Am J Psychiatry 1995; 152:505-515
Copyright © 1995 by American Psychiatric Association
Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935-1954): a historical overview
VW Swayze 2nd
Department of Psychiatry, University of Iowa Mental Health Clinical Research Center, Iowa City.
OBJECTIVE: This article provides an overview of the history of
psychosurgery as a treatment for psychiatric illnesses. METHOD: The author
reviewed articles describing psychosurgery between 1935 and 1954 in order
to summarize surgical techniques, clinical indications for surgery, patient
selection, complications, and outcome. RESULTS: Patients were operated on
for a wide variety of psychiatric illnesses. Initially, a large number of
uncontrolled studies reported considerable therapeutic benefit in at least
one-third of the patients operated on. Complications with the early
surgical techniques included hemorrhage, seizures, infection, and
personality changes. Surgical techniques proliferated in hopes of achieving
greater therapeutic benefit while minimizing detrimental side effects. As
psychosurgery became more widely accepted, its principal supporters began
to use it as a routine therapy. A number of uncontrolled and controlled
short-term studies supported the efficacy of psychosurgery, but long-term
controlled studies showed mixed results. CONCLUSIONS: Psychosurgery was
promoted as a treatment for patients who had shown little or no response to
less drastic therapies. In the context of an era when no efficacious
treatments were available for psychosis, its use was understandable.
However, its history illustrates the importance of critical evaluation of
new treatments in the context of long-term controlled outcome studies, the
natural course of specific illnesses, and an understanding of brain
physiology.
