3 - Between the Ego and the Ice Pick

Summary

Psychosurgery and psychoanalysis enjoyed a surprisingly close relationship in the 1950s. While it might seem inevitable that two radically different approaches would hold distinct and opposing views of psychosurgery, I argue that this was not the case. Psychodynamically oriented psychiatrists and psychosurgeons crafted a common, eclectic discourse on psychosurgery containing elements from both theories. This discourse had far-reaching effects on therapeutic practice. Both psychosurgeons and psychodynamically oriented psychiatrists and psychoanalysts endorsed various forms of psychotherapy before and after psychosurgery. For certain psychoanalysts, psychosurgery was a means by which to obtain more effective analyses. Many patients also viewed psychosurgery and psychotherapy as complementary treatments with shared goals.

Although psychosurgery was a radical treatment involving the destruction of organically healthy brain tissue in order to ameliorate mental illness, very little opposition was voiced by psychodynamic or psychoanalytically oriented psychiatrists. No professional group was formed to actively protest the use of psychosurgery, and very few reviews critical of the concept of psychosurgery were published. Even the most scathing critiques of lobotomy usually conceded that there were certain situations in which the procedure might be justified.

The 1948 report on psychosurgery published by the Group for the Advancement of Psychiatry (GAP), led by William Menninger, and consisting of psychodynamic psychiatrists, has been cited by historians of psychosurgery, including Jack Pressman, as an example of institutionalized objection to lobotomy. While the report claims that psychosurgery “represents a mechanistic attitude toward psychiatry which is a throwback to our pre-psychodynamic days,” it adds that this “in itself would not be of great concern if it were successful and did not harm the patient.”