Discussion: lobotomize the patient or lobotomize the system

[Jo Dirt]

Mental health centers are not a place where alot of nurses flock to to work. There have been several situations around my town where workers were killed or hurt by the mentally ill. Its dangerous enough in the hospital. Even if we had no nurses shortage, which I still say we have nurses, just many of them choice to not work in this field anymore, we would still have a shortage of nurses who want these jobs.

This is why I am a firm believer in lobotomies for those who have been proven to be violent.

[Jo Dirt]

My cousin is a paranoid schizophrenic, very large, and has physically assaulted my aunt more than once. She is on some very strong medications and even still can't remain stable. Who do you think should take the next assault when she goes off the deep end?

A system where the violent and dangerous receive lobotomies would never work because inevitably the wrong kinds of people would be the ones to end up making the decisions about who should receive them.

[suanna]

I am by no means a mental health expert but to those of you who are- Are there not incurably violent patients who, although through no fault of thier own, have a propencity to pose a daily threat to themselves or society- especialy those who are charged with thier care. If a patient has a gangrenous leg that is endangering his life - we amputate it. The patient does suffer a loss, but is not dead. By the same token, if a patient is in constant danger of killing themselves or others, is not a lobotomy (by any name) just removing the diseased tissue that threatens thier life (and worse yet, those around them). Not a perfect solution, but neither is amputation of a leg. It is just the only solution medicine can offer with our current understanding of the disease. I am not an advocate, but neither can I dismiss the posibility that for some patients this may be the only way to correct the dangerous disease. Is it better that we allow them to kill or maim some innocent caregiver of other person and spend the rest of thier lives in a jail cell? They lose thier life/freedom as well as the loss/death of the person they attacked. I can see both sides. As to all the posters of family members or friends who have a mental illness and are appalled by the thought of labotomies- I don't think it was ever suggested in this forum they be used for mild depression, or bipolar disorder, or even schizophrenia. Very violent, untreatable, uncontrollable, unmanageable patients who have exhausted all other potential theraputic interventions are, I hope, the only consideration for this intervention.

[Mr Ian]

I am by no means a mental health expert but to those of you who are- Are there not incurably violent patients who, although through no fault of thier own, have a propencity to pose a daily threat to themselves or society- especialy those who are charged with thier care.

Yes there are.

If a patient has a gangrenous leg that is endangering his life - we amputate it. The patient does suffer a loss, but is not dead. By the same token, if a patient is in constant danger of killing themselves or others, is not a lobotomy (by any name) just removing the diseased tissue that threatens thier life (and worse yet, those around them).

This would be like considering an above knee amputation for an ingrowing toenail.

It is just the only solution medicine can offer with our current understanding of the disease. I am not an advocate, but neither can I dismiss the posibility that for some patients this may be the only way to correct the dangerous disease.

Is it medicine?

Is it a disease?

Is it better that we allow them to kill or maim some innocent caregiver of other person and spend the rest of thier lives in a jail cell? They lose thier life/freedom as well as the loss/death of the person they attacked. I can see both sides.

We intervene once harm has been done and risk reduction occurs as a result.

Lobotomising every violent persons with MH issues might well reduce the risk - it can also wipe the personality and effectively remove any chance of amelioration - since you've now got no leg attached.

As to all the posters of family members or friends who have a mental illness and are appalled by the thought of labotomies- I don't think it was ever suggested in this forum they be used for mild depression, or bipolar disorder, or even schizophrenia. Very violent, untreatable, uncontrollable, unmanageable patients who have exhausted all other potential theraputic interventions are, I hope, the only consideration for this intervention.

What are all the other options?

And at what point is exhaustion?

I can build, staff and manage a facility that will have near-0 incidents - I'm very confident of that. But it will cost money, require training, a shift in attitude and a whole lot more tolerance from Jo Public who simply doesn't understand and thinks we can 'cure' an ingrowing toenail by removing the leg.

If we prevented child abuse victims you'd probably cut the number of MH related violence in half.

[Jo Dirt]

Yes there are.

This would be like considering an above knee amputation for an ingrowing toenail.

Is it medicine?

Is it a disease?

We intervene once harm has been done and risk reduction occurs as a result.

Lobotomising every violent persons with MH issues might well reduce the risk - it can also wipe the personality and effectively remove any chance of amelioration - since you've now got no leg attached.

What are all the other options?

And at what point is exhaustion?

I can build, staff and manage a facility that will have near-0 incidents - I'm very confident of that. But it will cost money, require training, a shift in attitude and a whole lot more tolerance from Jo Public who simply doesn't understand and thinks we can 'cure' an ingrowing toenail by removing the leg.

If we prevented child abuse victims you'd probably cut the number of MH related violence in half.

This is a very Pollyana-ish way of looking at it.

[Whispera, MSN, RN]

perhaps lobotomizing is a Dirty Harry-ish way of looking at it...

[Mr Ian]

perhaps lobotomizing is a Dirty Harry-ish way of looking at it...

ba-boom~tish....

Touché

[NPAlby]

Just for the record I really don't think we're going to be seeing any lobotomies anytime soon. The idea is archaic. I do wish they were some way to physiologically affect the brain other than meds. In particular the psychopaths. But also the Bipolar or Schizophrenic patient who has a host of co-morbidites secondary to his/ her medication management.

[Mr Ian]

Just for the record I really don't think we're going to be seeing any lobotomies anytime soon. The idea is archaic. I do wish they were some way to physiologically affect the brain other than meds. In particular the psychopaths. But also the Bipolar or Schizophrenic patient who has a host of co-morbidites secondary to his/ her medication management.

It's an interesting concept.

And it's already rapidly growing.

Neuromodulation is already a tested technique (in rats) and has demonstrated that behaviour can be controlled not only by removing certain areas but also by stimulating them.

Neuroanalysis (Dr Avi Peled, psychiatrist) is also an interesting concept that seeks to amalgamate psychiatry with psychology and neurosciences.

Clinical Brain Profiling is his hypothesis - a modality of mapping the brain's functions. Profiling neurotypical ('normal') processes against those with 'disorders' - such as mood dysregulation; hearing voices; delusional thinking; etc is hoped to lead to identifying the neural networks involved in disorders of behaviour/experience.

The proposed advances in treatment choices is hoped to lead to developing ways that don't "cluster bomb" the brain with anti-psychotic medication but are more specific in enhancing plasticity and connectivity of the disaffected neural networks.