Technology or as I like to call it, gadgetry, is one thing; scientific thinking is another. The fact that scientific thinking produces technology like combustion produces smoke can distract us from the other fact that gadgetry with no merit can be produced – and be falsely associated with scientific thinking. Another way to put it is that the word “scientific” may refer to a mode of thought and dialogue, or it may refer to our culture’s professional imagery, status (either wholly establishment or wholly marginal), and trappings, usually involving devices and “rays.”
Don’t mistake me for a tech-is-progress advocate. My views on the matter are jaundiced to say the least, particularly concerning policy about technology. But blog posts must be focused, and instead of a survey-style perspective on all science, pseudoscience, politics, and pseudopolitics, I’m drilling down to one phenomenon: technology pretending to science.
The key to the evil thereof lies in this: professional institutional practice is a form of power. Once established as profitable and anointed through internal status mechanisms, medical practices (for instance) are especially prone to institutional resistance against review and reform, as well as imposing inordinate effects on policy and law.
You know what a prefrontal lobotomy is, right? Or maybe you don’t. The original technique, called leucotomy, starts with drilling a hole in each temple, inserting a wire knife into one and then the other, and each time going swipe swipe up-and-down to sever the connection between your cerebral cortex from your thalamus (sometimes they used alcohol injections to the same effect). This connection, called the corona radiata, is roughly how your neocortex receives processed sensory information. The idea is to reduce the input to the integrative, associative part of the brain, or rather, in the same way a sledgehammer’s impact reduces your attention to what’s going on around you.
Leucotomies were first attempted in the 1880s by the German physician Gottlieb Burkhardt, who ceased his investigations after a cold critical reception in 1890. They were rehabilitated in the 1930s by the Portuguese politician and medical researcher Egas Moniz, who was impressed by a single experiment on chimpanzees despite the evident variation in results, and the equally evident point that the single cranky chimp rendered docile was also reduced to complete incompetence in the tests she was supposed to be doing.
Moniz’s justification for using the technique on human patients fails even the most basic scientific standards, lacking any lower threshold for assessing negative results, or any patient followup past eleven days – however, he received the Nobel Prize for Medicine for it in 1949. Let me say that again: there was and never has been a historical “lobotomy works” clinical study on record. They just … did it.
The – I hesitate call it refined – version called lobotomy involves inserting an ice pick, yes, literally, into your eye socket above your eyeball, punching it toward the top of your head, and then going swipe swipe side-to-side, then do it again through the other eyesocket. The preferred method of anesthesia in this case was to run electricity through your brain first, inducing an epileptic seizure. The advantage, and again I use that word loosely, is that the procedure may be done as a one-stop visit to the doctor’s office.
This was called psychosurgery, a term which bears a closer look, because it implies precision, therapy (“cure”), and reliable results, none of which were the case. The technique is simply butchery, and I say that with authority: it was developed without parameters, without experimental trials, without controls, without analysis, and without any but the crudest theoretical justification beyond “it blocks the emotions.” Subjects display a wide range of results, but at the least, a person becomes less able to initiate behaviors, to put intent into motion, and to construct complex behaviors. At the most, they become wholly incompetent, effectively mentally obliterated.
The procedure was banned in the U.S.S.R. in 1950, but in the U.S., the physician Walter Freeman developed the ice pick method (later inventing a sturdier instrument because the ice picks broke off in patients’ heads, no lie), invented the word “lobotomy,” and successfully marketed the technique to physicians and psychiatrists throughout the U.S., Canada, and Europe. Warning: sickening photo.
From its initial use on patients in the 1930s until its final instances in the 1970s, lobotomy was performed on over 40,000 people in the U.S., 17,000 in the U.K., and 9,300 in Scandinavia, including for conditions such as male homosexuality and unruliness in children. And to put an especially non-illustrious cap on the story, lobotomies were ultimately discontinued not because they effectively ruined people’s brains for no good reason, but because chlorpromazine (Thorazine) effectively outcompeted them in cost and convenience, and only in that context did mounting scientific objections finally matter.
This procedure was a normalized medical practice, blessed with the circular justification that it was done because it was good, and good because it was being done. However, it was in no way – and clearly from the beginning – either medically or scientifically justified through any preliminary research worth the name. What it did provide was docility, which turned out to be a valuable client service, as opposed to a patient’s. If an unmanageable (or apparently, merely inconvenient) relative became docile, then well and good, and if they didn’t, now they could be institutionalized. Apparently this service was in some demand, and marketing the alleged benefits took it the rest of the way, with professional status providing inertia.
This specific combination of unsubstantiated claims and tacit demand is an ever-present risk in medical practice, constituting an outright social menace when not subject to scientific and social critique. The scientific and clinical objections date back to the beginning, but socially, there was no citizen outrage about it – vastly to the contrary; the paying clientele were generally pleased with the results.
Please notice as well that no one railed against lobotomies as an anti-nature abomination. This particular social and collective response never serves as an actual check on professional/institutional misuses of technology. I can’t think of anything more important for public discourse and policy-making than how we use our recent technologies and how we address the appearance of new ones.
The biology isn’t the question; it’s been available for discussion since that term was coined 200 years ago. The question concerns social policy. Democratic politics do not show their best face here. A given topic of study or a proposed technology is typically mined for its electoral value, which means being reduced to a caricature either toward an ideal or toward a fear, then slammed for pro or con into a bin of other issues which might not have anything to do with it. Since the anti-science, sorcery reaction is always available, and serves nicely to cement party bases, issues get parsed and divided across parties and religious identities on the basis of pure electoral strategy, irrespective of the actual capabilities and issues. The whole abomination response serves as a useful distraction to reinforce already-existing dividing lines between voters. Therefore technology – in this case, deeply un-scientific technology – continues to impact the world and people’s lives without the discussion that would actually accomplish anything; instead, they are subject only to profits, propaganda, and privilege.
How about those scientists? Shouldn’t they be the gatekeepers? I am pessimistic there as well. Scientists aren’t a socially or intellectually unified group and certainly are not a politically monolithic one; those who legitimately object to a politically popular, profitable, but scientifically unjustified technology have no enforcement methods. We’re historically profoundly stupid when it comes to policy and lobbying, and we include our share of profiteers and kooks like everyone else.
We face a public policy problem which is hugely important yet we have no mechanisms of discussion and policy-making which are worth the paper they are printed on. Don’t think lobotomy was reformed due to realizing it was stupid and wrong.
Readings: Elliot S. Valenstein, Great and Desperate Cures; Hernish J. Acharya, “The Rise and Fall of Frontal Leucotomy” in W.A. Whitelaw, The Proceedings of the 13th Annual History of Medicine Days; Howard Dully and Charles Fleming, My Lobotomy