Psychosurgery

The surgeon's knife can reach into the brain to sever the tensions which underlie a psychopathic personality. This drastic method of rescuing psychotic patients from complete insanity is not exactly a new invention. It has been developed in Lisbon by Dr. Egas Moniz since 1935. But now two men who have pioneered this treatment in the U.S.--Neurologist Walter Freeman and Neurosurgeon James W. Watts of George Washington University--have published a book, Psychosurgery (Charles C. Thomas; $6), based on their work. Some 300 people in the U.S. have had their psychoses surgically removed, Dr. Freeman revealed last week, and a score of U.S. surgeons are now using the revolutionary new technique.

The Brain Is Sliced. In their development of Dr. Moniz' methods, Drs. Freeman and Watts drill a small hole in the temple on each side of the patient's head where two skull bones meet. Surgeon Watts then inserts a dull knife into the brain, makes a fan-shaped incision upward through the prefrontal lobe, then downward a few minutes later. He then repeats the incisions on the other side of the brain. No brain tissues are removed. (In two operations they have cut cerebral arteries. Both patients died.)

The patient is given only a local anesthetic at the temples--the brain itself is insensitive--and the doctors encourage him to talk, sing or recite poems and prayers while the operation is in progress. As his lobes are sliced, he becomes drowsier, more confused and incoherent. When his replies to questions show that his mind is thoroughly disoriented, the doctors know they have cut deep enough into his brain. (Dr. Freeman once casually asked a patient, "What's going through your mind now?" Said the patient: "A knife.")

Cutting Connections. Purpose of the operation is to sever most of the nerve connections between the prefrontal lobes and the thalamus. The thalamus is lower, nearer the spinal cord. This part of the brain is widely believed to be the seat of emotions--fear, rage, lust, sorrow, other purely animal instincts. All animals have a thalamus, but the higher animals--above all, man--developed superimposed layers of brain tissue which exercise some control over the thalamus.

In man's prefrontal cortex is the seat of mental power which restrains the thalamus --foresight, self-consciousness, social adjustment, imagination, etc. The reasoning, self-conscious cortex is integrated via thousands of millions of nerve cells with the emotional thalamus, so that a normal mind is a more or less harmonious mixture of intellect and emotion. But sometimes this integration takes on a fixed, unhealthy pattern: foresight becomes anxiety, anxiety becomes fear, and the psychotic victim may head for lunacy unless treated by psychoanalysis, shock therapy (e.g., with electricity or insulin) or--as a last resort --psychosurgery.

The surgeon's incisions radically disrupt the connection between the prefrontal lobes and the thalamus. Not all the connections are severed, since a patient might then become a victim of his unrestrained thalamus. But old ideational patterns are destroyed. The brain is forced to reintegrate itself, to form new internal pathways.

New Personalities. After psychosurgery a patient requires months, sometimes a year or more, before he is mentally reintegrated and can lead a useful life. His personality is changed: he is neither his psychopathic nor his pre-psychopathic self.

His capacity to project himself into the future is reduced. He is less self-critical, more extroverted. Say Drs. Freeman and Watts of their patients: "The freedom from painful self-consciousness, and also from preoccupation with former conflicts, repressions, frustrations and the like, and the associated elevation in mood, renders life particularly agreeable to them and they enjoy it to the fullest."

After recovery a patient's emotional responses are vivid but somewhat superficial. He is indifferent to social amenities, may speak his mind and joke so tactlessly that he embarrasses his family and friends. Yet he will apologize for his behavior with real sincerity. His foresight is impaired. Some of these changes would be undesirable if the alternative--an unchanged psychotic personality leading to complete insanity--were not much worse.

Of their 136 cases, Drs. Freeman and Watts regard 98 as greatly improved, 23 as somewhat improved, twelve as failures. Only 13 patients are still in mental hospitals; most are back at their jobs or housekeeping after one to six years of psychotic incapacity.

Drs. Freeman and Watts by no means think that psychosurgery should be used on all psychotics. They make clear the risks--possible death, possible mental dullness from too much brain-cutting. Psychosurgery, they say, is a last resort after less drastic therapy has failed.

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