Journal - May 27, 2016

I am trying to understand what difference it makes to me whether my mom had a lobotomy or some other kind of brain surgery. Both have the potential to cause personality disorder. I guess if it were a lobotomy then there would be someone to blame for all of it—or most of it. If she had a stroke or something and required surgery then it would have just been a horrible tragedy. Why does it matter now that she's dead and all that happened 45 years ago. What difference does it make? I think it's because it is shrouded in so much secret. If it had been a stroke then it wouldn't have been covered up in all this family lore yet secrecy. Why would NO ONE in my family other than my mother ever mention the brain surgery. That seems very weird to me. It seems like a big event. Something is wrong about it.
And the question of my dad. Why would he stay with her for so long? A part of me thinks he felt guilty because of what he signed off on. But I don't know.
This is what I do know:
In 1970 mom had brain surgery
Her personality changed or became permanently psychotic
She lacked inhibitions
She was abusive
She had two holes drilled for the surgery. From what I remember they were near the top, back of her head. I could be wrong about this. My brother said there were three holes. (She told everyone different things)
So I'm finding different kinds of psychosurgery used during that time, more precise than the frontal lobotomy. My mind keeps returning to this neurology professor I took a class from. I wonder if he would meet with me and let me ask some questions about these kinds of surgeries and the plausibility that a botched surgery could cause the kind of behaviors my mother exhibited. Or, another option is that she didn't have postpartum, that it was the onset of schizophrenia and it was exacerbated by the trauma of the surgery. I don't think that's likely because her brand of psychosis was not like someone with schizophrenia. She rarely had hallucinations. She was mostly narcissistic, sadistic, lacked inhibition, very emotional, and delusional. Violent. I would say she was violent. But, she could carry on a normal conversation. (sort of). She would do almost anything for attention, really crazy stuff. She wasn't above pretending to be unconscious, making us look sick, screaming, doing humiliating things in public.
Really all these things are limbic system (except maybe the inhibition part is the frontal cortex)? I wish I knew more about neurology!'


 (The following in italics taken from psychosurgery at assignment point. http://www.assignmentpoint.com/science/medical/psychosurgery.html)
"Psychosurgery is a collaboration between psychiatrists and neurosurgeons. During the operation, which is carried out under a general anesthetic and using stereotactic methods, a small piece of brain is destroyed or removed. The most common types of psychosurgery in current or recent use are capsulotomy, cingulotomy, subcaudate tractotomy and limbic leucotomy. Lesions are made by radiation, thermo-coagulation, freezing or cutting. About a third of patients show significant improvement in their symptoms after operation. Advances in surgical technique have greatly reduced the incidence of death and serious damage from psychosurgery; the remaining risks include seizures, incontinence, decreased drive and initiative, weight gain, and cognitive and affective problems. All the forms of psychosurgery in use today (or used in recent years) target the limbic system, which involves structures such as the amygdala, hippocampus, certain thalamic and hypothalamic nuclei, prefrontal and orbitofrontal cortex, and cingulate gyrus — all connected by fibre pathways and thought to play  a part in the regulation of emotion. There is no international consensus on the best target site.
Anterior cingulotomy was first used by Hugh Cairns in the UK, and developed in the US by H.T. Ballantine jnr. In recent decades it has been the most commonly used psychosurgical procedure in the US.The target site is theanterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region. Anterior capsulotomy was developed in Sweden, where it became the most frequently used procedure. It is also used in Scotland and Canada. The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei.
Subcaudate tractotomy was the most commonly used form of psychosurgery in the UK from the 1960s to the 1990s. It targets the lower medial quadrant of the frontal lobes, severing connections between the limbic system and supra-orbital part of the frontal lobe.
Limbic leucotomy is a combination of subcaudate tractotomy and anterior cingulotomy. It was used at Atkinson Morley Hospital London in the 1990s and also at Massachusetts General Hospital. Amygdalotomy, which targets the amygdala, was developed as a treatment for aggression by Hideki Narabayashi in 1961 and is still used occasionally, for example at the Medical College of Georgia.
(all taken from psychosurgery at assignment point. http://www.assignmentpoint.com/science/medical/psychosurgery.html)
A weird thing I'm thinking about as I'm reading about psychosurgery was what society must have been like when brain surgery was an accepted for of psychiatric treatment. That is so damned scary. It is nightmarish. One thing I read described how they sometimes did these surgeries under local anesthesia and how the patient, particularly given their anxious tendencies are nervous and talking about how nervous they are as the doctor is drilling the holes and they can hear the metal instruments clanging. So fucking horrible. (I also saw and realized I never read Tennessee Williams' Suddenly Last Summer about a lobotomy. His sister Rose was given a frontal lobotomy and it went bad.)
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