Shutter Island and the Defence of the Lobotomy

Shutter Island is amazing, as is Leonardo DiCaprio, who I love with the heart of a hormonal thirteen-year-old who has just watched Titanic four times. My heart will go on, Jack...*sob*

Ahem.

Shutter Island, a film taking place in the fifties on a remote island housing the criminally insane, has some other stuff going for it, too. Things like hallucinogenic drugging, human experimentation, and the ever popular lobotomy (a procedure used frequently on psychiatric patients in the forties and fifties, despite severe, irreversible side effects).

The removal of the prefrontal cortex of a patient with schizophrenia (or other severe psychotic disorders) is not a popular subject - for many, it represents the modern culmination of a long history of abuse. Psychiatric patients have been exorcised, burned as witches, confined, beaten, neglected, and sexually abused; throughout human history, there is very little that we haven’t inflicted on those that are vulnerable, and mental patients seemed like ideal subjects for medicine’s wildest whims.

According to my good friend Wikipedia, the side effects of the lobotomy are as follows: “Convulsive seizures are reported as sequelae of prefrontal lobotomy in 5 to 10 percent of all cases. Such seizures are ordinarily well controlled with the usual anti-convulsive drugs. Post-operative blunting of the personality, apathy, and irresponsibility are the rule rather than the exception. Other side effects include distractibility, childishness, facetiousness, lack of tact or discipline, and post-operative incontinence.” Of those that were lobotomized, the vast majority were women.

The lobotomy met its end in the mid nineteen-fifties, when psychotropic medication began to take effect and forever change psychiatry, and by the nineteen seventies and One Flew Over the Cuckoo’s Nest, lobotomies had largely fallen out of use.

For those of you who watched Jack Nicholson sit with his friend, the Chief, and saw the scar on his forehead and that vacant look in his eyes and yelled at your respective televisions in shock and horror, the lobotomy was the perfect symbol of all that was wrong with psychiatry.

And lucky for you, I’m here to tell you that you’re wrong.

Because, while archaic, while crude, and while riddled with side-effects, the lobotomy represented a giant leap forward for psychiatry and the treatment of mental patients.

I’ve argued in defense of the lobotomy, and the similarly maligned ECT, and will continue to do so, but not because either represents an ideal, or even a particularly ‘good’ option for treating the mentally ill. And that’s because there simply aren’t any ‘good’ options when it comes to treating severe and chronic mental disorders like depression, psychosis, or paranoid schizophrenia.

As unconscionable at the removal of a person’s prefrontal lobe might be, I do find it preferable to the standard of care pre-lobotomy (namely, chaining up patients in an asylum and trying to beat them to sanity at least once or twice a day, every day, until they died). And the very idea of living a life of severe mental illness - say, schizophrenia - is itself unconscionable, even with the option of today’s ‘modern’ pharmaceutical treatments - which, while less invasive than brain surgery, are not without devastating side effects (tardive dyskinesia, a Parkinson's-like disease, is one of the more visible and gruesome examples of antipsychotic effects.)

When my (stupid) brother argued against the treatment of women with ECT (electric-shock treatment, in case you weren’t a psych major), I was offended - because ECT remains one of the most effective treatments of severe depression available. Nobody like’s the idea of electrocuting their brain - of course not - but for the patients who have ECT as an option, it’s a flicker of very real hope, after years of failed attempts at psychopharmaceutical therapy (which involve random manipulations of poorly understood brain chemicals, often with severe side effects, too). Such patients are often severely disabled, suicidal, and unable to live in their homes - so in a choice between a lifetime of suicide watch in a psych ward and the alternative, as difficult as that decision would be...I would like to keep open the option of ECT.

Treatments keep getting better, and strides in research continue to be made - and the simple fact is that, for many people, removing a small section of their prefrontal lobe, with a drill, improved their lives. The illnesses best treated by lobotomy are those of compulsive and damaging over-thinking - chronic severe anxiety, OCD, and affect disorders such as dysthymia. It makes sense - the damage done by lobotomy seems not dissimilar to the effects of Ativan or valium in ‘sedating’ patients, relaxing them, and lowering their IQs.

And, were it a choice between losing 15 points on my IQ and having chronic incontinence, or believing that the woman trying to feed me a bagel was operating a secret cult of cannibals bent on devouring my body and soul as operatives of a CIA agent conspiracy...and I don’t know what I’d chose. I’m glad I don’t have to make that decision. But condemning options hardly seems like the right answer.

There is simply the reality of severe and chronic mental illness, no matter what, and it is always, painfully sad.