[2] In 1889 Thomas Claye Shaw reported mental improvement in a case of General Paralysis of the Insane after a neurosurgical intervention.
[3] In the 1930s the Portuguese neurologist Egas Moniz developed a surgical technique for the treatment of mental illness and called it "leucotomy" or "psychosurgery".
They called their operation, where burr holes are drilled in the side of the skull and the white matter is sliced through in order to sever the connections between the frontal lobes and deeper structures in the brain, lobotomy.
British psychiatrist William Sargant met Freeman on a visit to the United States and on his return to England encouraged doctors at the Burden Neurological Institute in Bristol .
The surgeon who performed Leucotomy operations there was Dr Harold Crow who treated my father after an unknown surgeon in London performed the operation on him without his consent, which had an awful effect on his personality and empathy after he was invalidated on returning to UK after working as an intelligence officer in Lille spying on German collaborators but was poisoned in his drink by a German officer with subsequent anxiety for his digestion and for our family.
[8] Beginning in the 1940s doctors devised "modified operations" with less extensive cuts or more specific targets (for example, rostral leucotomy and cingulotomy) in an attempt to reduce the damage done by the surgery.
Reasons for this decline included increasing concern about the deaths and damage caused by the operation, the introduction of neuroleptic drugs, and changing ideas about the nature and treatment of mental illness.
The decline in psychosurgery has continued to 2007, with the latest figures from the Mental Health Act Commission showing that 5 operations were authorised in Wales in the 2-year period 2005–2007.
In the past it was also used in the treatment of schizophrenia and a wide variety of other disorders; some patients had been in a mental hospital for years before operation, others only briefly or not at all.
One of the discharged patients, a veteran of World War I who had broken down during the bombing raids on Bristol and had been diagnosed as neurotic, was operated on after just 4 days in hospital.
[13][14][15] Warlingham Park Hospital, Croydon, Surrey, started to experiment with psychosurgery soon after the Burden Neurological Institute and published the results of their first four operations in the same issue of The Lancet.
[18] After the results of at the Burden Neurological Institute and Warlingham Park were published, mental hospitals throughout Great Britain began to use psychosurgery.
[21] Runwell Hospital, Essex: psychiatrist Rolf Strom-Olsen and surgeon Geoffrey Knight formed a psychosurgery partnership that was to last for thirty years.
McKissock developed a peripatetic psychosurgery service, visiting hospitals all over the south of England (except for part of Kent, which was the territory of Knight) and Wales on Saturdays and performing thousands of leucotomies.
The first series of 24 patients operated on 1942–1944 were selected for their failure to respond to other treatments (usually electroconvulsive therapy) and, in at least half the cases, the demands they made on nursing staff.
They formed a large proportion of the most violent, hostile, noisy, excited, destructive or obscene cases in the hospital; the type who distress their relatives, upset the other patients and consume the time and energy which could be put to so much better purpose by the staff".
[26]Two died of cerebral haemorrhage, two were discharged (of whom one relapsed); of those remaining in hospital two-thirds had shown at least some improvement, needing less staff time and supervision.
[28] Superintendent George Mackay found the results sufficiently encouraging to extend the programme to include "a wider group of clinical types".
A text book of the day went into more detail about personality changes, suggesting that they always occurred to greater or lesser extent and left the patient with diminished judgement, childish behaviour, carelessness, loss of ambition, and generally living at a lower level than previously.
[7] Beginning in the early 1940s, psychiatrists and surgeons experimented with different techniques of psychosurgery, mainly in order to reduce the risk of death, complications and severe personality damage associated with the operation and thus extend its use to depressed and neurotic patients.
Instead of holes being drilled in the skull, a sharp instrument was hammered through the roof of the eye-socket (the orbital plate) and then swung through the white matter in the frontal lobes.
John Walsh at Tone Vale Hospital in Somerset operated on eight women in 1949, on three occasions (including one as a demonstration at a meeting of the south-western division of the Royal Medico-Psychological Association) using electroconvulsive shock as an anaesthetic.
Although McKissock approached from the opposite direction, the cut was similar to that of Freeman's transorbital leucotomy, undercutting Brodmann's areas 9 and 10 of the frontal cortex.
[37] Cingulotomy, where part of the anterior cingulate gyrus is destroyed, was pioneered in Great Britain in 1948 by Hugh Cairns, first Nuffield Professor of Surgery at the University of Oxford.
A team at Kings College Hospital under psychiatrist Stuart Checkley took over the work of the unit and performed 23 stereotactic subcaudate tractotomies over the next five years, using radiofrequency to destroy brain tissue.
[47][48] Multifocal electroleucoagulation, in which white matter is gradually destroyed by passing electric current through electrodes implanted in the frontal lobes, was the invention of doctors at the Burden Neurological Institute in 1959.
[53] Donald Winnicott in a letter to The Lancet in the early days of leucotomy suggested that those who wanted to perform destructive operations should first establish that mental disorders were actually "brain-tissue diseases".
[56] Walter Maclay, president of the section of psychiatry of the Royal Society of Medicine, chose the subject of "death due to treatment" for his 1952 address.
[47] Egas Moniz coined two terms to describe his operation: leucotomy (cutting of the white matter of the brain) and psychosurgery (surgery for psychiatric disorder).
The American neurologist Walter Freeman and neurosurgeon James Watts adapted Moniz's techniques and coined a new term: lobotomy (cutting of the lobe).