Saturday, December 24, 2011

NYT: When Lobotomy Was Seen as Advanced

This is an eye-opening essay about how lobotomies were used back in the day.
[posted via email]
From The New York Times:
ESSAY: When Lobotomy Was Seen as Advanced
New research indicating that Eva Perón was lobotomized not long before her death is a reminder of how enthusiastically this operation was once embraced.


Sunny CA said...

I am hoping that it will not be long before ECT (Electroconvulsive therapy) is talked about in the same way, a misguided attempt to effect a "cure" without concern for the patient's cognitive ability. The article says a reason for the decline in lobotomy was "a growing unease among doctors with the confusion and stupor that resulted from the operation." Let us hope that there is a growing unease among doctors with the loss of memory and decline in cognitive ability of patients who have had ECT. I feel that both lobotomy and ECT are procedures that bring fast, easy money to the practitioners, without regard for the patient's overall well being. I wonder how we managed to see lobotomy in its true light while continuing to administer, often against the will of the patient. Dr. Shock's blog linked to video diaries of one of his teenaged ECT patients, so I went to her website and watched the whole series from pre-ECT through her many treatments. Her cognitive decline was "shocking" and her depression continued. Dr. Shock posted the link early in her treatment and I doubt he had ever watched the whole series (or he never would have posted the link).

just me said...

Sunny Ca I totally agree with you. I was in a psychiatric hospital mother and baby unit for a few months and I had 3 friends all of whom were mothers of infants receiving ECT. Both of them had terrible terrible cognitive disturbance.
My friends would regularly ask me names of familiar nurses who had looked after them everyday. One of my friends had a doctor that started getting annoyed at her during appointments as every session she would ask the same questions again and again never able to recall the answers which were just given the day before.

When I saw my friends receiving round after round of ect with little to none improvement I grew very uneasy in my faith of my doctors. I began to wonder if this too was just another 'lobotomy phase' and one day the scientific world would wake up and realize that ect was just as misguided and dangerous as lobotmys.

Roy said...

I don't know about fast money. The reimbursement for an ECT treatment (90870) for a doc was $88 about ten years ago (probably not much more now).

While the side effects of ECT can be bad, for some people this treatment is quite literally life-saving, so would hate to see these people lose this option. And, there are brain surgeries being done even now for certain very disabling forms of psychiatric illness, such as severe OCD.

Sunny CA said...

Roy, I appreciate that you have a different perspective, but I have only heard your viewpoint from doctors, never from patients. I think that patients value their memories of the past and their current short term memory more than the doctors who treat them. I personally would rather die than live without my ability to remember the people and events of my live. I feel that my memory allows creation of the essence of who I am. Once my mother lost her memory (through dementia) she was lost as a person. I don't think we are ourselves anymore after our memories are erased and without the ability to create new memories.
I find it hard to believe that a hospital or facility can put a person under anesthesia and administer ECT for $88. A mammogram costs me over $250 and I am not under anesthesia.

Unknown said...

Lobotomies seem like an extreme cure for pain management today, but lest we are too condemning of our predecessors, its important to remember that today, many people consider euthanasia as a "treatment" for chronic, uncontrollable pain. Our pain management techniques have actually grown more extreme, rather than less.

Anonymous said...

I feel the same way as Sunny CA. Some things to me are worse than death.

Glad I got a second opinion and didn't do it.

If the video Sunny mentions is the same one I'm thinking of the woman can no longer read books following ECT. It's not exactly a ringing endorsement of ECT. While she is ok with that result, I would not be.

David Littleboy said...

My father reported that a doctor at the hospital he was working at around 1970 or so had some doubts about the performance of one of the ECT machines. So father, an electrical engineer on the staff there, read the specs, which claimed that the machine delivered a timed pulse of controlled current to the patient. He then disassembled to machine to find that what the circuit actually did was to connect the patient to the mains current for as long as the doctor held the button down. Oops.

rbh said...

I have had ECT trestments for a very severe depression that wouldn't lift. In two weeks I was OK again. Yes, there is some mild memory loss: I can't remember my roommate's name or the names of the nurses and orderlies that I saw everyday. But those treatments fixed me without the weight gain and subsequent diabetes I developed from the psych meds I have taken since.

If you don't want ECT then don't have it, but don't take it away from the many people it helps.

Anonymous said...

rbh, some patients have said no and are given ECT agaimst their will. It's not always as easy as saying no. I have no problem if people freely choose to have ECT. The problem is that some patients who dont want to accept the risks are forced to have it. Or some, like in my case, have a physician who tries to pressure them into doing it telling them it's the last option when that's bunk and without being open about the risks involved.

Sunny CA said...

In California, ECT can be administered without patient consent for anyone on a 5150 involuntary psychiatric hold, which means anyone who is suspected of being a danger to themselves or others. A procedure that destroys memory should never be forced and involuntary.

Sean said...

We have come a long way as a field. I did perhaps 50 or so ECT sessions as a resident. In learning about the method, the minimal amount of electricity is used nowadays to minimize side effects. The best turn-arounds I saw were depressed elderly patients who refused food and became mute. The treatment was life changing. Newer techniques like DBS, I have seen change a man with SEVERE OCD into a person who could eat and walk on his own.

I believe strongly that the barbary of old is in the past and that we have entered a much more ethically sound era of treatment.

Roy said...

ECT should not be used involuntarily, IMO. Can't be done in Maryland, even with an advanced directive requesting it (must competently consent).

Anonymous said...

I've known a few people who have been lobotomized. This happened many years ago. I know some people know who undergo ECT. Mostly I know a lot of people who were dumped out of institutions and onto the streets and lots of other people with the resources to get the drugs that give them diabetes etc. One day, someone will write about when psychiatry seemed advanced and it will be surreal.

jcat said...

I've had ECT a few times, always when absolutely nothing else had helped for months, and I was suicidal and desperate.

It has been an absolute miracle some of those times. Others, it did dipshit - but it NEVER made things worse!

The memory loss is limited to short term stuff , and only for the 2 - 3 weeks of treatment. During that time I functioned fine - hell, for at least 3 of the series, I had them done outpatient and went to work in between. On two separate occasions I solved really tough, mission-critical IT problems - which I only know about because I saw the evidence of my work afterwards. I can't remember most stuff for the duration of the treatments, but it didn't stop me functioning really well while it was happening, or afterwards.

And, the times that it worked, it was amazing - to go from suicidal and slicing my arms to ribbons with a razor-blade to really good within a few days....awesome.

When it gets too bad and lasts too long, I will always view ECT as a good and hopeful thing - only problem is the cost, because health insurance here doesn't pay for most of it.