Introduction
Lobotomy refers to a form of psychosurgery, which involves slicing the connections to and from the prefrontal cortex. Major personality changes and severe mental disabilities can result from such kind of operations. In the past these procedures were used as treatment for mental diseases such as schizophrenia and other anxiety disorders.
The application of a local anesthetic during prefrontal lobotomy proved to be cumbersome for the patients. This could be replaced with an electroshock machine which when connected to a 120 volts wall outlet is capable of sending the patient into a period of unconsciousness long enough for the doctor to perform prefrontal lobotomies the lobotomy.
The actual streamlined operation could involve hammering a sharp steel probe into the brain via the superior orbital rim into the brain. (Pressman,1998)
The probe could then be maneuvered back and forth to sever the connections of the frontal lobe. After the probe was removed, blood could be injected into the wound to further traumatize the frontal lobe. Bilateral lesions were supposed to be made in quick succession before the patient emerges from the electrically induced anesthetic. (El Hai, J.Wiley 2007) This technique was successful because it severed the neural connections which are found between the brains frontal lobes and the thalamus. They are said to be center for emotions in the human brain.
What researchers ought to have done
No one today is an advocate of prefrontal lobotomy for treatment of mental illness especially after the introduction of psychotherapeutic drugs. However researchers could have come up with various techniques that produce small lesions in the brain of the patient to treat isolated cases of mental diseases. Many methods have been utilized for treatment of psychiatric illness but four procedures which are considered to be the safest and most effective could have been utilized to prevent the mistake of prefrontal lobotomy.
One of these procedures is referred to as sub caudate tractotomy.
The effectiveness of this method is based on reducing the size of the lesion thus minimizing the side effects associated with the surgical procedures. Here the objective is to break off white matter paths between orbital that arise between orbital cortex and the sub cortical structures by putting a lesion in the areas of the substantia innominata.
Anterior cingulotomy as an open procedure could also be utilized has its safety based on the ability to ensure no impairment of motor and sensory function and particularly in the lower extremeties.Before the procedure is carried out a post –operative MRI scan is is performed to certify the position and extent of the lesion.
A combination of the above two procedures could also be adopted to save the situation. The method could be carried out to cut off the connection between the orbital frontal thalamic pathways from the former lesion.
The forth safe and effective procedure could involve the interruption of the presumed fronto-thalamic connections in the anterior limbin the internal capsule. This is where there is passage linking the head of the caudate nucleus to the putame.( Waziri R 1990)
Conclusion
In conclusion it important to point out that the controversy surrounding prefrontal lobotomy may be because it was associated with indiscriminate application with a number of side effects which characterized the earlier procedures. Researchers utilizing the above discussed procedures could see a reduction in the side effects associated with prefrontal lobotomy.
Reference
Tooth JC, Newton MP: Leucotomy in England and Wales 1942-1954. Reports on public health and medical subjects No. 104. London, Her Majesty’s Stationary Office, 1961.
Waziri R: Psychosurgery for anxiety and obsessive compulsive disorders. In Noyes R Jr., Roth M, Burrows GD (eds): The Handbook of Anxiety – The Treatment of Anxiety. Amsterdam, Elsevier Science Publications 4:519, 1990.
Pressman, Jack D. Last Resort: Psychosurgery and the Limits of Medicine. New York, NY: Cambridge University Press, 1998.
El Hai, J.Wiley and Sons, Hoboken, New Jersey, 2005; My Lobotomy, A Memoir, Dully H. and Fleming C. Crown Publishers, New York, 2007.
Tranøy, Joar; Blomberg, Wenche (2005). “Lobotomy in Norwegian Psychiatry” (PDF). History of Psychiatry 16 (1): 107. London, Thousand Oaks, Calif., and New Delhi: SAGE Publications.