At that stage, as far as I was concerned, they could have chopped my head off Nothing worked until the operation. There have been no side-effects.”It is known, however, that there can be post- operative side effects, including headaches for several days and muddled thinking. It is known, too, that one man died as a result of the operation when rods were misplaced in the brain. There is also some risk of epilepsy and fits, and patients are warned of the possibility of a cerebral haemorrhage which could produce a demented state, paralysis similar to a stroke, or even death.According to Dr Bridges, the operation allows 40 to 60 per cent of patients to live normal or near-normal lives. Critics, however, say there is no real objective measure of any improvement in such patients.

It is also acknowledged that, despite 60 years of psychosurgery, the mechanisms involved in the operations remain unclear.”We do now know that severe depression has a biochemical basis,” says Dr Bridges, “and we know it is a neuro-transmission disorder, like Parkinson’s disease. The operation is in known tracts in the limbic system that are to do with the emotions and seem to be located in the lower frontal lobe. We interrupt that tract by making a lesion with the rods and somehow that stops the illness and normality follows. We know no more detail than that.”At Cardiff, consultant psychiatrist Dr Roger Thomas and his surgical colleagues have treated between nine and 12 patients in the last few months, some of them referrals from the Brook. “The patients we see have been severely ill, usually for many years,” says Dr Thomas, “and they are the people who, in a sense, have nothing to lose because they don’t wish to carry on living the way they are.”People think of One Flew Over the Cuckoo’s Nest, but modern psychosurgery is as far away from that as keyhole surgery is from open surgery.”Consultant Dr Sashi Sashidharan is one of many psychiatrists who remains sceptical. “The effectiveness of psychosurgery for what are essentially psychological disorders is unproven,” he says.

“There is a tendency for people who practise psychosurgery to argue not only on the basis of very small figures but also on selective samples.”I would treat psychosurgery as a museum piece and I have yet to see any clinical condition that could be defined as responsive to such a traumatic intervention in the structure of the brain.”It is a sentiment echoed by the mental health pressure group MIND. “We are not happy with its continued use and believe there should be a rigorous review to see whether any use is justified,” said policy officer Alison Cobb.As the Maudsley unit gets ready to organiseoperations, the sudden arrival of lobotomy victims of the Forties, now seeking treatment in psychiatric hospitals, is grist to the sceptics’ mill. While there are no records of numbers, one unit estimated it sees a dozen cases a year.When these patients were younger and more mentally active, their depleted brains were able to compensate for the surgery carried out. It is also vital for standards in British universities in general that that some of the nation’s universities stay among the world’s best.As long as Britain has some institutions that are genuinely centres of world excellence, the rest of the system has a benchmark against which to measure itself, and our students will know that they are being taught by those who know what is the international meaning of “excellence”. For them keeping up with the international competition may not be so important For the LSE it is vital. Even when allowance is made for the grant that comes to the college from the Higher Education Funding Council for England, one set of students pays in direct fees at least three times what the British government pays for the others.This is highly inequitable and the manifest unfairness is beginning to rankle.

An American student working his or her way through the LSE might accept, for example, that she should pay three or four times what a British student is charged for the same course. But why should they also subsidise a German, an Italian or a Greek? And should a Bangladeshi from a poor family subsidise a Belgian from a rich one? A funding system which, on average, transfers resources from the poor to the rich does not fit my definition of equitable or fair.But the real issue for me as director of the LSE has always been excellence rather than equity. LSE is one of the world’s leading universities and my primary duty is to maintain that position. Keeping up with the best in the world is expensive as well as difficult. Securing the best teachers, the best libraries and the best facilities, particularly computer-based information technology resources, is very expensive.Other institutions have other missions and other purposes. A new scheme, of course, needs to be equitable, fair and to preserve opportunities of access to all able to benefit.I believe that can be done. It would certainly not be difficult to improve on the present situation.

It is only full-time British and European Union students who have their fees paid wholly by government grants. But opinions are changing fast under the pressure of the financial crisis that confronts us. The committee now supports a student contribution towards tuition fees provided they have access to a fair and equitable income-related loan scheme.This represents a significant change of heart since 1993. There are around 1.5 million British students currently at our universities; of these, one-third are studying part time and therefore pay their own fees, as do those students from countries outside the European Union.Fees for British and EU undergraduate students in classroom-based subjects are set at pounds 750 for this academic year At the LSE the rest pay pounds 7,800.