A Lewd Exhibit of Drooling Imbecility TM

Ocober 1, 1997

Eliminate the Ninnies and the Twits

My mind is going ...

There's something charming about a website that still dares call itself "the internet's only" anything, and when it's the internet's only history of the lobotomy, you can count simpleton as a fan. Corey Vest's brain-chomping survey of psychosurgery leaves a bit to be desired, but offers an entertaining history of behavioral brain surgery - beginning with the tale of Phineas Gage, the railroad worker who became neurosurgery's early adopter after a wacky you-got-peanut-butter-in-my-chocolate mishap (aficionados will recall how a misfired dynamite charge blew a spike through Gage's head - while Gage survived with no apparent physical damage, his personality was permanently changed. Once polite and abstemious, he became a boozing, cussing lout). Later, we get surprising details about the family of Walter Freeman, the trans-orbital Kevorkian (Freeman's father apparently flagellated himself in order to punish his misbehaving son). All in all, the lobotomy page is well worth the visit. Especially since, as this month's issue of Discover magazine informs us in a blaring headline, "Lobotomy's Back." Well, not quite back. The article that follows, a thoughtful history-cum-modest proposal by Pittsburgh, PA neurosurgeon Frank T Vertosick (and doesn't that last name sound like something you go to a neurosurgeon to get cured of?), takes a fairly balanced view of current experiments with cingulotomy, lobotomy's less jarring offspring (this time around the ice pick has been replaced by "computer-guided electrodes", which make possible a "magnetic resonance-guided" procedure. Sounds impressive, whatever it means). Instead of another no-holds-barred assault on the nation's frontal lobes, we're seeing, at most, a voluntary procedure being conducted by a handful of neurosurgeons. Vertosick concludes on a note of cautious optimism for the doctors who "risk the scorn of those who see only what psychosurgery was and not what it can be. I wish them luck. Given the lessons of history, they'll surely need it." Is this the face of a Mad Scientist? By the end of the article, I was wishing them luck too, if only for the prospect of getting a few of these "dangerously mental ill homeless people" out of my face. That babbling nincompoop who howled at you on your way home last night would have been locked in an asylum in Walter Freeman's day. Part of Freeman's icepick-brandishing zeal for his pet procedure (he kept a pick in his pocket at all times, and reportedly once performed an operation in a hotel room) stemmed from his desire to address the overcrowding of mental hospitals - a very real national health care crisis in its day. Gorey surgical details aside, how much worse is this than the miracle cure of the 90s - which is both more widespread and more expensive? After years of training in arcane psychic hocus pocus, psychiatrists are now conditioned to reach for their prescription pads before their books of dream interpretation. There's something disturbingly faddish in all this, since the chemical vs. psychological debate is a longstanding chicken-and-egg struggle in psychiatry - and while the chemical side is currently ascendant, the field has changed hands many times before. But there's something to be said for taking care of the symptoms, even if the disease can't be cured. And the prospect of an affordable new surgical treatment helps reset the terms of the debate. Right now there's a miniature backlash against mood-altering drugs, but those Luddites hoping to topple the National Mental Health State shouldn't lose sight of the point that most of us - including, in many cases, the mentally ill themselves - want the psychos to behave. To put it bluntly, the maniacs wandering the streets are not people who can afford to stay on Prozac for the rest of their lives. And when the county won't pay to house a crazy person,a little resonance-guided workout on the trans-orbital lobe might be just the ticket. Not that the decision will be ours to make. A few years back, an episode of Chicago Hope - the pop Talmud of medical ethics - centered on whether a patient should undergo a cingulotomy treatment. Wackiness ensued, but in the end, the patient opted out. We can expect any real life debate to follow similar lines - the rules have now changed so that no such operation can be performed without direct patient consent. But if cingulotomy threatens to catch on, you can expect a brouhaha that will make the Prozac backlash look like a kindergarten Time Out session. Indeed, you can expect Eli Lilly, whose sales of the wonderdrug can only be threatened by the one-time-only promise of neurosurgery, to provide major funding for the inevitable public awareness terror campaign (though Lilly is of course a great supporter of patient consent - and even insistence - when the treatment is chemical rather than surgical). Despite the disturbing prospect of cingulotomy's becoming the treatment of choice for the poor, it would be nice - and probably helpful - to see the fur fly between those who want to dope the brain up and those who want to cut it up. If the battle gets fierce enough, it might be enough to undo the ascendancy of chemical-based psychiatric theory, and allow shrinks to get back to doing their jobs. The point of all this? Well, in simpleton's first eight days of continuous publication, our readers - all three of you - have been requesting that we publish a mission statement. You just finished reading it.

Give simpleton a piece of your mind.

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