Book T of C
Chap T of C
This is the 2007 version. Click here for the 2017 chapter 02 table of contents.
The results of early lobotomies were difficult to interpret, because the people receiving lobotomies were already psychotic, seriously disturbed and out of touch with reality. In the late 1940s lobotomies were used on a new group: people suffering severe intractable pain : pain unresponsive to any form of treatment. Doctors had noticed that psychotic patients receiving lobotomies no longer complained of pain afterward. So it seemed lobotomies might be useful for people who suffered from pain alone, without any sort of psychological disorder. At first this seemed to be a success. Dynes (1950) wrote, "The patient [after lobotomy] was unconcerned about pain and in practically all instances he was no longer anxious and fearful as he had been prior to the lobotomy."
When pain patients were given lobotomies, what symptoms were discovered?
However, as time went on, some disastrous consequences were discovered. Dynes found that some patients were "slowed up in thinking and acting, they were dull, at times completely lacking in emotional expression or display and showed a striking reduction in interest and driving energy." Others receiving the same operation were "uninhibited and euphoric and they were somewhat restless with a purposeless type of activity."
What does it mean to be "stimulus-bound"??
Lobotomy patients were said to act stimulus-bound. They reacted to whatever was in front of them and did not respond to imaginary situations, rules, or plans for the future. Many of the patients became fat. If food was set in front of them, they ate, hungry or not. Some of the patients grew sexually promiscuous; they pursued immediate gratification without regard for consequences. Few of the lobotomy patients could plan effectively for the future or sustain goal-oriented activities. A goal requires that complicated plans be held in mind, and this was evidently beyond the capacity of lobotomy patients, who tended to be distracted by immediate stimuli.
Dr. Gosta Rylander of Stockholm described a patient whom he employed as a cook after the patient recovered from a prefrontal lobotomy. Originally the patient was very innovative in the kitchen, but after the operation she had difficulty in using new recipes and made ridiculous mistakes. She had no problem, however, with old recipes. When going out to buy food, she frequently disappeared for long periods, distracted by shop windows and often forgetting to buy the food.
What was Cobb getting at, with the idea of "long-circuiting"?
Cobb (1944) described the problem of lobotomy patients as a reduction in "long-circuiting." This metaphor suggests that reduction of brain tissue, and number of neural circuits, is responsible for the effects of lobotomies. It seems possible that lots of "brain space" is required to represent abstract, intangible things like goals, morals, intentions to diet, or even intentions to buy food. Cobb's metaphor is also supported by the finding that lobotomy-like symptoms are caused not only by damage to the frontal lobes but also by loss of large amounts of tissue almost anywhere in the brain.
C. Scott Moss was a psychology professor at the University of Illinois when he suffered a stroke in 1967. His book Recovery with Aphasia, written with the aid of his wife, is an inside look at experience of a stroke victim. He describes problems in "long-circuiting":
It took a great deal of effort to keep an abstraction in mind. For example, in talking with the speech therapist I would begin to give a definition of an abstract concern, but as I held it in mind it would sort of fade, and chances were that I'd end up giving a simplified version rather than one at the original level of conception. It was as though giving an abstraction required so much of my addled intelligence that halfway through the definition I would run out of the energy available to me and regress to a more concrete answer. Something like this happened again and again. (Moss, 1973, p.10)
How did brain scanning techniques confirm the importance of the prefrontal areas?
Lobotomies provided evidence that there was something special about the prefrontal cortex, the part of the brain located behind the eyes. Brain scanning techniques confirmed this. Prefrontal areas are activated when people exercise will power, make plans, or do creative thinking (Posner, 1993). The frontal lobes provide us with a capacity for comprehensive forward planning which is a hallmark of our species.
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