Abstract
The treatment of psychiatric patients presents significant challenges to the clinical community, and a multidisciplinary approach to diagnosis and management is essential to facilitate optimal care. In particular, the neurosurgical treatment of psychiatric disorders, or “psychosurgery,” has held fascination throughout human history as a potential method of influencing behavior and consciousness. Early evidence of such procedures can be traced to prehistory, and interest flourished in the nineteenth and early twentieth century with greater insight into cerebral functional and anatomic localization. However, any discussion of psychosurgery invariably invokes controversy, as the widespread and indiscriminate use of the transorbital lobotomy in the mid-twentieth century resulted in profound ethical ramifications that persist to this day. The concurrent development of effective psychopharmacological treatments virtually eliminated the need and desire for psychosurgical procedures, and accordingly the research and practice of psychosurgery was dormant, but not forgotten. There has been a recent resurgence of interest for non-ablative therapies, due in part to modern advances in functional and structural neuroimaging and neuromodulation technology. In particular, deep brain stimulation is a promising treatment paradigm with the potential to modulate abnormal pathways and networks implicated in psychiatric disease states. Although there is enthusiasm regarding these recent advancements, it is important to reflect on the scientific, social, and ethical considerations of this controversial field.
Highlights
The management of psychiatric disorders is challenging and often requires a multimodal approach to diagnosis and treatment
There is evidence of psychosurgery spanning multiple thousands of years throughout human history, the most exciting, and provocative developments have been within the past century, attributable to the combined efforts of scientists and physicians
In the 1950s, ablative surgery fell out of favor due to the rise of effective pharmacology and intense professional and public criticism, research and practice continued with more rigorous standards
Summary
The management of psychiatric disorders is challenging and often requires a multimodal approach to diagnosis and treatment. The legacy of “psychosurgery” has given rise to the development of modern standards for research and ethics, and has fostered. Surgery for Psychiatric Disorders a deeper understanding of the pathophysiology of human behavior. Despite a history of controversy, interest in the potential of surgery for psychiatric disorders has endured and even increased within the past few decades, primarily driven by the proliferation and success of neuromodulation and by improvements in structural and functional neuroimaging. It is important to view developments in psychosurgery in the context of the historical and current understanding of the neurobiology and pathophysiology of consciousness and behavior, the available treatments for psychiatric disorders, and the adherence to (or lack thereof) research ethics
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