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Science can be .... complicated.
And I don’t mean all the math that’s involved.
Or the jargon.
Or the fact that you can do an experiment
a dozen times and not get the same results

twice.
I’m just saying it can be … dicey.
Like, we’ve told you before about Fritz
Haber, the chemist who developed the technology

that made fertilizer possible, and helped
feed millions of people.

Except he didn’t use his discovery for that.
He used it to invent chemical weapons.
In a similar way, most of the innovations
that make all of modern space flight possible

were developed to make ballistic missiles
for Nazis.

Now, when you think about it, the science
in these cases was totally benign -- neither

good nor bad.
But sometimes, the things people learn from
scientific endeavor can lead them to conclusions,

and applications, that turn out to be just
… well, just wrong.

There are few better examples of this than
the work of Portuguese physician Antonio Egas

Moniz.
Moniz pioneered a surgical procedure that,
to his peers, was remarkably effective at

treating many kinds of mental illness.
It came to be adopted by neuroscientists,
surgeons, and psychiatrists around the world,

and especially in the US.
But it soon proved to be, at its best, irreversibly
destructive, and at its worst, inhumane.

And yet Moniz was awarded the Nobel Prize
in Medicine for it.

It’s quite possibly the most regrettable
Nobel Prize ever awarded.

Because Moniz was given the Prize for developing
the lobotomy.

[Intro]
The story begins with John Fulton, a Yale
neuroscientist, in 1935.

Fulton had spent the past five years cutting
out sections of chimpanzees’ brains and

studying how that affected their behavior.
He was mostly working with the cerebral cortex,
the outer layer of the cerebrum, which is

the largest part of the brain.
It’s also divided into four lobes.
And each lobe is responsible for a different
set of cognitive functions.

The temporal lobe, for example, is located
on the bottom of the brain and is associated

with memory, sound and language.
And the frontal lobe, at the front of the
brain, is the home of our personality.

It’s responsible for our higher reasoning,
our emotions, motor skills, and attention

span, among many other things.
In 1935, scientists like Fulton were just
beginning to understand how each of these

lobes behaved.
But most of their knowledge on the frontal
lobe came from just a few studies, or records

of brain injuries, like the case of a man
named Phineas Gage.

Gage was working on a railroad in 1848 when
an accidental explosion lodged a railroad

spike into his head.
The spike stabbed right through his frontal
lobe.

Amazingly, Gage survived, and his memory was
still in tact, but his personality was…

different.
He became kind of mean and aggressive, because
the part of his frontal lobe that was damaged

-- his orbitofrontal cortex -- was the part
that’s responsible for emotions.

And Fulton found that his results were similar,
when he removed the orbitofrontal cortex from

chimpanzees.
He performed this procedure on two chimps
named Becky and Lucy.

And they quickly began exhibiting inappropriate
behavior - defecating on the floor, throwing

temper tantrums, generally just acting out
of control.

However... when Fulton removed their entire
frontal lobe, they became more docile, relaxed,

calm.
Fulton presented his findings at the second
annual international neurological conference

in London in 1935.
And in attendance was Antonio Egas Moniz.
Now, in some ways, Moniz was a true renaissance
man.

He was a medical professor who served as the
Ambassador to Spain during World War One.

He was a successful legislator who wrote a
series of popular books on human sexuality.

And he was a flamboyant socialite who threw
lavish parties and designed his wife’s evening

gowns.
He was driven, passionate, confident, and
intelligent.

In fact, by the time he had met Fulton in
London, Moniz had already almost won the Nobel

Prize, for developing one of the most important
innovations in neurosurgery at the time.

Back in 1925, he had wanted to figure out
a noninvasive way to diagnose tumors in the

brain.
So he devised a concept called cerebral angiography,
in which a solution of sodium iodide was injected

into the carotid artery, in a patient’s
neck.

The solution would then flow into the brain.
Since sodium iodine can’t be penetrated
by most kinds of electromagnetic radiation,

it rendered blood vessels opaque when viewed
in an x-ray.

And this allowed doctors to find problems
in the brain’s blood vessels, caused by

tumors and other obstructions.
Moniz’s technique was a huge breakthrough
in brain imaging, and it laid the foundation

for methods we still use today to diagnose
conditions like aneurysms.

Moniz was nominated twice for the Nobel Prize,
but was thwarted, some historians say, by

a jealous Nobel chairman.
But when Moniz saw Fulton’s presentation
on his chimp research, he became newly inspired.

Because, in addition to his work on brain-imaging,
Moniz had spent years working with severely

depressed, anxious and schizophrenic patients.
And he had developed a theory -- not based
on any empirical data -- that mental illness

was caused by malfunctioning synapses, or
connections between brain cells, in the frontal

cortex.
He believed it was these bad connections firing
over and over again that led to obsessive

thought patterns that tormented many of his
patients.

However, Moniz had no way of identifying which
individual synapses were supposedly malfunctioning.

So he proposed a procedure, based on Fulton’s
work, to destroy the nerve fibers -- also

known as the white matter -- that connects
the frontal lobe to the thalamus, the structure

deep in the brain that receives and relays
sensory signals.

By severing that connection, Moniz believed
he could cut off the frontal lobe, and its

broken synapses, from the rest of the brain,
rendering it useless.

Four months after the London conference, Moniz
attempted this operation on a human for the

first time.
He didn’t perform it himself, because his
hands were deformed with gout.

Instead, he directed a lab assistant to drill
two holes into the skull of a 60-year-old

former prostitute suffering from psychosis.
The assistant then destroyed the nerve fibers
leading from the frontal lobe with two injections

of pure alcohol.
And the operation worked, in the sense that
the woman stopped displaying the symptoms

of psychosis.
But it depersonalized her.
Her disruptive thought processes seemed to
have stopped, but so did all of her emotions.

Essentially, it removed what made her human.
And over time, Moniz performed the operation
on nineteen other patients, eventually refining

the procedure with the use of a leucotome,
a tool resembling an ice pick that allowed

him to experiment with which nerve fibers
to cut.

However, only a complete severing of the nerve
fibers seemed to create the effects he wanted

-- which was for the patients to no longer
display any symptoms of anxiety, depression

or schizophrenia.
He called this technique the prefrontal leucotomy
-- leuco meaning “white matter” in latin,

and “tome” meaning knife -- and he published
these findings in 1937.

Moniz’ work soon caught on in the United
States, where the number of psychiatric hospitals

and patients had doubled since 1903.
Leucotomy’s strongest proponent in America
was neurology professor Walter Freeman, who

was also present at Fulton’s chimp presentation
and had corresponded with Moniz as he performed

his experiments.
Freeman and his assistant, Dr. James Watts,
performed their first leucotomy on a Kansas

housewife who suffered from a mood disorder.
And after the surgery, her mood swings stopped.
Subsequent testing showed that her memories
were intact, as well as her movements and

interactions with people.
However, the doctors also noticed that her
personality was essentially gone.

While no longer impaired by her mood disorder,
she was fundamentally impaired in many other

ways.
She simply... existed.
In the ensuing years, Watts and Freeman standardized
the leucotomy procedure and renamed it the

standard lobotomy.
They published a popular book about it in
1942, and after World War II ended and thousands

of soldiers returned to America with post-traumatic
stress disorder, the number of lobotomies

performed a year grew from 100 to 5,000.
The procedure became a kind of catch-all solution
at American psychiatric hospitals for a multitude

of symptoms including disorientation, insomnia,
anxiety, phobias and hallucinations.

Different versions of the procedure branched
out, as well.

The standard version gave rise to a transorbital
lobotomy, in which a thinner version of the

leucotome was pushed under the eyelid and
into the frontal lobe with a mallet.

The surgeon would then sweep the instrument
around to sever the lobe’s connection with

the thalamus.
Despite the rising popularity of this surgery,
there was soon plenty of criticism.

As early as 1937, doctors had noticed that
lobotomies caused strange, unexplained eye

movements in some patients.
In Chicago, psychologist Mary Francis Robinson
assessed 90 patients who received lobotomies

and discovered that most of them could no
longer concentrate, they appeared unmotivated,

and lost interest in their own lives.
Their creativity was destroyed.
Musicians stopped playing music; writers stopped
writing.

All of these darker symptoms, though, were
overshadowed by what many psychiatrists saw

as more stable outward behavior.
The lobotomy’s vogue reached a peak in 1949,
when Moniz, who was at this point considered

the father of the procedure, was awarded the
Nobel Prize in Medicine for his work.

The lobotomy remained common until 1952, when
a French pharmaceutical company changed psychiatry

forever by introducing chlorpromazine, a medication
that blocked dopamine receptors in the brain.

Dopamine is a neurotransmitter, a chemical
released by nerve cells that lets them communicate

with other nerve cells.
And it’s vital in regulating moods and emotions.
Overactive dopamine systems can cause heightened
emotions and conditions like psychosis, and

the drug worked by blocking dopamine receptors
on brain cells, calming their activity.

With this new drug now available, there was
no need for costly and dangerous surgery,

and soon, the use of lobotomies decreased
rapidly.

Today, the lobotomy is considered dangerous
and archaic, a blunt tool for treating the

subtle intricacies of mental illness.
And the careers of Fulton, Freeman and Moniz
are thought by some to comprise one of the

darkest chapters in medical history.
Because, since their time, attitudes about
mental health, and the ways we take care of

it, have changed a lot.
It’s been 80 years since John Fulton first
described his experiments on chimpanzees.

Today, conditions like depression, anxiety,
and mood and personality disorders are all

treated biomedically with drugs, along with
different kinds of psychotherapy, like cognitive

and behavior therapies.
And instead of focusing on getting rid of
the symptoms of mental illness, psychiatric

treatment today aims to help patients stay
functional and productive.

In the end, much like the minds that gave
us chemical weapons and ballistic missiles,

Antonio Egas Moniz did pursue some important
work whose effects are still being felt and

used today.
It’s just that the work he’s remembered
for most wasn’t his best.

Thanks for joining me for this special SciShow
Infusion, especially to our Subbable subscribers,

who keep these episodes coming.
To learn how you can support us, just go to
subbable.com to learn more.

And don’t forget to go to YouTube.com/scishow
and subscribe!

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The Worst Nobel Prize Ever Awarded

643 Folder Collection
Kana kawai published on November 15, 2017
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