History of Psychosurgery in The United Kingdom - Decline of Psychosurgery

Decline of Psychosurgery

The use of psychosurgery in the United Kingdom peaked in the late 1940s and early 1950s, with nearly 1,500 operations a year. Although some mental hospitals never used psychosurgery, or abandoned it after a brief trial, only a few voices were raised against it in the medical literature. Retired professor James MacDonald reminded psychiatrists at the Royal Medico-Psychological Association’s March 1943 symposium on pre-frontal leucotomy that the frontal lobes represented the highest form of evolution, that there was no rational basis for leucotomy, and that the operation was of questionable legality. Donald Winnicott in a letter to The Lancet in the early days of leucotomy suggested that those who wanted to perform destructive operations should first establish that mental disorders were actually "brain-tissue diseases". Clifford Allen questioned the ethics of operating on people to make them easier to nurse and said it was little less than criminal to operate on people who were mildly or only recently ill.

Several works published in the 1950s drew attention to the damaging and sometimes fatal effects of psychosurgery, though their authors were not opposed to the treatment. Maurice Partridge’s follow-up of 300 patients operated on by McKissock revealed a higher death rate than was usually acknowledged, with six per cent of patients dying wholly or partly as a result of the surgery. The book described how many patients, even those whose surgery was considered as success by their doctors, were left with serious disabilities. Walter Maclay, president of the section of psychiatry of the Royal Society of Medicine, chose the subject of "death due to treatment" for his 1952 address. He counted 180 deaths directly resulting from leucotomy over a period of five and a half years. Also mentioned as a "possible lethal complication of leucotomy" were three murders committed by people who had undergone leucotomy. In his book Personality changes following frontal leucotomy Peter MacDonald Tow, psychiatrist at Runwell Hospital, described his search all over England for "normal subjects" – people who in spite of having been selected for leucotomy did not have severe mental illnesses. Eventually he found sixty subjects. Several died as a result of the operation, or were left too damaged to co-operate with testing. MacDonald Tow’s research on the survivors demonstrated that the operation often caused serious intellectual damage.

When the Board of Control published their second survey in 1961 the use of psychosurgery had declined by more than half; the decline being attributed to an awareness of the risks of irreversible effects and the introduction in 1955 of neuroleptic drugs. By 1961 nearly half of mental hospitals in the United Kingdom were no longer carrying out leucotomies. Approximately 500 operations were performed a year, and were unevenly distributed over the country. Someone hospitalised in the North East Metropolitan region was more than 15 times more likely to undergo psychosurgery than someone hospitalised in the neighbouring East Anglian region. There were also random differences in the type of operation used and the type of illness treated. Twenty per cent of operations were still standard pre-frontal leucotomies; the rest were new operations, and a few centres used stereotactic techniques. Some hospitals still used psychosurgery to treat chronic schizophrenia, in others the only indications were depression or obsessive illness. Psychosurgery continued to decline during the 1960s and 1970s. In 1976 about 120 operations were carried out in the United Kingdom. There were still a few standard leucotomies, but by the mid 1970s stereotactic subcaudate tractotomy, cingulotomy and stereotactic limbic leucotomy accounted for more than 50 per cent of operations. Depression was the most common diagnosis; people were also operated on for anxiety, violence, obsessive-compulsive disorder, schizophrenia, anorexia and other diagnoses.