Home > observations > Uspeakable horror… but let us speak of it anyway

Uspeakable horror… but let us speak of it anyway

July 25, 2007

Occasionally I get to thinking that the FDA should be an advisory-only agency, usually when I consider stupid actions like banning the Chinese herb ephedra because a few people with heart defects took 5x the recommended dose and then turned out for high school football. 

But then I read something like Neurophilosophy’s Rise and fall of the prefrontal lobotomy. (The article is not for the squeamish)  There’s a clear description of how the operation evolved during the time it was practiced, and some context; for instance I was not aware that John F. Kennedy’s sister Rosemary had the operation, and was completely incapacitated by it.  And there are a few stories – most notably that of Howard Dully, who was lobotomized at the request of his stepmother because she found him a disobedient child.  It is not easy reading.

Previous cultures have held that the soul resides in the heart.  But the heart is a pump; a person does not become a machine while on a heart-lung machine.  If there is a soul, its surely resides in the brain.  In the top, the front, of the brain, where in the 1940’s and 1950’s a few doctors performed thousands of acts of ignorant vandalism.  There could be no operation more invasive to the person on which it is performed.

In recent years I have heard people make overheated comparisons between such horrors, and giving Ritalin to kids who have ADHD.  Instinctively I recoil from the staggering disproportion between the two – it is like comparing school detention to the Gulag Archipelago. But there is a discussion to be had.  In short, the two are not at all comparable along the axis of irreversibility, or of effect.  But by way of illustration and example it is worth discussing if the problem is really with the child, or with the school and family.  We’re awfully quick to try to change the child.

In the end, we may look at new medical technologies and give the green light.  For example that seems to be the outcome with stem cell research and therapies in most of the world except here (where cells apparently have souls). We’re squeamish about selling organs, too, for no reason I can quite discern.  And if informed autonomy is the core of medical ethics, I’m left without any explanation for the ban on medicinal (or any other) use of marijuana, or the ban on euthanasia.

Why speak of lobotomy all?  Because, now that the operation is all but forgotten, so is the ethical range of comparison.  We’re introducing new medical procedures and technologies at a pace undreamed of in the middle of the last century when lobotomies were all the rage, and we need well-maintained tools for discussing their ethical implications.  If nothing else, when someone makes too strained a comparison (usually involving Nazis) we know what has happened here, and how it differs from giving someone a pill that will wear off in four hours.  And, how other things fit in between. 

Categories: observations
  1. July 25, 2007 at 19:39 | #1

    We’re awfully quick to try to change the child.

    So true!  I am not at all a fan of most kinds of ADD or ADHD meds.  I have taken multiple kinds in my days and all had the same effect.  Turned me into an impotent (short term at least), mindless, soulless, zombie.  I never understood the purpose of wanting to change the characteristics of your child just because you’re too lazy to deal with him/her.

    I hated myself while on them but I never understood why.  Every once in awhile I feel as though the effects of the meds come back, when I feel my personality drifting away.  Sometimes I still act just as I did on the meds around my fiance.

    For a couple days I stopped taking them and my parents wanted me to keep going.  I told them what it did to me and they hardly listened.  My pops said he would take it to see what the effects were.  He wouldn’t directly admit it but it had the same effects on him.

    The problem with ADD is that ADD brains have less frontal lobe activity during simple tasks such as homework and reading than normal brains.  Which is why it’s hard for those with ADD to concentrate on tasks.  I can’t remember the author of the book that did the brain imaging scans but he said it appeared some children were missing their frontal during activities that would use the frontal lobe.

    The other problem is that when you get video stimulation your brain secretes dopamine.  This keeps your body begging for more, but with ADD you run out quicker.  Thus having the effect where you keep watching TV and you don’t know why, even if nothing is on.

    I know people that smoke marijuana, some for pure recreational use, others for actual practical purposes.  For some it’s one of the few things they can do to level out.  For them it works better than drugs and has only a side effect of munchies.

    Because of it’s illegality I stick to more practical methods.  Some things I learned DOF, such as writing everything down and storing it in a very accessible database are important for those with poor short term memory and/or ADD.  I also recommend a diet high in natural whole foods, and plenty of exercise, for the body as well as the mind.  The same doctor from above seemed to find that children with ADD and diets high in sugar and refined foods did worse than those with healthy diets and exercise.

    If nothing else, when someone makes too strained a comparison (usually involving Nazis) we know what has happened here, and how it differs from giving someone a pill that will wear off in four hours

    While I agree and would never compare a lobotomy to taking ADD pills, I am sure what people mean when they make the comparison is the zombie like effect that happens.  The emotionless personality that ensues.  And I can tell not all ADD pills wear off in just 4 hours.

  2. July 25, 2007 at 21:32 | #2

    Wow – long comment, Webs.  Hyperfocus really is an ADD characteristic. 

    I am not at all a fan of most kinds of ADD or ADHD meds.  I have taken multiple kinds in my days and all had the same effect.  Turned me into an impotent (short term at least), mindless, soulless, zombie.

    Treating ADD/ADHD is a specialty in itself.  It is too easy for doctors to prescribe the ADD drugs the big companies push, because they help the “average” person with ADD.  It is now known there are many kinds of ADD/ADHD and even more kinds of drugs, plus the biochemical individuality of the person taking them.  Got to come up all cherries to get the jackpot, otherwise, it’s nothin’ but side-effects. That’s apparently what you got.

    I never understood the purpose of wanting to change the characteristics of your child just because you’re too lazy to deal with him/her.

    Harsh, dude.  Walk in the parents’ shoes first.  They see their bright kid struggling, getting injured by impulsive behavior, even slipping behind in school, and they start to grasp at straws. There is no shortage of experts who tell them what to do, and worry and exhaustion do funny things to your thinking.  And remember, for many people (those who pull the lever and get all cherries) the meds are a godsend, open up a whole new life.

    I can’t remember the author of the book that did the brain imaging scans but he said it appeared some children were missing their frontal during activities that would use the frontal lobe.

    Daniel Amen.  He uses a SPECT (Single Positron Emission Computed Tomography) scanner to map brain activity during sample activities.  I have one of his books I’ll give you.  Interesting stuff – and he’s no fan of “prescribe and see.”

    I know people that smoke marijuana…  For them it works better than drugs

    LOL!  You cannot seriously be unaware that marijuana is a drug…  (don’t answer that)  and it’s really, really bad for developing brains, say under the age of 20.  Permanent damage.  I’m personally not in favor of anyone using it, I just don’t think it should be illegal for adults.

    And I can tell not all ADD pills wear off in just 4 hours.

    Yeah.  Some (like Strattera) have to be tapered up and tapered down – the whole cycle takes a couple weeks or more.  Still no ethical comparison to psychosurgery, and I’m mainly talking about the ethical scale here.

    Doctors do tell people to change their lifestyles – stop smoking, eat the right foods, exercise, get plenty of rest, etc.  Just gargle with salt water for that sore throat.  They learn pretty fast that when the patient has paid for an appointment, they want to leave with a prescription for something.  We’re a pretty drug-centric culture. 

    Back in the late ‘50’s, housewives by the millions took Valium, (known colloquially as “mother’s little helper”) until some bright mind figured out that intelligent people need to do something with a bit of challenge to it, and scrubbing floors wasn’t it.  Along came women’s lib, college, careers, and zammo!  everybody’s happy now.  Well, except for the multi-billion market in SSRI drugs like Prozac.  We’ll take almost any pill as long as we can avoid living differently than the way television prescribes for us.  Heck, television even prescribes the pills now.  Ask your doctor about Advertex

    Some things I learned… such as writing everything down and storing it in a very accessible database are important for those with poor short term memory and/or ADD.  I also recommend a diet high in natural whole foods, and plenty of exercise, for the body as well as the mind. 

    Very good example of the best first approach, to be followed by medication only if those nondrug strategies don’t work.  We do things bass-ackwards ‘round these parts.

    So speaking of hyperfocus, did anything else in the post catch your eye?  Did you read the article about lobotomy? (count yourself lucky you weren’t Howard Dully!  Just imagine the doctors his stepmom would have taken you to)

    Returning to the original topic, what will the next ethical equivalent of a lobotomy be?  Something totally invasive, irreversible, perhaps appropriate for rare cases but widely practiced perhaps by unqualified physicians.  I’m guessing some kind of gene therapy for conditions that really aren’t that serious.

  3. July 25, 2007 at 22:38 | #3

    Doctors do tell people to change their lifestyles – stop smoking, eat the right foods, exercise, get plenty of rest, etc.

    Not a single doctor or psychiatrist I saw said anything about diet and exercise.  In fact one, that was considered some kind of expert with ADD (in other words he treated a lot of patients), said there is no linkage between diet and exercise and ADD.  He was pretty adamant about prescribing the newest pill.

    But I will normally agree with you there.  And perhaps part of the problem is that doctors keep telling people diet and exercise till they’re blue in the face, but no one listens.  So like you say, we are looking for something of a solution and so out comes the pill. 

    I know my Uncle has had countless number of patients that are overweight and have problems.  My uncle has told everyone to diet and exercise, and in some cases has laid out a plan for them.  But he told my brother and I, “Only one has ever listened to me, only one.  And you know who that was… Your Grandfather!”

    We’ll take almost any pill as long as we can avoid living differently than the way television prescribes for us.

    So true.  On this topic, have you seen the commercial for lypozene.  Supposedly medically tested to reduce fat around the midsection.  Notice the name, sounds like liposuction…

    Did you read the article about lobotomy?

    LOL, sorry.  Yes I did, and I found it to be a page turner… or um wheel scroller.  It was very interesting and I had little understanding of the topic partly due to my age and just never coming across any info about it. 

    It kind of worries me that maybe we are doing the same thing but with other instruments like meds.  I know a lot studies are done on approved chemicals and such, but I am sure those performing the lobotomies say they had a lot of evidence and studies as well.  I guess the one comforting thing is our understanding of the brain and the body is a lot better now.  And we the people have access to a lot of info, with the help of the Internet, that we didn’t have back in the 50s.

    Another thing that surprised me was that they went all the way up to the 50s.  I would of thought surely someone sane would have put a stop to it sooner.

    The other thing that got me was how the aunt betrayed Howard’s trust in her and her decisions.  And the sickos performing the lobotomies misplacing the trust of thousands of people.  I mean really WTF.  No wonder so many people are afraid of surgeries and think twice bout going to the doctors.

    I guess it’s another reason why it’s crucial for people to have a deep grasp of science and logic.

  4. July 26, 2007 at 07:52 | #4

    I know a lot studies are done on approved chemicals and such, but I am sure those performing the lobotomies say they had a lot of evidence and studies as well.

    I’m particularly concerned with irreversible procedures, of which a number are on the developmental horizon.  There the ethical standard is several orders of magnitude higher.  Housewives can stop taking Valium, school kids can go off Ritalin, but gene therapy is permanent, and needs correspondingly careful oversight.

    I would of thought surely someone sane would have put a stop to it sooner.

    Here’s a contest for you; of how many other things in human history could you say the same?  The point of ethical review is to prevent doing things in the first place that lead to that observation.

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