Respectful Insolence

…At least, that’s what I most definitely say after reading this account of The rise & fall of the prefrontal lobotomy.

One question that stands out: How could a stepmother force her stepson to get a lobotomy just because she didn’t like his sullenness and defiance, even after being told by other doctors that there was nothing wrong with the boy? An observation that stands out is that medicine and surgery are periodically caught up in fads. That’s why it’s every bit as important to apply evidence-based medicine to the newest procedures and treatments as it is to apply it to alternative medicine.

Comments

  1. #1 Colugo
    July 25, 2007

    “That’s why it’s every bit as important to apply evidence-based medicine to the newest procedures and treatments as it is to apply it to alternative medicine.”

    For example, the bowel removal surgical fad promoted by William Arbuthnot Lane.

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1119264

  2. #2 beajerry
    July 25, 2007

    The story of Freeman and his reckless lobotomies never gets any less horrifying.

  3. #3 Elizabeth Reid
    July 25, 2007

    My doctor is sometimes almost too honest; I wish fewer of my conversations with him about my pending childbirth didn’t include this acknowledgment, “There’s no evidence that X improves outcomes, but we’re still going to do it.” I appreciate his candor but it’s annoying that, for instance, I’m going to be subjected to continuous fetal monitoring not because it’s safer but because it’s required by hospital policy. What good is collecting evidence if it’s not heeded?

  4. #4 Coin
    July 25, 2007

    Something that continually bothers me in discussions of both mainstream and “alternative” medicine is the enormous extent to which parents have basically complete leeway in performing anything they personally interpret as “medical care” on their children. This degree of leeway is rarely if ever questioned, and when it is questioned the reaction to said questioning is generally universal horror, with even quite modest limits on a parent’s ability in this regard being thought of as some kind of horrible totalitarian abrogation of rights.

    The rights of the child, on the other hand, don’t seem to really ever come up, even if the medical care in question potentially has serious consequences for (or prevents entirely) the later life of the child the once they are no longer a minor.

  5. #5 Jon H
    July 25, 2007

    “Something that continually bothers me in discussions of both mainstream and “alternative” medicine is the enormous extent to which parents have basically complete leeway in performing anything they personally interpret as “medical care” on their children.”

    The problem is, if not the parents, then who?

    The doctor? There are plenty of shady practitioners out there.

    The government? You never know whether the official concerned will be a skilled, ethical practitioner, or a hack, or a kook, or a Scientologist, or an ideologue with an axe to grind.

  6. #6 wrg
    July 25, 2007

    The problem is, if not the parents, then who?

    There’s the trouble, indeed. In an ideal world, parents, doctors, judges, bureaucrats, and politicians would all have exhibit concern and good judgment when considering how to treat a minor.

    Sadly, there are troubling stories where any of the above is either heedless of a child’s welfare or deluded. I’m reminded of a fellow I know who had diagnosed bipolar disorder but was at a facility where the physician in charge eventually medicated him for schizophrenia, despite side effects. When his parents withdrew him from the facility, the psychiatrist and a colleague had him committed, even though he didn’t seem more likely to harm himself or others then than he ever had.

    Fortunately, the parents were able to get another doctor to take over the case. All is as well as can be expected, now, with bipolar disorder managed by medication. There hasn’t been any talk of schizophrenia since then.

    Although I present this as a case when parental intervention helped to change an unsuitable course of treatment, I don’t mean to imply that parents always know best. I really don’t know an ideal answer for how we should treat minors. Mental illness presents troubling issues even with patients who aren’t minors.

    P.S. Any Scientologists who want to quote-mine this really shouldn’t, since most of the psychiatrists involved in the case were helpful. If we were to buy in to the lies against psychiatry, this fellow would never have medication to keep his bipolar disorder under control and he’d be dealing with depression some of the time, mania much of the rest, and consequent misery pretty much always.

    P.P.S. Firefox thinks that “Scientologists” is an incorrect spelling. I’ve got to love a browser that disbelieves in bad fiction.

  7. #7 AnnR
    July 25, 2007

    Well, the stepmother does sound evil and manipulative, but the issue of parents being responsible for their children is tough.

    About the best I can say from my experience is that at the time you usually think what you are doing is right.

    My son had tubes in his ears. One had a complication that a pediatrician urged me to have corrected at a early age because he didn’t think the insurance plan I was switching onto would cover the repair. Was I a good consumer who verified that? Nope – I went with what the Dr. told me.

    That repair spawned two more surgeries. Some years later he’s fine, but to this day I think back and wish I hadn’t listened to that pediatrician and had let that hole just stay there a few more years. The insurance plan I switched onto paid for the two other surgeries anyway! But how was I to know? I was just a Mom who wanted her son to have all the touted benefits of unclogged up ears and listened to her Dr.

  8. #8 Coin
    July 25, 2007

    The problem is, if not the parents, then who?

    Alas, I don’t have the foggiest idea.

  9. #9 DuWayne
    July 25, 2007

    I heard this story on NPR, last year. I remember getting extremely angry, as they allowed several of Freeman’s “patients” tell their stories. The last and by far the most heartwrenching, was that of Dully. At the end, when they played the first discussion he ever had with his dad, about the lobotomy, I actually cried.

    Coin -

    The problem is that parents, first and foremost, have to be the decision makers for their children’s healthcare. It’s easy to get upset at the stories of quackery, but one must keep in mind that these are relatively rare. Far more serious a problem, is when EBM doctors make bad recommendations, or support a certain amount of quackery themselves. This is going to be an interesting idea for a post on my own blog, thanks for mentioning it.

  10. #10 Eamon Knight
    July 25, 2007

    Apropos parents and bad medical decisions, another “refusing cancer treatment” story, from my neck of the woods:
    http://www.cbc.ca/canada/ottawa/story/2007/07/25/ot-chemo-070725.html

  11. #11 DrFrank
    July 26, 2007

    Wow, the amazing level of disregard shown whilst actively mincing other people’s brains simply astounds me :S

  12. #12 notmercury
    July 26, 2007

    Me too DuWayne,
    I listened to it in the car and it was one of the saddest stories I’ve ever heard.

  13. #13 trrll
    July 26, 2007

    My father, a neurosurgeon, used to tell this (possibly apocryphal) story about frontal lobotomy:

    A man, married and gainfully employed, had the problem of being a binge drinker. Every few weeks he would go on a bender, get into a fight, and smash up a bar. Needless to say, this introduced various difficulties, the most troubling being that he was wracked with guilt over this behavior which he was unable to control.

    Somewhere, he developed the idea that the cure for his problem was a frontal lobotomy. He went from neurosurgeon to neurosurgeon, and none wanted to do the procedure. But finally he found one that would.

    And it worked!

    He still got drunk and smashed up bars…but he no longer felt guilty about it.

  14. #14 Shanghai Johnny P
    July 29, 2007

    The Kennedy’s did it to one of their children.
    I’m pretty sure the Bushes at least supported it.*
    (*No,I can’t tell you whether or not Bush the Younger had one that worked!!)
    After all,both Joe Kennedy and Prescott Bush were beleivers in Eugenics as well as Nazi sympathizers.
    Both families suffer from Mental Illness and Alcoholism.
    “I Would Never Join A Club That accepts Me as A Member.”-Groucho Marx.

  15. #15 Julia
    August 2, 2007

    My grandparents moved into a retirement home in 1980, and two of the people they met there were sisters — one of them had had a lobotomy to treat depression, and after that, sure, she wasn’t depressed, but she wasn’t quite up to taking care of herself, either. I had a few conversations with her; she was pleasant, but there was something just a little lacking. (I was 12 or 13 when I was told about her condition, and came away from the whole thing thinking that a lobotomy wasn’t all that great.)

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