Custom psychosurgery

Abstract

Summary It seems fundamentally improbable that different mental symptoms and personality disorders should be relieved by one single form of operation on the brain. The present paper describes five operations which can be performed with benefit to different types of psychiatric abnormality; namely, unilateral temporal lobectomy, unilateral or bilateral temporal lobotomy, inferior quadrant pre-frontal leucotomy, paramedian frontal leucotomy and posterior cingulectomy. The symptoms that represent an indication for these various operations and the results of the operations on the symptom complexes are described. The proposition is put forward that only operations suitable for the precise psychiatric diagnosis should be used. A new form of analysis of sphenoidal lead examinations is described which is of primary importance in conjunction with psychiatric examination in deciding which operation a particular patient would or would not benefit from. A concept of diencephalic instability is introduced in connection with this EEG analysis to supplement the usual concept of centrencephalic epilepsy. Diencephalic instability as defined here seems to respond specifically to paramedian lobotomy, provided of course the clinical condition justifies such a step.

Psychosurgery and the limbic system

“…The historical development of these modifications and the results of this type of operation and its different effects are considered by Turner (1973). Lower quadrant frontal lobotomy with the plane of section in front of the anterior horn of the lateral ventricle via a lateral approach gives good results in depression (Turner, 1973). This approach is similar to that used by Harvey Jackson (1954) who also obtained good results in depression and anxiety states .…”

“…Turner (1973) considers that the division of the limbic system into two parts, onesfor emotion and temperament and one for memory is justified, since he effects of ablation operations on the two parts are quite different. Anterior cingulate , or posterior cingulate (Turner, 1973) lesions have no detectable effect on memory, whereas other structures in the Papez circuit, such as the hippocampus, fornix, mamillary bodies and mammillo-thalamic tract, are apparently concerned Channel 2, respiration with decrease in amplitude. Channel 3, blood pressure with increase in systolic and diastolic pressures.…”

“…The operations all concentrate on the lower medial quadrant, and divide both of the frontal lobe projections to the septo-hypothalamo-mesencephalic continuum (central 'limbic core'). The historical development of these modifications and the results of this type of operation and its different effects are considered by Turner (1973). Lower quadrant frontal lobotomy with the plane of section in front of the anterior horn of the lateral ventricle via a lateral approach gives good results in depression (Turner, 1973).…”

“…Para-median lobotomy is considered by Turner (1973) to benefit patients with anxiety and impulsive behaviour, usually of an aggressive nature. Young patients with obsessional neurosis do not usually respond to this operation, however.…”

“…The baso-lateral and defence reaction circuits Personality disorders associated with epilepsy, and aggressive outbursts or 'uncontrollable rage, usually of a particular kind ushered in by experiences of sudden fear, panic or stark terror' respond to temporal lobotomy (Turner, 1973). The site of operation is at, or just behind the uncus of the hippocampus and in, or just behind the amygdaloid nucleus.…”