Psychological Changes Following Prefrontal Leucotomy; A Review

Changes in Porteus Maze Scores of Brain-Operated Schizophrenics After an Eight-Year Interval

The voluminous literature reporting the effects of cortical lesions has shown contradictory and diverse findings from the earliest studies to the present (Franz, 1907; Klebanoff, 1945; Klebanoff, Singer and Wilensky, 1954; Meyer, 1957). Some investigators found no losses in intellectual function regardless of the locus of the lesion; others, a temporary loss followed by recovery of original capacity. Still others have reported significant losses following brain damage in the forebrain or other portions of the central nervous system. But for investigators in all three categories, what did “brain damage” consist of? The neurologists Brain and Strauss have observed “The study of psychological problems without an adequate knowledge of the physiology and pathology of the central nervous system can be likened to the exploration of the uncharted seas without the aid of a compass; and yet there are many psychologists who undertake the rash venture” (1955, p. vi). And what of the criteria on which the conclusions were based? An additional source of ambiguity is indicated by the fact that the overwhelming majority of conclusions on “mental” changes by psychiatrists and neurologists have generally been based on clinical or subjective estimates.Measurement, a crucial factor in any study, is of special importance in studies of brain damage and brain function, although despite a multiplicity of tests, there are few measures designed with attention to their unique problems. Tests employed in many psychological studies of brain damage were originally oriented toward quite different problems and had been carefully developed and standardized on non-brain damaged populations.

The lower quadrant leucotomy

In recent years efforts have been made to analyse the part played by the frontal lobes in the integration of personality. The pioneer work of Bianchi (1922) based on pathological lesions in human subjects, and on experimental bilateral ablations in monkeys, dogs and foxes, still appears to be as true to-day as when originally enunciated. Sherrington (1901) also described the changes following destruction of the frontal lobes. It was noted that such animals lost the power to learn and to enjoy themselves. They had no curiosity, but became restless, hyperactive and easily distracted. Brickner (1936) studied over many years a patient with bilateral frontal lobectomy who showed a diminished ability to synthesize abstract thoughts. Goldstein (1941) found that patients with frontal lobe damage lose their power for abstract thought and this is replaced by concrete behaviour, as shown by object grouping tests and their use of words. Similarly Penfield and Hebb (1940), in a case of extensive lobectomy for an infiltrating oligodendroglioma in an intelligent housewife, described a lack of ability for complex planning, such as is necessary for preparing a meal of several courses. Jefferson (1937) was unable to find any deficiency in cases of unilateral lobectomy. Rylander (1939), on the contrary, after lobectomy for tumours was able to detect changes similar to those found by Goldstein, and in cases with frontal lobe injury he found a lack of social sense. These patients were embarrassingly outspoken, and sometimes showed excessive activity or fatigue. Hebb (1945) concluded that studies on pathological lesions of the frontal lobes were not very helpful, owing to the lack of precision of the lesions due to the uncertain extent of the pathology.

RESTRICTED ORBITAL UNDERCUTTING; A STUDY OF ITS EFFECTS ON 350 PATIENTS OVER THE TEN YEARS 1951-1960

“The great majority of physicians, including our own specialty, have written off frontal lobe surgery as a therapeutic weapon for any illness short of chronic major psychosis.”

The use of vocabulary in the measurement of intellectual deterioration; a review

The problem of determining whether or not a particular individual has deteriorated intellectually or with respect to other skills is one which has exercised the ingenuity of clinical psychologists for a long time. Clearly the most satisfactory method from the point of view of reliability and validity is by means of the test-retest method over a given period of time, using tests for which adequate statistical information is available. However, since a direct estimate of the individual's previous level of intelligence is usually not available and since the psychologist often cannot wait six months or longer to obtain a direct retest, some method had to be devised which would overcome this difficulty. Babcock (1930) hit on the method of using the Vocabulary test as an estimate of previous level of intellectual ability and contrasting it with performance on other tests supposedly sensitive to deterioration in order to measure the amount of decline which had taken place.

Some aspects of the use of vocabulary in clinical psychological testing have been reviewed by a number of writers (Cronbach, 1942; Feifel, 1949; Hunt, 1936; Jastak, 1949; Lewinski, 1948; Raven and Walshaw, 1944; Shakow, 1946), and the immense interest shown in vocabulary as a test may be inferred from the 101-page bibliography of vocabulary studies published by Dale (1949). However, previous reviews suffer from two defects in that (a) they do not attempt to cover the ground thoroughly or systematically, being usually introductory to an experiment, or not specifically concerned with the subject matter of this paper; and (b) they naturally give no information about the important research which has taken place in this field within the last few years. The present review has been undertaken for these reasons, and because of the intrinsic importance of the problem.

A comparison of the personality changes after prefrontal selective surgery for the relief of intractable pain and for the treatment of mental cases; cingulectomy and topectomy

Extensive lesions of the frontal lobes are followed by pronounced personality changes. This has been shown beyond doubt by the effect of neuro-surgery performed for the removal of brain tumours or for the relief of mental illness. To identify such changes and the lesions responsible for them at least four conditions seem necessary: (a) Knowledge of the limits, variations and connections of the main pre-frontal areas.—In this field the researches of Professor Alfred Meyer and his associates, Mrs. Beck and T. McLardy, are of primary importance (1950).