The Political Economy Of Lobotomies [Opinion]

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In their recently revised study “Gordon Tullock Meets Phineas Gage: The Political Economy of Lobotomies in the United States,” published on the Social Sciences Research Network, Raymond J. March and Vincent Geloso track the complicated relationship between state funding and the “lobotomy boom” of the 1940s and 1950s. Their findings show that despite a scientific consensus that lobotomies were ineffective, the use of the controversial procedure proliferated due to expanded government and an attendant increased provision for mental health hospitals and asylums during that period.

There is arguably a long history in America of delays in the application of scientific discoveries — somewhat due to misaligned institutional factors — which might negatively affect the health of patients, sometimes for decades. For example, the link between tobacco smoking and increased risk for certain cancers had reached a scientific consensus in the 1930s, but the Surgeon General did not release a report on it until 1964. It took a tobacco company whistleblower to finally push public opinion away from the tobacco industry in the 1990s.

A similar case is found in the performance of 50,000 lobotomies in the United States over the course of a nearly 40-year period from the 1930s to the 1970s. Some have called it one of the most spectacular failures in the history of medicine. Perhaps the most troubling fact in the history of lobotomy surgery is that it was reviled by the medical community during the time that it was used the most. By the early 1940s, within five years of the first lobotomy have been performed in America, medical professionals reached a consensus that the procedure was ineffective. The procedures were denounced by the American Medical Association in 1941.

It has been speculated that lobotomies proliferated due to the absence of knowledge that the procedure was ineffective, but this is clearly not the case. March and Geloso suggest that the key to understanding the popularity of the procedure lies in financial incentives generated by the institutional structure of mental health provision.

Funding for public mental hospitals and asylums was (and some would argue still is) extremely poor. Public institutions lacked the financial resources to give their wards proper attention and care, and the lobotomy provided a convenient solution. The resulting brain damage made patients more docile, and the procedure was cost-effective. Physicians performed cost and conflict-minimizing treatment because there was no incentive to do otherwise.

A point of comparison lies in the private mental hospitals and asylums of the time, which were funded by the patients, their caregivers, or through philanthropic donations. Inadequate or ineffective treatment would reduce income to the institution, and thus physicians were required to give quality care. As such, private institutions were far less likely to perform the lobotomy procedure. At the height of the lobotomy boom, only 6 percent of lobotomies were performed in private institutions.

The authors of the paper suggest that the findings show that less state-sponsored funding can provide for the advancement of scientific inquiry and proper medical care. Clearly, however, America must choose a direction. As the lobotomy boom shows, the middle ground that our nation has tread for so long is a dangerous and errant path.