Medicine: Psychosurgery

The surgeon's knife can reach into the brain to sever the tensions which underlie a psychopathic personality. This drastic method of rescuing psychotic patients from complete insanity is not exactly a new invention. It has been developed in Lisbon by Dr. Egas Moniz since 1935. But now two men who have pioneered this treatment in the U.S.—Neurologist Walter Freeman and Neurosurgeon James W. Watts of George Washington University—have published a book, Psychosurgery (Charles C. Thomas; $6), based on their work. Some 300 people in the U.S. have had their psychoses surgically removed, Dr. Freeman revealed last week, and a score of U.S. surgeons are now using the revolutionary new technique.

The Brain Is Sliced. In their development of Dr. Moniz' methods, Drs. Freeman and Watts drill a small hole in the temple on each side of the patient's head where two skull bones meet. Surgeon Watts then inserts a dull knife into the brain, makes a fan-shaped incision upward through the prefrontal lobe, then downward a few minutes later. He then repeats the incisions on the other side of the brain. No brain tissues are removed. (In two operations they have cut cerebral arteries. Both patients died.)

The patient is given only a local anesthetic at the temples—the brain itself is insensitive—and the doctors encourage him to talk, sing or recite poems and prayers while the operation is in progress. As his lobes are sliced, he becomes drowsier, more confused and incoherent. When his replies to questions show that his mind is thoroughly disoriented, the doctors know they have cut deep enough into his brain. (Dr. Freeman once casually asked a patient, "What's going through your mind now?" Said the patient: "A knife.")

Cutting Connections. Purpose of the operation is to sever most of the nerve connections between the prefrontal lobes and the thalamus. The thalamus is lower, nearer the spinal cord. This part of the brain is widely believed to be the seat of emotions—fear, rage, lust, sorrow, other purely animal instincts. All animals have a thalamus, but the higher animals—above all, man—developed superimposed layers of brain tissue which exercise some control over the thalamus.

In man's prefrontal cortex is the seat of mental power which restrains the thalamus —foresight, self-consciousness, social adjustment, imagination, etc. The reasoning, self-conscious cortex is integrated via thousands of millions of nerve cells with the emotional thalamus, so that a normal mind is a more or less harmonious mixture of intellect and emotion. But sometimes this integration takes on a fixed, unhealthy pattern: foresight becomes anxiety, anxiety becomes fear, and the psychotic victim may head for lunacy unless treated by psychoanalysis, shock therapy (e.g., with electricity or insulin) or—as a last resort —psychosurgery.

The surgeon's incisions radically disrupt the connection between the prefrontal lobes and the thalamus. Not all the connections are severed, since a patient might then become a victim of his unrestrained thalamus. But old ideational patterns are destroyed. The brain is forced to reintegrate itself, to form new internal pathways.