Walter Freeman was one of the biggest proponents of the "ice pick" lobotomy, performing more than 3,000 during his lifetime. He's one of the ten most dangerous doctors to have ever lived and you can read more about him and the rest of these men in this great Ty.rannosaur.us article.
Link
Okay, I'll get off my soap-box now
In the same way, modern doctors do not think it is necessary to identify the cause of depression, but treat it with mind-altering drug with all kinds of side-effects. Least of which is dependency on the drug.
I've known people who suffered severe depression and took SSRIs. It didn't help them in the long-run, it made them more depressed. A side-effect of SSRIs is suicidal tendencies.
I'm not sure what you mean by "the brain matter was seen as unnecessary" as the idea of functional specialisation of brain function (that all the different parts of the brain served different specific functions) had been popular for around 100 years prior to Freeman's lobotomies.
If you intended on generalising your statement about doctors preferring to treat depression with mind-altering drugs over identifying the underlying cause to psychiatrists/psychologists, that is incorrect. Psychological research is constantly being conducted to shed insight into the potential causes of depression. Mental health practitioners also typically employ a number of methods to treat depression including investigating potential specific causes at the individual level, counseling methods such as cognitive behavioural therapy, advice relating to exercise, and in many, but not all cases, drugs such as SSRIs.
SSRIs are not addictive and typically do not lead to dependency if usage is monitored by a psychiatrist or doctor. The most common form of depression, major depression, typically takes the form of episodes that last for weeks to months, meaning the biological causes tend to go away in time. As such a good medical practitioner monitors the length of the treatment phase and reduces dosage very gradually after a few months before deciding with the patient whether it is appropriate to discontinue usage. It is true that sudden cessation of SSRIs can sometimes result in SSRI discontinuation syndrome (not to be confused with serotonin syndrome), which can have negative side effects including temporary depressive and somatic symptoms, however a very gradual reduction in dosage over the space of about 3 months minimises this risk. Suicidal ideation is a possible side effect of taking SSRIs, however it is extremely uncommon independent of the depression itself.
As for your anecdotes relating to your friends, there is absolutely no way if knowing whether the SSRIs were the cause of their worsening symptoms, however I am not surprised that it didn't help them in the long run considering that SSRIs are not intended to provide a long-term solution and shouldn't be relied upon as such.
I'm saying there are a lot of things we don't know until it is too late. By the methods and standards of his time Freeman was in-line, that's why thousands of people opted to have the procedure, hundreds of doctors learned the procedure from Freeman, and Rose Marie "Rosemary" Kennedy sister to John F. Kennedy also had a frontal lobotomy at the hands of Walter Freeman.
If you think it was obvious at all that the procedure was counter-productive you don't understand the history of medicine. It was not very clear at all that removing large portions of brain matter would result in serious dysfunction. Beginning with Aristotle it was believed that the brain was a radiator for the body, that it cooled blood and little else. The animate essence of the human was said to be in the "Vital Spirits" that circulated the blood, and thus the Heart, not the Brain, was the seat of the soul. Vitalism didn't die when William Harvey plotted out the circulatory system in the 1600s, but it may have marked the decline of elan vital.
Nevertheless, during the behaviorist dominance of mental health the brain was believed to be a static entity, and that removing faulty parts would help patients. There was no concept of healing the broken bits, because there was no concept of neuroplasticity. If there was something wrong with a part of your brain, it would just be removed. Frontal Lobotomies aren't the only such procedures. Split-brains that have been severed down the connecting fibres of the corpus callosum are still common for treating severe epileptic seizures. Michael Gazzaniga has done extensive research on split-brain patients and has done some pioneering work in revealing the defecits acquired by people who have the two hemispheres of their brain disconnected from each other. It is difficult to tell there is any defecit because each half of the brain is consistent with itself an handles different sensorymotor tasks. The split becomes apparent when one half of the brain says it believes in God and the other half says it doesn't. When the researcher says "Draw whatever you like" the left and right hands draw different objects. Its as if the brain which normally facilitates one personality and one set of beliefs, is not split into two personalities with two different sets of beliefs and preferences. Otherwise there doesn't appear to be any side-effects of splitting the brain in half down the corpus callosum.
Even less is known about the effects of pharmaceutical drugs, especially drugs that target receptors in the brain. The brain is poorly understood, but we know that seratonin is implicated all over the brain and especially regarding mood regulation. We know that the brain habituates, the whole body habituates at a quick pace. I just bought some Senekot-S last night to help with bowel function and the label clearly warns of habituation "Prolonged use may cause dependence on Senekot-S for bowel movements." They are only saying this because they know and have demonstrated with multiple clinical trials that people become dependent on the drug. If they didn't know that with such rigor, they couldn't say it. Just as they never used to say that having your brain cut in half would also split your personality in half, that wasn't demonstrated. Lack of awareness of a defecit is called anosagnosia and it is pretty common with brain injury.
Anyway, cognitive behavior therapy is poor as well, there is a reason people spend their whole lives performing dull rites to a nebulous God they can neither prove nor have adequate faith in, the reason is; they don't want to get better, they don't want to repent or be healed. The same is true of depression a lot of times, people are depressed because they think they ought to have something and they are not having it, or they ought to be something and they are not being it. I've known dozens of people on SSRIs who eventually drop whatever is causing them to be depressed and then they have to deal with SSRI discontinuation syndrome. You may think it is "well monitored" but it really isn't, just tell your doctor you are particularly depressed and he or she will authorize extra dosage. Their primary concern is making patients stable, not working through their deep psychological problems. The latter requires the involvement of the patients will to self-reflection, the former just requires consumption which is pretty much par for popular treatment methods.
A similar thinking factors into neuropharmacology, that there is some genetic cause for brain abnormalities that must be corrected by pharaceuticals. They don't ask whether or not the psychological issues are existential and recommend seeing a priest or monk. They may not know the difference, it is a joke that researchers speak of a "Normal brain" as if there was a kind of brain that everyone had except the abnormals. This is ridiculously near-sighted and ego-centric. Some "autistics" have become wise to this and jokingly refer to themselves as "Neuro-Atypicals" and reject the term "Autistic".
There is no need to hark back to the days of Aristotle, or to quote Huxley, who was no authority on neuroscience. By Freeman’s time, cognitive psychology was in the process of overtaking radical behaviourism as the “in vogue” psychological approach. There was plenty of evidence at the time that damage to different areas of the brain would cause serious dysfunction as exhibited by famous lesion case studies such as Phineas Gage and patient Tan. The debate over the existence of specialisation of specific brain structures had been gaining momentum for about 100 years prior to when Freeman was operating at his peak, and the consensus at the time was tipping in favour of this view.
You seem again to be referring to doctors rather than psychiatrists/psychologists. Of course a doctor isn’t going to work through a patient’s deep psychological problems as they are unqualified to do so. They should be making referrals for such things. The failings of doctors to provide referrals for appropriate intervention and to monitor dosage are not the failing of SSRIs, but the failure of the medical establishment due to the inappropriate implementation of SSRIs. Of course any drug that is inappropriately prescribed and used can cause harm, but that is not to say that the drug doesn’t work when prescribed and used appropriately. I know one must consider prescriptive drugs in a real life context (effectiveness) in addition to how they work in empirical clinical settings (efficacy), but the way that SSRIs are implemented can be improved upon. Obviously living on opposite sides of the world, our respective health systems will differ in their implementation of SSRIs, so I am speaking generally here.
It is primarily the implimentation I take issue with. If the system is out of balance and SSRIs are needed to keep it from going completely haywire, fine, but that is a temporary solution.
Nevertheless, I know kids that are taking Resperidone every day for "ADHD", and according to my girlfriends Compendium of Pharmaceuticals, it shouldn't even be administered to children. It's definitely not addressing the problem.
By Freeman's time there may have been BAs or other specialization theories like the Triune Brain Model, but the point I was trying to make was that there was little concept of neuroplasticity. There are rudiments of such a hypothesis in the writings of Freud, but it wasn't made explicit until Hebb's work "The Organization of Behavior" in 1949, and even then it was swept under the rug until about four decades had passed. Freeman was doing his dirty work beginning in 1936.
They would remove, or separate (as you say) parts of the brain so that those "dysfunctional" parts would be effectively destroyed. Because as cogs in a machine, when it is broken, they yank it out. The distinction between separating it and pulling it out is probably semantic, I don't see any functional difference. But you are right, they would stick the ice-pick through the orbit above the eye and do a circular motion that would separate the brain.
Phinease Gage, great story, I have a video on my youtube channel that is about 10 minutes long and describes the incident, it has been used by professors all over the world to teach Psychology 101. But my voice is incredibly monotone and the students wind up on my youtube channel complaining about having to sit through the video in class listening to my boring, dull voice. No good deed goes unpunished, they say.
They didn't think the brain could adjust, they thought it was like a car engine, it contains well-defined parts that once broken are no longer useful. Neuroplasticity meant that even after a brain region became damaged, it had the potential to regain function through Cognitive Behavior Therapy or Constraint-Induced Therapy. But up until the 1980s the prevailing belief was in the removal of faulty mechanisms.
I spoke to my mother last night, a rather dismal conversation as my brother has been diagnosed with a rare autoimmune disease known as vasculitis, that has the potential to require amputation. Our conversation seemed to revolve around illnesses and I had the opportunity to ask her about her experiences with SSRIs. She wasn't familiar with the term, but she was familiar with Prozac.
As a young mother of three, one of which she almost lost in a near-fatal motorvehicle accident (me), and a cheating husband, she found herself quite depressed and upon seeking medical treatment, found herself taking Prozac. It made her feel suicidal and unable to function at even normal levels, but her physicians refused to discontinue administering the drug to her. She insisted on quiting with or without their help and they warned her "You will not be able to go off Prozac without medical care." She said "I know it is messing with my head, making me want to do things." and she quit cold-turkey. I remember the way she was, Prozac wasn't the only drug she was taking, she was taking drugs to counter-act other drugs and her whole life was a depressive mess. She became bipolar while taking prescription drugs, and said she felt like a Guinea Pig much of the time. I remember the amount she used to cry and contemplate suicide, it was very unsettling for her children. To speak to her now, she is nothing like she was, I don't have to worry about saying the wrong thing or upsetting her, she is incredibly strong, way stronger than she was. When she talks about recovering from depression, the things she mentions are not drugs, not therapy and not even family and friends, the things she talks about is her own psyche, how she dropped anxieties and false beliefs, matured and "woke up" to reality.
A) All suffering is the result of ignorance.
B) Ignorance is the result of ignoring truth.
C) Truth is ignored because it is harmful to one's sense of self-worth.
D) Self-worth is clung to because we fear our own mortality.
These four principals, and maybe there is more, are a constant reinforcement of my psychological well-being. Whenever I feel suffering in the form of depression, anxiety or what-not, I look to my own mortality, try to see in what ways my suffering is bound-up in clinging to existence and self-worth. Pretty soon, I find the answers I'm looking for and I'm lifted out of the abyss. Drugs will never help with this, they can only provide a temporary relief with the consequence of becoming dependent and more depressed. The mind seeks a balance, drugs may aim to rebalance a mind gone haywire, but they are generally global effects that throw the mind into greater disequilibrium.
Regarding your talk of thinking of your mortality, perhaps you would be interested in terror management theory:
http://en.m.wikipedia.org/wiki/Terror_management_theory
It has implications in the research of religious beliefs, tradition, and interestingly, disgust.
That looks interesting, somewhat reminds me of Erich Fromm's work (See: The Anatomy of Human Destructiveness). I've heard of Becker but not studies his work, I'll have a closer look at this soon. Thanks.