Waning enthusiasms and growing doubts cluster around the worth of the shock therapies as time shows their effects to be limited and transient. Fresh hopes for the relief of mental illness by physical methods begin to swell the literature in accounts of the results of prefrontal leucotomy.
This British study is a calm and sincere statement of experience with two hundred cases, written in a readable, graceful style. Frank begins with a just objection to clinical psychiatry's heedlessness toward the unique properties of the individual when dealing with descriptive terms, mass observations and statistics. For example, apart from the fact that in almost every leucotomy operation different fibers are cut, the response of a particular individual to
WARNING! This text is printed for personal use. It is copyright to the journal in which it originally appeared. It is illegal to redistribute it in any form. - 270 -
brain injury cannot be predicted by any clinical criterion. In addition to a clinical descriptive classification of his illness (admittedly difficult because of the confusion in psychiatric nosology), and assessment of chances of spontaneous recovery, the quality of the individual's present and past personality as well as the social environment into which he will be discharged must be considered among the indications for leucotomy.
The cases selected were those of the chronic population of an average county mental hospital. All had proved refractory to psychotherapy or some form of shock treatment. Those showing permanently disturbing hallucinations, unmanageable aggressiveness, increasing melancholic agitation, or constant unrelieved anxiety were chosen for leucotomy. Favorable prognostic criteria were sudden onset of the psychosis after some justifiable psychological or physical cause, plasticity of symptom formation, cyclic tendencies and an island of integrated personality beneath the psychosis.
Leucotomy was of questionable value when the patients had no one to look after them outside the hospital or their families had lost interest in them. Follow-up observation varied from nine months to three years. A social recovery consisted of ability to earn a living or to look after a household as before the illness. Considered improved were those who were more manageable and had diminished psychotic symptoms but were not well enough to be on their own.
The results showed that among schizophrenics the numerical results were disappointing although individual cases made startling recoveries; alterations of mood of manic-depressives seemed curable by leucotomy; involutional melancholia responded well; aggressive mental defectives responded poorly; three of four chronic obsessives made an excellent social recovery. In the case of schizophrenia it is noteworthy to read Frank's emphatic statement that the success of the operation is absolutely dependent on the proper handling of the postoperative course in which the environmental situation must be managed to provide an appealing reality with no possibility of experiencing failures.
Among the complications of leucotomy were noted some neurological sequelae as well as appetite and hair-growth disturbances. In patients under fifty-five intellectual deficit after one year was undetectable. In the successful cases recovery was always gradual, taking months. None of the patients regained insight or was able to appreciate what the operation was for. No patient in the series was worse after operation. The mortality was 2.5 percent.
WARNING! This text is printed for personal use. It is copyright to the journal in which it originally appeared. It is illegal to redistribute it in any form. - 271 -
Colby, K. (1949). Journal of Mental Science. XCII, 1946. Psychoanal. Q., 18:270-271