Barahona Fernandes and Leukotomy Opinion

Today, on January 14th, I had the opportunity to watch a television documentary about the problem of psychosurgery and in particular the so-called “prefrontal leukotomy”, the surgical technique developed by Egas Moniz. The debate is illustrated by a famous case of a leukotomized patient, the wife of Marcelo Caetano.

Among other things, some specialists, neurologists, neurosurgeons and psychiatrists with different orientations are interviewed. At one point Barahona Fernandes, who had completed a long internship in Germany from 1934 to 1936, is said to have been influenced by the German philosophy of the time; and it is assumed that he then had an influence from the National Socialist ideology, which correlated with his adherence to the biological therapies of the time (electric shock, insulin therapy, psychosurgery).

The idea of ​​leukotomy goes back to Egas Moniz, who is led by the work of Foulton and Jacobsen on chimpanzees. surgical interventions were performed by Almeida Lima; Before and after the intervention, Barahona Fernandes compiled the medical history of the first leukotomized patients.

It is true that Barahona was shaped by German philosophy, but not by fascist thinking, which he always vehemently and frontally rejected. He was a student of Karl Jaspers, a psychiatrist, philosopher and founder of psychopathology who was himself persecuted by Hitler’s regime. and he became a pupil of Nicolai Hartmann, from whom he took over the layered theory of the psychic apparatus.

In addition to these illustrious figures, he worked for psychiatrists like Kurt Schneider and neuropsychiatrists like Carl Kleist. After his return from Germany, still young, Barahona modernized Portuguese psychiatry in all its areas, in terms of clinic, research and teaching.

I met him in 1960 as a student on the Medical Psychology course: he then expressed great enthusiasm for the appearance of the first psychotropic drugs; and I worked since 1970 as his assistant in the mental hospital of the Hospital de Santa Maria and since 1974 in the medical faculty of Lisbon. In the same year he became the first rector of the democratic era.

During these years of work and until it disappeared, we discussed numerous theoretical and practical aspects of psychiatry. One subject that always separated us was that of psychosurgery. Because I never accepted the legitimacy of such a practice and neither of us convinced the other of its reasons.

No patient has been suggested for a leukotomy since working with Barahona Fernandes. It wouldn’t have been possible already – the leukotomy had become truly anachronistic and definitely had its place in the history of medicine.

However, the arguments he advanced were well founded: on the one hand, when the leukotomy occurred, no psychopharmaceuticals were available, especially neuroleptics, and psychotic patients voted for great and endless suffering; On the other hand, the international scientific community had given its therapeutic guarantee for leukotomy, as evidenced by the award of the Nobel Prize to Moniz (together with the Swiss Walter Rudolf Hess – unfortunate coincidence of the name with that of a Hitler minister!) Works by Hess on cerebral neurophysiology) .

In the foreword that I wrote for the volume, in which a large part of Barahona’s articles is summarized, I have now reread the following paragraph: “I have spoken critically and with complete freedom – as always – with Barahona Fernandes several times the “case of the leukotomy”. Against my ethical (patient rights), noetic (irreversible intellectual reduction), and aesthetic objections (violation of the magnificent plexus of neural networks at their phylogenetically highest point), he rejected the pragmatic argument for improving severe and possibly unrecoverable forms of schizophrenia. Obsessive-compulsive diseases and certain melancholy states. ” [1]

Finally, there is one more thing to say: since I started working with Barahona Fernandes, no patient has been suggested for a leukotomy. It would not have been possible either, although the technique has since become much more rigorous and less harmful due to the use of stereotactic means with great precision. The leukotomy had become truly anachronistic and definitely had its place in the history of medicine.

[1] Foreword to: Barahona Fernandes – Anthroposciences of Psychiatry and Mental Health, Volume I, Lisbon, 1998 (Fundação Gulbenkian), pp. XXVI-XVII.

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