Butchery

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.

… for crimes against humanity – oh wait, no, I meant, Nobel Prize for Medicine

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

Next: Passion

 

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7 thoughts on “Butchery

  1. Are you doing more on science/medical ethics. Maybe the insulin shock/electroshock therapy practice. IIRC that was developed without any theory as to the physiological understanding of how inducing comas or seizures leads to improved mental functioning. Other than the brain saying “holy crap, I gotta get myself together and stop whatever the hell is putting me into comas!”

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    • It’s a matter of what insight I want to present. Saying, “Geez, lobotomy [or fill in the blank] was completely unjustified, but once it was policy, was assumed justified,” isn’t itself my point. That is well-known, widely discussed, and often dramatized or in the case of Dully, testified. Similar historical events are listed at multiple sites and are easily found.

      My point is to show how there is no popular – meaning, of the populace – mechanism to address these issues. Particularly when the foulness of the practice does serve a need for certain individuals who have power over others, at the expense of those others. Instead, what passes for public indignation regarding a particular medical or technological policy is a matter of gross manipulation and echo-chamber identity politics. The most powerful political force we know, mass public action, is entirely incapable of addressing the very real problem I defined – when technology isn’t actually science.

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  2. On the general point: Can we not have public indignation/involvement without gross manipulation and echo-chamber identity politics? I mean, experience would indicate it’s super-hard to do so, but doesn’t that offer a possible step back from “entirely incapable”?

    I confess that general horror at the practice of lobotomy, combined with personal horror at the anguish of the chronically mentally ill and the loved ones trying to help them, make it hard for me to look at this as an exemplar for a broader point. Any other examples of tech that isn’t science?

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    • I’ll add – also horrifying is the idea that the validation of “it’s science!” provides hucksters, profiteers and megalomaniacs a tool to exploit the exhausted, the desperate, and the un- or mis-informed. There’s probably no escaping that, no matter the example. Meaning yes, some kind of potentially-effective social policy intervention would be really, really great to have!

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    • Grim and cynical response #1: the “loved ones” apparently wanted docile and/or absent dependents as opposed to difficult/unpredictable dependents. I am not seeing that their loving anguish and desire for the dependents to have a better life are apparent as meaningful variables, at least in a way that wasn’t easily co-opted into abuse.

      Grim and cynical response #2: the practice never fell under public pressure due to outright horror or to medical practitioners saying “gee this sucks,” but was merely replaced by pharmaceutical methods. Those methods present their own profile of benefits/drawbacks, but what matters in terms of practice is that they’re cheaper and easier.

      Public indignation/involvement without gross manipulation and echo-chamber … I do think it’s possible. I also think that social mechanisms which prevent it are far more developed and are far more in current use than any social mechanisms to encourage and refine it. I’m doubtful that latter mechanisms are known in the context of modern life.

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      • Disclosure: I am currently one of the few supports for a friend who has a mentally ill family member. The options are awful, the consequences of both doing something and NOT doing something are potentially catastrophic, and I can’t help but feel I KNOW the anguish and desire to help can be meaningful variables. Which I think makes it even more heinous when providers/caretakers/family are told “science says this will be good for the patient” when no such thing is true.

        I’m entirely with cheaper/easier alternatives as key to why lobotomies stopped (and why medication is the current go-to “treatment”), and mostly mention horror as MINE. Personal horror as detracting from my ability to be analytical (though of course I try).

        I’m with you on the last paragraph too – just clinging tightly to the idea that it’s possible, no matter how unfamiliar the mechanisms to support it might be currently.

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  3. “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 most powerful political force we know, mass public action, is entirely incapable of addressing the very real problem I defined – when technology isn’t actually science.”

    That’s pretty much the definition of mass public action, though, right? You don’t get a mass public movement regarding an entirely abstract procedural questions (“We demand better vetting for economics fellowships!”), nor do you get them for a deeply disturbing technique that only affects a tiny percentage of the population. Mass public action addresses concrete, large-scale social injustices, whether actual or perceived.

    Absent those kinds of issues, the most potent force in American politics is a bunch of gatekeeper billionaires who determine the scope of legislative–that is, meaningful–debate. (Maybe it’s different in other countries; I’d like to think so.) I suspect the Koch brothers give zero fucks about evolution, and so it’s okay if the Republican candidates denounce it to snag some votes from the religious types,. But if Fox News decided tomorrow that everyone needed to be doctrinaire Darwinists, the pivot would be instantaneous and no one would comment on it.

    In other words: if the scientists can’t stop bad science masquerading as good stuff, and the public can’t be mobilized, your only bet is to luck into a phenomenally rich person who has a personal stake in the issue. Which seems unlikely, but isn’t completely impossible.

    (There’s a side point here about how the U.S. information ecology, at least on political matters, has pretty much completely bifurcated, and each side likely suffers from severe confirmation bias. Obviously this fucks up the populace’s ability to *gather* data, much less process it, and we have never been particularly hot at either.)

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