{"id":4314,"date":"2010-08-31T21:55:54","date_gmt":"2010-09-01T01:55:54","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=4314"},"modified":"2013-01-24T05:41:35","modified_gmt":"2013-01-24T10:41:35","slug":"for-review-3","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2010\/08\/31\/for-review-3\/","title":{"rendered":"for review…"},"content":{"rendered":"
Like countless medical students before me, my first encounter with Schizophrenia was jarring and remains with me still. The woman was in her late thirties in a Memphis mental hospital. As she began to tell me of her delusional ideas, I felt myself disengaging [involuntarily]. Her ideas were bizarre, paranoid, and fantastic, yet they were delivered with almost no emotion. I had no idea what to say or think, but when I later heard that Psychiatrists were formerly called Alienists, I knew exactly why that term was chosen. It’s an overwhelming illness for the afflicted, their families, and those who attempt to treat it. In many ways, the history of its treatment is a testimonial to the magnitude of that illness we know as Schizophrenia: <\/div>\n
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Ant\u00f3nio Egas Moniz [1874-1955]<\/font><\/a><\/strong><\/div>\n

… at a 1935 neurology conference in London that Egas Moniz attended, he noted the data presented by Jacobsen and Fulton showing that a leukotomy on two chimpanzees successfully reduced their aggressive behavior without untoward side effects. Learning of this likely prompted Moniz’s bold step to attempt the process, and in 1936, he published his first report of performing a prefrontal leukotomy on a human patient. Moniz refined his surgical methods by fashioning a "leucotome", a surgical instrument with a movable wire loop which he replaced with a steel band. He used this instrument to cut six holes in each of the brain’s two hemisphere’s white matter, severing the connections of the prefrontal cortex to the rest of the brain. Moriz judged the results acceptable in the first 40 or so patients he treated. However, he conceded that patients who had already deteriorated from the mental illness did not benefit much from the operation. Moniz concluded the following, "Prefrontal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorder."Moniz did no long term follow up, and his evaluations of the success of the procedure were short term only. He believed deeply that the benefits of surgical lesions in the frontal lobes, even if some behavioral and personality deterioration occurred, were needed to treat the debilitating effects of severe mental illness. He was the first to write a scientific report of lobotomy as a psychosurgical treatment for severe mental disorders in 1936.<\/sup> <\/p>\n

In 1939, Moniz was shot by a disaffected patient and as a result was confined to a wheelchair for the rest of his life. In 1949 he received the Nobel Prize, "for his discovery of the therapeutic value of leucotomy in certain psychoses."<\/font><\/strong>  This procedure consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain. The procedure immediately became popular, as at that time there was not an effective treatment for psychosis… Soon Dr. Walter Freeman developed a version of the procedure [the transorbital lobotomy] which was much easier to carry out. Due in part to this procedural ease, lobotomy was often prescribed injudiciously and without regard for modern medical ethics. Endorsed by such influential publications as The New England Journal of Medicine, lobotomy became so popular that, in the three years immediately following Moniz’s receipt of the Prize, some 5,000 lobotomies were performed in the United States alone, and many more throughout the world. Even Joseph Kennedy, father of U.S. President John F. Kennedy, had his daughter Rosemary<\/a><\/strong> lobotomized when she was in her twenties. Freeman performed at least 4,000 lobotomy operations during his career. Since the 1950s, this procedure has fallen into disrepute and is even prohibited in many countries.<\/sup><\/div>\n<\/blockquote>\n
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Ugo Cerletti [1877-1963]<\/font><\/strong><\/a> <\/div>\n

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Convulsive therapy was introduced in 1934 by Hungarian neuropsychiatrist Ladislas J. Meduna who, believing mistakenly that schizophrenia and epilepsy were antagonistic disorders, induced seizures with first camphor and then metrazol (cardiazol). Within three years metrazol convulsive therapy was being used worldwide.  In 1937, the first international meeting on convulsive therapy was held in Switzerland by the Swiss psychiatrist Muller. The proceedings were published in the American Journal of Psychiatry and, within three years, cardiazol convulsive therapy was being used worldwide.  Italian Professor of neuropsychiatry Ugo Cerletti, who had been using electric shocks to produce seizures in animal experiments, and his colleague Lucio Bini developed the idea of using electricity as a substitute for metrazol in convulsive therapy and, in 1937, experimented for the first time on a person. Sherwin B. Nuland, having discussed the matter with a first-hand observer in the 1970s, gave the following description of the results of the first use of ECT on a person:<\/sup><\/div>\n