A CORRELATION OF LOBOTOMY RESULTS WITH BASIC REACTION TYPES
OLOF JOHNSON M. A.1, and
RUTH EHRENBERG M. D.2
1 Psychologist, Boston State Hospital.
2 Senior Physician, Boston State Hospital.
1. As suggested by previous lobotomy studies, the grouping of patients by basic reaction types of emotional disturbance, graded according to severity, reveals a consistent and marked correlation between level of illness and the degree and rate of clinical and social recovery. Though this correlation exists throughout the continuum of degree of illness, all types of disintegrated schizophrenics tend to respond to lobotomy in a generally limited degree and the groups of so-called "integrated" psychotics also tend toward a similar and more favorable reaction to the operation.
2. Similarly, the speed of recovery after lobotomy correlates in high degree with severity of illness. The time required for recovery to the point of readiness for discharge from the hospital is on the average more than double for the "full schizophrenics" than for the integrated psychotics. The speed of recovery is not a function of the length of illness before operation.
3. A careful differentiation of all patients into 2 general groupings of those maintaining a basic integration of the self and those suffering from widespread schizophrenic disorganization demonstrates marked differences in rate and degree of clinical and social recovery. Thus 82% of the former group are symptom-free and have been discharged from the hospital, but only 8% of the latter were freed from psychosis and but 10% have been returned to the community.
4. Although less favorable results have been consistently reported by investigators for schizophrenic cases, the high recovery rate of 77% in a special classification of "schizophrenics with accompanying trends" suggests that the crucial factor in prognosis is not the presence of a schizophrenic process but whether this illness has progressed to a stage of chronic and general personality disorganization marked by the persisting features of emotional dulling, loss of contact with people, widespread delusions, hallucinations, and intellectual disintegration.
5. Of the total group of 71 lobotomized patients here considered, 30% recovered quite completely from their illness and have been returned to the community. Another 13% is considerably improved but still institutionalized and an additional 27% made a slight but significant gain in level of adjustment within the hospital. Nine percent are more ill after the operation than before. These results are comparable to those recorded elsewhere for similar groups of patients but toward the lower end of the range of gains.
6. Despite the degree of recovery reported above, with an understandable emphasis on the criterion of discharge from the hospital, the postoperative progress of these patients toward personal independence and social effectiveness is limited, since two-thirds of those discharged are completely or partly dependent on others for economic support or supervision. Since the symptoms of previous illness have been generally removed in these cases, this impairment in personal efficiency seems due in considerable part to the frontal lobe deficit produced by lobotomy with the technique employed in our cases.
