Magical Mystery Cure
This is an excellent article by Danielle Egan, a friend of Psychosurgery.org. It appeared in This Magazine earlier this year:
Magical Mystery Cure
What would you do if a lobotomy was your only hope for happiness? Today the procedure is called psychosurgery and it continues to be prescribed to treat mental illness, though many psychiatrists argue the mentally ill need it like a hole in the head
“I remember when I was having the surgery, they had put a lot of drugs in me and I was feeling heavily drunk. They said, ‘How do you feel?’ I said, ‘I feel drunk.’ They were trying to put this jig on my head, and these guys couldn’t get it on. I’m going, ‘Oh my god, what am I doing here in this operation room? This is crazy. You’re going to drill holes in my head and you can’t get this thing on!’ I didn’t think it was funny. I was a lot worried.”
Bruno (not his real name) and I are having lunch at a Chinese restaurant on the main drag of a small town just south of Edmonton. The neatly dressed 33-year-old speaks in a loud, calm voice as he describes a psychiatric neurosurgery, or psychosurgery, performed on him in November 2002 as a last resort treatment to curb his obsessive-compulsive disorder (OCD). The disorder appeared as excessive hand-washing when Bruno was 10, but eventually became debilitating. He dropped out of university during his third year and started seeing Dr. Lorne Warneke, an Edmonton psychiatrist who specializes in OCD. They spent the next 10 years trying dozens of pharmaceutical treatments, in addition to cognitive behaviour therapy, while Bruno worked on and off selling insurance. But Bruno, like about 20 percent of people who try the standard methods of treatment for mental illness, found they didn’t help him. So Warneke told him about a type of surgery that could treat his OCD by destroying pathways in his brain thought to be overactive in people with anxiety disorders.
“At first I couldn’t think of someone drilling a hole in my head and frying my neurons, you know,” says Bruno, letting off a loud booming laugh. “I talked about it with Dr. Warneke. Finally, I guess, I thought that’s what I should do.”
Performed at University of Alberta Hospital in Edmonton, the surgery, called a stereotactic bilateral anterior capsulotomy, is one of four psychiatric neurosurgeries used around the globe to treat people with severe depression and anxiety disorders. Specialists in the field aren’t sure how or why these surgeries work, and all four operations target different parts of the brain. The goal is to interrupt the neural pathways between the frontal lobes—known as the seat of personality and the brain’s CEO because they’re involved in higher functions like problem-solving, motor-control, language, memory-sorting and impulse-control—and the so-called “lower” areas of the brain, including the thalamus, amygdala and hippocampus, which initiate mood, hormones and emotions ranging from sexual pleasure to fear.
With the anterior capsulotomy, the target is the internal capsule, an area dense with nerve connections between the frontal lobes and the thalamus. About four such procedures have been done each year at University of Alberta Hospital since Warneke started referring some of his most severe treatment-resistant patients to neurosurgeon Dr. John McKean in the early 1990s. In order to be referred, the patients must have failed a number of years of standard treatment, including pharmaceuticals and psychotherapy, and be “considerably debilitated.” Psychosurgery, Warneke explains, is “a very simple procedure that effectively cuts nerve fibres. It’s a bit like cutting some wires in a telephone trunk line to reduce the amount of messages getting through.”
His explanation is similar to that of Portuguese neurologist Dr. Egas Moniz, who developed the first psychosurgeries (then called prefrontal leucotomies) in the 1930s. Moniz claimed the procedure was necessary to “change the paths chosen by the [dysfunctional] impulses … and force thoughts into different channels.” While tools and technologies have certainly evolved over the years, the premise of severing pathways in order to treat psychiatric illnesses remains the same as it was back in the early days of lobotomy.
The “jig” placed on Bruno’s head is a large metal device that makes it easier for surgeons to pinpoint the coordinates of the spots to be destroyed. When the neurosurgeon arrived and showed the attendants how to work the stereotactic frame, “there was a sigh of relief,” Bruno says, laughing heartily before taking a few bites of his buffet lunch. Bruno’s skull had already been locally anaesthetized so that he wouldn’t feel pain from the drill, and two spots on the top of his head just above the hairline had been shaved. The brain itself doesn’t feel pain, so Bruno was wide awake as doctors drilled two dime-sized holes in his skull. “I remember the sound of the drill, but no pain, just a little pressure. Then I remember the doctor going, ‘How many fingers?’ It felt like I was only there 15 minutes. I was in and out.”
read the rest
Magical Mystery Cure
What would you do if a lobotomy was your only hope for happiness? Today the procedure is called psychosurgery and it continues to be prescribed to treat mental illness, though many psychiatrists argue the mentally ill need it like a hole in the head
“I remember when I was having the surgery, they had put a lot of drugs in me and I was feeling heavily drunk. They said, ‘How do you feel?’ I said, ‘I feel drunk.’ They were trying to put this jig on my head, and these guys couldn’t get it on. I’m going, ‘Oh my god, what am I doing here in this operation room? This is crazy. You’re going to drill holes in my head and you can’t get this thing on!’ I didn’t think it was funny. I was a lot worried.”
Bruno (not his real name) and I are having lunch at a Chinese restaurant on the main drag of a small town just south of Edmonton. The neatly dressed 33-year-old speaks in a loud, calm voice as he describes a psychiatric neurosurgery, or psychosurgery, performed on him in November 2002 as a last resort treatment to curb his obsessive-compulsive disorder (OCD). The disorder appeared as excessive hand-washing when Bruno was 10, but eventually became debilitating. He dropped out of university during his third year and started seeing Dr. Lorne Warneke, an Edmonton psychiatrist who specializes in OCD. They spent the next 10 years trying dozens of pharmaceutical treatments, in addition to cognitive behaviour therapy, while Bruno worked on and off selling insurance. But Bruno, like about 20 percent of people who try the standard methods of treatment for mental illness, found they didn’t help him. So Warneke told him about a type of surgery that could treat his OCD by destroying pathways in his brain thought to be overactive in people with anxiety disorders.
“At first I couldn’t think of someone drilling a hole in my head and frying my neurons, you know,” says Bruno, letting off a loud booming laugh. “I talked about it with Dr. Warneke. Finally, I guess, I thought that’s what I should do.”
Performed at University of Alberta Hospital in Edmonton, the surgery, called a stereotactic bilateral anterior capsulotomy, is one of four psychiatric neurosurgeries used around the globe to treat people with severe depression and anxiety disorders. Specialists in the field aren’t sure how or why these surgeries work, and all four operations target different parts of the brain. The goal is to interrupt the neural pathways between the frontal lobes—known as the seat of personality and the brain’s CEO because they’re involved in higher functions like problem-solving, motor-control, language, memory-sorting and impulse-control—and the so-called “lower” areas of the brain, including the thalamus, amygdala and hippocampus, which initiate mood, hormones and emotions ranging from sexual pleasure to fear.
With the anterior capsulotomy, the target is the internal capsule, an area dense with nerve connections between the frontal lobes and the thalamus. About four such procedures have been done each year at University of Alberta Hospital since Warneke started referring some of his most severe treatment-resistant patients to neurosurgeon Dr. John McKean in the early 1990s. In order to be referred, the patients must have failed a number of years of standard treatment, including pharmaceuticals and psychotherapy, and be “considerably debilitated.” Psychosurgery, Warneke explains, is “a very simple procedure that effectively cuts nerve fibres. It’s a bit like cutting some wires in a telephone trunk line to reduce the amount of messages getting through.”
His explanation is similar to that of Portuguese neurologist Dr. Egas Moniz, who developed the first psychosurgeries (then called prefrontal leucotomies) in the 1930s. Moniz claimed the procedure was necessary to “change the paths chosen by the [dysfunctional] impulses … and force thoughts into different channels.” While tools and technologies have certainly evolved over the years, the premise of severing pathways in order to treat psychiatric illnesses remains the same as it was back in the early days of lobotomy.
The “jig” placed on Bruno’s head is a large metal device that makes it easier for surgeons to pinpoint the coordinates of the spots to be destroyed. When the neurosurgeon arrived and showed the attendants how to work the stereotactic frame, “there was a sigh of relief,” Bruno says, laughing heartily before taking a few bites of his buffet lunch. Bruno’s skull had already been locally anaesthetized so that he wouldn’t feel pain from the drill, and two spots on the top of his head just above the hairline had been shaved. The brain itself doesn’t feel pain, so Bruno was wide awake as doctors drilled two dime-sized holes in his skull. “I remember the sound of the drill, but no pain, just a little pressure. Then I remember the doctor going, ‘How many fingers?’ It felt like I was only there 15 minutes. I was in and out.”
read the rest
posted by Christine at Tuesday, August 02, 2005
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