lobotomy, since the operations were carried out using almost incomparable methods on patients with different diagnoses. Whether or not recovery occurred was often decided on the basis of such a pragmatic criterion as improving the patient's manageability.

Even in cases where aggressiveness, delusions, hallucinations, or depression were stopped in patients as a result of lobotomy, after 5-15 years, nerve fibers from the frontal lobes often grew back into the medulla, and delirium, hallucinations, aggressiveness resumed or depressive disorders developed again. phases. An attempt to repeat the lobotomy led to a further increase in the intellectual deficit.

In the early 1950s, about 5,000 lobotomies per year were performed in the United States. Between 40,000 and 50,000 Americans were lobotomized between the late 1950s. The indications were not only schizophrenia, but also severe obsessive-compulsive disorder. Operations were carried out mainly in non-sterile conditions. Often, lobotomy was performed by doctors who did not have surgical training, which was one of the abuses of this psychosurgical intervention. Not trained as a surgeon, Freeman nevertheless performed about 3,500 of these operations, traveling around the country in his own van, which was named after him. lobomobile .

Lobotomy was widely used not only in the USA, but also in a number of other countries of the world, including Great Britain, Finland, Norway, Sweden, Denmark, Japan, the USSR. Tens of thousands of patients have undergone this operation in European countries.

The decline of the lobotomy began in the 1950s after the serious neurological complications of the operation became apparent. In the future, lobotomy was banned by law in many countries. In the USSR, lobotomy was officially banned in 1950.

After the decline of lobotomy, the development of psychosurgery did not stop, other surgical techniques developed, associated with fewer side effects and lower mortality. Ultimately, psychosurgical intervention began to be accepted as an option in a small proportion of patients with resistant mental disorders, most often affective or anxiety disorders. Common interventions include anterior cingulotomy, subcaudal tractotomy, limbic leucotomy, and anterior capsulotomy.

Lobotomy in the USSR

At the VII session of the Neurosurgical Council () N. N. Burdenko refuted the opinion that psychosurgery is “music of the distant future”. Back in 1944, he instructed his doctoral psychiatrist Yu. B. Rozinsky to study the possibilities and results of lobotomy in various serious diseases, mainly schizophrenia.

Egorov proposed his own modification of the lobotomy. Instead of a closed access through a burr hole or the roof of the orbit, he used osteoplastic trepanation, which gave a wide view of the surgical field and made it possible to more accurately navigate in determining the target of surgical intervention. Lobotomy was carried out sparingly, as a rule, only in one frontal lobe, its pole sections and always in front of the anterior horn of the lateral ventricle and subcortical nodes. With this technique, damage to the pyramidal tracts and subcortical formations was excluded.

B. G. Egorov considered theoretical basis The therapeutic effect of lobotomy is the separation of the prefrontal cortex and subcortex. Academician L. A. Orbeli, who consulted and collaborated with the Institute of Psychiatry of the Ministry of Health of the RSFSR, wrote that “he takes the liberty of talking about the physiological conclusions following from lobotomy”, namely: “the separation of the frontal lobes from the rest of the central nervous system leads not so much to the exclusion of the role of the frontal lobes from their participation in the formation of cortical processes, which leads to the elimination or weakening of the possible influence of the subcortical nodes on the cerebral cortex and to establish the influence of the cerebral cortex on subcortical formations, "and at the same time" intracortical connections are almost not violated ".

The selection of patients for lobotomy was very tough. The surgical method was offered only in cases of ineffectiveness of the previous long-term treatment, including both insulin therapy and electroshock. All patients not only underwent a general clinical and neurological examination, but were also carefully studied psychiatrically. Postoperative control was dynamic and objectified, both acquisitions in the emotional sphere, behavior and social adequacy of surgical activity, as well as possible losses were recorded. All this made it possible to develop certain indications and contraindications for prefrontal lobotomy.

A new direction in the 1940s in Leningrad was developed by the neurosurgeon Professor I. S. Babchin. He developed a sparing surgical approach for lobotomy. To approach the frontal lobes, burr holes were placed parasagittally. Next, the frontal-thalamic pathways were damaged using a leukotome of the original design. I. S. Babchin called his operation “frontal leucotomy”. At the same time, research was launched to study the anatomy and topography of the cortical-subcortical pathways. MS Korotkevich, in her Ph.D. thesis, clarified the connections between the cerebral cortex and the subcortical nuclei. A. A. Vagina, in her doctoral dissertation, substantiated lobotomy, having managed to complete important fragments before the ban: "Anatomical analysis of experimental leukotomy" and "Connections of the frontal lobe with the thalamus".

Lobotomy began to be performed in other cities of the USSR (Gorky, Kyiv, Kharkov, Alma-Ata, Sverdlovsk, Rostov-on-Don, etc.). The total number across the country began to number in the hundreds of observations. Not all patients with incurable schizophrenia were helped by surgery. In addition, performance without proper conditions and surgical skill often gave various complications that create an unfavorable impression of the method.

The struggle of opinions about the admissibility of lobotomy as a therapeutic method was at first in a natural framework and forms. Opponents and supporters of psychosurgery discussed the problem at the Plenum of the All-Union Scientific Society of Neurologists and Psychiatrists.

The accumulated ... clinical experience, based on the material of over 400 people operated on, showed that the operation of the frontal lobotomy is a relatively effective and relatively safe method of treating some forms of severe schizophrenia that are completely unresponsive to other currently existing conservative methods. This gives grounds to consider justified and humane the desire to alleviate the suffering of patients with the help of surgical intervention and try to return to life and work these permanent residents of psychiatric hospitals.

Lobotomy ban

In May 1950, psychiatrist Professor Vasily Gilyarovsky proposed to return to the discussion of leucotomy again in order to prohibit its use as a method of treatment in psychiatric institutions. The issue was again considered at the Plenum of the All-Union Scientific Society of Neurologists and Psychiatrists on June 22-24, 1950. The adopted resolution confirmed the previous decision: “Recognize the use of frontal leucotomy as a treatment modality mental illness appropriate when all other treatments have failed therapeutically".

28 of the 30 members of the Board voted in favor of this resolution, two were against. Professor Gilyarovsky insisted that his dissenting opinion be written down: "I do not consider leucotomy a method of treatment that can be recommended to psychiatric institutions."

V. A. Gilyarovsky obtained an order from the USSR Ministry of Health to verify the results of prefrontal leukotomy in the field. In the report on the verification of the Leningrad Institute. V. M. Bekhterev indicated that 176 patients underwent leukotomy, of which 152 were diagnosed with schizophrenia. The commissions were demonstrated by 8 patients with good results, but all of them had certain defects, some organic decline. Operations were performed by both surgeons and psychiatrists. Patients after leukotomy were usually transferred to other medical institutions, and therefore long-term outcomes were not studied properly.

Soon an article by the same Gilyarovsky was published in the journal "Medical Worker" (No. 37 of 09/14/1950) "Pavlov's teaching is the basis of psychiatry." It sharply criticizes the lobotomy method. For example:

It is assumed that the transection of the white matter of the frontal lobes disrupts their connections with the thalamus opticus and eliminates the possibility of stimuli coming from it, leading to excitation and generally disturbing mental functions. This explanation is mechanistic and has its roots in the narrow localizationism characteristic of American psychiatrists, from which the leucotomy was transferred to us.

Reflection in society

Lobotomy is depicted and mentioned in many famous movies and books, including the novel All the King's Men by R. P. Warren, the play by T. Williams "Suddenly, Last Summer", the Anxiety series of season 4 of The X-Files, the novel "Flying Over cuckoo's nest" by K. Kesey and its film adaptation of the same name, the thriller "Shutter Island" by Martin Scorsese, the film "Forbidden Reception", the song of the Green Day group, the fantastic action movie "Total Recall" and others. The dominant image of the effects of lobotomy in works of art is a demonstration of a patient falling into a vegetative state after surgery, unable to speak or think. Thus, the authors seek to portray the inhumanity of psychiatrists.

Cases of almost complete recovery after a lobotomy were rare - this happened, for example, with Howard Dalli, who underwent surgery at the age of 12 and subsequently wrote a book about himself, My Lobotomy. Another famous case was the story of Rose (Rosemary) Kennedy, sister of US President D.F. Kennedy, who, at the request of her father, was operated on by W. Freeman in 1941. Disabled by surgery, she spent the rest of her life in various institutions and died in 2005 at the age of 86.

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30. Dobrokhotova T.A., Bragina N.N., Zaitsev O.S., Urakov S.V., Karmenyan K.K. .

An excerpt characterizing Lobotomy

The peasants came up and took him by the shoulders and legs, but he groaned plaintively, and the peasants, after exchanging glances, let him go again.
- Take it, put it, everything is the same! shouted a voice. Another time they took him by the shoulders and put him on a stretcher.
- Oh my god! My God! What is it?.. Belly! This is the end! Oh my god! voices were heard among the officers. “It buzzed by a hair’s breadth,” said the adjutant. The peasants, having adjusted the stretcher on their shoulders, hurriedly set off along the path they had trodden to the dressing station.
- Walk in step ... Eh! .. peasant! - the officer shouted, stopping by the shoulders the peasants who were walking unevenly and shaking the stretcher.
“Make things right, Khvedor, but Khvedor,” said the man in front.
“That's it, it's important,” said the rear one happily, hitting the leg.
- Your Excellency? A? Prince? - Timokhin ran up in a trembling voice, looking into the stretcher.
Prince Andrei opened his eyes and looked from behind the stretcher, into which his head was deeply buried, at the one who spoke, and again lowered his eyelids.
The militia brought Prince Andrei to the forest, where the wagons stood and where there was a dressing station. The dressing station consisted of three spread out tents with rolled-up floors on the edge of a birch forest. There were wagons and horses in the birch forest. Horses in the ridges ate oats, and sparrows flew to them and picked up spilled grains. Crows, smelling blood, cawing impatiently, flew over on birches. Around the tents, more than two acres of space, lay, sat, stood bloodied people in various clothes. Around the wounded, with dull and attentive faces, crowds of porter soldiers stood, who were vainly driven away from this place by the officers in charge of order. Not listening to the officers, the soldiers stood, leaning on the stretcher, and intently, as if trying to understand the difficult meaning of the spectacle, looked at what was happening in front of them. Loud, angry cries, then plaintive moans were heard from the tents. From time to time paramedics ran out of there for water and pointed to those that had to be brought in. The wounded, waiting at the tent for their turn, wheezed, moaned, cried, shouted, cursed, asked for vodka. Some were delusional. Prince Andrei, as a regimental commander, walking over the unbandaged wounded, was carried closer to one of the tents and stopped, waiting for orders. Prince Andrei opened his eyes and for a long time could not understand what was happening around him. Meadow, wormwood, arable land, a black spinning ball and his passionate outburst of love for life came to his mind. Two paces from him, speaking loudly and drawing general attention to himself, stood leaning on a bough and with his head tied, a tall, handsome, black-haired non-commissioned officer. He was wounded in the head and leg by bullets. Around him, eagerly listening to his speech, a crowd of wounded and porters gathered.
“We fucked him up like that, so we threw everything away, they took the king himself!” shouted the soldier, shining with black, heated eyes and looking around him. - Come only at that very time, the reserve, his b, my brother, there is no rank left, therefore I tell you right ...
Prince Andrei, like everyone around the narrator, looked at him with a brilliant look and experienced a consoling feeling. But isn't it all the same now, he thought. – What will happen there and what was it here? Why did I feel so sorry for losing my life? There was something in this life that I did not understand and do not understand.

One of the doctors, in a bloody apron and with bloody small hands, in one of which he is between the little finger and thumb(so as not to stain it) held a cigar, went out of the tent. This doctor raised his head and began to look around, but above the wounded. He obviously wanted to rest a little. Moving his head to the right and left for some time, he sighed and lowered his eyes.
“Well, now,” he said to the words of the paramedic, who pointed him to Prince Andrei, and ordered him to be carried to the tent.
A murmur arose from the crowd of waiting wounded.
“It can be seen that in the next world the masters live alone,” said one.
Prince Andrey was carried in and placed on a table that had just been cleared, from which the paramedic was rinsing something. Prince Andrei could not make out separately what was in the tent. Plaintive groans from all sides, excruciating pain in the thigh, abdomen and back entertained him. Everything that he saw around him merged for him into one general impression of a naked, bloody human body, which seemed to fill the entire low tent, just as a few weeks ago on this hot August day this same body filled a dirty pond along the Smolensk road. . Yes, it was the same body, the same chair a canon [meat for cannons], the sight of which even then, as if predicting the present, aroused horror in him.
There were three tables in the tent. Two were occupied, Prince Andrei was placed on the third. For some time he was left alone, and he involuntarily saw what was being done on the other two tables. A Tatar, probably a Cossack, was sitting on the near table, according to his uniform, which had been thrown beside him. Four soldiers held him. A doctor in glasses was cutting something in his brown, muscular back.
- Wow, wow, wow! .. - the Tatar seemed to be grunting, and suddenly, raising his cheeky black snub-nosed face upwards, baring his white teeth, he began to tear, twitch and squeal with a piercing ringing, drawn-out squeal. On another table, around which a lot of people crowded, on the back lay a large, fat man with his head thrown back (curly hair, their color and shape of the head seemed strangely familiar to Prince Andrei). Several paramedics fell on the man's chest and held him. A large, white, plump leg quickly and often, without ceasing, twitched with feverish flutters. This man sobbed convulsively and choked. Two doctors silently - one was pale and trembling - were doing something on the other, red leg of this man. Having dealt with the Tatar, who was thrown over his overcoat, the doctor in glasses, wiping his hands, went up to Prince Andrei. He looked into the face of Prince Andrei and hastily turned away.
- Undress! What are you standing for? he shouted angrily at the paramedics.
The very first distant childhood was remembered by Prince Andrei, when the paramedic, with his hastily rolled up hands, unbuttoned his buttons and took off his dress. The doctor bent low over the wound, felt it, and sighed heavily. Then he made a sign to someone. And the excruciating pain inside the abdomen made Prince Andrei lose consciousness. When he woke up, the broken bones of the thigh were taken out, shreds of meat were cut off, and the wound was bandaged. They threw water in his face. As soon as Prince Andrei opened his eyes, the doctor bent over him, silently kissed him on the lips, and hurried away.
After suffering, Prince Andrei felt bliss that he had not experienced for a long time. All the best, happiest moments in his life, especially the most remote childhood, when they undressed him and put him to bed, when his nurse sang over him, lulling him to sleep, when, burying his head in imagination, not even as the past, but as reality.
Near that wounded man, whose head outlines seemed familiar to Prince Andrei, the doctors fussed; lifted him up and calmed him down.
– Show me… Oooooh! O! ooooh! - heard his groan interrupted by sobs, frightened and resigned to suffering. Listening to these moans, Prince Andrei wanted to cry. Is it because he was dying without glory, because it was a pity for him to part with his life, or because of these irretrievable childhood memories, or because he suffered, that others suffered, and this man groaned so pitifully before him, but he wanted to cry childish, kind, almost joyful tears.
The wounded man was shown a severed leg in a boot with gore.
- ABOUT! Oooooh! he sobbed like a woman. The doctor, who was standing in front of the wounded man, blocking his face, moved away.
- My God! What is this? Why is he here? Prince Andrew said to himself.
In the unfortunate, sobbing, exhausted man, whose leg had just been taken away, he recognized Anatole Kuragin. They held Anatole in their arms and offered him water in a glass, the rim of which he could not catch with his trembling, swollen lips. Anatole sobbed heavily. “Yes, it is; yes, this man is somehow closely and heavily connected with me, thought Prince Andrei, not yet clearly understanding what was before him. - What is the connection of this person with my childhood, with my life? he asked himself, finding no answer. And suddenly a new, unexpected memory from the world of childhood, pure and loving, presented itself to Prince Andrei. He remembered Natasha as he had seen her for the first time at the ball of 1810, with a slender neck and slender arms, with a frightened, happy face ready for delight, and love and tenderness for her, even more alive and stronger than ever, woke up in his soul. He remembered now the connection that existed between him and this man, through the tears that filled his swollen eyes, looking at him dully. Prince Andrei remembered everything, and enthusiastic pity and love for this man filled his happy heart.
Prince Andrei could no longer restrain himself and wept tender, loving tears over people, over himself and over their and his own delusions.
“Compassion, love for brothers, for those who love, love for those who hate us, love for enemies - yes, that love that God preached on earth, which Princess Mary taught me and which I did not understand; that's why I felt sorry for life, that's what was left for me, if I were alive. But now it's too late. I know it!"

The terrible sight of the battlefield, covered with corpses and wounded, in combination with the heaviness of the head and with the news of the dead and wounded twenty familiar generals and with the consciousness of the impotence of his formerly strong hand, made an unexpected impression on Napoleon, who usually liked to examine the dead and wounded, thereby testing his mental strength (as he thought). On this day, the terrible view of the battlefield defeated that spiritual strength in which he believed his merit and greatness. He hurriedly left the battlefield and returned to the Shevardinsky barrow. Yellow, swollen, heavy, with cloudy eyes, a red nose and a hoarse voice, he sat on a folding chair, involuntarily listening to the sounds of firing and not raising his eyes. With painful anguish, he awaited the end of the cause, which he considered himself the cause of, but which he could not stop. Personal human feeling for a brief moment prevailed over that artificial phantom of life that he had served for so long. He endured the suffering and death that he saw on the battlefield. The heaviness of his head and chest reminded him of the possibility of suffering and death for himself. At that moment he did not want for himself either Moscow, or victory, or glory. (What more fame did he need?) The only thing he wanted now was rest, peace and freedom. But when he was at the Semyonovskaya height, the chief of artillery suggested that he put up several batteries on these heights in order to intensify the fire on the Russian troops crowded in front of Knyazkovo. Napoleon agreed and ordered that news be brought to him about what effect these batteries would produce.
The adjutant came to say that, by order of the emperor, two hundred guns were aimed at the Russians, but that the Russians were still standing.
“Our fire is tearing them out in rows, and they are standing,” said the adjutant.
- Ils en veulent encore! .. [They still want to! ..] - Napoleon said in a hoarse voice.
– Sire? [Sovereign?] - repeated the adjutant, who did not listen.
“Ils en veulent encore,” Napoleon croaked in a hoarse voice, frowning, “donnez leur en. [If you want more, well, ask them.]
And without his order, what he wanted was done, and he ordered it only because he thought that orders were expected from him. And he was again transported to his former artificial world of ghosts of some kind of grandeur, and again (like that horse walking on a sloping drive wheel imagines that it is doing something for itself) he dutifully began to perform that cruel, sad and heavy, inhuman the role that was assigned to him.
And not for this hour and day alone, the mind and conscience of this man were darkened, who, heavier than all the other participants in this work, bore the whole burden of what was being done; but never, until the end of his life, he could understand neither goodness, nor beauty, nor truth, nor the significance of his actions, which were too opposed to goodness and truth, too far from everything human, so that he could understand their significance. He could not renounce his actions, praised by half the world, and therefore had to renounce truth and goodness and everything human.
Not only on this day, going around the battlefield, laid by dead and mutilated people (as he thought, by his will), he, looking at these people, counted how many Russians there are for one Frenchman, and, deceiving himself, found reasons to rejoice that there were five Russians for one Frenchman. Not on that one day alone did he write in a letter to Paris that le champ de bataille a ete superbe [the battlefield was magnificent] because there were fifty thousand corpses on it; but also on St. Helena, in the quiet of solitude, where he said that he intended to devote his leisure time to the presentation of the great deeds that he had done, he wrote:
"La guerre de Russie eut du etre la plus populaire des temps modernes: c" etait celle du bon sens et des vrais interets, celle du repos et de la securite de tous; elle etait purement pacifique et conservatrice.
C "etait pour la grande cause, la fin des hasards elle commencement de la securite. Un nouvel horizon, de nouveaux travaux allaient se derouler, tout plein du bien etre et de la prosperite de tous. Le systeme europeen se trouvait fonde; il n "etait plus question que de l" organizer.
Satisfait sur ces grands points et tranquille partout, j "aurais eu aussi mon congres et ma sainte alliance. Ce sont des idees qu" on m "a volees. Dans cette reunion de grands souverains, nous eussions traites de nos interets en famille et compte de clerc a maitre avec les peuples.
L "Europe n" eut bientot fait de la sorte veritablement qu "un meme peuple, et chacun, en voyageant partout, se fut trouve toujours dans la patrie commune. Il eut demande toutes les rivieres navigables pour tous, la communaute des mers, et que les grandes armees permanentes fussent reduites desormais a la seule garde des souverains.
De retour en France, au sein de la patrie, grande, forte, magnifique, tranquille, glorieuse, j "eusse proclame ses limites immuables; toute guerre future, purement defensive; tout agrandissement nouveau antinational. J" eusse associe mon fils a l "Empire ; ma dictature eut fini, et son regne constitutionnel eut commencement…
Paris eut ete la capitale du monde, et les Francais l "envie des nations! ..
Mes loisirs ensuite et mes vieux jours eussent ete consacres, en compagnie de l "imperatrice et durant l" apprentissage royal de mon fils, a visiter lentement et en vrai couple campagnard, avec nos propres chevaux, tous les recoins de l "Empire, recevant les plaintes, redressant les torts, semant de toutes parts et partout les monuments et les bienfaits.
The Russian war should have been the most popular in modern times: it was a war of common sense and real benefits, a war of peace and security for all; she was purely peaceful and conservative.
It was for a great purpose, for the end of accidents and the beginning of peace. A new horizon, new works would open, full of well-being and well-being for all. The European system would be founded, the question would be only in its establishment.
Satisfied in these great questions and at peace everywhere, I too would have my congress and my holy union. These are the thoughts that have been stolen from me. In this assembly of great sovereigns, we would discuss our interests as a family and would reckon with the peoples, like a scribe with a master.
Indeed, Europe would soon constitute one and the same people, and everyone, traveling anywhere, would always be in a common homeland.
I would say that all rivers should be navigable for everyone, that the sea should be common, that permanent, large armies should be reduced to the sole guard of sovereigns, etc.
Returning to France, to my homeland, great, strong, magnificent, calm, glorious, I would proclaim its borders unchanged; any future defensive war; any new distribution is anti-national; I would add my son to the reign of the empire; my dictatorship would end, his constitutional rule would begin...
Paris would be the capital of the world and the French would be the envy of all nations!...
Then my leisure and last days would have been dedicated, with the help of the empress and during the royal education of my son, to visit little by little, like a real village couple, on their own horses, all corners of the state, receiving complaints, eliminating injustices, scattering buildings in all directions and everywhere, and beneficence.]
He, destined by providence for the sad, unfree role of the executioner of peoples, assured himself that the goal of his actions was the good of the peoples and that he could direct the destinies of millions and, through power, do good deeds!
“Des 400,000 hommes qui passerent la Vistule,” he wrote further on the Russian war, “la moitie etait Autrichiens, Prussiens, Saxons, Polonais, Bavarois, Wurtembergeois, Mecklembourgeois, Espagnols, Italiens, Napolitains. L "armee imperiale, proprement dite, etait pour un tiers composee de Hollandais, Belges, habitants des bords du Rhin, Piemontais, Suisses, Genevois, Toscans, Romains, habitants de la 32 e division militaire, Breme, Hambourg, etc .; elle comptait a peine 140000 hommes parlant francais. L "expedition do Russie couta moins de 50000 hommes a la France actuelle; l "armee russe dans la retraite de Wilna a Moscou, dans les differentes batailles, a perdu quatre fois plus que l" armee francaise; l "incendie de Moscou a coute la vie a 100000 Russes, morts de froid et de misere dans les bois; enfin dans sa marche de Moscou a l" Oder, l "armee russe fut aussi atteinte par, l" intemperie de la saison; elle ne comptait a son arrivee a Wilna que 50,000 hommes, et a Kalisch moins de 18,000.”
[Of the 400,000 people who crossed the Vistula, half were Austrians, Prussians, Saxons, Poles, Bavarians, Wirtembergers, Mecklenburgers, Spaniards, Italians and Neapolitans. The imperial army, as a matter of fact, was composed of a third of the Dutch, Belgians, inhabitants of the banks of the Rhine, Piedmontese, Swiss, Genevans, Tuscans, Romans, inhabitants of the 32nd military division, Bremen, Hamburg, etc .; there were hardly 140,000 French-speaking people in it. The Russian expedition cost France proper less than 50,000 men; the Russian army in the retreat from Vilna to Moscow in various battles lost four times more than the French army; the fire of Moscow cost the lives of 100,000 Russians who died of cold and poverty in the forests; finally, during its transition from Moscow to the Oder, the Russian army also suffered from the severity of the season; upon arrival in Vilna, it consisted of only 50,000 people, and in Kalisz less than 18,000.]
He imagined that by his will there was a war with Russia, and the horror of what had happened did not strike his soul. He boldly accepted the full responsibility of the event, and his clouded mind saw the justification in the fact that among the hundreds of thousands of dead people there were fewer French than Hessians and Bavarians.

Several tens of thousands of people lay dead in various positions and uniforms in the fields and meadows that belonged to the Davydovs and state peasants, in those fields and meadows where for hundreds of years the peasants of the villages of Borodino, Gorki, Shevardin and Semenovsky had simultaneously harvested and grazed cattle. At the dressing stations for the tithe, the grass and earth were saturated with blood. Crowds of wounded and unwounded different teams of people, with frightened faces, on the one hand wandered back to Mozhaisk, on the other hand - back to Valuev. Other crowds, exhausted and hungry, led by the chiefs, went forward. Others stood still and continued to shoot.
Over the whole field, formerly so cheerfully beautiful, with its sparkles of bayonets and smoke in the morning sun, there was now a haze of dampness and smoke and smelled of a strange acid of saltpeter and blood. Clouds gathered, and it began to rain on the dead, on the wounded, on the frightened, and on the exhausted, and on the doubting people. It was like he was saying, “Enough, enough, people. Stop... Come to your senses. What are you doing?"
Exhausted, without food and without rest, the people of both sides began to equally doubt whether they should still exterminate each other, and hesitation was noticeable on all faces, and in every soul the question was equally raised: “Why, for whom should I kill and be killed? Kill whoever you want, do whatever you want, and I don't want any more!" By the evening this thought had equally matured in the soul of everyone. Any minute all these people could be horrified by what they were doing, drop everything and run anywhere.
But although by the end of the battle people felt the full horror of their act, although they would have been glad to stop, some kind of incomprehensible, mysterious force still continued to guide them, and, sweaty, in gunpowder and blood, remaining one by three, artillerymen, although and stumbling and choking with fatigue, they brought charges, charged, directed, applied wicks; and the cannonballs flew just as quickly and cruelly from both sides and flattened human body, and that terrible deed continued to be done, which is done not by the will of people, but by the will of the one who leads people and worlds.
Anyone who would look at the upset behinds of the Russian army would say that the French should make one more small effort, and the Russian army will disappear; and whoever looked at the backs of the French would say that the Russians had to make one more small effort and the French would perish. But neither the French nor the Russians made this effort, and the flames of the battle slowly burned out.
The Russians did not make this effort because they did not attack the French. At the beginning of the battle, they only stood on the road to Moscow, blocking it, and in the same way they continued to stand at the end of the battle, as they stood at the beginning of it. But even if the goal of the Russians were to knock down the French, they could not make this last effort, because all the Russian troops were defeated, there was not a single part of the troops that did not suffer in the battle, and the Russians, remaining in their places lost half of their troops.
The French, with the memory of all the previous fifteen years of victories, with confidence in the invincibility of Napoleon, with the consciousness that they had captured part of the battlefield, that they had lost only one quarter of the people and that they still had twenty thousand intact guards, it was easy to make this effort. The French, who attacked the Russian army with the aim of knocking it out of position, had to make this effort, because as long as the Russians, just like before the battle, blocked the road to Moscow, the goal of the French was not achieved and all their efforts and losses were wasted. But the French made no such effort. Some historians say that Napoleon should have given his old guard intact in order for the battle to be won. To talk about what would happen if Napoleon gave his guards is like talking about what would happen if spring became autumn. It couldn't be. It was not Napoleon who did not give his guard, because he did not want to, but this could not be done. All the generals, officers, soldiers of the French army knew that this could not be done, because the fallen morale of the troops did not allow it.
Not only Napoleon experienced that dream-like feeling that the terrible swing of the arm falls powerlessly, but all the generals, all the soldiers of the French army participating and not participating, after all the experiences of previous battles (where, after ten times less effort, the enemy fled), experienced the same feeling of horror before that enemy, who, having lost half of his army, stood just as formidably at the end as at the beginning of the battle. The moral strength of the French attacking army was exhausted. Not that victory, which is determined by picked up pieces of matter on sticks, called banners, and by the space on which the troops stood and are standing, but a moral victory, one that convinces the enemy of the moral superiority of his enemy and of his impotence, was won by the Russians under Borodin. The French invasion, like an angry beast that received a mortal wound in its run, felt its death; but it could not stop, just as the weakest Russian army could not but deviate. After this push, the French army could still reach Moscow; but there, without new efforts on the part of the Russian army, it was to die, bleeding from a fatal wound inflicted at Borodino. A direct consequence of the battle of Borodino was Napoleon's unreasonable flight from Moscow, his return along the old Smolensk road, the death of a five hundred thousandth invasion and the death of Napoleonic France, which for the first time near Borodino was laid down by the strongest enemy in spirit.

Absolute continuity of movement is incomprehensible to the human mind. The laws of any kind of movement become clear to a person only when he considers arbitrarily taken units of this movement. But at the same time, from this arbitrary division of continuous movement into discontinuous units, a large part of human delusions arise.
The so-called sophism of the ancients is known, which consists in the fact that Achilles will never catch up with the tortoise walking in front, despite the fact that Achilles walks ten times faster than the tortoise: as soon as Achilles passes the space separating him from the tortoise, the tortoise will pass ahead of him one tenth of this space; Achilles will go through this tenth, the tortoise will go through one hundredth, and so on ad infinitum. This problem seemed unsolvable to the ancients. The senselessness of the decision (that Achilles will never overtake the tortoise) stemmed from the fact that discontinuous units of movement were arbitrarily allowed, while the movement of both Achilles and the tortoise was continuous.
By accepting smaller and smaller units of motion, we only get closer to the solution of the problem, but we never reach it. Only by assuming an infinitesimal value and a progression ascending from it up to one tenth and taking the sum of this geometric progression, we reach the solution of the problem. The new branch of mathematics, having achieved the art of dealing with infinitesimal quantities, and in other more complex questions of motion, now provides answers to questions that seemed unsolvable.

1. Lobotomy or leucotomy- This is an operation in which one of the lobes of the brain is separated from the rest of the areas, or completely excised. It was believed that this practice could treat schizophrenia.

2. The method was developed by the Portuguese neurosurgeon Egas Moniz in 1935, and trial lobotomy took place in 1936 under his leadership. After the first hundred operations, Moniz observed the patients and made a subjective conclusion about the success of his development: the patients calmed down and became surprisingly submissive.

3. Results of the first 20 operations were as follows: 7 patients recovered, 7 patients showed an improvement in their condition, and 6 people remained with the same ailment. But the lobotomy continued to evoke disapproval: many of Moniz's contemporaries wrote that the actual result of such an operation was the degradation of the personality.

4. Nobel committee considers lobotomy a discovery which is ahead of its time. Egas Moniz received the Nobel Prize in Physiology or Medicine in 1949. Subsequently, the relatives of some patients requested that the award be canceled, since the lobotomy causes irreparable harm to the health of the patient and is generally a barbaric practice. But the request was rejected.

5. If Egas Moniz argued that leucotomy is a last resort, then Dr. Walter Freeman considered lobotomy a remedy for all problems, including willfulness and aggressive character. He believed that the lobotomy eliminates the emotional component and thereby "improves the behavior" of patients. It was Freeman who coined the term "lobotomy" in 1945. Throughout his life he operated on about 3,000 people. By the way, this doctor was not a surgeon.

6. Freeman once used an ice pick from his kitchen for an operation. This “necessity” arose because the former instrument, the leukote, could not withstand the load and broke in the skull of the patient.

7. Subsequently, Freeman realized that ice pick is great for lobotomy. Therefore, the doctor designed a new medical instrument based on this model. The orbitoclast had a pointed end on one side and a handle on the other. The point was marked with divisions to control the depth of penetration.

8. By the middle of the last century lobotomy has become an unheard of popular procedure: it has been practiced in the UK, in Japan, in the USA and in many European countries. In the US alone, about 5,000 surgeries were performed per year.

9. In the USSR new method treatment was used relatively rarely, but it was improved. Soviet neurosurgeon Boris Grigorievich Egorov proposed to use osteoplastic trepanation instead of eye socket access. Egorov explained that trepanation would allow more accurate orientation in determining the area of ​​surgical intervention.

10. Lobotomy was practiced in the USSR for 5 years, but was banned at the end of 1950. It is believed that the decision was driven by ideological considerations, because this method is most widely used in the United States. By the way, in America, lobotomy continued to be practiced until the 70s. However, there is also an opposite point of view: the ban on lobotomy in the USSR was due to the lack of scientific data and, in general, the dubiousness of the method.

Gleb Pospelovo lobotomy - the most famous and darkest of the psychosurgical operations

Oh, yes, after treatment, he will turn into a vegetable! .. - - every psychiatrist heard this or a similar phrase more than once, trying to persuade the patient and his relatives to be hospitalized. Everyone knows that in psychiatric hospitals people are "zombified", "burned out the brain", "poisoned", "turned into a plant" - in general, they destroy as a person in all possible ways.

And before the hospital, the patient was - just a feast for the eyes, aha!

In general, this way of thinking has a very scientific name: social stigmatization. In fact, a person who is discharged from a psychiatric hospital is often completely different from what his relatives are used to. Was sociable - became withdrawn, was active, nimble - became inhibited and lethargic. And means mass media, books, cinema - willingly show exactly how pests in white coats carry out their hellish experiments on people. I'll tell you a "secret": if anything turns our patients into "plants", it's not a cure, but a disease. However, this was not always the case...

Remember the famous book (or its film adaptation) One Flew Over the Cuckoo's Nest and the fate of its protagonist, McMurphy? Let me remind you: McMurphy was subjected to a lobotomy for violations of the hospital regime. Cheerful, self-confident, groovy rogue-simulant turns into a weak-minded, into a drooling ruin. The author of the novel, Ken Kesey, who worked as an orderly in a mental hospital, described the "frontal syndrome" or "frontal lobe syndrome" that developed in people after lobotomy surgery.

bold idea

Brain lobotomy was developed in 1935 by the Portuguese psychiatrist and neurosurgeon Egas Moniz. In 1935, at a conference, he heard a report on the consequences of damage to the prefrontal zone in chimpanzees. Although the focus of this report was on learning difficulties associated with damage to the frontal lobes, Moniz was particularly interested in how one monkey became calmer and more docile after surgery. He hypothesized that the intersection of nerve fibers in the frontal lobe can help in the treatment of mental disorders, in particular - schizophrenia (the nature of which was still very vaguely understood). Moniz believed that the procedure was indicated for patients in serious condition or those whom aggressiveness made socially dangerous. Moniz performed the first operation in 1936. He called it "leukotomy": a loop was introduced into the brain with the help of a guide, and with rotational movements the white matter of the neuronal connections connecting the frontal lobes with other parts of the brain was cut.

Prefrontal lobotomy, or leucotomy (from other Greek λοβός — share and τομή — cut), — a neurosurgical operation in which the white matter of the frontal lobes of the brain is dissected on one or both sides, the cortex of the frontal region is separated from the underlying parts of the brain. The consequence of such an intervention is the exclusion of the influence of the frontal lobes of the brain on the rest of the structures of the central nervous system.

Moniz performed about a hundred such operations and observed patients. He liked the results, and in 1936 the Portuguese published the results of the surgical treatment of twenty of his first patients: seven of them recovered, seven improved, and six showed no positive dynamics.

Egas Moniz was awarded the Nobel Prize in Physiology or Medicine in 1949 "for his discovery of the therapeutic effects of leucotomy in certain mental illnesses." After the Moniz Prize was awarded, leucotomy began to be used more widely.

So, Egas Moniz, in his "lobotomy" practice, observed hardly two dozen patients; he never saw most of the others after the operation. Moniz has written several articles and books on lobotomy. Criticism followed: opponents argued that the changes after the operation most of all resemble the consequences of a brain injury and, in fact, represent a degradation of the personality. Many believed that brain mutilation could not improve brain function and damage could lead to the development of meningitis, epilepsy, and brain abscesses. Despite this, Moniz's report (Prefrontal leucotomy. Surgical treatment of certain psychoses, Torino, 1937) led to rapid adoption of the procedure on an experimental basis by individual clinicians in Brazil, Cuba, Italy, Romania, and the United States.

In a land of opportunity

The American psychiatrist Walter Jay Freeman became the leading promoter of the operation. He developed new technology, which did not require drilling of the patient's skull, and called it "transorbital lobotomy". Freeman aimed the narrow end of a surgical instrument, resembling an ice pick, at the eye socket bone, pierced a thin layer of bone with a surgical hammer, and inserted the instrument into the brain. After that, the fibers of the frontal lobes of the brain were cut with the movement of the knife handle. Freeman argued that the procedure would remove the emotional component from the patient's "mental illness". The first operations were carried out with a real ice pick. Subsequently, Freeman developed special tools for this purpose - the leukotome, and then the orbitoclast.

In the 1940s, lobotomy in the United States became more common for purely economic reasons: the "cheap" method allowed the "treatment" of many thousands of Americans held in closed psychiatric institutions, and could reduce the costs of these institutions by a million dollars a day! Leading newspapers wrote about the successes of the lobotomy, drawing public attention to it. It should be noted that there were no effective methods treatment of mental disorders, and cases of return of patients from closed institutions to the community were extremely rare.

In the early 1950s, about five thousand lobotomies were performed in the United States a year. Between 1936 and the late 1950s, between 40,000 and 50,000 Americans were lobotomized. The indications were not only schizophrenia, but also severe obsessive-compulsive disorder. Lobotomy was often performed by doctors who had no surgical training. Not having the training of a surgeon, Freeman, however, performed about 3,500 such operations, traveling around the country in his own van, which he called "lobotomobile".

Lobotomy was widely used not only in the USA, but also in other countries of the world - Great Britain, Finland, Norway, Sweden, Denmark, Japan, the USSR. In Europe, tens of thousands of patients underwent this operation.

Result on the face

Already in the late 1940s, psychiatrists "saw" that the first studies of lobotomy were carried out without a solid methodology: they operated with disparate methods on patients with different diagnoses. Whether or not recovery has occurred is a question that has often been decided on the basis of such a criterion as improving the patient's manageability. In the 1950s, more thorough research revealed that, in addition to death, which was observed in 1.5-6% of those operated on, lobotomy can cause seizures, large weight gain, loss of coordination, partial paralysis, urinary incontinence and other problems. Standard tests of intelligence and memory usually did not show any significant deterioration. Patients retained all types of sensitivity and motor activity, they did not experience impairments in recognition, practical skills and speech, but complex forms of mental activity disintegrated. More subtle changes have often been reported in the form of reduced self-control, foresight, creativity, and spontaneous action; selfishness and lack of concern for others. At the same time, criticism of one's own behavior was significantly reduced.

Patients could answer ordinary questions or perform habitual actions, but the performance of any complex, meaningful and purposeful acts became impossible. They stopped experiencing their failures, experiencing hesitation, conflicts, and most often were in a state of indifference or euphoria. People who were previously energetic, restless, or aggressive in nature may develop changes towards impulsiveness, rudeness, emotional breakdowns, primitive humor, and unreasonable ambitions.

In the USSR, special methods for performing lobotomy were developed - much more accurate in the surgical sense and sparing in relation to the patient. The surgical method was offered only in cases of failure of long-term treatment, which included insulin therapy and electroshock. All patients underwent a general clinical and neurological examination and were carefully studied by psychiatrists. After the operation, both acquisitions in the emotional sphere, behavior and social adequacy, as well as possible losses, were recorded. The lobotomy method itself was recognized as fundamentally acceptable, but only in the hands of experienced neurosurgeons and in cases where the lesion was recognized as irreversible.

With maintenance therapy with nootropics and drugs that correct mental disorders, a significant improvement in the condition was possible, which could last several years, but the end result still remained unpredictable. As Freeman himself noted, after hundreds of operations performed by him, about a quarter of patients were left to live with the intellectual capabilities of a pet, but "we are quite satisfied with these people ...".

Beginning of the End

The decline of the lobotomy began in the 1950s after the serious neurological complications of the operation became apparent. In the future, lobotomy was prohibited by law in many countries - data have accumulated about the relatively low effectiveness of the operation and its greater danger compared to antipsychotics, which were becoming more and more perfect and actively introduced into psychiatric practice.

In the early 70s, lobotomy gradually faded away, but in some countries they continued to operate until the end of the 80s. In France, between 1980 and 1986, 32 lobotomies were performed, during the same period 70 in Belgium, and about 15 at the Massachusetts Hospital; about 15 operations were carried out annually in the UK.

In the USSR, lobotomy was officially banned in 1950. And this was not only an ideological underpinning. In the foreground were reasons of a purely scientific nature: the absence of a strictly substantiated theory of lobotomy; lack of strictly developed clinical indications for surgery; severe neurological and mental consequences of the operation, in particular "frontal defect".

"Lobotomy" bullet

More than 60 years have passed since the ban on lobotomy in our country. But people continue to get head injuries, get sick with various ailments (Peak's disease, for example), leading to a completely distinct "frontal" symptomatology. I will give a vivid observation of the consequences of the “frontal syndrome” from my own practice.

Two soldiers at the firing range, laughing, began pointing machine guns loaded with live ammunition at each other and shouting something like “Tra-ta-ta!..”. Suddenly he said his "word" and the machine gun ... The result - one had a bullet in the head. The neurosurgeons somehow managed to revive and repair the guy; they inserted several plates into his skull and sent him to us to resolve the issue with further treatment and disability.

In conversation, the patient made a strange impression. Formally, his mind was not affected, his memory and stock of knowledge were at a normal level; he behaved quite adequately too — at first glance... An unnatural calmness, up to indifference, was striking; the guy indifferently talked about the injury, as if it did not happen to him; made no plans for the future. In the department he was absolutely passive, subordinating; for the most part, he lay on the bed. They invited me to play chess or backgammon, asked me to help the staff - I agreed. Sometimes it seemed -   order him to jump out the window -   he will do so, and without thinking.

And we received an answer to our questions a week later, when the patient was “caught up” with documents from neurosurgery, where his injury was treated. The surgeons described that the wound channel passed right through the frontal lobes of the guy. After that, all questions about the patient's behavior were removed for us.

By the will of fate, I happened to meet this patient again, almost ten years after we met. It happened in a rehabilitation center where I worked as a consultant. The guy has changed little in appearance. In communication there was sharpness, rudeness; mental faculties were completely preserved. I did not notice the main thing: self-confidence and independence. The man had empty eyes... In life, he "went with the flow", completely indifferent to what was happening around him.

In conclusion, as before, I want to wish: take care of yourself and your loved ones and remember that in most cases even severe and painful treatment is worth defeating a disease that deprives a person of his human appearance.