Tuesday, 10 March 2015

Foreword @dchristmas: science, enlightenment, women, lobotomies, bias and objectivity; "a surgically induced childhood"

Returning to Dr David Christmas's MD Thesis on NMD and a wee look at the Foreword headed up by this quote from Adam Smith, key Scottish Enlightenment figure at the time, born in Kirkcaldy, Fife.

Following the dark ages and the domination of religion, the advent of science brought light.  At least among the academic male fraternity.  It appeared to take another couple of centuries for women to be seen as human beings rather than chattels, allowed to vote and a purpose beyond childbearing.  The world wars no doubt helped push women to the fore when the men were away at the Front.  Fighting.

"1.1 Overview (1st para):  "..the huge burden of treatment-refractory psychiatric illness is the driving force behind the continued use of neurosurgical techniques ..."

If this is the case then it makes sense to look at the reasons as to why
film info on wikipedia
"psychiatric illness" isn't being helped by "treatment" which in my family's experience, 8 of us since the 1950's, in psychiatric settings, has consisted of drugs and ECT, forcibly given if resistant, the latter less of an invasive force since the film and book "One flew over the cuckoo's nest".  


Although there are still attempts made by some to keep ECT as a valid treatment when the drugs don't work.  I blame the dominance of biological psychiatry and its influence on therapeutic engagement with people experiencing mental distress.  

Biopsychosocial "interventions" with BIO in large letters, dominating the discourse.  (see blog post on biobiobiopsychosocial BJPsych articleLooking in brains for the cause of mental anguish rather than listening to the person as to why they are feeling pain.


1.1 Overview, page 2

I think it's somewhat of an understatement to say that Moniz (credited with inventing lobotomies) and Freeman (ice pick lobotomies) were not "truly objective".  The fact is that these men powered ahead with invasive brain surgery which severed the neural pathways to and from the prefrontal cortex, the anterior parts of the frontal lobes of the brain.

When searching for articles on these pioneers of brain surgery I came upon these interesting extracts by Mical Raz, MD, PhD, a physician and historian of medicine:

"The preoccupation of physicians and patients with the capacity to work, and the emphasis on productivity, industry and personal responsibility, were contributing factors to the success of lobotomy in the US.'Psychosurgery, Industry and Personal Responsibility', 1940–1965; Mical Raz, Soc Hist Med 23 (1): 116-133

"A Surgically Induced Childhood" from The Lobotomy Letters, The Making of American Psychosurgery By Mical Raz:

 "In 1947 Freeman answered a letter from a frustrated father of a lobotomy patient. The father complained that his daughter was often uncooperative and childish, and that he and his wife experienced considerable difficulties in caring for her at home. “The best means of controlling such behavior,” Freeman advised, was “a rapid change from one type [of activity] to another around the house and frequent outdoor activity, lots of affection and once in a while a good old span[k]ing if she does not behave herself.” On this point, Freeman cautioned, “It may take two of you to get her down,” but the spanking “should be a good one and followed by a dish of icecream [sic], then a kiss and make up.” 

This patient, however, was not a child. Rose Samuel, whom we met in the previous chapter, was a young woman in her late twenties. She had first been admitted to a psychiatric hospital in 1942, diagnosed with dementia pracox, a term later replaced by schizophrenia. After her discharge that same year, she improved sufficiently to live an independent life, and was married in 1945. In 1947, suffering from hallucinations and described as “disturbed and quite violent,” Freeman and Watts decided that a lobotomy would be advisable. The results were unsuccessful; the patient returned to live with her parents, who found her daily care challenging. Freeman explained to her father why he recommended such an unorthodox approach. “She is acting like a child,” he wrote, “and I think she should be handled like a child.”'

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In the following interview, Mical Raz, author of What’s Wrong with the Poor?: Psychiatry, Race, and the War on Poverty discusses how the understanding of poverty and mental health has affected social policy in the United States:

Interview: Mical Raz on poverty, mental health, and U.S. social policy



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