Last Resort: Psychosurgery and the Limits of Medicine

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Overview

During the 1940s and 1950s, tens of thousands of Americans underwent some form of psychosurgery; that is, their brains were operated upon for the putative purpose of treating mental illness. From today's perspective, such medical practices appear foolhardy at best, perhaps even barbaric; most commentators thus have seen in the story of lobotomy an important warning about the kinds of hazards that society will face whenever incompetent or malicious physicians are allowed to overstep the boundaries of valid medical science. Last Resort challenges the previously accepted psychosurgery story and raises new questions about what we should consider its important lessons.

The book contains black-and-white illustrations.

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Editorial Reviews

Doody's Review Service
Reviewer: Robert P. Hudson, BA, MA, MD (University of Kansas School of Medicine)
Description: Psychosurgery was a major innovation in America during the 1940s and 1950s, just as the new specialty of psychiatry was seeking identity and acceptance. Despite its flimsy scientific basis, crude techniques, and many failures, tens of thousand of persons underwent frontal lobotomies, often as office procedures.
Purpose: Historical assessments of the lobotomy story usually dismiss it as a medical catastrophe and a warning of the consequences of science running amuck. The author demonstrates that this depiction is not only simplistic, but wrong-headed. He shows that lobotomy was based on a reasonable application of contemporary science, that it was done in the psychiatric mainstream rather than by a few peripheral zealots, and that many results were perceived as beneficial, particularly in overcrowded state hospitals where lobotomy rendered difficult patients manageable, even at the price of severely altered personalities.
Audience: The history of therapeutics is generally underdeveloped at present, despite its critical importance to the current scene, where the naive acceptance of everything called alternative medicine threatens to return medicine to the chaos of the nineteenth century. Practical matters alone should recommend this book to healers of all stripes at any stage of their careers, to social planners, historians of the life sciences, and the immense population most affected by the vagaries of medical practice, the consumer.
Features: The story of the rise and fall of lobotomy demanded an explication of the forces shaping psychiatry as we know it today. This story is integrated seamlessly and economically into the overriding account of a fledgling specialty seizing on the unscientific destruction of normal brain tissue in quest of scientific legitimacy.
Assessment: Many studies document America's scientific illiteracy. Most of us fail to understand the methods, capabilities, and limitations of science. As a nation we need more books like this one. Reading the remarkable epilogue, "Last Resort," alone would be a good place for anyone to begin.
From the Publisher
"The physician's maxim to 'do no harm' never clashes more with the desperate need to 'do something' then in the case of psychosurgery. Jack Pressman's thorough analysis in Last Resort has deep implications for the decisions that doctors make every day." Dr. Michael Brown, Nobel Laureate, University of Texas Southwestern Medical Center at Dallas

"To cut into a person's brain on rather dubious scientific grounds seems like the ultimate in medical imperialism. But as the late Jack Pressman shows in this impressive but flawed work, the story is much more complex...Pressman's main point is that much of the condemnation of leuctotomy has taken no account of its history, in that it ignores the clinical and administrative problems faced by those who used it and has an unreal view of the actual process of mediccal advance...Regrettably, Pressman died shortly after finishing this work. Had he lived, he would undoubtedly have made further important contributions to medical history." Hugh Freeman, Nature

"...first-rate...." Donald W. Goodwin MD, JAMA

"Last Resort is medical history at its best....it illuminates the meaning of a misguided therapeutic innovation so as to shed light on the dilemmas medicine continues to face in assessing therapeutic options. Pressman has conducted a close, careful, and thoroughly documented examination of original sources. This book is much more than an important contribution to medical history....Every student and practitioner in psychiatry, psychology, and social work--in short, any student who wants to understand contemporary psychiatry and medicine--will find Last Resort extremely rewarding. It should become required reading for all psychiatric house officers. We owe Jack Pressman an enormous debt for Last Resort." Leon Eisenberg, MD; The New England Journal of Medicine

"Jack Pressman has written a truly important book that addresses fundamental questions about the nature of medical progress and therapeutic effectiveness. This book is all the more remarkable for exploring these questions by way of one of the most discredited medical interventions of the twentieth century, namely, lobotomy." Joel Braslow, Journal of the History of the Behavioral Sciences

"Pressman's project is so vast that any single chapter could stand on its own as an independent, well-written monograph. The originality of Pressman's topic, his staggering amount of research, and the cogency of his theme are impressive, but it is the depth of his analysis and the subtlety of his synthesis that set his work apart. Historians of medicine and neuroscience in particular will welcome this book, but any historian will read it profitably." Thomas P. Gariepy, Isis

"...a well-written, thorough understanding of psychosurgery and the surrounding feelings, pro and con, at the height of its popularity." George B. Murray, Journal of Interdisciplinary History

"...long, detailed, and engaging book..." Elizabeth Lunbeck, Journal of the History of Medicine

"...well-documented, definitive study of the rise and fall of psychosurgery...hist owrk inspires friends and admirers to write their own social histories of American medicine and psychology." Westwick

Robert P. Hudson
Psychosurgery was a major innovation in America during the 1940s and 1950s, just as the new specialty of psychiatry was seeking identity and acceptance. Despite its flimsy scientific basis, crude techniques, and many failures, tens of thousand of persons underwent frontal lobotomies, often as office procedures. Historical assessments of the lobotomy story usually dismiss it as a medical catastrophe and a warning of the consequences of science running amuck. The author demonstrates that this depiction is not only simplistic, but wrong-headed. He shows that lobotomy was based on a reasonable application of contemporary science, that it was done in the psychiatric mainstream rather than by a few peripheral zealots, and that many results were perceived as beneficial, particularly in overcrowded state hospitals where lobotomy rendered difficult patients manageable, even at the price of severely altered personalities. The history of therapeutics is generally underdeveloped at present, despite its critical importance to the current scene, where the naive acceptance of everything called alternative medicine threatens to return medicine to the chaos of the nineteenth century. Practical matters alone should recommend this book to healers of all stripes at any stage of their careers, to social planners, historians of the life sciences, and the immense population most affected by the vagaries of medical practice, the consumer. The story of the rise and fall of lobotomy demanded an explication of the forces shaping psychiatry as we know it today. This story is integrated seamlessly and economically into the overriding account of a fledgling specialty seizing on the unscientific destruction ofnormal brain tissue in quest of scientific legitimacy. Many studies document America's scientific illiteracy. Most of us fail to understand the methods, capabilities, and limitations of science. As a nation we need more books like this one. Reading the remarkable epilogue, ""Last Resort,"" alone would be a good place for anyone to begin.
New England Journal of Medicine
Last Resort is medical history at its best....This book is much more than an important contribution to medical history (as if that were not enough). Every student and practitioner in psychiatry, psychology, and social work -- in short, any student who wants to understand contemporary psychiatry and medicine -- will find Last Resort extremely rewarding. It should become required reading for all psychiatric house officers.

4 Stars! from Doody
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Product Details

Table of Contents

Acknowledgements; Introduction; 1. Psychiatry's renaissance; 2. Sufficient promise; 3. Certain benefit; 4. Active treatment; 5. Human salvage; 6. Localized decisions; 7. The politics of precision; 8. Medicine controlled; Epilogue and conclusion; Appendix.
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Sort by: Showing 1 Customer Reviews
  • Anonymous

    Posted January 1, 2012

    Exceptional study in medical history

    This is a deeply researched and well written history of the lobotomy as medical practice in the 1950's. A large book, but well worth reading if one is interested in the true history of psychosurgery over the more common depiction of the procedure as an immoral practice by those on the medical fringe.

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