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Grt & Desperate Cures Hardcover – May 11, 1986
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From Publishers Weekly
Neuropsychologist Valenstein (Brain Control, etc.) here offers a critical and academic history of psychosurgery that he deems a "cautionary tale." The same factors that contributed to the rapid, injudicious acceptance of the lobotomy operationdesperate patients and their families, overcrowded mental institutions, sensationalism by the popular media, physicians' self-aggrandizementtoday still play a major role in prematurely promoting "miracle" medical techniques, warns the author. Beginning with a chronicle of early psychomedical experimental cures, Valenstein examines the development of shock therapy and the careers of the first psychosurgeon, Egas Moniz, and his successor, Walter Freeman, now infamous for his 10-minute "ice-pick operation." This rather chilling account will foster a profound, and not unhealthy, distrust of science, the medical profession and the media; one hopes its academic nature will not deter the general reader from attempting it.
Copyright 1986 Reed Business Information, Inc.
From Library Journal
This is a lively, fascinating, and yet scholarly account of the history of the use of psychosurgery in treating men tal disorders. Focused in particular on the extraordinary Walter Freeman, with whom psychosurgery is most as sociated, the book explores the rise in use of lobotomies and similar proce dures through the 1950s and the de cline ever since (apart from a brief flurry in the 1970s). Valenstein, a re search psychologist and the author of Brain Control (1973), writes in a lucid, even-handed way even while conclud ing with a strong plea for restraint in the use of untested medical interven tions. The book makes compelling reading for both laypeople and schol ars. However, its narrow focus on psychosurgery makes it interesting mainly as history. Paul Hymowitz, Psychiatry Dept., Cornell Univ. Medi cal Ctr., New York
Copyright 1986 Reed Business Information, Inc.
Top customer reviews
He wrote in the Preface to this 1986 book, "This history of lobotomy began... with an earlier book of mine, Brain Control, which was published in 1973, a time when concern over what was perceived to be the beginning of a 'new wave' of lobotomy had led to a raging controversy... I was thus soon drawn into the 'psychosurgery controversy'... as a result of this activity... [I was asked] to survey the extent of psychosurgery being performed around the world, to determine the results of these operations, and to comment on related ethical and social problems... I edited Psychosurgery Debate... It had become evident that lobotomy was not an aberrant event but very much in the mainstream of psychiatry... I began to see the history of lobotomy as casting light on current practice..." (Pg. xi-xii)
He observes, "Psychosurgery was not a medical aberration, spawned in ignorance... Psychosurgery was recommended by distinguished psychiatrists and neurologists and performed by equally prominent neurosurgeons, many of whom were affiliated with highly respected medical centers and universities... leading to their ultimate accolade when, in 1949, the man who had introduced psychosurgery was awarded the Nobel Prize in Medicine." (Pg. 4) He tells about Electrotherapy and Hydrotherapy (pg. 26-27), Insulin Therapy (pg. 58-59), and says that "interest in brain surgery to treat mental illness continued up into the 1930s, when [António Egas] Moniz started to perform psychosurgery. Thus... it is evident that many psychiatrists and neurologists were willing to try almost any somatic treatment claimed to ameliorate mental illness. For many physicians, risking any therapeutic possibility was preferable to confessing helplessness." (Pg. 44)
He criticizes Moniz's claims of success: "The evidence that seven patients were cured was not at all convincing... Their anxieties or delusions were simply said to be gone, but the monograph presented no examples of any behavior indicating how well they were functioning... In four of the seven 'cured' patients, the last observation Moniz recorded... was less than eleven days after the operation!" (Pg. 108) He adds, "Why did Moniz move so rapidly to broadcast his results?... He was, after all, over sixty, and had not many years left to achieve a place in history... An explanation... is that Moniz was aware that several other physicians ... were considering a similar undertaking." (Pg. 117-118) About Moniz's colleague Walter Freeman, he observes, "No one received more attention in the popular media than Freeman. He thoroughly enjoyed all the publicity and made a great effort to remain in the limelight." (Pg. 160) Of Moniz's Nobel Prize, he notes, "The Nobel Prize committee received many nominations for Moniz ... Some of the nominations apparently were evoked by Moniz himself... With the war so recently over, there had been few nominations that year, and only fifteen nominees were considered worthy of serious consideration for the award in medicine." (Pg. 225)
He summarizes and concludes, "Was, then, the irreparable harm done to many patients by prefrontal lobotomny unavoidable? Must great harm often follow as part of the natural course of progress in medicine? I believe the answer to both questions is no... In my view, it is essential that we minimize the harm caused by premature claim of cures, by unbridled ambitions, and by uncritically enthusiastic promotion. This can be accomplished only by establishing new procedures for testing innovative therapies before they are broadly used." (Pg. 295-296)
This is an excellent, very informative book, that will be of great interest to anyone studying psychosurgery, or other controversial treatments of the mentally ill.
This book is a very important contribution to thinking about ethics around neurosurgery. Valenstein also extends his approach to non-neurosurgical procedures such as cardiac bypass operations in a highly thought-provoking manner. In the end, I would love to see two updates. First, how would Valenstein define psychosurgery? Is DBS or pallidotomy for a movement disorder a type of psychosurgery? How about a cingulotomy for depression or pain? I think that one could make the argument that all of the above are psychosurgeries, not because of their intended results but because they all have effects, whether subtle or pronounced, on cognition. Second, I would love to see an update of how common different types of psychosurgeries are today, both in the US and elsewhere around the globe.
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