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Colby, K.M. (1950). Journal of Neurology, Neurosurgery and Psychiatry. XII, 1949: Clinical and Pathological Observations on Relapse After Successful Leucotomy. T. McLardy and D. L. Davies. Pp. 231–238.. Psychoanal Q., 19:287-288.
Psychoanalytic Electronic Publishing: Journal of Neurology, Neurosurgery and Psychiatry. XII, 1949: Clinical and Pathological Observations on Relapse After Successful Leucotomy. T. McLardy and D. L. Davies. Pp. 231–238.
Nowadays there are three ways of impairing the brain with therapeutic intent—deprive it of glucose, shock it with electricity and cut into its substance. Refinements of the latter vogue are considered in the above-listed papers.
Kolb reviews the literature of lobotomy with a bibliography of one hundred fifty-eight references. He divides the topic under the subtitles of Historical Perspective, Surgical Techniques, Neurophysiological Investigations, Psychological Investigations and Therapeutic Evaluation. For the psychotherapist the question of the therapeutic value of this operation is perhaps of most interest. 'The use of the technique on an experimental basis is justifiable but to conclude at this juncture, a decade after the initial operation, that it has indubitable merit as a therapeutic agent in a wide range of conditions is uncritical.' (Ethical objections to the experimentally justifiable procedure are dismissed as 'nonscientific moralizing'.) The author, pleading for more careful analyses, makes clear that the present statistics of therapeutic evaluation are a mess, with favorable results ranging from fifteen percent to eighty-eight percent. A remarkable figure emerges from five hundred ninety-nine cases of schizophrenia in the British Board of Control lobotomy series in which the discharge rate as recovered and improved was twenty-three percent. Bellak in his review of the literature on prognosis of schizophrenia without shock therapy reports of recovery rate between twenty-two percent and fifty-three percent and Rennie in a twenty-year follow-up of two hundred twenty-two cases of schizophrenia states twenty-seven percent recovered!
Another striking observation is that of the neurosurgeon Walker who reported that in obsessive-compulsive states, in which prefrontal lobotomy supposedly has its greatest value, the results for recovered and improved cases approximate those of psychoanalytic therapy. Kolb adds that while psychoanalysis is long and expensive, the patient at least has the chance of ending his treatment successfully with an intact nervous system. Lobotomy produces its best results in patients whose illness is of sudden onset and short duration and is accompanied by affective responsiveness. These are also the very clinical criteria which herald a favorable prognosis in all mental illnesses, treated or untreated. Kolb concludes, 'At the present time then, the evidence is quite inadequate to lead to the conclusion that lobotomy has significant therapeutic value in the treating of schizophrenic reactions though it may be effective in causing remissions of specific symptoms'.
Goldstein goes beyond this opinion to ask whether lobotomy actually has disadvantages which outweigh its advantages. That the usual I.Q. tests after lobotomy show no intellectual deficits only illustrates the inadequacies of
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such tests. He feels that lobotomized patients suffer an impairment in their ability to abstract. In his experience this ability, once lost, can never be regained by training or learning. Hence the patient who made use of abstraction to an important extent in his premorbid life loses an essential of his personality through the operation. (In this connection the observation of Freeman and Watts is significant: after lobotomy, though relieved of symptoms, no physician, dentist, artist, musician or writer has been able to function successfully in his former occupation.)
The final paper is noteworthy in that it is the first report in the literature correlating relapse after recovery with the actual position and dimensions of the leucotomy lesions as established after death. Six patients are described whose preoperative psychosis recurred in full and who subsequently died—two of suicide, one of insulin shock, one during electronarcosis, one during an epileptic fit and one from chronic phthisis. Four of the cases had practically complete bilateral isolation of the prefrontal cortex. 'Bilateral isolation, therefore, of practically the whole prefrontal cortex does not prevent the remanifestation, after their relatively prolonged disappearance or striking amelioration, of many of the commonest psychotic symptoms.'
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Colby, K.M. (1950). Journal of Neurology, Neurosurgery and Psychiatry. XII, 1949. Psychoanal. Q., 19:287-288