Talk:Lobotomy/Archive 2

Archive 1

Archive 2

Archive 3

Shutter Island (film)

I have removed the material on the film Shutter Island. The "portrayals" section of the article begins, "Lobotomies have been featured in several literary and cinematic presentations that both reflected society's attitude towards the procedure and, at times, changed it." That's a pretty good criterion for deciding what should and should not be included in such a section (otherwise it would list scores or hundreds of works using lobotomy as some kind of plot device) and under that criterion Shutter Island doesn't qualify. It just uses lobotomy as a plot device, threat/dilemma for one character, etc. And with due respect to Dr. Gilligan, "his" comments made in promotional production notes for the film do not qualify as a reliable source. EEng (talk) 06:31, 4 April 2010 (UTC)

Given I wrote the lead sentence you quoted and rewrote the entire section from this state [1] where there was an ugly list of indiscriminate trivia of songs, movies, etc., I respectfully disagree. This movie comes from a highly respected director and is not a horror movie but utilizes lobotomy appropriate to the movie's setting. I'm unsure of the use of scare quotes around "his" but Dr. Gilligan has the background to comment on the movie's objectives and serves as an appropriate source. Exactly which part of WP:RS states that an involved individual in a work of art can't comment on that work of art? It is a reflection of the artistic objectives not from a promotional piece per se (as in an ad) but as part of the production notes of the movie which is a common source of information for critics both commercial and academic. You state that this is a plot device for one individual -- so you would disqualify All the King's Men? Suddenly Last Summer? In fact, all of the listed works of art would be disqualified under that criteria. This movie is a piece of cinema that is portraying the use of lobotomy in the 1950s and is clearly critiquing its use. Cuckoo's Nest is a similar movie. Thoughts? ∴ Therefore cogito·sum 17:31, 4 April 2010 (UTC)

I wrote the comment for the portrayal section that reads:

PLEASE DO not ADD NON NOTABLE EXAMPLES TO THIS SECTION An example needs to be relevant to the subject -- how a work of art portrays lobotomy and in what way. Do not include references to songs, television shows that happen to use the word "lobotomy" as a metaphor or a passing mention or as a trivial plot device such as a horror movie.

All of the works in this section use lobotomy as a plot device by definition. I revert instances when it is used as a trivial plot device, for instance from the original list of pop cultural references, a Simpsons character dreams of lobotomizing someone or the Planet of the Apes or an X-Files episode. Shutter Island, on the other hand, is a notable work of art portraying lobotomy and the text you deleted went on to show how this work of art was critiquing its use. It falls under all the criteria in my comment section. Thoughts? ∴ Therefore cogito·sum 18:10, 4 April 2010 (UTC)

In case you didn't read the referenced production notes or for anyone else reading this thread, here is what it says about Dr. Gilligan:

To assure that the film would authentically depict psychiatric ideas and treatments of the period, Scorsese recruited a special consultant: Dr. James Gilligan, who had directed Massachusetts’ prison mental hospital for the criminally insane (the Bridgewater State Hospital) in the 1970s. The federal courts had ordered the state to allow members of the Harvard Medical School faculty, led by Dr. Gilligan, to provide the treatment programs at Bridgewater in an effort to improve the quality of mental health care there, and he has been a leader in the struggle to reform mental and penal institutions ever since, throughout America and around the world.

“We were very fortunate to have Dr. Gilligan as our technical advisor,” says Scorsese. “His book on violence is a classic and he was there in the psychiatric hospitals of the ‘60s when things were changing. Not only is he an authority on the subject, but he also understands how to tell a story and how works of art over time have reflected man’s nature.”

Gilligan accepted his assignment at Bridgewater in the days following the outcry over Fred Wiseman’s documentary film Titicut Follies, a politically explosive exposé of how despicable conditions there were, and took charge of the place during the period that marked its transformation into a more humane institution providing real hope for patients. He recalls the atrocities he witnessed firsthand: “Cells resembled medieval dungeons. Patients were literally chained to the walls, left in their own excrement. Animals in zoos were cared for more humanely,” he says. “Bridgewater went through many of the same changes, experiments and conflicts that are part of this movie.”

Having played a significant role in changing the practice of mental health care in the state of Massachusetts, Gilligan was especially excited by the themes of Shutter Island, and by Scorsese’s determination to bring authenticity to the film’s fictional hospital for the insane. “Marty made it clear that, within the fictional world of the story, he wanted the hospital to be depicted realistically,” he says. “We worked together to make sure the story reflected a true war that was going on in the mid-20th century within the psychiatric community: a war between those clinicians who wanted to treat these patients with new forms of psychotherapy, education and medicine, and those who regarded the violent mentally ill as incurable and advocated controlling their behavior by inflicting irreversible brain damage, including indiscriminate use of shock treatment and crude forms of brain surgery, such as lobotomies.”

His statements carry weight and are an appropriate comment on the movie ∴ Therefore cogito·sum 18:27, 4 April 2010 (UTC)

I don't know if anyone's noticed this yet or not...

...but this article says a whole lot of filler and not enough detailing what this *procedure* actually does. A lot of "it was used to cure this patient of blah" and not enough "... by **** the *** causing *** to function differently".

It's basically all fluff on history, and too few details on the actual procedure. —Preceding unsigned comment added by 99.18.89.69 (talk) 12:43, 9 February 2011 (UTC)

Leucotomy is about much more than simply a procedure. Its social, medical and cultural context are very important. In any case, the article contains considerable detail on the procedure:

"This new "transorbital" lobotomy involved lifting the upper eyelid and placing the point of a thin surgical instrument (often called an orbitoclast or leucotome, although quite different from the wire loop leucotome described above) under the eyelid and against the top of the eyesocket. A mallet was used to drive the orbitoclast through the thin layer of bone and into the brain along the plane of the bridge of the nose, around fifteen degrees toward the interhemispherical fissure. The orbitoclast was mallated five centimetres into the frontal lobes, and then pivoted forty degrees at the orbit perforation so the tip cut toward the opposite side of the head (toward the nose). The instrument was returned to the neutral position and sent a further two centimetres into the brain, before being pivoted around twenty eight degrees each side, to cut outwards and again inwards (In a more radical variation at the end of the last cut described, the butt of the orbitoclast was forced upwards so the tool cut vertically down the side of the cortex of the interhemispherical fissure; the "Deep frontal cut".) All cuts were designed to transect the white fibrous matter connecting the cortical tissue of the prefrontal cortex to the thalamus. The leucotome was then withdrawn and the procedure repeated on the other side."FiachraByrne (talk) 19:57, 26 February 2011 (UTC)

Okay, that's not in the article, for one. For another, that tells the physical process of performing a lobotomy, but doesn't address the previous person's problem - there is little to no discussion in the article of what the effects of a lobotomy actually are. It's like telling the history of how pencils were invented, with notes on mechanical pencils and drafting pencils, and the preference for No. 2 pencils for scantrons, but not actually saying they're used for writing. 128.194.22.133 (talk) 12:10, 27 February 2011 (UTC)

If you read the article you'll find that it is a direct quotation from it. However, you're right in that I did not read his original question correctly. He won't get an answer like the one he is looking for. It doesn't really exist in the literature. This was an experimental procedure and generally performed "blind" the regions of the brain effected, therefore, could differ significantly. Generally, the best you'll get is observation of behavioural changes after the operation. I'd be pleasantly surprised if I'm incorrect in this, however. FiachraByrne (talk) 12:34, 27 February 2011 (UTC)

I agree: there isn't enough in the article about what the procedure actually was, and what the consequences were. And what *is* there in the article, has to be searched for between the other stuff. In fact, the discussion in this paragraph alone has taught me more about the actual procedure than the article has. I understand what FiachraByrne says about it being experimental and not clearly defined. But can't we at least put *that* in the article? Readers are looking for a section called "Procedure" or "How it works" or whatever, and it simply isn't there. If you just make such a section, even if it would (hypothetically) only say "medical records are unclear about how it worked", than at least that much is established. Because right now, the reader just keeps searching the article for something that isn't there. RagingR2 (talk) 09:59, 8 August 2011 (UTC)

Don't post your opinions. —Preceding unsigned comment added by 161.38.221.233 (talk) 21:36, 3 March 2011 (UTC)

Sign your posts. Oh and it seems that mainstream opinion of lobotomy is severely inaccurate, a good example being movies, One Flew over the Cuckoo's Nest, Sucker Punch etc. where usually a lobotomized patient becomes little more than a vegetable. Reading this article and the discussion section seems to indicate that if a vegetative state could be a possible outcome, it was not by far a staple outcome. Maybe we need a "Perception in popular culture" section? Doriphor (talk) 11:58, 29 June 2011 (UTC)

If what you say is true, and there are sources for it, then why not just put that in the article under a section "Procedure and consequences"? (a section that is unfortunately lacking from the article at the moment, by the way) That should be enough; and then you don't need the "Perception" section; at least not for the purpose you are mentioning. RagingR2 (talk) 10:02, 8 August 2011 (UTC)

Fair points. Not sure why I've been so resistive to this. The selection of patients for the procedure could differ markedly from institution to institution. However, generalising from the medical literature and the few decent historical treatments, patients were not selected on a diagnostic basis but the degree to which they exhibited was termed "tension" and/or emotional distress and particularly where distress was perceived to be linked to a specific delusion. Tension was a notably ambiguous term and in practice it was generally used to refer to patients whose ward behaviour was problematic. Thus one of the most frequently noted outcomes of the procedure was that leuctomised patients who had been difficult management problems for an institution required far less nursing supervision postoperatively. An improvement in such cases refers, therefore, to their improved manageability in an institutional context. Where emotional distress linked to a delusional state was relieved a typical and well observed effect in a proportion of patients was that the delusion would be retained but the patient would be indifferent to it. E.g.:

… I would like to recount the story of one of the lobtomized people whose records I have kept.

He was a young Normandy peasant, very attached to his land, who had suffered all his childhood from the tyranny of an alcoholic, emotionally disturbed father, who died during a delirium tremens crisis. Heir to the estate, the patient married and had three children. He was a relentless worker, and nothing interested him except the land and what he sowed and what came up. Although well-off, he lived frugally, and his wife used to say, ‘Sometimes I wonder whether he ever thinks about the children and me’.

One day he came back to the farm and without saying anything barricaded himself in his room. When urged to come out, he called out that he did not want to see his father any more. Later, following his admission to hospital with ea chronic hallucinatory psychosis, his story could be put together. One morning in a field, he had suddenly developed a pain in his back, and it took all his strength to straighten his spine – all too often stooped over. As he raised his eyes, there, in an apple tree, he saw his father sitting astride a branch, ordering him about and shouting abuse just as he used to. This had never stopped; he could see his father everywhere, speaking to him and insulting him. Only thirty-five years old, he had been a compulsory in-patient for four years. A psychiatrist at Sotteville-lès-Rouen had referred him to [the neurosurgeon] Puech after unsuccessfully trying electroconvulsive therapy and even a Sakel treatment [insulin coma therapy]. With great difficulty the patient’s young wife had taken over the running of the farm; wanting to try everything to get her husband better, she consented to a lobotomy on his behalf.

‘The Norman’, as he was called in the department, was operated upon by Puech, and apparently this was successful – so much so that when some London psychiatrists came to pay a visit it was decided to show them the patient. Given the task of making the presentation, I went to find him in his room and explained what was going to happen.

‘These are doctors interested in your case, and you are going to give them your story, your childhood with your father, then your marriage and the reappearance of your father, and finally, the operation and you feel about things now.’

I had made summaries as a framework for the presentation and explained to the Norman how I would ask him questions in front of our foreign colleagues. Everything had to go without any hitches, to give our visitors a favourable impression. Before leaving the room, I added, ‘Of course, you will say how you feel now, and especially that, since the operation, you don’t keep seeing your father anymore.’

At this point I caught a dubious pout on the Norman’s face which struck me as being odd, so I persevered. ‘You do understand, the important thing is to say that you don’t still have an apparition of your father following you everywhere, and stopping you working.’

The Norman didn’t answer. Anxiously, I asked, ‘You understand me? You still don’t see your father.'

Always slow in answering since the operation, but well enough oriented and adjusted, the Norman shook his head, ‘No doctor, that’s right. I don’t see him anymore. That’s true!'

He paused, then added, ‘But you see, I hear him.’

Dismayed, I stood frozen to the spot, and closed the door. In the consulting room Puech and his visitors from abroad were waiting for the wonderful demonstration of ‘hallucinolytic lobotomy’ [i.e. a lobotomy that would remove hallucinations]; and there I was with my good fellow who was now going to admit to auditory hallucinations. Everything was ruined, and the demonstration was going to turn into a disaster.

At the risk of losing all respect and credit from those reading these lines I will confess to the bargain I struck, and my deceitfulness. I got the Norman to sit on the edge of his bed and stood close to him.

‘You remember your four years of being held at Sotteville. You know that when you leave here it will be to go home, to your farm. Your wife and children are waiting for you. You agree with this?’

‘Oh yes!’ he replied, with a big smile.

‘Well, if you now say that you still hear your father, everything is mucked up – finished. Goodbye to the farm, your wife, your children. You’ll be readmitted and sent to the asylum till the end of your days.’

The Norman seemed surprised.

‘But, doctor, you haven’t understood me. I told you I still hear him, but now it doesn’t bother me.’

In this answer lies the essence of the good lobotomy result: lack of interest, loss of painful and distressing emotional drive from the psychological problem in question. Being a beginner in the speciality, and a sycophantic house physician to a powerful chief, instead of debating and analysing the significance of a comparative success, I wanted a complete cure. I insisted, ‘You simply must not say that you can still hear your father, otherwise you’ll be back in the asylum.’

The Norman understood my instructions and agreed not to mention his father’s voice.

When, shortly afterwards, after I had given his history, he was asked about his hallucinations, it was with immense assurance that he replied, ‘Since the operation, I don’t see my father any more. He has vanished.’ And turning to me he added, ‘And I assure you that I don’t hear him any more.’

The secret that bound us together was well kept. I saw the Norman again several times after he had gone back to his professional and family life. Everything went well and he had some more children. When he came to see me we never spoke about his father’s voice. I like to think that, like his visual appearances, it must have vanished.

— Extract: Jean Thuillier, Ten years that changed the face of mental illness, trans. Gordon Hickish (London, 1999), pp 8-9.

FiachraByrne (talk) 10:55, 8 August 2011 (UTC)

In terms of the actual procedure it was intended to sever the fibres linking the frontal lobes to the thalamus. Most commonly this was seen as severing the link between intelligence (frontal lobes) and emotion (thalamus). There were also Freudian interpretations where the frontal lobes was perceived as the site of the superego and the thalamus of the id or the drives. Theory, however, largely followed procedure rather than leading to it. The many different leucotomy and lobotomy procedures differed largely in the degree to which they were intended isolate the frontal lobes from the rest of the brain. I'm not aware of any contemporary neuroanatomical, neuropsychological or neurocognitive study that has explored what effect the operation was likely to have had based upon current knowledge of brain function. The best historical source on leucotomy/lobotomy in the U.S. is probably Jack Pressman's Last Resort: Psychosurgery and the Limits of Medicine. FiachraByrne (talk) 11:17, 8 August 2011 (UTC)

Restructuring

Jesus this page gets about 9k visits a day.

Ok - I've moved the Gottlieb section to the Psychosurgery article. It's not directly relevant here. Other sections in psychosurgery article will now have to be expanded as well now I think.

I'm going to change the title of the section Pioneers to History. The Moniz section will be retained as is for the moment. The Walter Freeman section is going to be split in two: the first will be the Freeman-Watts technique; the second will be Transorbital lobotomy.

A range of other surgical techniques were developed (rostral, topectomy, etc) and these should get a section which will describe the technique and the rationale underlying it.

So the idea here is to restructure the article more around the variety of procedures. These will retain reference to whatever theory lead to or more frequently followed the evolution of a novel procedure.

There's now a section called Indications and Outcomes. At the time I just inserted some quotes from a 1970s Dictionary of Psychiatry that I had lying around. I think I'll wipe the content of this section and start again. Any suggestions or contributions would be appreciated.FiachraByrne (talk) 18:34, 8 August 2011 (UTC)

Image and description of the procedure

Image to be added, text - meh.

I have removed the caption from that image -- the quotation is too long to constitute fair use, and therefore is a copyright violation, even on a talk page. I don't think there would be any objection to extracting a sentence or two from it. Looie496 (talk) 20:43, 11 August 2011 (UTC)

It's ok. I'll just paraphrase it.FiachraByrne (talk) 18:09, 12 August 2011 (UTC)

Reference Checking

I found a dead reference link in the last sentence of the "Criticism" section and removed it, and was unable to find the referenced article elsewhere online (and it was in French anyway). The sentence itself may need to be rewritten as it essentially says that 15 psychosurgeries per year were performed at Mass General Hospital in 2001. 15 per year, in that one year? I also was unable to find another reference to support this claim, or any claim as to how often the hospital currently performs such surgeries. Maybe the article in general should be reference-checked as well. --Kangabell (talk) 22:41, 2 December 2011 (UTC)

The refs look pretty good to me - although I can't vouch all those mentioned in footnote 14, or for the Russian one. The ccne website appears to be having problems, but I expect the article will be back eventually. About the 15 a year - I expect it was someone writing in 2001, saying that MGH carried out 15 operations a year.Staug73 (talk) 09:58, 5 December 2011 (UTC)

Footnote 14 refs are good but I must have been insane to add so many. FiachraByrne (talk) 02:54, 7 November 2012 (UTC)

Massive Assumption in Opening

This article makes the massive assumption that the reader is already informed of the intended neurological outcome of the procedure.

DarkRabbitRevenge (talk) 20:06, 24 April 2012 (UTC)

It isn't actually all that clear what neurological outcome was intended, in a lot of cases -- beyond "improvement" of some sort. But I agree that the article is not very clearly written. Looie496 (talk) 20:22, 24 April 2012 (UTC)

Well there you go! If the article gave the impression that you just did in the outset then it would be a lot easier for "the lay" to understand a great many things about this disgusting act. I knew nothing but rumours about this procedure (which was nothing but "they put a hole in your head, and SOMETHING is relieved"... which was nothing at all), so when I arrived on this Wiki page I was under the impression that these Doctors actually had ONE SINGLE CLUE of what they were doing. Am I understood or am I just rambling? DarkRabbitRevenge (talk) 07:02, 1 May 2012 (UTC)

Explanation of laws pertaining to lobotomy

If I look up "ECT", I get a relatively detailed explanation of the laws surrounding the practice. If I look up this article, "lobotomy", I don't get any explanation. — Preceding unsigned comment added by 50.0.107.248 (talk) 16:02, 23 June 2012 (UTC)

I agree that this article should discuss the topic, but it is less important here, because while ECT is currently in wide use, no lobotomies have been done for over 30 years; no doctor in the developed world could get permission to do one; and any doctor who did would be treated as a criminal. Looie496 (talk) 16:21, 23 June 2012 (UTC)

Notable Cases

In the section Notable Cases the link for Rosemary Kennedy is unuseable. Link 55 leads to an online book with something like 300+ pages available for viewing except pages 271-273 which are blank and it says unavailable for viewing. The link 55 says to see page 271. Mylittlezach (talk) 00:04, 16 August 2012 (UTC)

In Google Books, books with a "preview", like this one, show a limited number of pages, but the specific pages you can see vary from visit to visit. This isn't really an online book, just a previous of a physical book, and there is nothing that can be done about it. Looie496 (talk) 02:43, 16 August 2012 (UTC)

Eslinger and Damasio

I removed the following section from the article for the moment. If I'm not mistaken it's attempting to show the effects of leucotomy/lobotomy based upon research on this patient in the mid-1980s? If that's so it's relevant but it needs a rewrite and, I think, the subheading should relate to something about the effects of the procedure rather than the name of these two researchers. Also it would need to contain a lot more research (it's a study of one patient, after all).FiachraByrne (talk)

Paul Eslinger and Antonio Damasio

Neuroscientists, Paul Eslinger and Antonio Damasio researched the effects of damage to the orbitofrontal cortex by using their patient, E.V.R. According to Damasio, decision-making regions of the brain are connected to the emotional centers, even after damage to the frontal lobe, a theory he tested on a subject referred to as E.V.R., who also had frontal lobe damage, specifically bilateral damage to his orbitofrontal cortices during removal of a brain tumor. What Damasio and Eslinger found was that the subject’s responses to social situations, moral reasoning and intelligence was superior, but he could not easily make decisions or meet his personal and professional responsibilities. For example, he would obsess over comparing restaurants or what to wear, leaving him the inability to make simple, quick decisions. Eslinger and Damasio concluded that E.V.R lacked sympathetically mediated skin conductance responses to neutral and emotional visual images and that frontal lobe damage doesn’t affect memory or intelligence, but the emotional and cognitive centers of the brain.

Along with Eslinger and Damasio’s experiment on patient E.V.R., Carlyle Jacobsen and John Fulton also experimented on chimpanzees involving the removal of the tissue from the frontal lobe, which resulted in the improvement of one of the animals' behavior. Their findings showed that damage to the frontal and prefrontal cortex led to an immense reduction in aggression, and the complete removal of the frontal cortex resulted in the chimpanzees’ inability to do certain tasks and the distress it caused when the chimps made mistakes.

— Preceding unsigned comment added by FiachraByrne (talk • contribs) 03:44, 13 October 2012 (UTC)

References

Changing citation style

I'd like to change to change the citation style to a short footnoting system - sfn & harvnb. I'd also like to create a section in the bibliography for non paginated online sources, kind of like I'm doing here. Are there any objections to this? FiachraByrne (talk) 02:58, 7 November 2012 (UTC)

First, a technical note... see WP:ORDER:

"Bibliography", "Discography", or "Filmography" are occasionally used where appropriate; however, "Bibliography" is discouraged because it is not clear whether it is limited to the works of the subject of the article.

Then see also WP:FNNR and WP:FURTHER (and what they link to) for a somewhat, um, diffuse discussion of possible ways to list sources.

Beyond that... See if you get any ideas from Phineas Gage, which has an eclectic approach -- evolved over time and not entirely consistent, but I'm please with it if I do say so myself. Notice the split between "Notes" and "References" -- Notes (denoted by superscript letters) give additional substantive detail -- side stuff that would weigh down the main text -- along with pointers to sources; but References (superscript numbers) give only sources. This way the reader can tell, without jumping to the end of the article, whether a note/ref will have something substantive, or just boring ol' source information. "Further reading" is really a combination of suggested reading and "other works cited". Anyway, as I said maybe you'll get some ideas. I'd also appreciate feedback or comments on the Gage article.

EEng (talk) 04:42, 7 November 2012 (UTC)

Hi EEng! As you may have guessed I'm in one of my fitful periods of activity on wikipedia - which generally indicates I have real world work that I really should be doing instead. In regard to the Bethlem article I was using a notes/reference system as seen in this dif [2] but I abandoned it for a variety of subjective and aesthetic reasons. Perhaps that was premature. For this article would a Notes/Footnotes/References division be ok (where notes are explanatory footnotes, footnotes are short cites to actual sources and references contains the bibliographic details of works cited)? The Phineas Gage article is excellent - I think I last read it around 2009/10 and it has really improved. I presume you'll be putting it forward as a good article nominee or featured article candidate in the near future? I'll leave a more substantive comment on that article's talk page. FiachraByrne (talk) 10:08, 7 November 2012 (UTC)

Impact of lobotomy & zombie-like patients

I reverted this recent edit by editor ‎87.67.18.206 FiachraByrne (talk) 01:57, 23 January 2013 (UTC)

For example, lobotomy patients have difficulty putting themselves in the position of others because of decreased cognition and detachment from society.<ref name="Shutts1982">{{cite book|author=David Shutts|title=Lobotomy: resort to the knife|url=http://books.google.com/books?id=54BsAAAAMAAJ|accessdate=22 January 2013|year=1982|publisher=Van Nostrand Reinhold|isbn=978-0-442-20252-1}}</ref> The popular conception of a lobotomee is of a zombielike person who has been left in a barely cognizant state by their unfortunate encounter with the surgeon's knife.<ref name="Doonan2003">{{cite book|author=Simon Doonan|title=Wacky Chicks: Life Lessons from Fearlessly Inappropriate and Fabulously Eccentric Women|url=http://books.google.com/books?id=048lZeUTlicC&pg=PA228|accessdate=22 January 2013|date=21 April 2003|publisher=Simon and Schuster|isbn=978-0-7432-5459-5|pages=228–}}</ref>

I think there's a definite lack of discussion of the effects of the procedure in the article. But I think this should be elaborated in the body of the text first before being added to the lead (conversely, anything in the lead that is not now in the body of the text should be added to the body of the text and citations removed from the lead).

The first sentence is not actually an example of contemporary attitudes to lobotomy and the recognition of its side-effects. We'd need a source looking at medical responses to the procedure in the 1940s-60s really. At that time they rarely described its effects in these terms (quite vague in their statements and often to the effect that there was "something lacking" in those lobotomised but that this was discernible only to the trained - psychiatric - eye).

The second statement is, I guess, pretty true - but I'd really like a better source (e.g. a medical history or medical article). FiachraByrne (talk) 01:57, 23 January 2013 (UTC)

You may be need the book which contains then psychiatrists’ outlooks on lobotomy Alexander, G.J.; Scheflin, A.W. (1998). Law and Mental Disorder. Durham, NC: Carolina Academic Press. pp. 955-967. In the book, lobotomist Walter Freeman describes lobotomized people as people with killed soul. --Psychiatrick (talk) 03:36, 23 January 2013 (UTC)

I believe a medical response from the 1940s-60s cannot really be considered as contemporary (such as Freeman's who died 40 years ago). Science and ethics have evolved too much since then. I also believe that medical sources focus on the psychiatric results, but care little for the effects on cognition and other side effects (correct me if I am wrong.) In particular, Freeman didn't seem concerned with cognition, seeing how he hacked at Rosemary Kennedy's brain (lobotomy paragraph of the article) until she wouln't make sense anymore, and left her mentally incapacitated. Her case also indicates that the cognition change was something obvious, not a subtle change only visible to a trained professional. This view is coherent with the description of the prefrontal cortex and the fact that lobotomy is its removal. 87.67.18.206 (talk) 06:37, 23 January 2013 (UTC)

I have created a "side effects" paragraph with the text since you recommended it in the edit history. I hope this was appropriate.87.67.18.206 (talk) 07:51, 23 January 2013 (UTC)

I have removed the second sentence of the reinserted material. First, it was word by word plagiarized (copy-pasted) from its source. Don't ever do that again. Second, it was from an utterly unreliable source. Third, it doesn't belong in this section – the section must be about what the side effects actually are, not about what the "popular perception" of them is (or, if such popular perceptions were to be named, it must be clearly explained to what extent they are true, obviously on the basis of sources that meet the rigid standards of WP:MEDRS.) Fut.Perf. ☼ 08:08, 23 January 2013 (UTC)

Also, I asked you to register an account before you pursue any content dispute further. Please do that now. Fut.Perf. ☼ 08:10, 23 January 2013 (UTC)

Thanks Psychiatrick - I wasn't aware of that source. @87.67.18.206 - I mean contemporary with the period when lobotomies were carried out on a significant scale (particularly earlier responses from about 1940-50). We'd also need a secondary source - such as Psychatrick has provided above - to interpret those primary sources. At the time, when talking about negative effects of the procedure psychiatrists most often put it in terms akin to what Psychiatrick records Freeman as saying above (although the descriptions tended to be less extreme); they'd refer to loss in the spirit of the person, the moral sense, or some kind of ineffable quality of the human. There were some psychological assessments at the time but these tended to downplay any loss of intellectual function. Jack Pressman's Last Resort would be a good source for this for lobotomies in the US - I'll check what he has to say later. Braslow interprets the operation as tending to eliminate the subjectivity of the patient but Pressman's is a more sophisticated analysis. Also, we're not here talking about what were the objective changes consequent to the procedure (much harder to substantiate) but the psychiatric assessment of change in lobotomised patients, which is quite a different thing. In regard to Freeman's transorbital procedure, it was applied much more indiscriminately but was, at least in terms of brain tissue, actually less destructive than the prefrontal technique. Also, reflecting the mores of the time, often psychiatrists would have been less concerned with any loss of intellectual function for housewives, manual workers etc, as they may have believed that intellectual function was less important to such classes of people.

The popular perception question is interesting and certainly that is the current perception (and some patients were hugely damaged by the procedure). At the time, it was seen as a modern, scientific technique with the potential to cure or at least improve "chronic" or "troublesome" patients. There were ideals for clinical, social and managerial outcomes which we could go into. Popular perception is mostly determined by popular media - not sure of a good source for this. FiachraByrne (talk) 10:03, 23 January 2013 (UTC)

Since I started the conversation with this IP, I won't register until my ISP gives me a new IP. This way, I can be identified as the same user.87.67.18.206 (talk) 10:12, 23 January 2013 (UTC)

You're under no obligation to register and anyone who tells you otherwise is misinformed. FiachraByrne (talk) 10:24, 23 January 2013 (UTC)

IQ drop

I have found the following cognitive side effects. The IQ drop following a lobotomy is between 9.2 and 17 (for an individual with normal intelligence before the lobotomy). Normal intelligence is defined with an IQ above 90 as per http://wiki.riteme.site/wiki/IQ_reference_chart. The quote meets the rigid standards (scientific journal), however I don't know how to make a Wiki quote hence why I'm writing here. The book can be found here: http://onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1955.tb00890.x/abstract Porteus refers to the Porteus maze test: http://www.amsciepub.com/doi/abs/10.2466/pms.1956.6.3.135 "SOME COMMON‐SENSE IMPLICATIONS OF PSYCHOSURGERY SD Porteus - British Journal of Medical Psychology, 2011 - Wiley Online Library ... Individuals over 85 IQ in the Binet had an average decline of 9.2 IQ points after lobotomy while those under 85 IQ actually gained 2.6 points. In the Porteus those above 85 IQ in the Maze had an average decline of 17 IQ points, while those below 85 lost only 10 IQ points." 87.67.18.206 (talk) 10:12, 23 January 2013 (UTC)

There are lots of reports on changes consequent to leucotomy (sample below). A lot of studies from the 1950s would support the outcomes in the study you cite above. However, we need secondary sources (by which I don't mean WP:MEDRS sources but historical treatments) to evaluate this literature, I think.

Fleming, G. (1942). "Some preliminary remarks on prefrontal leucotomy". Journal of Mental Science. 88 (371): 282.

Hutton, E.L. (1942). "The investigation of personality in patients treated by prefrontal leucotomy". Journal of Mental Science. 88 (371): 275–81.

Strom-Olsen, R. (1943). "Results of prefrontal leucotomy in thirty cases of mental disorder". Journal of Mental Science. 89 (375): 165. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Meyer, A. (1945). "Neuropathological problems arising from prefrontal leucotomy". Journal of Mental Science. 91 (385): 411. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Reitman, F. (1945). "Autonomic Responses in Prefrontal Leucotomy: Preliminary Report". Journal of Mental Science. 91 (384): 318.

Berliner, F. (1945-09-15). "Prefrontal leucotomy: report on 100 cases". Lancet. 246 (6368): 325–8. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Frank, J. (1946). "Clinical survey and results of 200 cases of prefrontal leucotomy". Journal of Mental Science. 92 (388): 497.

Hutton, E. L. (1947). "Personality changes after leucotomy". Journal of Mental Science. 93 (390): 31.

Hutton, E. L. (1948). "The effect of leucotomy on creative personality". Journal of Mental Science. 94 (395): 322. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Garmany, G. (1948-04). "Personality Change and Prognosis after Leucotomy". The British Journal of Psychiatry. 94 (395): 428–438. doi:10.1192/bjp.94.395.428. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

McLardy, T. (1949). "Anatomical correlates of improvement after leucotomy". Journal of Mental Science. 95 (398): 182. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

Petrie, A. (1949-04). "Preliminary Report of Changes after Prefrontal Leucotomy". The British Journal of Psychiatry. 95 (399): 449–455. doi:10.1192/bjp.95.399.449. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

Rosie, J. M. (1949-04). "The Results of Prefrontal Leucotomy in 68 Patients Not Discharged from Hospital". The British Journal of Psychiatry. 95 (399): 431–448. doi:10.1192/bjp.95.399.431. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

Freudenberg, R. K. (1949-10). "Investigation into Intellectual Changes Following Prefrontal Leucotomy". The British Journal of Psychiatry. 95 (401): 826–841. doi:10.1192/bjp.95.401.826. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Edwards, A. M (1950). "Preliminary Report on Transorbital Leucotomy". Journal of Mental Science. 96 (405): 935.

Stengel, E. (1950). "A follow-up investigation of 330 cases treated by prefrontal leucotomy". Journal of Mental Science. 96 (404): 633–62.

Freudenberg, R. K. (1950-01). "Experimental Studies on Frontal Lobe Functions in Monkeys in Relation to Leucotomy". The British Journal of Psychiatry. 96 (402): 143–156. doi:10.1192/bjp.96.402.143. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Stengel, E. (1950-07-01). "A Follow-Up Investigation of 330 Cases Treated by Prefrontal Leucotomy". Journal of Mental Science. 96 (404): 633–62. doi:10.1192/bjp.96.404.633.

Crown, S. (1951). "Psychological changes following prefrontal leucotomy; a review". Journal of Mental Science. 97 (406): 49. ISSN 0007-1250.

Crown, S. (1951-01). "Psychological Changes Following Prefrontal Leucotomy; A Review". The British Journal of Psychiatry. 97 (406): 49–83. doi:10.1192/bjp.97.406.49. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

Vidor, M. (1951-01). "Personality Changes Following Prefrontal Leucotomy as Reflected by the Minnesota Multiphasic Personality Inventory and the Results of Psychometric Testing". The British Journal of Psychiatry. 97 (406): 159–173. doi:10.1192/bjp.97.406.159. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

Klein, R. (1952). "Immediate Effects of Leucotomy on Cerebral Functions and their Significance: A Preliminary Report". Journal of Mental Science. 98 (410): 60.

Stengel, E. (1952). "The Patients' Attitudes to Leucotomy and its Effects". Journal of Mental Science. 98 (412): 382.

Klein, R. (1952-01). "Immediate Effects of Leucotomy on Cerebral Functions and their Significance: A Preliminary Report". The British Journal of Psychiatry. 98 (410): 60–65. doi:10.1192/bjp.98.410.60. ISSN 0007-1250. Retrieved 2011-08-09. {{cite journal}}: Check date values in: |date= (help)

Kostic, Slobodan (1953-10-01). "Experiences and Results in Prefrontal Leucotomy: A Clinical Study of 339 Leucotomized Patients". Journal of Mental Science. 99 (417): 786–95. doi:10.1192/bjp.99.417.786.

Pippard, J. (1955). "Personality changes after rostral leucotomy: a comparison with standard prefrontal leucotomy". The British Journal of Psychiatry. 101 (425): 774. ISSN 0007-1250.

Pippard, John (1955-10-01). "Second Leucotomies". Journal of Mental Science. 101 (425): 788–793. doi:10.1192/bjp.101.425.788.

Pippard, John (1955-10-01). "Rostral Leucotomy: A Report on 240 Cases Personally Followed up After 11/2 to 5 Years". Journal of Mental Science. 101 (425): 756–73. doi:10.1192/bjp.101.425.756.

Costello, C.G. (1956-07). "The effects of prefrontal leucotomy upon visual imagery and the ability to perform complex operations". Journal of Mental Science. 102 (428): 507–16. ISSN 1097-0088. {{cite journal}}: Check date values in: |date= (help)

Robin, A. A. (1958). "A Retrospective Controlled Study of Leucotomy in Schizophrenia and Affective Disorders". Journal of Mental Science. 104 (437): 1025.

Thorpe, F. T. (1958). "An evaluation of prefrontal leucotomy in the affective disorders of old age: A follow-up study". Journal of Mental Science. 104 (435): 403.

FiachraByrne (talk) 10:33, 23 January 2013 (UTC)

I'll try and write something later on this and maybe then we could add a quote box and quote a representative study. FiachraByrne (talk) 10:57, 23 January 2013 (UTC)

The modern papers on changes consequent to lobotomy:

Jasper, HH (1995). "A historical perspective. The rise and fall of prefrontal lobotomy". Adv Neurol. (66): 97–114. PMID 7771315.

Benson, DF; Stuss, DT; Naeser, MA; Weir, WS; Kaplan, EF; Levine, HL (1981). "Long-term effects of prefrontal leucotomy--an overview of neuropsychologic residuals". J Clin Neuropsychol. 3 (1): 13–32. PMID 7276194. {{cite journal}}: Cite has empty unknown parameter: |1= (help); Unknown parameter |month= ignored (help)

Stuss, DT; Kaplan, EF; Benson, DF; Weir, WS; Naeser, MA; Levine, HL (1981). "Long-term effects of prefrontal leucotomy". Arch Neurol. 38 (3): 165–9. PMID 7469849. {{cite journal}}: Unknown parameter |month= ignored (help)

--Psychiatrick (talk) 14:25, 23 January 2013 (UTC)

Ah - thanks Psychiatrick. Do you have access to these papers? I doubt that I do (although I haven't checked yet). Actually, I may be able to get hard-copies as I think there still is a physical library somewhere that still stocks actual physical journal volumes. FiachraByrne (talk) 18:13, 23 January 2013 (UTC)

Lobotomy in the Soviet Union

The above cited papers can be received from western libraries by their institutional subscribers among such western neuroscientists as Looie496. I am from Russia, not the West. Here I can add that the lobotomy was criticized and stopped in the Soviet Union after Soviet psychiatrist Vasily Gilyarovsky wrote in the journal Meditsinskiy Rabotnik (Medical Person) No 37 of 14 September 1950:

It is assumed that the transection of white substance of the frontal lobes impairs their connection with the thalamus and eliminates the possibility to receive from it stimuli which lead to irritation and on the whole derange mental functions. This explanation is mechanistic and goes back to the narrow localizationism characteristic of psychiatrists of America, from where leucotomy was imported to us.

Предполагается, что перерезка белого вещества лобных долей нарушает их связи с зрительным бугром и устраняет возможность поступления из него стимулов, приводящих к возбуждению и вообще расстраивающих психические функции. Это объяснение механистично и уходит своими корнями к узкому локализационизму, свойственному психиатрам Америки, откуда и перенесена к нам лейкотомия.

The paper by Gilyarovsky proved to be enough to stop the practice of lobotomy in the Soviet Union for years to come.--Psychiatrick (talk) 02:58, 24 January 2013 (UTC)

Thanks Psychiatrick. We should set up a collaborative library of sources for such articles that all of us could access. Could you hazard a translation of the 1950 article title? Also, do you think that the resistance to lobotomy in Russia had anything to do with a rejection of brain localisation theories? FiachraByrne (talk) 03:08, 24 January 2013 (UTC)

Here are the data of the paper: Vasily Gilyarovsky (14 September 1950). “Pavlov’s teaching is the basis of psychiatry.” Meditsinskiy Rabotnik, No 37. In Russian: Василий Гиляровский. Учение Павлова — основа психиатрии // Медицинский работник № 37, 14 сентября 1950. Yes, I think that the resistance to lobotomy in Russia had something to do with a rejection of the assumption that each mental function, motion, emotion, etc. is strictly and entirely localized in a certain part of cerebrum. I am also influenced by Russian neuroscientists and think each mental function evokes the activation of all parts of cerebrum, not only one of its parts. This activation of all the parts of cerebrum related to various cognitive and emotional processes would be impossible if each mental function were strictly localized in only one part of cerebrum. There is the paper on the theme: Лихтерман, Л.Б.; Лихтерман, Б.Л. (2001). "История запрета психохирургии в СССР". "Вопросы нейрохирургии" им. Н.Н. Бурденко [Zhurnal Voprosy Neirokhirurgii Im N N Burdenko] (2): 35–38. PMID 11558172. {{cite journal}}: Unknown parameter |month= ignored (help); Unknown parameter |trans_title= ignored (|trans-title= suggested) (help) --Psychiatrick (talk) 14:54, 24 January 2013 (UTC)

Thanks again for the clarification. Could you also check footnotes 41 and 42 to make sure that they're ok? FiachraByrne (talk) 03:02, 25 January 2013 (UTC)

Footnotes 41 and 42 are ok. --Psychiatrick (talk) 09:51, 25 January 2013 (UTC)

Further question: what was Gilyarovsky's official position within Soviet psychiatry at the time of that article? FiachraByrne (talk) 03:06, 25 January 2013 (UTC)

At the time of Vasily Gilyarovsky’s paper, Gilyarovsky within Soviet psychiatry held the position of the director of the Institute of Psychiatry of the USSR Academy of Medical Sciences (now the Institute created by Gilyarovsky is called the Mental Health Research Center of the Russian Academy of Medical Sciences). Gilyarovsky’s opinion that “Pavlov’s teaching is the basis of psychiatry” became the official position, and the basis, of Soviet psychiatry after pavlovian session. As a result, psychosurgery and, in particular, lobotomy were banned in the Soviet Union. That was good I think not for neuroscientists, but for the mentally ill who did not want to be lobotomized. After pavlovian session, the best neuroscientists of the time were labeled as anti-Pavlov, anti-materialist, reactionaries and were discharged from their positions. --Psychiatrick (talk) 09:51, 25 January 2013 (UTC)

I have the Selected Works by Gilyarovsky in Russian. The book contains the information that lobotomy was banned in the USSR on the initiative of Gilyarovsky.

In the Don hospital, V.А. Gilyarovsky introduced new methods of active therapy. It is no exaggeration to say that this hospital applied all types of therapy except for leucotomy, of which he had always disapproved. It is known that this type of treatment was banned in the USSR on the initiative of V.А. Gilyarovsky. (Gilyarovsky, V.А. (1973). Selected Works. Moscow: Medicine. p. 4 [in Russian])

В Донской лечебнице В. А. Гиляровский внедрил новые методы активной терапии. Не будет преувеличением сказать, что в этой больнице применялись все виды терапии, за исключением лейкотомии, к которой он всегда относился отрицательно. Как известно, этот вид лечения был запрещен в СССР по инициативе В. А. Гиляровского. (Гиляровский В.А. Избранные труды. — Москва: Медицина, 1973. — С. 4.)

--Psychiatrick (talk) 13:51, 25 January 2013 (UTC)

OK. I have a few more questions as, on the basis of a very cursory search, I can't find anything substantive on lobotomy in the USSR based on English language sources (actually, the only country which is really adequately covered in the sources is the US; everything else is pretty fragmented). When was lobotomy first introduced into the USSR? Is it known how many operations were performed before the 1950 ban? How long did the ban remain in place before lobotomy/psychosurgery was reintroduced? FiachraByrne (talk) 22:20, 2 February 2013 (UTC)

The Soviet newspaper Pravda of 29 November 1950 wrote, “As early as 1944, professor M. Goldenberg, the head of the department of psychiatry at the Gorky Medical Institute, conducted an operation by the method of lobotomy.” Perhaps, lobotomy was first introduced into the Soviet Union in 1944. In his book Prodolzhenie “Zdes-2” published in 2007, Russian neurologist Doctor of Medical Sciences Leonid Boleslavovich Likhterman wrote that a report on the audit of the Bekhterev Leningrad Institute stated that 176 patients underwent leucotomy. Probably, only 176 patients in the Soviet Union underwent leucotomy from 1944 to 1950 when leucotomy was banned. The ban remained in place from 1950 to 1998 when psychosurgery in Russia was reintroduced and then again banned in 2002. See Hall, Wayne (2006). "Stereotactic neurosurgical treatment of addiction: minimizing the chances of another 'great and desperate cure'". Addiction. 101 (1): 1–3. doi:10.1111/j.1360-0443.2005.01363.x. PMID 16393184. Retrieved 2 February 2013. {{cite journal}}: Unknown parameter |month= ignored (help) --Psychiatrick (talk) 23:34, 2 February 2013 (UTC)

That's great Psychiatrick. 1944 could be right; a little late but most countries didn't start lobotomies on any scale until the mid 1940s (Italy was exceptional). Just to clarify, it is Boleslavovich's or your conclusion that there were probably only 176 leucotomies in the USSR from 1944–1950 and the introduction of the ban? Also, is there any mention of the Nobel Prize in 1949 in relation to the ban? FiachraByrne (talk) 23:58, 2 February 2013 (UTC)

It is my conclusion that there were probably only 176 leucotomies in the USSR from 1944 to 1950. By the way, Boleslavovich is Likhterman’s middle name. His surname is Likhterman. There is no mention of the Nobel Prize in 1949 in relation to the ban. Psychiatrick (talk) 00:11, 3 February 2013 (UTC)

Thanks for pointing out my mistake in regard to Likhterman's name; otherwise I probably would have perpetuated it. It's not so unusual that there might have been one surgeon or centre that dominated in the field of leucotomy in a given country (e.g. Wylie McKissock in the UK) but there must have been other neurosurgical centres in the USSR interested in the procedure. Puusepp was (re-)converted to the virtues of psychosurgery by 1937; that may have had some influence ... ?

OK. Rereading your post above you state: "...a report on the audit of the Bekhterev Leningrad Institute stated that 176 patients underwent leucotomy". Presumably that is the same institution that Puusepp worked with Bekhterev in the early 20th century? It makes sense, therefore, that that was the leading centre for leucotomy in the USSR if Puusepp was still attached to or influential within that neurosurgical unit. FiachraByrne (talk) 00:49, 3 February 2013 (UTC)

The Leningrad Institute where Vladimir Bekhterev had worked was named after him after he died. Psychiatrick (talk) 01:16, 3 February 2013 (UTC)

Very good. Now I wonder what kind of role Puusepp may have had, if any, in introducing leucotomy to the Bekhterev institute, given his role at the Racconigi hospital in Italy. FiachraByrne (talk) 02:02, 3 February 2013 (UTC)

I don’t know whether Ludvig Puusepp performed the psychosurgical operations by the method of lobotomy (i.e. on the frontal lobes) or not. According to the Soviet newspaper Pravda of 29 November 1950, M. Goldenberg in the Soviet Union was the first who performed psychosurgical operations by the method of lobotomy since 1944. Psychiatrick (talk) 14:36, 3 February 2013 (UTC)

40,000 lobotomies in the US?

Do you have any sources reporting how many lobotomies were conducted in the United States? Do you think that there are such sources? The wikiarticle reads, "In the United States approximately 40,000 people were lobotomized." Approximately to what extent? The same is true for sources about lobotomies conducted in the Soviet Union. Psychiatrick (talk) 01:16, 3 February 2013 (UTC)

That section currently cites this article, but the 40,000 figure is derived from Jack Pressman's Last Resort (maybe El-Hai has a different estimate); I'll try and get the exact reference now. FiachraByrne (talk) 02:10, 3 February 2013 (UTC)

Pressman/Ed Shorter: 1936–1951 18,608 lobotomies in US (figures derived from Proceedings of the Third Research Conference on Psychosurgery', 1954).

Hmmm. I don't see the 40,000 figure in Pressman. Could be from Valenstein's 1986 book (Great and Desperate Cures) which I don't have to hand. I'll keep looking but the 40,000 figure is almost certainly some kind of estimate rather than based on any kind of hard data. FiachraByrne (talk) 02:21, 3 February 2013 (UTC)

Mical Raz (see article for full cite), citing Pressman and Valenstein, says that there "tens of thousands" of lobotomies in the US between 1935 and 1965. Pretty certain there's no definitive figure and not sure how they're estimating for period after 1951. Pressman may mention another figure so will reread. FiachraByrne (talk) 02:26, 3 February 2013 (UTC)

40,000 estimated figure for US is quoted in a Rotarian Magazine article dated 1977 [3]. Valenstein had a text out in 1973, Brain Control, and it could be from that ... It's likely a very rough estimate.FiachraByrne (talk) 02:59, 3 February 2013 (UTC)

Bah - 650 books say "it is estimated that 40,000 lobotomies were performed in the US" but I can't find out where they're taking this figure from. Must be Valenstein[4] FiachraByrne (talk) 03:04, 3 February 2013 (UTC)

I think the figure comes from the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research which investigated psychosurgery in 1976 and reported the following year. The Commission was created by Congress in 1974 to look at controversial areas of scientific research. Campaign by Peter Breggin was instrumental in getting the Commission to look at psychosurgery (not just lobotomy). The 40,000 figure is for number psychosurgical procedures since the end of WWII until 1977.FiachraByrne (talk) 03:17, 3 February 2013 (UTC)

No, Valenstein is already quoting the 40,000 figure in 1973 [5]. FiachraByrne (talk) 11:51, 3 February 2013 (UTC)

Thanks. Other sources give the figure up to 50,000 lobotomies carried out in the USA since the introduction of lobotomy. "Since its introduction, it has been estimated that somewhere between 40,000 and 50,000 lobotomies have been carried out in the USA alone. It has also been widely used in other countries. For example, in Great Britain around 10,000 lobotomics were carried out between 1942 and 1952, though the number has dropped sharply since that time." Quoted from Cox, Erika (2001). Psychology for A-Level. Oxford University Press. p. 677. ISBN 0198328389. Psychiatrick (talk) 12:16, 3 February 2013 (UTC)

Yeah - I've seen the 50,000 figure; most often they state between 40,000 and 50,000 but there's no indication of where this estimate is derived from. I'd really like to find the original instance of the 40,000 figure. FiachraByrne (talk) 12:41, 3 February 2013 (UTC)

Here's the Report from the 1977 Commission on Psychosurgery [6] It quotes the 40,000 figure but doesn't indicate where it comes from. I wonder did Peter Breggin have any role in coming up with this figure? It's not an unreasonable figure actually. Lobotomies peaked at 5,000 in the US in 1949. Precise figures stop at 1951 but it did undergo a slight decline from 1949-51. By 1951 there had been 18,604 lobotomies. Assuming a rate of about 5,000 lobotomies a year, there would have been 23,000 lobotomies in the US by 1952, 28,000 by 1953, 32,000 by 1954, 37,000 by 1955, and 42,000 by 1956. Interesting that there appears to be a decline before the introduction of antipsychotics in 1954. I think the same observation, that decline precedes the antipsychotics, has been made for the UK.

I think it's also instructive, however, that Pressman, whose history of lobotomy in the US is the best one by some distance, does not quote the 40,000 figure.FiachraByrne (talk) 12:06, 3 February 2013 (UTC)

Then again, that it peaked in 1949 might reflect the influence of the Nobel Prize. FiachraByrne (talk) 12:09, 3 February 2013 (UTC)

I guess it's possible that Freeman provided the estimate? [7] FiachraByrne (talk) 12:18, 3 February 2013 (UTC)

Yes, he did. "Freeman later estimated that of the 40,000 to 50,000 lobotomies done in this country between 1936 and the late 1950s, he had personally performed or directed 4,000 of them in at least 30 hospitals in 15 states." Quoted from Frackel, Glenn (14 June 1980). "'Operation Icepick' characterized age of lobotomy". Anchourage Daily News. Psychiatrick (talk) 12:46, 3 February 2013 (UTC)

Freeman gave that estimate of the number of lobotomies that he performed himself at his retirement. I don't think that is the source of the 40,000 figure. FiachraByrne (talk) 13:08, 3 February 2013 (UTC)

Jebus, now a paper is stating that by 1952 40,000 lobotomies had been performed worldwide Nijensohn, Daniel E. (2012-03). "New Evidence of Prefrontal Lobotomy in the Last Months of the Illness of Eva Perón". World Neurosurgery. 77 (3–4): 583–590. doi:10.1016/j.wneu.2011.02.036. ISSN 1878-8750. Retrieved 2013-02-03. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help). It cites this publication in support: Kaplan AD, Lambre J, Veppo AA: "Bimedial lobotomy in the treatment of pain." Second International Congress of Neurosurgery, Washington DC, 1961.FiachraByrne (talk) 12:57, 3 February 2013 (UTC)

Which reminds me we haven't covered lobotomy as a treatment for chronic pain.FiachraByrne (talk) 12:59, 3 February 2013 (UTC)

Inappropriate material

I'd like to note that currently the article contains two things added by the 87 IP editor that I don't think are appropriate:

• In Notable cases, the line Josef Hassid, a famous Polish violonist and composer, was murdered with a bilateral prefrontal leucotomy at age 26 is not supported by our article about him.

• In Literary and cinematic portrayals, the line It was the writers and film-makers who got across to the public the full horror of carving up the human brain like a Thanksgiving turkey. This may be the opinion of a newspaper writer, but it does not belong in a Wikipedia article without attribution.

I have already reverted these items once, and it is my policy never to repeat-revert the same material, so I'll have to leave these to others to deal with. Looie496 (talk) 17:47, 23 January 2013 (UTC)

LOL. Thank you. The language, if nothing else, is not encyclopedic. I haven't worked on the article in a while so I'll give it a good read through and edit/copy-edit. FiachraByrne (talk) 18:10, 23 January 2013 (UTC)

The "thanksgiving turkey" line was also, again, plagiarized. The IP editor really needs to stop doing that. Fut.Perf. ☼ 19:57, 23 January 2013 (UTC)

Josef Hassid (1923–1950), musical prodigy, born in Suwalki Poland, died in Longrove Psychiatric Hospital Surrey. Became psychotic at 18 years of age when on tour in London (already hailed as a musical genius at this point); diagnosis of schizophrenia (persecutory delusions, grimacing, posturing). First admission to psychiatric hospital in 1941 (St Andrews Northampton). 60 insulin comas over 3 months: no effect. 20 ECT sessions from Nov 1941: some improvement. After further course of 25 ECT discharged May 1942; returned to London. Relapsed Dec 1942; certified; admitted to Moorcroft House, Hillingdon, Middlesex. Insulin comas; attempted escape; transferred to Longrove ("evasive, inconsequential"; disinclined to speak; "brooding"; "laughed inanely"; "deluded"; "suspicious"). According to case notes, remains psychotic for 7 years. 20 Oct 1950, Bilateral leucotomy performed; fever 5 days later; signs of cerebral infection; died from complications subsequent to the operation (meningitis), 7 Nov 1950. COD: "suppurative meningitis due to Bacillus Pyocyaneus following prefrontal leucotomy performed for the treatment of dementia praecox and schizophrenia". Summary of: Feinstein, Anthony (March 1997). "Psychosurgery and the child prodigy: the mental illness of violin virtuoso Josef Hassid". History of Psychiatry. 8 (29): 55–60. doi:10.1177/0957154X9700802904. ISSN 1740-2360 0957-154X, 1740-2360. Retrieved 31 January 2013. {{cite journal}}: Check |issn= value (help) FiachraByrne (talk) 01:15, 3 February 2013 (UTC)

Actually, that cite can support almost all the text from the "Illness and death" section of the Hassid article, which is currently uncited; I'll add it now. FiachraByrne (talk) 01:19, 3 February 2013 (UTC)

In-pop-cult/literary portrayals/etc. material

I'm adding this at this point on the page because to some extent it follows from the immediately previous section. Hats off to BiancaFern ;) for taking the axe to the pop culture material. I had a very unpleasant time abt 2 years ago trying to get rid of the Shutter Island baloney and finally gave up.

In the context of another article, I proposed a standard for inclusion of pop culture material which, to my astonishment, not only gained unanimous consensus but actually converted someone who had proposed mention of a certain fictional work to the point of view that doing so would not, after all, be appropriate. (Some of you may have read about this historically unique achievement in connection with my having been nominated for the Nobel Prize for it.) Anyway, here (slightly tweaked) is what I proposed:

A fictional or semifictional portrayal of an article's subject is worth noting or discussing in the article on that subject to the extent that reliable secondary sources demonstrate that the portrayal adds to an understanding of the subject itself or of the subject's place in history or popular perception.

Later in the discussion (linked here: Talk:Lizzie Borden/Archive 2#popcult_discussion) I gave examples:

• The play Macbeth is what most people know about the historical Macbeth
• The film Lawrence of Arabia taught most people everything they know about T.E. Lawrence
• The Dylan song "Hurricane" probably was a strong reason that Ruben Carter's case was reopened
• War and Peace powerfully affected Russians' view of Napolean's invasion seventy years earlier, and did so with sufficient permanence that echoes of its thematic elements were incorporated into Russian propaganda of World War II
• Turgenev's Fathers and Sons was a catlyst, in late 19th-century Russia, for discussion of social and political conditions, and would certainly have a place in an article on events leading to the Russian Revolution
• The Protocols of the Elders of Zion would certainly be covered in a discussion of the history of popular perceptions of Judaism
• Any comprehensive history of slavery in the US would include a discussion of Uncle Tom's Cabin

So it's not true that discussion of fictional or artistic presentations don't belong in factual articles. But the standard is high, and a minimum requirement is that secondary sources must discuss the work's effect on popular perception etc. -- lacking such sources, even such "obvious" statements about how a given work related to (returning to the topic at hand) Lizzie Borden, drawn from direct reading of the work itself, is WP:OR, which is a no-no.

Do others think such a standard could be usefully applied in this article?

EEng (talk) 02:09, 24 January 2013 (UTC)

Burn it with fire! Yes. Yes. Write a policy proposal. Ken Kesey's work probably has a claim but I'll have to look at the sources to confirm.FiachraByrne (talk) 02:40, 24 January 2013 (UTC)

Um, I'm not sure what Burn it with fire means but I gather it's an expression of enthusiasm. When you suggest writing a policy proposal, do you mean for an overall WP guideline? If so, then -- again -- I'm glad for the enthusiasm but for the moment I was just proposing we use it here on this article -- if someone has the fortitude to propose it as a WP-wide guideline I'd be flattered but I don't think I'm the person to do that.

Just from my own knowledge of literature and culture (US, anyway) I'd predict the following fates, under my proposed criterion, of works now mentioned in the article:

• Absolutely qualifies for inclusion: Cuckoo's Nest
• Likely: Frances; Bell Jar; Suddenly, Last Summer
• Perhaps: All the King's Men, Fine Madness
• Unlikely: Planet of the Apes

However, as they are presented in the article now, none of these carry cites meeting the burden of my prososed standard. The Grenander article goes partway, in that it describes how each work portrays lobotomy, but it doesn't (I don't think) say much or anything about how popular perceptions were affected. Gabbard seems like it might be likely to do the latter, but I don't see it there offhand either.

I'm still hoping to get more editors' thoughts on this. EEng (talk) 17:08, 24 January 2013 (UTC)

Further discussion

I think it should be mentioned in title only, movies, shows, books that revolve around the topic at least in part, but no information should be given outside a brief description. ie. "sucker punch follows a girl who is undergoing a lobotomy and slips into a fantasy world before the procedure is completed." or "planet of the apes has a character suffering the effects after a lobotomy was performed" for more on the plot reader can view the wiki for that title. we cant just erase fiction, its part of our existance and deserves a place. tag the section "fictional works around lobotomy" or similar. Kevintampa5 (talk) 19:13, 17 August 2013 (UTC)

I strongly disagree. Mad scientists frequently do mysterious and shocking things to unwilling subjects' brains ("that must be a lobotomy!"), cut up bodies and sew them back together and zap them with electricity ("let's add that to the Frankenstein article!") and so on, but unless we can draw on a secondary source's comment on how a given work adds to an understanding of the subject, or has changed the way the public perceives the subject, such a listing is just WP:OR trivia. People who want pop references can just Google "fictional lobotomy" or "fictional brain surgery" or look here, which appears to list something like 70 fictional instances. You really think all that stuff belongs in the article? EEng (talk) 18:08, 20 August 2014 (UTC)

EEng sent me here after we both participated in a similar discussion at Talk:P versus NP problem#Popular culture. I don't think we should be aiming for comprehensive lists of books and movies and games that happen to mention a particular idea or even that use it in a nontrivial way; TVTropes does that better and we don't need to duplicate them. Rather we should be aiming for an encyclopedic discussion of how and why a particular scientific/technical topic is typically used in media, backed up by scholarly sources. That is, an entry should not be included here because it is a famous work that mentions lobotomy, but rather only when some scholar has given in-depth coverage to the connection between lobotomy and some particular work. A couple of examples of other topics with lists of cultural examples that I think do it reasonably well are Quincunx#Literary symbolism and Squaring the circle#In literature. In both of those examples each listing is backed up by a scholarly publication that attests to and explains the significance of the subject in the work listed. These two examples also tend to include more works of classical literature and fewer of popular culture, but I don't think that's an important distinction to be making in this context; it didn't happen because I or other editors here think that pop culture is bad or trivial (I certainly don't), but rather because the scholarly secondary sources for these tropes tend to concentrate more on classical literature. So, by all means include a discussion on lobotomy in literature, film, and the arts — there's a lot of material out there to choose from — but make it about how authors have used lobotomy as an indirect way to talk about the doublethink necessary to act as a cog in the machinery of the military-industrial complex, or about the changing views of mental patients in society, or something else in-depth, rather than the trivial "Repo Man has a lobotomized character". And do it only with reliably published secondary sources that cover lobotomy as a significant aspect of the story rather than as an incidental detail. I strongly disagree with Kevintampa5's suggestion that we only briefly mention titles that use lobotomy: I think we should only include titles here when we can do more than briefly mentioning them. —David Eppstein (talk) 22:32, 20 August 2014 (UTC)

I want to highlight a particularly incisive point just made (slightly restated): The fact that we can't do more than briefly mention a work is a sure sign it doesn't merit inclusion. EEng (talk) 01:29, 21 August 2014 (UTC)

That all sounds like a sane enough standard for what gets included; which, I guess excludes the obvious Pink Floyd quote - surprisingly absent from the TVTropes page - "You raise the blade, you make the change, you rearrange me 'til I'm 'sane'; you lock the door - and throw away the key - there's someone in my head, but it's not me." Historically too late to have influenced public perception against the procedure, though it articulates well the aghast view once it was over. 84.215.40.194 (talk) 23:35, 26 April 2015 (UTC)

Dark Side of the Moon is right up there with Sgt. Pepper as one of the handful of greatest albums of all time, and part of what makes it great (to me) is that I'm always discovering something new in it. That this might be a lobotomy reference never occurred to me. But I agree it doesn't belong in the article, unless we've got a secondary source discussing etc etc and so on and so forth. EEng (talk) 23:55, 26 April 2015 (UTC)

DO NOT ADD SUCKER PUNCH

For the record I've added

<!-- and that includes "Sucker Punch" -- DO NOT ADD /// SUCKER PUNCH // -- see Talk -->

to the warning in the "Portrayals" section about inappropriate additions. If anyone objects (i.e. the film has worthwhile elements we've overlooked) then let's discuss. EEng (talk) 13:37, 2 July 2015 (UTC)

This is not an objection, but a question regarding Sucker Punch. Is there any other film that graphically depicts both the surgical instruments and the procedure of performing a lobotomy? How <awful?> <easy?> the portrayed ice pick method must have been. I could scarcely contain my horror. Could that actually have been done to a conscious human (if indeed that depiction was accurate). At any rate kudo's to Snyder for peeling back the barbarism in psych hospitals in the first half of the 20th century. N0w8st8s (talk) 21:46, 13 October 2015 (UTC)n0w8st8s

I haven't seen the film and can't find the right clip online (I'd appreciate it if you could direct me to one) but the transorbital procedure was frighteningly quick‍—‌Freeman could do it in seven minutes, apparently. [8] p.185. It was done under anaesthesia, usually via administration of ECT, since almost all mental hospitals had ECT equipment, but few were equipped for general anaesthsia. The horror about ice picks reflects ignorance, however‍—‌historically, everyday items were frequently pressed into surgical service when new techniques were being developed. EEng (talk) 23:23, 13 October 2015 (UTC)