Last Resort
In the words of one expert, “the main reason for doing the operation is that it usually works; it brings results sufficiently successful to make it worthwhile.” The operation in question was the lobotomy, the subject of a very interesting book by Jack D. Pressman, Last Resort: Psychosurgery and the Limits of Medicine (Cambridge, 1998) (Dewey Decimal Call # 616.891 P93). The lukewarm endorsement of psychosurgery seems appalling to us today, when we know that slicing up parts of the brain serves no medical therapeutic good. Even one of its proponents, reflecting on the lack of understanding of brain function, called the lobotomy a “stab in the dark.” Mortality rates for the operation were 1 to 3%, and around 10% of those operated on developed induced epilepsy.
Yet what we know about therapeutic good and medical science is the real topic of Pressman’s book. It is not (or was not) just a matter that psychosurgery became popular with a fringe group of practitioners. Nor is it a simple matter that psychiatrists didn’t know any better, didn’t have the advantages of all the advances since the 1930s (psychosurgery began in 1934). Pressman shows that psychosurgery made sense both within the world of psychiatry (the therapeutic and administrative issues of the mental institution) and within the world of medical science. Well-known and widely respected surgeons practiced and promoted the lobotomy, and one of the most prominent neurophysiologists in the country not only promoted it but also proudly staked a claim as one of its inventors.
On the medical side of the equation, Pressman shows in chapter 2 how scientific authority and consensus were negotiated during the 1930s around the idea of psychosurgery. The neurological and psychiatric science of the decade coincided in a view of mental disease as disordered behavior. Experimental evidence showed (seemed to show, from our point of view) that behavioral abnormalities would yield to surgical intervention.
In later chapters Pressman shows that within the therapeutic calculus of the 1930s and 1940s, psychosurgery worked. One of the directors of a committee studying the operation “concluded that, if the ‘primary purpose’ of mental hospitals was ‘to relieve human suffering and to restore patients to happy and productive lives in their homes and communities’ then psychosurgery was well suited to the task and deserved the support of all psychiatrists.”(233) Both the medical view of mental illness, and the treatment regimen within mental institutions, worked to provide a favorable estimate of psychosurgery’s success. Pressman’s topic is psychiatry, but his work should alert us to the contextual nature of medical treatment (and also, I think, to the contextual appraisal of other therapies).
An interesting later chapter in the book develops a portrait of a private mental hospital during the heyday of psychosurgery. Pressman shows how therapeutic decisions were made and how patients were appraised based on administrative needs of the institution. Perhaps nothing could better answer the obvious questions: Who got lobotomies? Why?
A strength of Pressman’s work is that he persistently reflects on the ways that a particular historical event can be understood, beginning with our tendency to fall back into a paradigm of scientific progress--since we know how things work now, we can judge the foolishness of our ancestors. But he won’t let the reader get away with such facile conclusions. At the same time, I feel obliged to mention, Pressman discusses interpretive frameworks a good bit more than I found helpful. While the work is interesting and even moving, Pressman simply wrote too much discussion into each chapter.
While not a Rutgers graduate, Pressman did work as a postdoctoral fellow at the Institute for Health at Rutgers Univ. He went on to become a member of the faculty at UC San Francisco. He died suddenly in 1997.