3 ms·

We're still doing psychosurgery - far more precise and advanced than Freeman and Watts's lobotomies, but not fundamentally different. Today the most common targ

We're still doing psychosurgery - far more precise and advanced than Freeman and Watts's lobotomies, but not fundamentally different. Today the most common targets are in the cingulate gyrus rather than the prefrontal cortex, but we're still basically cutting or burning out bits of brain. It has become comparatively rare due to the wide array of treatment options now available for severe mental illness, but psychosurgery may still be the least-worst option for people with debilitating and intractable depression, OCD or chronic pain where all other treatments have failed. Freeman was undoubtedly a cowboy, but his poor practice has warped our understanding of psychosurgery. Freeman didn't invent the lobotomy and was widely condemned by many of his contemporaries, including his former surgical partner James Watts. We overlook the extraordinary suffering caused by severe mental illness and forget just how few treatments existed prior to the great pharmaceutical revolution of the 1950s. Freeman's more conservative contemporaries were, for the most part, responsible clinicians trying to do their best for patients who were experiencing unbearable suffering and had no better options. https://en.wikipedia.org/wiki/Psychosurgery https://en.wikipedia.org/wiki/Psychosurgery

goodluckchuck 3y ago
That’s horrifying.
bigger_inside 3y ago
Before we make idealizing comparisons between "barbaric pasts" and seemingly enlightened presents (the "arrogance of the present" in which we assume that whatever we do now is knowledgable, good, just, right, at the end point of progess), let's remember that today's "medications" were largely chance discoveries, where the "chance" consisted of the recognition that they would calm patients and make them more manageable - and in this light, they were praised, in their time, as "chemical lobotomy". Joanna Moncrieff makes this explicit in her book, "The Bitterest Pills". Also elaborated on here: https://www.psycovery.com/images/Postpsychiatrys-challenge-Olga-Runciman-2013.pdf https://www.psycovery.com/images/Postpsychiatrys-challenge-O... We're still doing the same thing, just without knives (and, as the comment noted, often also WITH knives).
- chasil 3y ago
  At the same time, DSM-V continues to define a "disorder" as something intimately connected with "distress." These are real people, in great suffering, and we still don't have answers for many of the diagnostic codes found in the DSM. Modern psychiatry and neurology may never substantially improve in addressing these disorders, as the human brain is the most complex object known to exist, perhaps beyond comprehension. DSM-IV definition of mental disorder: A: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual. B: Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. C: Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one). D: A manifestation of behavioral, psychological, or biological dysfunction in the individual. E: Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual. Other considerations F: No definition adequately specifies precise boundaries for the concept of ‘mental disorder’. G: The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161428/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161428/

goodluckchuck 3y ago

That’s horrifying.

bigger_inside 3y ago

Before we make idealizing comparisons between "barbaric pasts" and seemingly enlightened presents (the "arrogance of the present" in which we assume that whatever we do now is knowledgable, good, just, right, at the end point of progess), let's remember that today's "medications" were largely chance discoveries, where the "chance" consisted of the recognition that they would calm patients and make them more manageable - and in this light, they were praised, in their time, as "chemical lobotomy". Joanna Moncrieff makes this explicit in her book, "The Bitterest Pills". Also elaborated on here: https://www.psycovery.com/images/Postpsychiatrys-challenge-Olga-Runciman-2013.pdf https://www.psycovery.com/images/Postpsychiatrys-challenge-O... We're still doing the same thing, just without knives (and, as the comment noted, often also WITH knives).

chasil 3y ago
At the same time, DSM-V continues to define a "disorder" as something intimately connected with "distress." These are real people, in great suffering, and we still don't have answers for many of the diagnostic codes found in the DSM. Modern psychiatry and neurology may never substantially improve in addressing these disorders, as the human brain is the most complex object known to exist, perhaps beyond comprehension. DSM-IV definition of mental disorder: A: A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual. B: Associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom. C: Must not be merely an expectable and culturally sanctioned response to a particular event (e.g. the death of a loved one). D: A manifestation of behavioral, psychological, or biological dysfunction in the individual. E: Neither deviant behavior (e.g. political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual. Other considerations F: No definition adequately specifies precise boundaries for the concept of ‘mental disorder’. G: The concept of mental disorder (like many other concepts in medicine and science) lacks a consistent operational definition that covers all situations. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161428/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8161428/