 Scientists have tried to conquer the mind, through many different ways for many different reasons. One such is in the treatment of mental disorders. Experimental science has, in some of its most controversial studies, shed a light into how the brain works. We have seen this in this very series with the monkey mother, baby Albert and Milgram experiments. But how about the treatment of mental disorders in a world before modern-day medicinal drug-based therapy? Around the mid-20th century, a form of invasive surgical procedure would gain praise for being able to tackle the problem of overcrowded mental hospitals and treat the previously untreatable. It would eventually be known as the lobotomy. The surgery would go down in the annals of time as a barbaric and cruel procedure, which would leave behind thousands of patients in its wake with devastating side effects including confusion, incontinence, seizures and in some cases even death. One of the main characters in the story of this surgical procedure would describe the operation as surgically induced childhood. Eventually, the surgery would become synonymous with the mishandling of mental health and the running rough shot over patients' rights. As such, I'm going to rate this dark page in scientific history a 9 on my plainly difficult ethical scale. Welcome to the dark side of science. It is the turn of the 20th century. Mental health institutions throughout Europe and the USA have become dangerously overcrowded. During the 19th century, where scientific discovery took leaps and bounds, many attempts to treat the mentally ill had failed, leading to a large population of incurable patients. This was due to many industrialised countries having national systems of regulated asylums. These institutions sought out care for patients that had been disposed of in the system by their families, poor houses and the criminal justice system. With no proper ways of treating inhabitants of the asylums, many different forms of medical procedure were tested on the unfortunate patients. There were many gruesome types of treatment on offer in the early 20th century. In 1917, malaria therapy was introduced, where a patient would be deliberately infected with the zoonotic disease to induce fever to fight neurociphalus. In 1920, the barbiturate induced deep sleep therapy for premature dementia, aka precocious madness, or in its modern name form schizophrenia. This treatment used drugs to keep patients unconscious for days or even weeks. In 1927, you might have been given insulin shock treatment, which used the peptide hormone to introduce daily comas. In 1934, patients could be prescribed with the first type of seizure therapy, where a patient would be deliberately induced into convulsions by the use of PTZ. This therapy would be superseded by the more familiar electroshock therapy. Although these treatments could cause long-term lasting psychological and physical trauma, the patient had not undergone a surgical procedure to eradicate the disorder. But in 1935, in Portugal, a doctor named Antonio Moniz would change this when he performed the first leukotomy on a patient. The leukotomy in its most basic form was the deliberate damage of brain tissue in order to treat mental illness. The name would later be changed to a more recognisable name when a procedure spread across the Atlantic Ocean, but that will come later on in our story. The thinking that inspired Moniz was that mental illnesses originated from abnormal neural connections in the frontal lobe. Moniz had seen the aft effects of soldiers who had received injuries to the frontal lobe, in which the vectorins would show a calm and quiet disposition. The brain is made up of two types of matter, grey and white. Grey matter is the brain's neurons and associated blood vessels and extensions. The white matter is the nerve fibres that connected to the areas of grey matter and carry messages between them through electrical impulses. Moniz theorised that by severing the white matter fibres from the frontal lobe would improve the patient's mental illness. Although in theory this might make sense, the connections within the brain in reality are far more complex than what was thought at the time. The grim procedure in its first form would involve drilling holes in the skull either side of the prefrontal cortex and injecting the connecting fibres with alcohol to destroy them. Moniz found this method to not yield very good results due to the solution damaging much more than the white matter. A tool was developed called a leukotome, which looked like a long stick with a retractable wire loop inside. It allowed the operator to insert a metal loop into the brain, which was used to sever the white matter by extending and then retracting said loop. The process cut six cores in the white matter of each hemisphere using the new tool. Because the procedure involved cutting through the skull, the patient had to be operated on in a proper operating theatre under general anesthetic. To test the theory, Moniz enlisted neurosurgeon Almedia Lima to conduct a surgery on 20 test subjects. While these initial 20 patients who were suffering from depression, schizophrenia and anxiety, Moniz claimed seven cures, seven improvements and six unchanged cases. Although the results were open to interpretation, Moniz claimed that the risk of some behavioural and personality deterioration outweighed the debilitating effects of severe psychiatric illness, which is understandable when taking mental health care at the time as a contextual background. A second set of patients were operated on due to the success of the first trial. These 18 patients all suffered from schizophrenia and three were considered as almost cured and another two had also become improved. Moniz did conclude that patients that had deteriorated considerably from their condition pre-procedure did not benefit much from the operation. In a well-known quote from Moniz, he described his radical new surgery. Pre-funtal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder. The procedure would eventually earn Moniz a Nobel Prize in 1949. But initially, Moniz's new way of treating the thought to be untreatable was widely derided by the medical community. In 1936, Moniz published his results through articles in the medical press and a monograph, but to little attention. On the 26th of July 1936, one of his assistants gave a presentation at the Parisian meeting of the Society Medico Psychologic on the results of the second test subjects, the 18 people suffering from schizophrenia leukotomized by Lima. This meeting wouldn't go down well as the lead doctor at the Institute in Lisbon, who had supplied the first set of patients to Moniz, was also in attendance and widely denounced the after effects of the surgery. Saying that patients who had returned to his institute post operation were diminished and had suffered a degradation of personality. Further adding that the initial results of calmness and improvement were more likely attributed to the severe shock of the surgery and ultimately from the horrible brain trauma that the procedure induced on its victims. Many other physicians denounced the procedure, but bizarrely, this isn't the end. As several individual clinicians thought Moniz's leukotomy could be useful on an experimental basis on severe patients. And as such, the surgery was spread throughout Europe and even to the US during the mid to late 1930s and this leads us down an even darker path. It is here that we are introduced to American doctors Walter Freeman and James W. Watts. Inspired by Moniz's new surgical procedure in 1936, the duo performed their own leukotomy. Walter had learned of the procedure after a chance meeting of Moniz at the London Hosted Second International Congress of Neurology in 1935. The American was fascinated by the surgical technique. Upon returning to the US, Freeman started communicating with the Portuguese doctor. Moniz, during the correspondence, promised to send a monograph on leukotomy and urged him to purchase a leukotone of his own. Upon receiving the paper on the procedure, Freeman reviewed it and set about with his colleague Watts on experimenting with the surgery, which led to September 1936. Seeing flaws in the surgery, Watts and Freeman developed their own variation which renamed the procedure the standard prefrontal lobotomy to differentiate it from the Moniz method. This version severed more of the white matter and would be the de facto method moving forward for lobotomies performed in operating theatres. Walter thought that the lobotomy could be streamlined even further still. The new standard procedure had the same shortcoming of the Moniz method and that was access to the brain. You see, cutting through the patient's skull required the operation to be conducted in an operating theatre. With all the trappings, anesthesiologist, qualified surgeon, hygiene and so on and so forth. Walter had heard of an Italian doctor, Amorello Fiamberti, who had performed the leukotomy by accessing the prefrontal lobe through the eye socket in 1937. Fiamberti's method was to puncture the thin layer of orbital bone at the top of the eye socket and then, much like Moniz's early experiments, inject alcohol into the white matter or in later surgeries, cutting the white matter with a hypodermic needle. Walter took this process and modified it using probably one of the most unlikely of tools. This is a surgical tool or is this a surgical tool? It's hard to tell as one was used in psychosurgery and the other is an ice pick, but the similarity is not a coincidence as Freeman's improvements on Amorello Fiamberti's transorbital lobotomy replaced a needle with a nice pick. In development of this new method, Freeman took an ice pick from his own kitchen and started practicing on a watermelon. He would eventually graduate to using cadavers. The thinking was that if the lobotomy could be performed without exposing the brain, then it could be performed by psychiatrists in psychiatric hospitals, allowing more people to be operated on. These are the tools used to the Freeman transorbital lobotomy, a new tool called the orbiter class, essentially an ice pick with markings along the side and a hammer. The method would involve the patient being either under anesthetic or electroconvulsive therapy used to render the subject unconscious. Then the orbiter class sharp end is placed under the eyelid and against the top of the eye socket. The hammer is then used to penetrate the surgical instrument through the thin layer of bone and into the brain along the line of the bridge of the nose, eventually going five centimeters deep. The orbiter class was then pivoted 40 degrees at the orbital perforation, so the tip cut towards the opposite side of the head. After this, the tool was then hammered in a further two centimeters into the brain. Again, the orbiter class was pivoted around 28 degrees each side to cut outwards and again inwards. Once this was complete, it was removed and the process was repeated on the other eye socket. The first patient to receive the procedure was in 1946, but once Freeman's partner Watts had heard about this new method, he'd left their practice disgusted at the transorbital lobotomy. But like every other chapter in this story, this would not hamper the procedure's prevalence. The lobotomy had now been transformed from a serious surgical procedure of last resort to a 10 minute doctor's office job. Along with this came a severe lack of follow-up care and monitoring, which led to high relapse rates. Because of this, towards the end of the 1940s, nearly 20,000 people in the US have received the procedure. But not only that, the transorbital lobotomy would spread across the world and even back to the Leucotomy's home ground of Europe, spreading further still to the Soviet Union and Japan. To get a lobotomy in its late 1940s peak, you really didn't need to have much of a mental health condition. With the treatment touted for all kinds of ailments, the list of treatable illnesses with a lobotomy included but were certainly not limited to ADD, OCD, anxiety, PTSD, postnatal depression, chronic pain, Alzheimer's, criminality and violent outbursts. Freeman, Everda Showman, was responsible for a patient's death in 1951 when pausing a lobotomy to pose for a photo, in doing so causing severe brain hemorrhaging. He was even known to lobotomize two patients at the same time, one with each hand. The doctor even performed the operation on minors, including children as young as four. In total, around 15% of patients who received the lobotomy died, but many more were changed for life, a shell of what they once were. For those who survived the ordeal, relapse would often follow. But like its first unveiling to the world in Paris in 1936, the procedure didn't go uncriticized. In the late 1940s, as Moniz was set to receive his Nobel Prize, multiple voices in the medical community spoke out on a barbaric procedure. But it wouldn't be the criticism for the December banning of the procedure in the USSR. But the synthesization of chlorpromazine, the first anti-psychotic. As a side note, Soviet psychologist Dr Nikolai Orozetsky was quoted saying that lobotomies violate the principles of humanity. And that was from an official from 1950s USSR. The procedure gradually fell out of vogue, but Freeman would continue to perform the lobotomy all the way until 1967, when after their third lobotomy, one of Walter's patients died of a hemorrhage. This final procedure would get him banned from performing it ever again. The USSR wouldn't be the last to ban lobotomies, as even Moniz's Portugal would disallow the procedure from use. With further developments in drugs such as SSRIs, anti-psychotics and types of therapy like CBT, the need for surgical intervention slowly faded away, and by the 1980s lobotomy became a thing of the past. Now how would you rate the lobotomy on my ethical scale, one being good and nine being pure cruelty? Let me know in the comments. This is a plainly difficult production. All videos on the channel are Creative Commons attribution share like licensed. Plainly difficult videos are produced by me, John, in a sunny southeastern corner of London, UK. Help the channel grow by liking, commenting and subscribing. Check out my Twitter for all sorts of photos and odds and sods, as well as hints on future videos. 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