Review
Pressman, Jack D. Last resort: Psychosurgery and the Limits of Medicine. New York: Cambridge University Press, 1998.
Reviewed by: Hans Pols, Harvard University
When most of us are thinking about lobotomy, images of One Flew Over the Cuckoo's Nest come to mind. In popular histories of mental hospitals, tales of dangerous physicians administering cruel punishments disguised as medical treatment abound. Psychiatrists, after all, have advocated pulling patients' teeth, hydrotherapy, forced sterilization, malaria fever therapy, metrazol shock therapy, insulin coma therapy, and electroshock therapy as exciting new breakthroughs in the treatment of the mentally ill. Lobotomy is generally considered to be the proverbial zenith to this series of inhumane, cruel, and almost murderous treatment methods. These impressions, however, are sorely mistaken, Jack Pressman claims. In the late 1940s, lobotomy was considered a miracle cure improving the lives of scores of chronic mental patients. The Portuguese neurologist who introduced lobotomy, Egas Moniz, received the 1949 Nobel prize in physiology and medicine. Walter Freeman, the most important protagonist of the procedure within the United States, annually received hundreds of enthusiastic letters from patients who had undergone the operation. In the 1940s and early 1950s, lobotomy was (almost) universally praised for restoring chronically ill schizophrenic patients to a happy and fulfilling life.
Instead of presenting a moral tale of crime, punishment, and redemption, Pressman asks how it was possible that a medical procedure highly praised at one point in time could fall into disrepute a decade or two later. In his study on the history of psychosurgery, Pressman not only relays the fate of this particular medical procedure, but also raises important issues on the nature of medical care and how to conduct research in the history of medicine. His book addresses physicians, psychiatrists, and historians; it contains important lessons for all of them.
Pressman provides an exhaustive and definitive account of the rise and fall of psychosurgery based on the professional literature at the time, correspondence between physicians, and patient records. He convincingly places lobotomy in the context of mental hospital care as it had been provided from the 1880s on, when mental hospitals increasingly filled up with incurable chronic patients who generally left the hospital only in coffins. Not only did most of these patients fail to improve; they were also very difficult to handle. Any measure that promised to change this desperate situation could expect to be received favorably. A long tradition of somatic treatments, which were all hailed as definitive breakthroughs when they were introduced, paved the way for the introduction of psychosurgery. Somatic treatments aspire to cure diseased minds through interventions aimed at patients' bodies. In this tradition, troublesome and recalcitrant behavior was interpreted as symptomatic of mental illness; the success of therapy was measured by the degree patients became more agreeable and manageable within the institution. The rather lethargic state of mind of patients after undergoing psychosurgery could therefore be interpreted as therapeutic and desirable. Pressman also sketches how the psychiatric profession as the medical speciality of lowest regard was desperate to improve its social and professional image. Psychosurgery linked mental illness to pathology in the brain, thereby presenting a welcome medical image to the discipline. Several well-funded research centers attempted to find links between brain and behavior; lobotomy provided persuasive evidence that this link was crucial. These are only a few of the reasons Pressman provides to explain the rise and eventual decline of psychosurgery in American psychiatry.
Unfortunately, Jack Pressman did not live to see his work appear in print. He unexpectedly died, at the young age of 40, on June 23rd, 1997, leaving behind his wife and two children. His death is a tremendous loss to historians of medicine and psychiatry. To commemorate his life and work, a symposium was organized by the Department of History & Sociology of Science at the University of Pennsylvania, where Jack received his PhD, on November 14, 1997, followed by a memorial service. Jack's colleague at the University of California at San Francisco, Guenther Risse, organized a panel around the book during the Annual Meeting of the American Association for the History of Medicine in Toronto in May, 1998. Henrika Kuklick has organized a panel at the meeting of the History of Science Society, which met at Kansas City, MO, US.