The unkind cut

There can be few Nobel Prize winners whose award the Karolinska Institute feels a need to defend. But the invention of Portuguese neurologist Egas Moniz, now generally known as the lobotomy, has fallen catastrophically from grace. And today its inventor is largely forgotten, overshadowed by the American neurosurgeon Walter Freeman - the ‘freak of an evangelist’ who zealously promoted its use during the McCarthy period.

Thanks to a Wellcome Trust history of medicine fellowship Dr Zbigniew Kotowicz is aiming to find out more about the forgotten Nobellist, who was awarded a Nobel Prize in 1949 ‘for his discovery of the therapeutic value of leucotomy [lobotomy] in certain psychoses’. Dr Kotowicz ‘stumbled across Moniz by accident’. Intrigued to learn what concept of mind could have led to such an operation, he was surprised to find practically nothing, certainly not in English-language literature.

"There are some very fine monographs on developments in the USA, where the technique gained its hold on the public mind. But in a way the USA inherited something already tried and tested in Europe. And studying psychosurgery without Moniz is a bit like studying psychoanalysis without bothering to find out what Freud was up to. Being a deeply rooted European, I wanted to know the European story."

Dr Kotowicz may have found his subject by accident, but several strands in his own history make his selection seem a natural one. Born of émigré Polish parents, he returned with them to Poland in 1959, after the fall of Stalin. There he studied clinical psychology and worked for some years in psychiatric hospitals. Then, attracted like many of his generation to the ideas of Laing and the antipsychiatrists (who contended that ‘mental illnesses’ were simply variations of normal behaviour), he came to London to train in psychotherapy. However, while psychoanalysis grew in popularity, he ‘retained a fondness for madness’. At the same time, a personal love of philosophy took him along a six-year parallel track to a PhD on the work of Gaston Bachelard, the leading French philosopher of science of his generation.

While his experiences as a clinical psychologist will help Dr Kotowicz to understand the ‘frustrations and helplessness of the practitioner’ and thus to sympathise with the conditions under which psychosurgery began, the ‘forensic frame of mind’ of a philosopher will, he believes, be invaluable in exploring Moniz’s developing ideas. And his deep love and knowledge of Portugal (he has published a book on Portugal’s great modernist poet Fernando Pessoa) gives him an understanding of the sociopolitical milieu in which Moniz worked.

His studies will take Dr Kotowicz from his base at Goldsmith’s College in London to archives in Lisbon, France and Italy. He will focus on the archives of Egas Moniz in Portugal and on little known material in Rome and Paris, which documents early European responses to Moniz’s invention. "I’ve also been promised access to the papers of his closest assistant, the neurosurgeon Pedro Almeida Lima, the only one to whom he confided his thinking. It was he who performed the lobotomies: Moniz wasn’t a trained surgeon, and anyway his hands were deformed by gout."

One of the outstanding neurologists of his time, Moniz had already won international fame for his development of the cranial angiogram. "He also practised as a psychiatrist and was drawn, like many at that time, to Freud. Yet he finds a very ‘biological’ solution to psychosis. Influenced by the emerging understanding of the brain’s nervous structure, he suggested that synapses are the organic foundation of thought, and that morbid ideas are the result of ‘abnormally repetitive and overactive circuits’. Destruction of the morbid thoughts could, he reasoned, be achieved by surgical intervention."

"It might turn out that his thinking is not very sophisticated. But the curious thing was that that he got it ‘right’, in the sense that no one appreciably improved on his results. Within a year his technique was tried in half a dozen countries, and he ended up being awarded the Nobel Prize."

Psychosurgery is rarely performed today, but research continues and "there remain pertinent questions to be asked," Dr Kotowicz believes. "Neurosurgery treats a diagnosed lesion or dysfunction in the brain: with psychosurgery no such diagnosis is possible. Our geography of the mind remains tentative and psychosurgery is closer to the ‘conceptual’. Obviously there have been huge leaps forward in technology - no one would now dream of opening a brain and poking in a knife as they did in the Forties, but it remains to be seen whether the thinking behind it has actually developed. I can only establish that once I have tried to reconstruct Moniz’s scientific mind."

See also

• Writing the field hospital manual: Article on a History of Medicine Research Fellowship project on military archives

External links

• Antonio Caetano de Abreu Freire Egas Moniz, the 1949 Nobel Laureate in Medicine: Details of the award on the Nobel Prize Internet Archive