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ABSTRACT This article examines the use of lobotomy as a treatment for chronic intractable pain and reconstructs then-common perceptions of pain and of the patients who suffered from it. It delineates the social expectations and judgments implicit in physicians' descriptions of the patients, analyzing what was expected from such patients and how the medical establishment responded to non-normative expressions of suffering. I argue that the medicalized response to an expectation for normativity demonstrates the convergence between psychiatric and palliative interventions. Based on a historically informed perspective of psychiatric interventions in the field of pain medicine, I examine the use of psychiatric medications for pain syndromes today and evaluate the interface between depression, chronic pain, and terminal illness. While not detracting from the medical imperative to alleviate pain, I question the usage of social criteria and normative judgments in the clinical decision of how to treat pain. What normalizing social function does the use of psychiatric interventions in pain treatment fulfill? This approach leads to a reexamination of perceptions of dualism in pain medicine.
PSYCHOSURGERY IS A FORM of brain surgery performed on the organically intact brain, in an attempt to alleviate what is perceived as severe mental illness. Lobotomy, an early form of psychosurgery, was developed by the Portuguese neurologist Egas Moniz, who in 1949 was awarded the Nobel Prize in Physiology or Medicine.The first lobotomy in the United States was performed in 1936, by neurologistWalter Freeman and neurosurgeon JamesWatts. Between the years 1935 to 1965, tens of thousands of lobotomies were performed on Americans in order to treat and cure mental illness (Pressman 1998). Freeman's role in the widespread implementation and endorsement of lobotomy has been widely acknowledged, as has his reliance on positive portrayals of the procedure in the media (Diefenbach et al. 1999). In 1947, Freeman developed the transorbital ("ice-pick") procedure, which enabled any physician, though untrained in surgery, to perform lobotomies as an office procedure and to have the patient ambulatory within an hour (El-hai 2005; Pressman 1998;Valenstein 1986). Surgical interventions on the brain are still used today to treat severe mental illness that is resistant to more conventional therapeutic methods. However, from the late 1940s until the 1960s, lobotomies were also performed to treat chronic and intractable pain.This use...