Psychosurgery

Psychosurgery indicates the sporadic and faddish attempts to alleviate severe and intractable mental disease by direct operative procedures on the brain. This term should not be confused with the para-scientific practice of psychic surgery[?].

There is evidence that trephining[?] (or trepanning) was in widespread, if infrequent, use since 5000 BCE but psychosurgery was not commonly practised until the 20th Century.

The first systematic attempts occurred from 1935 when the neurologist Egas Moniz[?] teamed up with the surgeon Almeida Lima at Lisbon University to perform a series of prefrontal leucotomies - cutting the connection between the prefrontal cortex[?] and the rest of the brain. They obtained fair results, especially in the treatment of depression although about 6% of patients did not survive the operation and there were often marked and adverse changes in the personality of the survivors. Despite the risks the process was taken up with some enthusiasm, notably in the US, as a treatment for previously incurable conditions. Moniz received a Nobel Prize in 1949. This procedure is commonly called a lobotomy, although this name should refer to a whole class of unrelated surgeries.

The criteria for treatment were quite steep, only a few conditions of "tortured self-concern" were put forward for treatment. Severe chronic anxiety, depression with risk of suicide and incapacitating obsessive-compulsive disorder were the main symptoms treated. The original leucotomy was a crude operation and the practice was soon developed into a more exact, stereotactic procedure where only very small lesions were placed in the brain.

Some patients did benefit from the more precise psychosurgery, but there was a strong division amongst the medical profession as to the viability of the treatment and concern over the irreversible nature of the operation and the extension of the surgery into the treatment of unsuitable cases (drug or alcohol dependence, sexual disorders etc). Whatever the truth, psychosurgery was offered in only a few centres and by the 1960s the number of operations was in decline. The signal improvements in psychopharmacology and behaviour therapy[?] gave the opportunity for more effective and less invasive treatment.

Psychosurgical interventions such as bilateral cingulotomy are still performed in servere cases which don't respond to other treatments.

References

• G. Rees Cosgrove, Scott L. Rauch: "Psychosurgery" Neurosurg. Clin. N. Am. 1995; 6:167-176 online version (http://neurosurgery.mgh.harvard.edu/Functional/psysurg.htm)