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Lobotomy and electroshock therapy have an undeserved reputation as being barbaric and futile. We've substantially refined both techniques and we still use them

Lobotomy and electroshock therapy have an undeserved reputation as being barbaric and futile. We've substantially refined both techniques and we still use them where other options of failed. In the case of lobotomy, we now use stereotactic guided procedures to precisely ablate small parts of the brain, mainly for the treatment of severe OCD and treatment-resistant depression. In the case of ECT, we perform the procedure under full sedation and use EEG monitoring to deliver the minimum possible energy. Both treatments still carry a substantial burden of side-effects, but they work when nothing else does. The uncomfortable reality is that a lot of people have debilitating, life-threatening mental health problems that don't always respond to medication or psychotherapy. Most of us don't want to think about what very severe mental illness really looks like - the person who is too depressed to sit up in bed, the person with OCD who picks at their wounds until they hit bone, the person with mania who is keen to test their belief that they're immortal. If you were treating a patient with that level of disability, what would you do? The real disaster of psychiatry isn't the failed attempts, but all the stuff that we don't yet know how to treat or don't have the resources to treat. Mental illnesses are the single biggest cause of disability in the developed world. There's so much we could be doing, so much we should be doing, but we're not spending nearly enough on research or treatment. We're watching helplessly as people live short, miserable lives because of diseases that are treatable or potentially treatable.

belorn 7y ago
As someone who has relative who underwent electroshock therapy in the 70s and read documentation from before, during and after, I will say that the treatment is worse than barbaric. For all practical purposes it was a treatment to remove the issue out of sight and out of mind. As a teenage child he went from someone considered gifted (very high grades), to someone who could not tie his own shoes. Extreme cognitive impairment which his parents noticed and objected to during the ongoing treatment. In contrast, with modern psychology he would likely had gotten a diagnose of ADHD or autism because of his temper tantrums, and treatment outcome would look very different. We have to consider that cultural environment of the 60s and early 70s. A lot of society, especially education, demanded a military style discipline. A student who did not obey got literally beaten until they did, breaking people physically and mentally until they would fit the mold. Electroshock therapy in that culture worked very effectively in doing so.
btilly 7y ago
I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. What is done today far more rarely and far more selectively has no relationship to the old treatment. I'm also aware that electroshock therapy has real uses. However the widespread use of it with little cause has gone the way of the dodo for good reasons. But a lot of people suffered before psychiatry stopped using it as a routine treatment to use as a first resort for a wide variety of conditions.
- jdietrich 7y ago
  >I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. All surgery is barbaric in those terms. You're knocking people out and cutting them apart, it's never going to be pretty. It's only actually barbaric if you're doing it for no good reason. Lobotomy was crude and error-prone, but it was a lifesaving intervention for a substantial proportion of patients. Although some patients were probably needlessly subjected to a lobotomy, the absolute number of patients treated represented a very small proportion of the overall population living with severe and enduring mental illness. We didn't abandon lobotomy because we realised it was barbaric, we abandoned it because we discovered tricyclic antidepressants, antipsychotics and lithium. The discovery of those drugs was also the fundamental reason for de-institutionalisation in the 1960s and 70s - to a great extent the asylums emptied themselves, because enormous numbers of patients were now capable of independence. The fundamental lesson of the past isn't "psychiatry is terrible and we should be afraid of it", but "terrible things happen when you have desperately ill people and no good treatments". The solution is not a crusade against psychiatry, but a massive investment in developing new treatments and actually using the treatments we already have.
  - ncmncm 7y ago
    "We didn't abandon lobotomy because we realised it was barbaric" Exactly the problem, right there. Many thousands of people were lobotomized not because they had severe, untreatable illnesses, but just because they were inconvenient. In only slightly more barbaric times and places they would be slaughtered or starved, as happened quite recently in China, Russia, Cambodia, Mozambique, Guatemala, Germany, ...

belorn 7y ago

As someone who has relative who underwent electroshock therapy in the 70s and read documentation from before, during and after, I will say that the treatment is worse than barbaric. For all practical purposes it was a treatment to remove the issue out of sight and out of mind. As a teenage child he went from someone considered gifted (very high grades), to someone who could not tie his own shoes. Extreme cognitive impairment which his parents noticed and objected to during the ongoing treatment. In contrast, with modern psychology he would likely had gotten a diagnose of ADHD or autism because of his temper tantrums, and treatment outcome would look very different. We have to consider that cultural environment of the 60s and early 70s. A lot of society, especially education, demanded a military style discipline. A student who did not obey got literally beaten until they did, breaking people physically and mentally until they would fit the mold. Electroshock therapy in that culture worked very effectively in doing so.

btilly 7y ago

I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. What is done today far more rarely and far more selectively has no relationship to the old treatment. I'm also aware that electroshock therapy has real uses. However the widespread use of it with little cause has gone the way of the dodo for good reasons. But a lot of people suffered before psychiatry stopped using it as a routine treatment to use as a first resort for a wide variety of conditions.

jdietrich 7y ago
>I'm sorry, inserting an icepick through the eye then scrambling the brain behind it has a pretty well-deserved reputation as being barbaric. All surgery is barbaric in those terms. You're knocking people out and cutting them apart, it's never going to be pretty. It's only actually barbaric if you're doing it for no good reason. Lobotomy was crude and error-prone, but it was a lifesaving intervention for a substantial proportion of patients. Although some patients were probably needlessly subjected to a lobotomy, the absolute number of patients treated represented a very small proportion of the overall population living with severe and enduring mental illness. We didn't abandon lobotomy because we realised it was barbaric, we abandoned it because we discovered tricyclic antidepressants, antipsychotics and lithium. The discovery of those drugs was also the fundamental reason for de-institutionalisation in the 1960s and 70s - to a great extent the asylums emptied themselves, because enormous numbers of patients were now capable of independence. The fundamental lesson of the past isn't "psychiatry is terrible and we should be afraid of it", but "terrible things happen when you have desperately ill people and no good treatments". The solution is not a crusade against psychiatry, but a massive investment in developing new treatments and actually using the treatments we already have.
- ncmncm 7y ago
  "We didn't abandon lobotomy because we realised it was barbaric" Exactly the problem, right there. Many thousands of people were lobotomized not because they had severe, untreatable illnesses, but just because they were inconvenient. In only slightly more barbaric times and places they would be slaughtered or starved, as happened quite recently in China, Russia, Cambodia, Mozambique, Guatemala, Germany, ...