Lobotomies
Lobotomies are forms of psychosurgery which are neurosurgical treatment of mental diseases or psychiatric diseases. It has a history that dates back to antiquity and it involves all the clinical processes that are involved in the neurosciences (Acharya, 2004).
Introduction
Before looking into the intricacies of lobotomy, it is important to understand that the main aim of this procedure is to cure mental disorders and thus it is important to try and understand what mental disorders are all about. The nature of mental disorder is such that they are so dynamic and thus their management is no walk in the park. A dynamic problem requires an integrated approach and so has the approach to mental disorders management been. The exact cause of mental disorder cannot be easily ascertained as it depends on a number of issues and may also be as a result of a complex interplay of a number of factors (Meleis, 2006). The evaluation of the patient in such a case is therefore difficult and thus an integrated approach which is people and time intensive becomes necessary in carrying out the evaluation. Evaluation is not only required at the diagnosis stage, since continuous evaluation is required to asses any development that have been made with regards to the patients health (Meleis, 2006). An integrated approach to medical delivery employs the use of biological, psychological, socio-cultural, environmental and pharmacological approaches in delivery of medical services to a patient (Meleis, 2006). Health being the total well being of an individual, the integrated approach is seen as the best approach in ensuring the provision of better healthcare (Meleis, 2006). In a mental healthcare system the nurse is charged with the following responsibilities Biological There role of the doctors has for a long time been considered as the evaluation of the patient (Meleis, 2006). In an integrated approach the system is such that the role of the nurse in evaluation of the patient is on the increase as they play an important role in the evaluation of the patients.
A lobotomy is a surgical procedure that is carried on the brain of a patient, and it is thus psychosurgery since it involves neurology, and it is also known as leucotomy or even leucotomy. The procedure involves the cutting off of the connections that run all the way to the prefrontal cortex to the anterior parts of the brain especially on the frontal lobes (El-Hai, 2004). The procedure has always been controversial ever since it was introduced in the year 1935, despite that fact that it has been the main form of prescribed treatment for more than two decades and even some times being prescribed occasionally for some other conditions (El-Hai, 2004). This has been done despite the fact that there have been claims and even evidence that the procedure is known to produce frequent and in most cases very serious side effects. The time that its usage was most prominent was between the years 1940 and 1950 and it was also during this time that modern antipsychotic drugs were introduced. By the end of the year 1951, more than 20,000 lobotomies had been performed with America (Acharya, 2004).
Lobotomy was just one of a huge number of series of therapies that were developed in Europe within the first century (El-Hai, 2004). This presented a form of a break from the tradition of relegating patients with mental disorders to asylums, which was the norm considering that most of the forms of mental illness were considered to be hereditary disorders and thus they were regarded as unlikely to be mended by treatment. Most of the lobotomies were performed with America with an approximate number of 40,000 patients having been lobotomized (Acharya, 2004).
Despite these changes, the protocols and mechanisms used in handing the mental situation have been rather constant. In many cases the cause of mental problems which include personality, development and psychotic disorders can never be pointed to one particular factor. Many theories that have been proposed to explain the nature of mental disorders One of the theories that is predominant in the Middle East and Africa explains psychiatric disorders as a mixture of divine and magical considerations, some even belief that it is a result of witch hunt (Meleis, 2006). Industrialization and population growth are the two main factors that have been cited as being behind the increase in number of madhouses. The twentieth century saw the recognition of psychiatric disorders as a medical problem when World Health Organization in its definition of health included mental disorders as a medical condition that is considered a disease. American Psychologists Association (APA) and World Health Organization (WHO) have come out as two organizations that are very instrumental in dealing with the management of psychiatrists problems (Meleis, 2006). The two bodies have even merged their policies so as to come up with a more robust document that discusses all aspects of the management of psychiatric disorders. State of fear and anxiety are the main cause of psychiatric problems and include phobias and anxiety disorders. Furthermore, abnormal mood state referred to as mania are also very common though may people fail to recognize them as psychiatric problems (Acharya, 2004).
Rosemary Kennedy
Rosemary Kennedy who was born on September 13th 1918 was the first daughter to Rose Fitzgerald Kennedy and Joseph Patrick Kennedy, Sr. and also their third child. She was born just a year after her brother who later became the United States president President John F. Kennedy was born. At the age of 23, a lobotomy was performed on Rosemary Kennedy and it left her incapacitated permanently (Kotowicz, 2005).
In her early childhood years, she was described as being a very shy child and Intelligence Quotient tests indicated that she had a slight case of mental retardation, though this notion has been a question which has been put under much controversy (Kotowicz, 2005). At the age of 23, Rosemarys father was informed of a new procedure that the doctors thought was capable of assisting in calming her mood swings. This procedure was known as lobotomy and this was the year 1941. At that particular time, the number of lobotomies that had already been performed was relatively few (Kotowicz, 2005).
The result that was hoped for did not occur and instead, Rosemary was left with a condition of incontinence in the urinary functions and a mentality that is infantile. She could be found staring at walls blankly for hours and her speech was unintelligible and incoherent. This devastated Rose even more and it was termed as a tragedy in the Kennedy family (Kotowicz, 2005).
It was later in the year 1949 that Rosemary was taken to the St. Colettas Institute for Backward Children (Kotowicz, 2005). The severity of her condition caused her to be further detached from her family, though one her sisters managed to be able to visit her on a regular basis. Her condition was declared publicly as being mentally handicapped, with only a few doctors knowing the truth behind her condition (Acharya, 2004).
It has been argued by various researchers that Rosemary was probably the first person in America to receive this procedure prefrontal lobotomy. Watts was of the opinion that Rosemary was not mentally retarded, but was in fact depressed and talked in a manner that made her voice shaky and sounded agitated, and this tended to confuse her family into thinking that she was mentally retarded (Kotowicz, 2005). The procedure was carried out on Rosemary despite that fact that the procedure was meant to be carried out in cases of psychiatric illness only. During the days of Dr. Watts, performing a prefrontal lobotomy on a patient even if the patient was mentally retarded was considered to be a case of medical malpractice (Acharya, 2004).
Mental disorders and drugs that act as lobotomies
One of the most common modes of management is the prescription of mood stabilizers and ensuring the individuals are less exposed to situations that may catalyze high moods. Schizophrenia is a mental disorder that is characterized by an abnormal perception of reality. It is commonly manifested in hallucinations, paranoia and disillusion (Meleis, 2006). Poor speech and disorganized thinking also characterize the condition and it normally kicks in with the beginning of adulthood (Meleis, 2006).
Diagnosis like in most psychiatric cases is based on individual experiences and third party observations (Meleis, 2006). Genetics, environment, social issues and psychological conditions have been cited as the probable causes of the condition. A major problem in the diagnosis of the condition is that no one sign can be keyed on as being deterministic of schizophrenia and therefore diagnosis is quite tiresome. The method used in diagnosis is largely reliant on the presence, duration and degree of certain symptoms and signs. The evaluation of individuals suspected to be suffering from the condition involves a general medical examination and a thorough neurological examination (Meleis, 2006). The tests are rarely repeated except in cases where there is evidence of adverse effects of antipsychotic drugs. The cure for the diseases remains highly controversial, although some have suggested the use of remission as an approach to dealing with the problem (Meleis, 2006). The general trend in the treatment and management of the condition is the minimization of the rate of occurrence and degree of the symptoms. In severe conditions, the patient may be hospitalized for easier management of the symptoms though the treatment often takes on the outpatient approach. The patients are administered with antipsychotic medication and which help in the management of the symptoms. Therapy, especially electroconvulsive therapy, is also used with the drugs in handling the mental conditions (Meleis, 2006).
Dementia is the decline in cognitive abilities due to progressive brain damage for reasons beyond the normal aging process (Meleis, 2006). It can occur at any stage of a human life though it is more common in the elderly people. The condition has no specific set of symptoms and it affects the normal brain activities and may thus lead to loss of memory, attention, verbal activity and comprehension (Meleis, 2006). The disease is characterized by the loss of higher brain functions at its onset. Its symptoms are classified as either reversible or irreversible depending on the nature of its manifestation. The diagnosis of the condition requires specialized practitioners for it is complex, though there are some short tests that can be conducted effectively to determine if an individual suffers from reduced brain activity. The laboratory tests are aimed at determination of the absence of preventable cause and involve the determination of vitamin levels. Chronic use of substance has also been identified as a cause. Development in technology has made it possible for one to come up with images of the brain and help in identification of physical damage though such equipments do not in any way help in discovering the metabolic changes associated with the disease (Meleis, 2006). The disease manifest itself in several forms some treatable and other whose cure is yet to be developed. One management strategy employed in handling the condition is administration of drugs that help in slowing down the progression of the disease (Meleis, 2006). Therapy is widely used in managing the psychological torture that the patients undergo due to the inability to perform basic human activities.
Depression or unipolar depression is a mental condition whereby the patient is characterized by unusually low mood levels and a loss of interest in daily activities. The diagnosis is made when one has suffered a number of such depressive spells (Meleis, 2006). A majority of the reported cases have their onset at thirties and peak in the fifties (Meleis, 2006). The diagnosis is based on self reporting and observations made by third parties. The official test for this condition is non-existent and labs have resorted to testing for physical conditions that may cause similar symptoms (Meleis, 2006). The causative factors of the condition are classified as either biological or psychological and treatment include the use of medicine, therapy or a combination of both (Meleis, 2006). Psychopharmacological Principles Psychopharmacology is the study of various aspects that relate to drug induced behavior change (Meleis, 2006). The changes that are as a result of the administration of certain drugs could affect thinking, sensation and behavior (Meleis, 2006). The management of people under the influence of psychoactive drugs is a key area of psychopharmacology and plays an important part in the determination of the success of any approach to medical health. Though drugs are administered for a specific reason, their effects are never specific. Moreover, the effect a drug will have on an individual is so dynamic and cannot be predicted with ease. Therefore, any good health management system should also focus on the implementation of psychopharmacological principles of critical thinking, patient education skills and caring in a clinical setting to help in the management of drug induced behavior.
Critical thinking must be developed by all mental health care practitioners if they are to actively help in shaping up the area of mental health (Meleis, 2006). Mental processes, especially analysis and evaluation, are important in dealing with the rather complex nature of mental illness. The unpredictability of the patients is a major concern in management of their health problems thus a health system should provide avenues for the nurses to develop skills and abilities based on professional knowledge and experience that help in identification of behavior patterns and thus determination of what is expected of the patient (Meleis, 2006).
Antipsychotic drugs are some of the drugs that are in use that act in the same manner that lobotomies act, and they are used in the management of psychosis, including hallucinations and delusions (Stone, 2001). The first of this drugs was clozapine which was discovered somewhere in the year 1950s and was put into use clinically in the years 1970s. They also tend to block the receptors that are present in the dopamine pathways in the brain, just as lobotomy involves the cutting off of the connectors that serve the same purpose (Stone, 2001). There are numerous side effects that are associated with these drugs notably weight gain and the lowering of the life expectancy of the patients who tend to use it (Stone, 2001). Thus it is evident that in the present day, lobotomy is still in use, it is just that it is not surgical, as there are drugs that serve the same purpose that the surgical procedure does.
Conclusion
This shows that mental health has always been treated seriously and one of the main methods that have been used to treat mental disorders is the administration of drugs that aid in relieving the psychological discomfort and torture that the patients have been experiencing. But is this so There have been questions over the procedures that surgical psychology and clinical psychologists have been using, and if they uphold the ethical morals. Some of these methods have been viewed to be barbaric such as the lobotomies that are being discussed in this paper. There have also been drugs that have been prescribed to patients that have the same effect on the patients that these lobotomies would have on them, such as making them to be incoherent and damaging their brains even further leaving them in an infantile state.
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