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Psychosomatic Medicine 24:75-80 (1962)
© 1962 American Psychosomatic Society

The Effect of Leukotomy on Pain

JOHN C. NEMIAH M.D.1

1 Department of Psychiatry and Neurology, Harvard Medical School, and the Psychiatric Service, Massachusetts General Hospital, Boston, Mass.

A 40-year-old paraplegic underwent a Grantham frontomedian leukotomy for intractable pain in his legs. Preoperatively, he was anxious and depressed, complaining constantly of pain. In psychiatric interviews he repeatedly responded to questions about his concern over the effect of injury on his life situation with denial of such concern and with complaints of pain. Accordingly, he was interviewed before and after leukotomy and questioned systematically about the possible effect of his paraplegia on his life situation. The interviews were tape-recorded and analyzed for the number of pain and situational responses. There was a marked shift from pain responses preoperatively to situational responses postoperatively (significant at a level of less than 0.001 by chi-square test). Postoperatively, he showed no anxiety or depression. When questioned, he admitted to pain, but he did not spontaneously complain of it.

The following theoretical explanation is proposed: Preoperatively, awareness of the circumstances and significance of the patient's life situation resulting from his paraplegia threatened him with intolerable affect. To control anxiety and depression, the patient employed defenses of denial of feelings, and displacement of concern from his life situation to physical symptoms, thus intensifying his pain. Leukotomy physiologically reduced his capacity to experience affect. The need for psychological measures of defense against anxiety and depression was thereby removed; the patient was able consciously to face his life situation, and displacement of concern to symptoms was no longer necessary, resulting in diminution of pain. The importance of a theoretical structure containing both physiological and psychological terms is discussed.




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