Letters

Surgery for mental illness has been proved effective

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7073.75a (Published 04 January 1997) Cite this as: BMJ 1997;314:75
  1. R P Snaith, Senior lecturer in psychiatrya
  1. a School of Medicine, Division of Psychiatry and Behavioural Sciences in Relation to Medicine, University of Leeds, St James's University Hospital, Leeds LS9 7TF

    Editor–Sandra Goldbeck-Wood reports that Norway has offered compensation to all patients who have had a lobotomy in Norway in the past.1 Her article seems to leave the opponents of psychosurgery on a high moral ground. What the Norwegian fiscal administration chooses to do with presumably surplus money is its own decision, but Goldbeck-Wood's use of the word “victims” implies that patients who had a leucotomy in the past were the subjects of medical misjudgment, if not frank assault; this requires correction.

    The fact that the former patients who had a lobotomy in Norway are having to be located by advertisements in the media indicates that they are living out of contact with the hospital services and are not psychoneurological derelicts. The surgical procedure and the selection of patients who were thought likely to benefit were more uncertain decades ago than is the case today. Nevertheless, this must be set against the fact that no other treatments for severe psychotic illnesses were then available; consequently people with such illnesses were often consigned to a life of indescribable torment, usually in the back wards of mental asylums. That psychosurgery produced relief of this distress seemed to justify the difficult decisions involved in offering the treatment.

    As Bryan Christie pointed out in his article on neurosurgery for mentally ill people in Scotland, psychosurgery has been tarnished by its image in One Flew Over the Cuckoo's Nest 2–that is, of a procedure carried out by vengeful doctors in adversarial relationship with their patient. Since the introduction of psychosurgery the discovery of other methods of treatment has led to a considerable reduction in the need for it. The need does, however, still exist, and audits of the procedure (colleagues and I have just completed our own)3 justify its retention.

    Those who inveigh against the practitioners of psychosurgery, claiming some sort of unethical implication in its use, should be reminded of the unethical aspect of withholding information about a proved effective treatment from a patient on the grounds of their personal dislike of such an intervention. They should also be asked what better method they can offer to patients who have failed to respond to all other treatments available.

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