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Rzesnitzek L. The introduction of leucotomy in Germany: National Socialism, émigrés, a divided Germany and the development of neurosurgery. HISTORY OF PSYCHIATRY 2019; 30:325-335. [PMID: 31007062 DOI: 10.1177/0957154x19843036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thinking about the chronology of the introduction of leucotomy in Germany sheds new light on the hypothesis of a special 'radical' approach of German psychiatry to the treatment of the mentally ill during the period of National Socialism. Moreover, it offers new insights into the transnational and interdisciplinary conditions of the introduction of leucotomy in early divided post-war Germany.
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Affiliation(s)
- Lara Rzesnitzek
- Charité Psychiatric University Hospital at St Hedwig's Hospital; Charité Institute for the History of Medicine, Germany
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Barbosa DAN, de Oliveira-Souza R, Monte Santo F, de Oliveira Faria AC, Gorgulho AA, De Salles AAF. The hypothalamus at the crossroads of psychopathology and neurosurgery. Neurosurg Focus 2017; 43:E15. [DOI: 10.3171/2017.6.focus17256] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The neurosurgical endeavor to treat psychiatric patients may have been part of human history since its beginning. The modern era of psychosurgery can be traced to the heroic attempts of Gottlieb Burckhardt and Egas Moniz to alleviate mental symptoms through the ablation of restricted areas of the frontal lobes in patients with disabling psychiatric illnesses. Thanks to the adaptation of the stereotactic frame to human patients, the ablation of large volumes of brain tissue has been practically abandoned in favor of controlled interventions with discrete targets.Consonant with the role of the hypothalamus in the mediation of the most fundamental approach-avoidance behaviors, some hypothalamic nuclei and regions, in particular, have been selected as targets for the treatment of aggressiveness (posterior hypothalamus), pathological obesity (lateral or ventromedial nuclei), sexual deviations (ventromedial nucleus), and drug dependence (ventromedial nucleus). Some recent improvements in outcomes may have been due to the use of stereotactically guided deep brain stimulation and the change of therapeutic focus from categorical diagnoses (such as schizophrenia) to dimensional symptoms (such as aggressiveness), which are nonspecific in terms of formal diagnosis. However, agreement has never been reached on 2 related issues: 1) the choice of target, based on individual diagnoses; and 2) reliable prediction of outcomes related to individual targets. Despite the lingering controversies on such critical aspects, the experience of the past decades should pave the way for advances in the field. The current failure of pharmacological treatments in a considerable proportion of patients with chronic disabling mental disorders is reminiscent of the state of affairs that prevailed in the years before the early psychosurgical attempts.This article reviews the functional organization of the hypothalamus, the effects of ablation and stimulation of discrete hypothalamic regions, and the stereotactic targets that have most often been used in the treatment of psychopathological and behavioral symptoms; finally, the implications of current and past experience are presented from the perspective of how this fund of knowledge may usefully contribute to the future of hypothalamic psychosurgery.
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Affiliation(s)
- Daniel A. N. Barbosa
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 2Division of Neurosurgery and
| | - Ricardo de Oliveira-Souza
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 3Department of Neurology and Psychiatry, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro
| | - Felipe Monte Santo
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 4Intensive Care Unit, Icaraí Hospital, Niteroi, RJ
| | - Ana Carolina de Oliveira Faria
- 1Department of Clinical Neuroscience, D’Or Institute for Research and Education
- 3Department of Neurology and Psychiatry, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro
| | - Alessandra A. Gorgulho
- 5HCor Neuroscience, São Paulo, Brazil; and
- 6Department of Neurosurgery and Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Antonio A. F. De Salles
- 5HCor Neuroscience, São Paulo, Brazil; and
- 6Department of Neurosurgery and Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, California
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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Young GJ, Bi WL, Smith TR, Brewster R, Gormley WB, Dunn IF, Laws ER, Nijensohn DE. Evita's lobotomy. J Clin Neurosci 2015; 22:1883-8. [PMID: 26463273 DOI: 10.1016/j.jocn.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/19/2015] [Indexed: 11/18/2022]
Abstract
For 60 years, the details about Eva Perón's illness and lobotomy at the end of her life have been obscured from the public. Here, we examine the sociopolitical factors that may have contributed to this secrecy. The first involves Eva Perón's political status and the personality cult surrounding her image, including partisan efforts to present her as a patron saint of Peronism. The second involves the social perceptions, which are often stigmatizing, regarding disease in political or public figures. Notably, neuropsychiatric illness and associated indications for treatment were viewed as oligarchic by the Perón regime, and admission to a lobotomy may have been perceived as anti-Peronist. A third factor involves the growing ignominy of prefrontal lobotomy as a surgical modality, which may have precluded operative exposés. A final factor may be that Eva Perón's lobotomy was in fact performed for behavior and personality modification, and not just for pain control. A brief history of lobotomy is presented, highlighting its adoption as a procedural panacea for psychiatric illnesses, relief of intractable pain from cancer, and management of belligerent behavior, and its subsequent fall from clinical favor. Although a shroud of secrecy still surrounds Eva Perón's prefrontal lobotomy, these factors provide a potential rationale for the circumstances, as well as foster a discussion of cultural elements that may still play a role in the public perception of psychosurgery today.
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Affiliation(s)
- Grace J Young
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Ryan Brewster
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - William B Gormley
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA
| | - Edward R Laws
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-3, Boston, MA 02115, USA.
| | - Daniel E Nijensohn
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA
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Schoefert AK. Neither Physicians Nor Surgeons: Whither Neuropathological Skill in Post-war England? MEDICAL HISTORY 2015; 59:404-20. [PMID: 26090736 PMCID: PMC4597241 DOI: 10.1017/mdh.2015.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Neuropathologists constituted a small field in post-war England, perched between neurology, psychiatry, neurosurgery and pathology, but recognised as a discrete field of expertise. Despite this recognition, the success of the neighbouring fields of neurosurgery, psychosurgery and neurobiology, and the consultant status granted to pathologists in the National Health Service, neuropathologists struggled to stabilise their field. A discourse of skills, acquired and acquirable, became central to their attempts to situate the field in relation to surgeons' handicraft, physicians' diagnostic acumen and the technologies of the biological sciences.
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Affiliation(s)
- Anna Kathryn Schoefert
- Department of History and Philosophy of Science,
University of Cambridge, Free School
Lane, Cambridge CB2 3RH, UK
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