Psychosurgery, a Predecessor to ‘Gender-Affirming Care’

From “life-saving medicine” to medicalized dehumanization

Collage by Donovan Cleckley, Images from Illustrated (February 8, 1947), Tempo (July 25, 1949), and The New York Times (September 30, 1973)

Please consider subscribing and supporting our work at The Distance! We are thankful for any donations to support the writing and historical analyses. Our readers’ support keeps us going!

In one case, Dr. Andy removed a part of the brain of a 9‐year‐old hyperactive boy. The results of the first operation were not considered satisfactory, and several more such operations were performed. In the end, the boy’s hyperactivity was ameliorated, and Dr. Andy believes the operation prevented the child’s being kept under permanent sedation and restraint. But critics emphasize that the boy’s intellectual capacity deteriorated after the operations, and that—since some important brain development continues through childhood—the youngster never got his chance to learn what nature might eventually have done for him. It is mainly because of this uncertainty that American doctors have shied away from using the scalpel in such cases, though operations on hyperactive children as young as 5 years are performed with regularity in Japan, Thailand, and other nations. (p. 72)

- Lee Edson, “The Psyche and the Surgeon,” The New York Times, September 30, 1973

I’d always explain it to the families as a pause on puberty, allowing the youth to take a deep breath.

- Kimberly Herrmann, pediatrician and internist, Whitman-Walker Health, Washington D.C, (qtd. in The New Yorker, October 9, 2023)

All of the data suggests that it is the correct thing to do for a patient with a clear diagnosis. If they are going to develop the body of a grown man, it becomes difficult to undo those changes.

- Izzy Lowell, doctor, founder of QueerMed, a telehealth practice for “gender-affirming care” (qtd. in The New Yorker, October 9, 2023)

It’s really hard for cis people to fully appreciate the deep destabilizing physical betrayal that these kids are navigating on a day-to-day basis. It’s a period where you should be establishing confidence in yourself and your ability to interact with the outside world.

- Stephanie Arnold, doctor, Seven Hills Family Medicine, Richmond, Virginia (qtd. in The New Yorker, October 9, 2023)

Psychosurgery went from a rare, lesser-funded practice to one commonly used, with far greater funding, and now it is virtually nonexistent. First understood as medical progress in favor of relieving particularly neurotic patients of mental distress, psychosurgery has been reassessed as regressive and barbarous. A lingering issue among contemporary medical historians and ethicists looking back on this practice has been how society readily accepted doing harm. Support for “gender-affirming care” has followed a similar trend as that of psychosurgery. Here, on psychosurgery, I will be discussing populations being treated, particularly women and children, and some aspects of the social context, particularly media representation. Parallels between psychosurgery and “gender-affirming care” begin to emerge. Further discussions, to be continued in forthcoming writing, will include women’s responses to psychosurgery, as seen in feminist publications in the latter decades of the twentieth century.

A review of the literature on lobotomies performed in France, Switzerland, and Belgium from 1935 to 1985 indicates that, concerningly, female patients constituted the majority—84% of 1,340 subjects (Terrier et al., 2017, p. 523). Though it is “not clear,” the authors say, they suggest that apart from “a higher prevalence of mental illness among women at the time,” women’s “alarmingly common” status as “subjects,” perhaps better described as victims, could well have been a product of “their perceived inferior position in those societies” (Terrier et al., 2017, p. 523). The shortened review notes Portuguese neurologist and politician Egas Moniz having received the Nobel Prize in 1949 for what had been perceived as his pioneering work on lobotomy, living its afterlife in psychosurgery. Beyond the medical control of women, the lobotomy had been used in “treating,” or rather mistreating, children. According to the review, in summary:

Lobotomy is now one of the most highly criticized treatments in history, given its serious effects on the personality. Destructive techniques included classical lobotomy, irradiation with iridium-194, electrocoagulation, and intra-cerebral injection of cocaine derivatives. The treatment of children at this time was particularly deplorable, with 22 children lobotomized for psychomotor agitation to ‘restore the peace at home.’ (Terrier et al., 2017, p. 523)

This procedure aiming to relieve patient distress went from being relatively widespread, uncritically accepted for many in medical practice and in the media, to being, essentially, morally mandated out of existence. I borrow the phrase morally mandated out of existence from Janice G. Raymond (1979/1994), who wrote, “I contend that the problem of transsexualism would best be served by morally mandating it out of existence” (p. 178). Though her words have been misconstrued as “genocidal” against “trans people,” they have to do with the procedures, not the people. On the same page of The Transsexual Empire, Raymond (1979/1994) wrote:

Does a moral mandate, however, necessitate that transsexualism be legally mandated out of existence? What is the relationship between law and morality, in the realm of transsexualism? While there are many who feel that morality must be built into law, I believe that the elimination of transsexualism is not best achieved by legislation prohibiting transsexual treatment and surgery [emphasis added] but rather by legislation that limits it—and by other legislation that lessens the support given to sex-role stereotyping, which generated the problem to begin with. (p. 178)

In particular, Raymond argued that surgical and hormonal interventions, utilized for similar reasons to psychosurgery, must be, at minimum, limited and, over time, regarded as morally unconscionable. Reading the review from Terrier et al., we may consider how psychosurgery went from being understood in humane terms, as “life-saving medicine,” to being regarded as medicalized dehumanization. The last quoted material in Terrier et al. 2017—“restore the peace at home”—comes from a work on pediatrics in 1958, favoring the use of the lobotomy on children. Parents who consented to the lobotomization of their children did so with a promise that it would restore peace. 

Contemporary medical historians and ethicists have written at length on how this practice had a lack of clinical trials and ethical committee reviews, coupled with elaborate media promotion. In their longer review, published in World Neurosurgery in December 2019, Terrier et al. write: 

Clinical trials and ethical committee review were absent, which might explain how radioactive iridium 194, which had never previously been tested on humans, could have been used for lobotomy. Furthermore, at this time, media and popular opinion were able to influence the surgical indications. The popular opinion had a positive view concerning this particular brain surgery, which was seen as ‘magic and heroic.’ The title on the February 8, 1947 issue of the British magazine Illustrated was ‘Leucotomy, this is the name of a brain operation, which gives a new personality and a fresh outlook on life to certain sufferers from mental illness.’ Another Italian journal, Tempo, published an article on July 25, 1949 titled ‘After frontal lobotomy, J.K., criminal, declared: It’s like I became the good brother of myself.’ (Terrier et al., 2019, p. 217)

Media portrayals of brain surgery to control behavior used metaphors of transformation, making it seem as if “magic and heroic.” A problem with these portrayals, as understood now, had been a marketing effect on the masses. Propaganda had the effect of selling psychosurgery to people believing, in desperation, that it would cure either themselves or their loved ones. Families and parents, in particular, became convinced of the effectiveness of peculiar medical practice, where otherwise they would have been more skeptical. Thus, psychosurgery’s role as bad therapy of the twentieth century cannot be separated from how the media, at least for a time, portrayed it as positive.

With “gender-affirming care,” we find similar media coverage, such as in The New York Times or The New Yorker, as once had been the case for psychosurgery. Psychosurgery involved surgical interventions on the body to alleviate the mind. “Gender-affirming care” follows the same pattern. The medical model continues to deal with personality and behavior—now making the body “match” the mind. To quote Raymond (1979/1994) once more:

The medical model is at the heart of the transsexual empire. It serves as the ‘new the­ology’ for the therapeutic and medical priests. From time to time there are ‘in-house’ debates about certain ele­ments of the model, but on the whole, it functions at an established and consistent level of orthodoxy. […] Ultimately, one must ask if the transsexual problem is really amenable to surgery and thus to a medical model. Is the biomedical imperative that has functioned in other areas, such as genetic technology and psychosurgery, re­ducible to presuppositions about the nature of women and men? (pp. 120-121)

Where psychosurgery had been understood to give a “new personality,” “gender-affirming care” has been understood to give a “new sex,” through biomedical means, innocuously phrased in “gender identity.” Puberty blockers for children diagnosed with “gender dysphoria” to alleviate their distress has similar contemporary rationalization to brain surgery on hyperactive youth to ameliorate their problems. Even into the 1970s, coverage on psychosurgery continued to report allegedly positive effects of behavioral control under the biomedical imperative. However, into the twenty-first century, such reports lack the frequency they once had, nearing the point of nonexistence. Both psychosurgery and “gender-affirming care” have permitted medicalized dehumanization—harming as healing.

---

References

Edson, L. (1973, September 30). The psyche and the surgeon. The New York Times. 14-15, 72, 78-79, 86-88.

Raymond, J.G. (1979/1994). The transsexual empire: The making of the she-male. Teachers College Press. 

Terrier, L.M, Lévêque, M., & Amelot, A. (2017). Most lobotomies were done on women. Nature, 548, 523. https://doi.org/10.1038/548523e 

Terrier, L.M., Lévêque, M., & Amelot, A. (2019). Brain lobotomy: A historical and moral dilemma with no alternative? World Neurosurgery, 132, 211-218. https://doi.org/10.1016/j.wneu.2019.08.254 

Witt, E. (2023, October 9). A trans teen in an anti-trans state. The New Yorker. https://www.newyorker.com/magazine/2023/10/16/a-trans-teen-in-an-anti-trans-state