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Am J Psychiatry 1953;109:595-602.
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The Department of Neurology and Neurological Surgery, George Washington University.

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More than 1,000 lobotomized patients were graded according to level of achievement after convalescence had been completed, and their preoperative rating by the Malamud scale was studied in order to determine what factors were of good and bad omen. Favorable indications appeared in the fields of anxiety, obsessive thinking, and self-directed violence, while unfavorable indications appeared in the fields of hallucinations and delusions, scattered thought processes, and externally directed violence.The apparent paradox was disclosed that patients came to operation most frequently because of the latter phenomena. Since the objective of psychosurgery is to relieve overwhelming suffering, anything gained above this, as far as level of achievement is concerned, makes the operation even more worth while. The surgeon and the psychiatrist, working together, can select patients who will give almost any desired level of achievement. From the practical standpoint, the Malamud rating scale offers a modest predictive criterion for the selection of patients for psychosurgery.

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