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November 29, 2009

Psychosurgery: New techniques sure to raise old questions

When Americans hear the term "Brain Surgery" their first thought may be of Jack Nicholson's character in the 1975 movie "One Flew over the Cuckoo's nest" and the crippling lobotomy performed on him. Indeed, "Psychosurgery" was popularized in the United States during the 1930's and 1940's when the American physician Walter Freeman advocated the use of lobotomies to treat patients with various mental illnesses. Thousands of Americans were subjected to these brutal "procedures" to devastating effect.

But, scientific inquiry and progress is a long and winding road; and, it should be no surprise that new, less invasive psychosurgeries are being explored and performed for specific mental illnesses. I came across an excellent article on this topic in last Friday's New York Times, the latest in a series of articles on "Brain Power." The article describes four new brain surgeries including Gamma knife surgery where an M.R.I. like device focuses small beams of radiation to destroy small areas of brain tissue thought to cause Depression and Obsessive-Compulsive Disorder (O.C.D.). The article tracks two patients who underwent Gamma knife surgery; one patient claims the surgery was transformative and "saved my life" whereas the other patient seems to have had no measureable effect from the surgery. And, there is the cautionary tale of one U.S. patient who suffered disabling brain damage from one of these new operations which resulted in a $7.5 million dollar judgment against the hospital that performed the surgery.

While these new surgical techniques are still exploratory (only 500 people have undergone one of them in the last decade) for use with patients who suffer from depression and O.C.D, it seems inevitable to this writer that at some future point we will see the advent of "brain surgeries" for patients with bipolar disorder. This prospect is at once frightening and intriguing. It's not hard to imagine future patients, who have exhausted all conventional methods to combat bipolar disorder, turning to brain surgery as a choice of last resort; alternatively, among those who are less risk adverse, brain surgery might be a choice of first resort.

The way people with mental illnesses are treated for their afflictions has undergone a sea change during the past 60 years and, as a result, millions of people with bipolar disorder or other illnesses are able to live normal, productive lives. I wonder how our current techniques and medicines will be viewed 60 years from now; and, I wonder if brain surgery will be as commonplace as popping a pill.

Posted by Michael Lane at November 29, 2009 9:38 PM

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