Take a medical ice-pick and bop it into the brain

Neurological Notes

PSYCHOSURGERY IS largely redundant today. Intolerable states of mind - depression, rage and obsessions - are generally treated by pills rather than the scalpel, and the few operations that are still carried out - like that on Lena Zavaroni just before her death - are a matter of last resort.

Fifty years ago things were very different. Frontal lobotomies - the surgical cutting of the nerve fibres which connect the cerebral cortex (the part of the brain that sustains consciousness) to the unconscious limbic system beneath were used to treat everything from melancholy to schizophrenia. Such was the demand for them that, during the Forties, itinerant brain-surgeons would go from one mental hospital to another with their implements in the back of their cars, sometimes operating on dozens of patients in a single day.

One surgeon described his technique like this: "[There's] nothing to it. I take a sort of medical ice-pick, bop it through the bones just above the eyeball, swiggle it around, cut the brain fibers, and that's it. The patient doesn't feel a thing." Between 1940 and 1970, an estimated 100,000 people were operated on in this way.

The frontal lobotomy ( or leucotomy, as a slightly adapted form of the operation became known) owed its popularity to the Lisbon neurologist Egas Moniz. In 1935 Moniz - who had already gained a reputation for innovation by pioneering work on imaging blood vessels in the brain - attended the Second International Congress of Neurology in London. There he heard a lecture given by two young researchers from Harvard who had been experimenting with brain surgery in chimpanzees. The researchers described how an experimental operation in which they had cut the fibres in the front of the brain had changed one aggressive and frustrated animal into a docile and contented one.

Moniz was excited by the lecture, and returned immediately to his hospital where he started to select some patients to be guinea-pigs. Rumour has it that he was in such a hurry to start that he did not even wait for the second half of the lecture. If he had waited, he might have been more hesitant to try the animal experiments on people - the Harvard researchers went on to report an experiment on a second chimpanzee, in which the operation left the beast even more aggressive than before.

Moniz persuaded a surgeon colleague to operate on 20 patients. Afterwards, he claimed that seven were "cured", seven "ameliorated" and six unchanged. Others carried out similar experiments and reported similarly hopeful results. Word got around and, although it took a few years for the technique to be adopted widely, from the mid-Forties until the mid-Sixties it was used with abandon.

At the time psychiatrists had only a hazy idea of why cutting the brain in this way should produce changes in personality, but there was practically no other effective treatment for severe mental illness, so psychiatrists and neurosurgeons were grateful for any innovation that reduced their impotence. Lobotomies did, in general, quieten down agitated patients and in many they brought relief from unbearable mental anguish. But unfortunately these were not the only effects of the operation - it also tended to flatten out emotions, so that people felt listless or stupefied; deprived them of judgement, or inhibited their appetites and urges. And, like the second chimp in the Harvard study, some patients became anti-social and aggressive - even if they had not displayed these characteristics before.

In 1949 Moniz received the Nobel prize for his work on lobotomies. But he didn't bask in triumph for long - shortly afterwards he had to give up work on account of a spinal injury. The injury was caused by a bullet - fired by one of his own patients.

Rita Carter is the author of `Mapping the Mind - an illustrated guide to the brain' (Seven Dials, pounds 14.99)