The article argues that Beckett's Trilogy stages the effects of a lobotomy operation on a potentially politically subversive writer, and that the consequences of the operation can be traced in both the retreat of the narrator of the Trilogy into the mind and into comatose mental states and in the detail of the operation itself, based on the 'icepick' lobotomies performed by neurologist Walter Freeman in the late 1940s and early 1950s. To write about extreme psychiatric situations in the (...) post-war period is necessarily to invoke the political uses of psychosurgery with which this article engages. The article goes on to consider the figure of the brain-damaged mind as a Cold War trope in the references to botulism and the motif of the penetrated skull in The Unnamable. (shrink)

This paper primarily explores the ethical debate surrounding the use of memory erasure for therapeutic ends. It argues that procedures such as kinase inhibition therapy, which can entail memory erasure in the individual, incur a high cost in terms of the integrity of our individual identities, thus jeopardizing our claim to individual rights and accountability. Therefore, we should reserve such therapies for the extreme cases in which the procedures have the potential to actually restore a person’s autonomy. Furthermore, this paper (...) goes on to explore which situations might fit this criterion, while still accounting for the cost of memory erasure in each instance. (shrink)

In the 1940s and 1950s thousands of lobotomies were performed on people with mental disorders. These operations were known to be dangerous, but thought to offer great hope. Nowadays, the lobotomies of the 1940s and 1950s are widely condemned. The consensus is that the practitioners who employed them were, at best, misguided enthusiasts, or, at worst, evil. In this paper I employ standard decision theory to understand and assess shifts in the evaluation of lobotomy. Textbooks of medical decision making (...) generally recommend that decisions under risk are made so as to maximise expected utility (MEU) I show that using this procedure suggests that the 1940s and 1950s practice of psychosurgery was justifiable. In making sense of this finding we have a choice: Either we can accept that psychosurgery was justified, in which case condemnation of the lobotomists is misplaced. Or, we can conclude that the use of formal decision procedures, such as MEU, is problematic. (shrink)

Deep brain stimulation has recently been identified as the “new frontier” in the surgical treatment of major depressive disorder. Powerful memories of the lobotomy era, however, pose a rhetorical challenge to clinical researchers who wish to make a case for its therapeutic future. For DBS advocates, establishing the relationship between these two treatments is not just a matter of telling a history; it also requires crafting persuasive arguments for the lineage of DBS that relate the new psychosurgery in some (...) way to the old. Working from a rhetorical perspective, this article identifies and analyzes three strategies employed by DBS advocates to manage the memory of lobotomy, which it terms evolutionary, genealogical, and semantic. In conclusion, this article suggests that a rhetorical perspective might be brought to bear on the frequent calls for dialogue with regard to psychosurgery, which are meaningless without attention to the persuasive dynamics such dialogue entails. (shrink)

There is no subject at the interface of law, psychiatry and medical ethics which is more controversial than psychosurgery. The divergent views of the treatment begin with its definition. The World Health Organisation1 and others2 define psychosurgery as the selective surgical removal or destruction of nerve pathways or normal brain tissue with a view to influencing behaviour. However, proponents of psychosurgery demur on the basis that the `modern' treatment is concerned predominantly with emotional illness, without any specific effect upon behaviour. (...) The alternative definition offered is `the surgical treatment of certain psychiatric illnesses by means of localised lesions placed in specific cerebral sites.3It is difficult entirely to accept this definition because, as examined below, scientific psychiatry is not yet in a position to directly treat psychiatric illness solely through surgical intervention. There is no reliable theoretical relationship between particular cerebral sites (which are normal and healthy) and an identifiable psychiatric illness or symptomatology. Given this state of psychiatric understanding, it is misleading to suggest fine distinctions between generalised alteration of behaviour or mood and treatment of an illness. Highly divergent practices and theories (relating to the multiplicity of conditions treated, surgical methods adopted and areas of the brain operated upon) further undermine exaggerated claims that psychosurgery can scientifically `treat' specific illness through precise surgical intervention. Nonetheless, contemporary psychosurgery does not contain quite the same `broadbrush' approach of its ancestors and it can lay some legitimate claim as an effective empirical treatment in narrowly limited circumstances. Major ethical problems still, however, arise and these will be discussed in this article. (shrink)

Between 1935 and 1970, tens of thousands of people worldwide underwent brain operations due to psychiatric indication that were intended to positively influence their mental state and behaviour. The majority of these psychosurgical procedures were prefrontal lobotomies. Developed in 1935, the procedure initially met with fierce opposition, but was introduced in numerous countries in the following decade, and was employed up until the late 1960s. This article investigates why psychosurgery was widely accepted after World War II. It examines the effects (...) it was hoped psychosurgical intervention would have, the undesired outcomes in which the method could potentially result, and the significance these outcomes were given. The analysis of scientific articles of the period as well as one case study show that the goal of the operation was, first and foremost, to help the mentally ill adapt to the social order inside and outside the mental institution. After initial criticism, changes in personality, severe physical side-effects and death were accepted in order to reach this goal. Thus, with psychosurgical intervention the social adjustment of patients, also in their own interest, was rated higher than physical and psychic integrity. This widely held view shows that after World War II a post-bourgeoise order of the subject dominated, according to which an individual was to adapt and to function in the interests of the collective. According to the assumption, the triumph of lobotomy was related to the development of a new conception of the self that made possible a broad implementation of the procedure and that was consolidated through psychosurgery. (shrink)

Pains are unpleasant, universally unpleasant. What seems trivially true has been rejected by various pain scientists because of several phenomena which allegedly show that there can be pain which is not unpleasant. This rejection is partly based on the ambiguity of ‘pain unpleasantness’ which can be avoided by distinguishing between primary and secondary pain affect. As for the alleged counterexamples to the above, I will argue that experiences of episodic analgesia as well as the ‘pain’ experiences of some lobotomized and (...) morphine patients should not be construed as cases in which pain and unpleasantness come apart, but rather as cases in which nociceptive activity and pain dissociate. Regarding the notorious case of pain asymbolia, I will demonstrate that the behaviour of patients with this syndrome suggests that they do feel pain, and that their pain sensations are unpleasant, but much less unpleasant than the pains normal people would have if exposed to the same noxious stimuli. Adopting such an account of these phenomena allows us to retain the widely accepted IASP definition of pain, and thus avoids the issue of integrating non-unpleasant pains into a plausible definition of pain. (shrink)

Scholars have offered various critiques of Alberto Giubilini and Francesca Minerva's controversial article, ‘After-birth abortion: Why should the baby live?’ My book The Ethics of Abortion: Women's Rights, Human Life, and the Question of Justice presents four such critiques. First, Giubilini and Minerva argue from the deeply controversial to the even more controversial. Second, they presuppose a false view of personal identity called body-self dualism. Third, their view cannot secure human equality. And fourth, their account of harm cannot account for (...) harm found in some cases of murder. In the article, ‘Pro-life arguments against infanticide and why they are not convincing’, J. Räsänen examines and finds wanting these four critiques. This essay responds to Räsänen's defense of infanticide and argues that his responses to the four objections fail. (shrink)

Here we review 37 modern neuroimaging studies in an attempt to address this question posed by Halstead (1947) as he and other icons of the last century endeavored to understand how brain and behavior are linked through the expression of intelligence and reason. Reviewing studies from functional (i.e., functional magnetic resonance imaging, positron emission tomography) and structural (i.e., magnetic resonance spectroscopy, diffusion tensor imaging, voxel-based morphometry) neuroimaging paradigms, we report a striking consensus suggesting that variations in a distributed network predict (...) individual differences found on intelligence and reasoning tasks. We describe this network as the Parieto-Frontal Integration Theory (P-FIT). The P-FIT model includes, by Brodmann areas (BAs): the dorsolateral prefrontal cortex (BAs 6, 9, 10, 45, 46, 47), the inferior (BAs 39, 40) and superior (BA 7) parietal lobule, the anterior cingulate (BA 32), and regions within the temporal (BAs 21, 37) and occipital (BAs 18, 19) lobes. White matter regions (i.e., arcuate fasciculus) are also implicated. The P-FIT is examined in light of findings from human lesion studies, including missile wounds, frontal lobotomy/leukotomy, temporal lobectomy, and lesions resulting in damage to the language network (e.g., aphasia), as well as findings from imaging research identifying brain regions under significant genetic control. Overall, we conclude that modern neuroimaging techniques are beginning to articulate a biology of intelligence. We propose that the P-FIT provides a parsimonious account for many of the empirical observations, to date, which relate individual differences in intelligence test scores to variations in brain structure and function. Moreover, the model provides a framework for testing new hypotheses in future experimental designs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolf Meyer: Psychiatric AnarchistS. Nassir Ghaemi (bio)KeywordsMeyer, biopsychosocial model, Jaspers, pluralism, philosophy, psychiatryThey had weekly lunches in 1920s New York City: In one door stepped a stooped philosopher, with a mustache and a twinkle, perhaps ruminating on some recent Marxist theory; in the other door came the elegant Swiss physician, goateed and erudite. Every week, for a time, John Dewey (leader of American pragmatism) and Adolf Meyer (dean of (...) mid-twentieth century American psychiatry and long-time chair of the Johns Hopkins psychiatry department) lunched together and, somewhere in those conversations—one might imagine—the field of philosophy and psychiatry was born (Meyer 1948, 152).Yet pragmatism—as a proper school of philosophy—does not capture Meyer’s psychiatry. Rather, the core of his thinking, in my view, is to be found in a vague term that deserves analysis: eclecticism.EclecticismIt has been said that eclecticism is a vice in theory but a virtue in practice (Stone 1981), which highlights why so many are attracted to it. Deep down, practitioners just want to be free: They believe that their freedom of choice will tailor treatments best to patients and thus result in best outcomes. As a conceptual theory for psychiatry, eclecticism is a model that views any theory or method as potentially correct, but no theory or method as definitively incorrect. There is no way to avoid an “anything goes” practice with eclecticism: It is—to use a political analogy—an anarchism of mind.William James once remarked that the basis for all philosophies lies in the personalities of philosophers. So it was with Meyer’s eclecticism: congenial personally, he seemed congenitally incapable of disagreeing with any person. Any idea, even the most unusual, would receive a respectful hearing from Meyer. (Double brings out new, excellent documentary evidence of this extreme indecision in the drafts of Meyer’s unsent letters to the behaviorist John Watson.) Although quaint and commendable pedagogically, this excessive open mindedness left American psychiatry—so dependent on Meyer—prey to hard-headed biological radicals and psychoanalytic dogmatists. This is where his eclecticism failed us.Enabling Biological ExtremismMeyer played a key role in legitimizing extreme biological approaches. In addition to his interest in insulin coma (which Double mentions), Meyer enabled the popularization of colectomy and frontal [End Page 341] lobotomy. Psychiatric colectomy, developed by Henry Cotton, was based on the focal toxin theory of mental illness—the idea that mental illness was caused by toxins released by bacteria in the body, the specific locations of which where were the colon and rotted teeth. In one hundred case reports, with mostly short-term follow-up, published in his prominent text, The Defective Delinquent and Insane (Cotton 1921), Cotton laid out his case, which Meyer legitimized by writing a generous foreword. Meyer’s authority was powerful enough to render Cotton’s limited evidence base much more credible than it might otherwise have been. In the 1920s and 1930s, tens of thousands colectomies and full mouth teeth extractions were conducted in patients with mental illness. (Meyer himself sometimes recommended it).1The other biological extremist story is more famous. In a 1936 conference, with Meyer in attendance, the neurologist Walter Freeman presented, for the first time, cases of refractory schizophrenia treated with a new method: frontal lobotomy. Psychoanalyst attendees protested that Freeman was proposing nothing more than mutilation of the brain; yet Meyer intervened in favor of Free-man (“I am not antagonistic to this work, but find it very interesting” [El-Hai 2005]). Unfortunately, Freeman, like Cotton, was a dogmatist: Over time, he performed frontal lobotomy more and more extensively, not just as a treatment of last resort in the most ill schizophrenics (as in the first cases presented to Meyer), but later as a treatment of first resort for the mildest mood disorders. (By 1950 Freeman had personally conducted 2400 transorbital lobotomies, an “office procedure” that allowed him to lobotomize a patient in 15 minutes [El-Hai 2005]).2Lest my critique of Meyer in that era be seen as a Whiggish interpretation of history (the claim that we are so much smarter than those shrinks of the past; in fact I think... (shrink)

Science is a force for good in the world--at least usually. But sometimes, when obsession gets the better of scientists, they twist a noble pursuit into something sinister. Under this spell, knowledge isn't everything, it's the only thing--no matter the cost. Bestselling author Sam Kean tells the true story of what happens when unfettered ambition pushes otherwise rational men and women to cross the line in the name of science, trampling ethical boundaries and often committing crimes in the process. The (...) Icepick Surgeon masterfully guides the reader across two thousand years of history, beginning with Cleopatra's dark deeds in ancient Egypt. The book reveals the origins of much of modern science in the transatlantic slave trade of the 1700s, as well as Thomas Edison's mercenary support of the electric chair and the warped logic of the spies who infiltrated the Manhattan Project. But the sins of science aren't all safely buried in the past. Many of them, Kean reminds us, still affect us today. We can draw direct lines from the medical abuses of Tuskegee and Nazi Germany to current vaccine hesitancy, and connect icepick lobotomies from the 1950s to the contemporary failings of mental-health care. Kean even takes us into the future, when advanced computers and genetic engineering could unleash whole new sways to do one another wrong. Unflinching, and exhilarating to the last page, The Icepick Surgeon fuses the drama of scientific discovery with the illicit thrill of a true-crime tale. With his trademark wit and precision, Kean shows that, while science has done more good than harm in the world, rogue scientists do exist, and when we sacrifice morals for progress, we often end up with neither. (shrink)

In our current climate of rapid technological progress, it seems counterintuitive to think that modern science can learn anything of ethical value from the dark recesses of the nineteenth century or earlier. However, this happens to be quite true, with plenty of knowledge and wisdom to be gleaned by studying our scientific predecessors. Presently, our journals are flooded with original concepts and potential breakthroughs, a continuous stream of ideas pushing the frontiers of knowledge ever forward. Some ideas flourish while others (...) flounder; but what sets the two apart? The distinguishing feature between success and failure within this context is the ability to discern the appropriate time to accept an innovation with open arms, versus when to take a more cautious approach. And the primary arbiters for whether an idea will catch on or not are the professional audience. I illustrate this concept by comparing the initial reception of two innovative ideas from Medicine’s past: sterile technique, and prefrontal lobotomy. Sterile technique was first introduced by Dr. Ignaz Semmelweis and was initially ridiculed and rejected, with Semmelweis eventually dying in exile. Conversely, lobotomy was accepted and lauded and its inventor, Dr. Egas Moniz, won the Nobel Prize for his “discovery”. This begs the question: why was a technique with the potential to save millions of lives initially rejected, whereas paradoxically, one that compromised and sometimes destroyed lives, accepted? Here I explore and analyze the potential reasons why, suggest how we can learn from these mistakes of the past and apply new insight to some current ethical dilemmas. (shrink)

The emerging transdisciplinary field of consciousness studies merges transpersonal psychology with recent brain studies. In this paper, I argue that this new discipline must come to terms with the rhetorics of control in the history of brain research. I establish parallels between the discourses of lobotomy and psychosurgery, Electrical Stimulation of the Brain (ESB), and cybernetics, using the work of Jose Delgado, Norbert Wiener, and Bernard Wolfe. The rhetoric of social control remains a shadow side of brain research, of (...) the popularization of brain science, and of attempts to apply such research. (shrink)

The two introductory chapters are short, well written, and engaging. Chapter 1 constitutes an eloquent introduction to the state of Stoic philosophy. Naturalism and eudaimonism are central to Becker's new Stoic ethics, and his repeated use of the adjective “our” to describe Stoic remedies suggests that he preserves the ancient role of Stoic philosophy as a therapeutic ethics of diminished expectations. He might resist this characterization however, since he goes on to reject explicitly this vein within ancient Stoicism. Chapter 2 (...) seeks to correct the unfortunate fact that philosophers generally reject Stoic therapy along with “tranquilizers and prefrontal lobotomies as means to a good life”. Becker identifies five important features of his new Stoic ethics: eudaimonism, intellectualism, naturalism, the formal unity of the virtues, and particularity, that is, role or self-mastery. He distances his new Stoicism from that of his ancient forerunners by reconsidering the problem of cosmic teleology. Given the continuity of Stoic thought through modernity, “it is reasonable to suppose that stoics would have found a way to reject teleological physics and biology when scientific consensus did; that they would have found ways to hold their own against the attacks on naturalism launched in the modern era. And it is reasonable to suppose that the sheer variety of self-identified stoics over the centuries would have prevented, as it did in antiquity, the view that a stoic life is typically a bleak one'. The author disclaims the extremes of architectonic theoretical system and therapeutic encheiridion as characterizations of his book· It is, rather, an “investigation of neglected possibilities” which tries to show the viability of stoicism as an ethical system. (shrink)