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NAMI President Discusses Lobotomy; Medical Advancement

NAMI national board president, Anand Pandya, M.D., participated in a week-long on-line forum that followed the January 21 broadcast of the PBS documentary The Lobotomist, as part of the network’s popular American Experience series. The hour-long documentary about psychiatrist Walter Freeman, “the father of lobotomy,” in the 1940s and 50s, can still be viewed on the PBS Web site, along with the forum discussion.

The documentary is based on the book The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness by Jack El-Hai. It examines medical ethical issues involved in the now discredited procedure, which was used before the era of clinical trials, informed consent, and other consumer protections, and raises provocative questions about the advancement of psychiatry.

In the forum, Angelene Forester, whose mother received a lobotomy in the 1940s, was asked whether she thought it was a positive operation that she would have agreed to if had been up to her.

"Yes, if it was in the same time period, with the same facilities available and the technology and medicine of the time,” she answered. “If it was today, no! I wouldn't because we have other things today."

One question addressed by Dr. Pandya was whether lobotomy would still be considered an acceptable form of treatment if the chemical treatment Thorazine had not come into use in the 1950s.

"Aside from the discovery of Thorazine, there are several other treatments that were developed or refined around the same time and those treatments also have many advantages over frontal lobotomies,” Pandya noted. “These include Lithium, tricyclic antidepressants and electroconvulsive therapy as well as the development of psychosocial interventions such as clubhouses and residential models that empower patients, and cognitive and behavioral therapy. Together, these interventions would likely [still] have displaced frontal lobotomy."

In addition, starting in the 60s, we have had a revolution in society’s attitudes about the rights of people with mental illness. It is not acceptable (and, of course, it never should have been acceptable) to ignore the preferences of the person with the illness and their family. Nor is it acceptable to engage in such invasive procedures without offering the patient and their family information about the risks, benefits and alternatives. I believe that these reforms would have reduced the practice of frontal lobotomies even if we didn't develop better treatments.”

"Most frontal lobotomies were acts of desperation in a time before medication. In the centuries before frontal lobotomies, there were even more dangerous attempts to treat mental illness such as bleeding. Like bleeding, frontal lobotomies could calm a patient temporarily. When you look back over the course of history, you realize that frontal lobotomies seem like just a step on a long path. Our modern medications are probably just another step. They are far better than a frontal lobotomy but I believe that someday we will have treatments that are far better still."

"This doesn't mean that everything is always getting better. The lives of people with mental illness can and has become much worse at times when society is not willing to treat all people with dignity."

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