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.2013 Apr 5:4:49.
doi: 10.4103/2152-7806.110146. Print 2013.

Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy

Affiliations

Violence, mental illness, and the brain - A brief history of psychosurgery: Part 1 - From trephination to lobotomy

Miguel A Faria Jr. Surg Neurol Int..

Abstract

Psychosurgery was developed early in human prehistory (trephination) as a need perhaps to alter aberrant behavior and treat mental illness. The "American Crowbar Case" provided an impetus to study the brain and human behavior. The frontal lobe syndrome was avidly studied. Frontal lobotomy was developed in the 1930s for the treatment of mental illness and to solve the pressing problem of overcrowding in mental institutions in an era when no other forms of effective treatment were available. Lobotomy popularized by Dr. Walter Freeman reached a zenith in the 1940s, only to come into disrepute in the late 1950s. Other forms of therapy were needed and psychosurgery evolved into stereotactic functional neurosurgery. A history of these developments up to the 21st century will be related in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International (SNI).

Keywords: Frontal lobes; institutionalization; lobotomy; mentally ill; psychosurgery; trephination.

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Figures

Figure 1
Figure 1
Prehistoric adult female cranium from San Damian, Peru (unhealed trepanation). Smithsonian Institution
Figure 2
Figure 2
Prehistoric adult female cranium from Cinco Cerros, Peru (unhealed trepanation). Smithsonian Institution
Figure 3
Figure 3
Ceremonial tumi. Pre-Inca culture. Birmingham Museum of Art
Figure 4
Figure 4
Prehistoric adult male cranium from Cinco Cerros, Peru (healed trephination). Smithsonian Institution
Figure 5
Figure 5
Peruvian trephined and bandaged skull from Paracas, Nasca region, A.D. 500. CIBA Symposia, 1939; reproduced in E.A. Walker's A History of Neurological Surgery, 1967
Figure 6
Figure 6
Ancient Roman surgeons used the types of terebras illustrated here for perforating the cranium in surgical procedures
Figure 7
Figure 7
The Extraction of The Stone of Madness (or The Cure of Folly) by Hieronymus Bosch. Museo del Prado, Madrid, Spain
Figure 8
Figure 8
Peter Treveris’ engraving of trephination instrument in the Renaissance (1525)
Figure 9
Figure 9
St. Bethlehem Hospital in London (Bedlam), which opened in 1247, was the first institution dedicated to the care and treatment of the mentally ill
Figure 10
Figure 10
Phineas Gage case, trajectory of iron rod through cranium
Figure 11
Figure 11
Phineas Gage with his tamping iron (c. 1860)
Figure 12
Figure 12
Professor of Neurology, Dr. Antonio Egas Moniz (1874-1955)
Figure 13
Figure 13
Famous German psychiatrist, Dr. Emil Kraepelin (1856-1926)
Figure 14
Figure 14
American psychiatrist, Dr. Walter Freeman (1895-1972)
Figure 15
Figure 15
Dr. Walter Freeman, “The Lobotomist,” at work
Figure 16
Figure 16
Mentally ill, homeless, and dangerous. New York Post, December 10, 2012
Figure 17
Figure 17
The mentally ill, including paranoid schizophrenics and violent individuals roaming the cities of America contribute to the homeless, and they themselves become the subject of abuse or the perpetrators of crime in part due to their mental illness. New York Post, September 2009
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