Psychosurgery Returns

Psychosurgery, or modification of the brain to alter or control some aspect of personality, is an ancient operation. Trephining (opening the skull) was performed in Peru 12,000 years ago, probably to let out suspected demons; 14th century anatomy texts contain instructions for similar operations. Except for a brief period during the 1940s and 1950s, psychosurgery has never won wide acceptance in the U.S., and for good reason. Lobotomies, operations to lessen severe abnormal anxiety by severing nerve connections in the brain, resulted in improvement only half the time, and turned many patients into human vegetables.

Now, psychosurgery appears to be undergoing a renaissance. Though various old-style lobotomies have been abandoned, some doctors are turning once more to surgery to control the emotions. Using newly developed or refined techniques, they have been operating on areas of the brain believed to control specific emotions or responses. Furthermore, they seem to be meeting with some success.

Aggression. What has made this revival possible is a better understanding of the brain itself. As neurologists recognized the drawbacks of lobotomy, they began to shift their attention to the limbic system (which has diffuse interconnections throughout the brain), theorizing that it was somehow connected with mood and behavior. Others found that psychomotor epilepsy--a condition that can result from injury and makes some of its victims violently and uncontrollably aggressive--is often accompanied by the presence of tiny epileptic foci, or small scars, in the temporal lobe. Some doctors concentrated on the amygdala, a small, almond-shaped body whose removal appears to curb aggressive behavior.

This knowledge led to a whole series of new operations. Dr. Glenn Meyer, a University of Texas neurosurgeon, reports good results with a process called cingulotomy. Boring holes in the skull, he uses an electric current to cauterize and destroy bundles of nerve cells that connect various parts of the limbic lobe, or feeling brain. Performed on 59 patients, some of them schizophrenics or chronic alcoholics, the operation has produced a vast improvement in half, slight improvement in a fourth and no detectable change in the others.

Dr. Vernon Mark and Dr. Frank Ervin, of Harvard Medical School, use a different operation. Part of the amygdala was removed in 13 patients, all of whom suffered from periodic seizures of violent, even homicidal rage. One of the patients has had no rage attacks or seizures in more than three years, four have had only mild attacks, and one has apparently not improved; it is too early to assess the results in the other seven cases. Dr. Keiji Sano, head of neurosurgery at Tokyo University School of Medicine, uses a similar procedure on the hypothalamus. All of his patients were children with serious brain damage and uncontrollably violent behavior; out of 56, all but a few became relatively calm.

Most of the doctors who perform psychosurgery are enthusiastic about it but believe it is a desperation measure. Many agree with Dr. H. Thomas Ballantine Jr. of Massachusetts General Hospital that "the brain is no longer a sacred organ, excluded from surgical therapy because it supposedly houses the human soul." But few believe that psychosurgery should be performed casually.

Dr. Theodore Kurze, chief of neurosurgery at Los Angeles County-University of Southern California Medical Center, feels that such operations should be attempted only after more conventional approaches like psychiatry, shock treatment and drugs have failed to help the patient, and then only on patients who are dangerous to others or themselves. He also thinks such operations are justifiable to help patients to bear the pain of incurable diseases like cancer. "It makes the patient suffer less," he says, "but it's very disturbing because some of these procedures change the personality."

There are those who believe that brain surgery has sinister implications. Dr. Peter Breggin, a Washington, D.C., psychiatrist, thinks that any operation that alters the personality partially kills the individual and should therefore be outlawed. He also suggests that doctors are operating on the emotions, indiscriminately calming down prisoners, mental patients and hyperkinetic children to make them easier to handle, and tranquilizing neurotic housewives.

But doctors are fully aware of the potential dangers and abuses of psychosurgery; some reputable neurosurgeons avoid it entirely. Mark and Ervin operate on fewer than 1 % of the patients referred to them for that kind of operation. As a further safeguard, some hospitals have committees to screen applications for any psychosurgery.

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