Editing Psychosurgery (section)

==History==
{{main|History of psychosurgery}}

===Early psychosurgery===

Evidence of [[trepanation|trepanning]] (or trephining)&mdash;the practice of drilling holes in the skull&mdash;has been found in a skull from a Neolithic burial site in France, dated to about 5100 BC although it was also used to treat [[Blunt trauma#Blunt cranial trauma|brain cranial trauma]]. There have also been archaeological finds in South America, while in Europe trepanation was carried out in classical and medieval times.<ref name="Robison Surgery">{{cite journal|last=Robison|first=RA|author2=Taghva A |author3=Liu CY |author4=Apuzzo ML |title=Surgery of the mind, mood and conscious state: an idea in evolution|journal=World Neurosurg|date=2012|volume=77|issue=5–6|pages=662–86|doi=10.1016/j.wneu.2012.03.005 |pmid=22446082}}</ref>
The first systematic attempt at psychosurgery is commonly attributed to the Swiss psychiatrist [[Gottlieb Burckhardt]].<ref>For example,
{{Cite book
| chapter = A psychosurgical chapter in the history of cerebral localization: the six cases of Gottlieb Burkhardt
| location = Hove
| publisher = Psychology Press
| isbn = 978-0-86377-395-2
| last1 = Whitaker
| first1 = H. A.
| last2 = Stemmer |first2=B.
| last3 = Joanette |first3=Y.
| editor1-last = Code |editor1-first=Christopher
| editor2-last = Wallesch |editor2-first=C.-W.
| editor3-last = Joanette |editor3-first=Y.
| editor4-last = Roch |editor4-first=A.
| title = Classic Cases in Neuropsychology
| year = 1996
| pages = [https://archive.org/details/classiccasesinne0002unse/page/276 276]
| chapter-url = https://books.google.com/books?id=59pMz9m83yQC&pg=PA276
| url-access = registration
| url = https://archive.org/details/classiccasesinne0002unse/page/276
}}</ref> In December 1888 Burckhardt operated on the brains of six patients (one of whom died a few days after the operation) at the Préfargier Asylum, cutting out a piece of [[cerebral cortex]]. He presented the results at the Berlin Medical Congress and published a report, but the response was hostile and he did no further operations.<ref name="Kotowicz">{{Cite journal | last1 = Kotowicz | first1 = Z. | year = 2005 | title = Gottlieb Burckhardt and Egas Moniz – two beginnings of psychosurgery | journal = [[Gesnerus]] | volume = 62 | issue = 1–2| pages = 77–101 | doi = 10.1163/22977953-0620102004 | pmid = 16201322 | doi-access = free }}</ref>
Early in the 20th century, Russian neurologist [[Vladimir Bekhterev]] and Estonian neurosurgeon [[Ludvig Puusepp]] operated on three patients with mental illness, with discouraging results.<ref name="Kotowicz"/>

===1930s–1950s===

Although there had been earlier attempts to treat psychiatric disorders with brain surgery, it was Portuguese neurologist [[Antonio Egas Moniz|Egas Moniz]] who was responsible for introducing the operation into mainstream psychiatric practice. He also coined the term psychosurgery.<ref name="Kotowicz"/> Moniz developed a theory that people with mental illnesses, particularly "obsessive and melancholic cases", had a disorder of the [[synapse]]s which allowed unhealthy thoughts to circulate continuously in their brains. Moniz hoped that by surgically interrupting pathways in their brain he could encourage new healthier synaptic connections.<ref name="Moniz">{{cite book |first=E. |last=Moniz |year=1956 |contribution=How I succeeded in performing the prefrontal leukotomy |editor-first=A. M. |editor-last=Sackler |display-editors=etal |title=The great physiodynamic therapies in psychiatry: an historical reappraisal |location=New York |publisher=Hoeber |pages=131–137}}</ref> In November 1935, under Moniz's direction, surgeon Pedro Almeida Lima drilled a series of holes on either side of a woman's skull and injected [[ethanol]] to destroy small areas of subcortical white matter in the [[frontal lobe]]s. After a few operations using ethanol, Moniz and Almeida Lima changed their technique and cut out small cores of brain tissue. They designed an instrument which they called a leucotome and called the operation a [[leucotomy]] (cutting of the white matter).<ref name="Moniz"/> After twenty operations, they published an account of their work. The reception was generally not friendly but a few psychiatrists, notably in Italy and the US, were inspired to experiment for themselves.<ref name="Moniz"/>

In the US, psychosurgery was taken up and zealously promoted by neurologist [[Walter Freeman (neurologist)|Walter Freeman]] and neurosurgeon [[James W. Watts|James Watts]].<ref name="Heller">{{Cite journal | doi = 10.1227/01.NEU.0000240227.72514.27 | last1 = Heller | first1 = A. C. | last2 = Amar | year = 2006 | first2 = Arun P. | last3 = Liu | first3 = Charles Y. | last4 = Apuzzo | first4 = Michael L. J. | title = Surgery of the mind and mood: a mosaic of issues in time and evolution | journal = Neurosurgery | volume = 59 | issue = 4| pages = 720–740 | pmid=17038938| s2cid = 22958424 }}</ref> They started a psychosurgery program at [[George Washington University]] in 1936, first using Moniz's method but then devised a method of their own in which the connections between the prefrontal lobes and deeper structures in the brain were severed by making a sweeping cut through a burr hole on either side of the skull.<ref name="Heller"/> They called their new operation a [[lobotomy]].<ref name="Moniz"/>

Freeman went on to develop a new form of lobotomy which could be dispensed without the need for a neurosurgeon. He hammered an ice pick-like instrument, an orbitoclast, through the eye socket and swept through the frontal lobes. The transorbital or "ice pick" lobotomy was done under [[local anesthesia]] or using [[electroconvulsive therapy]] to render the patient unconscious and could be performed in mental hospitals lacking surgical facilities.<ref>{{cite book
| last = El-Hai
| first = Jack
| title = The Lobotomist
| publisher = Wiley
| year = 2005
| isbn = 978-0-471-23292-6
| url-access = registration
| url = https://archive.org/details/lobotomistmaveri0000elha
}}</ref> Such was Freeman's zeal that he began to travel around the nation in his own personal van, which he called his "lobotomobile", demonstrating the procedure in psychiatric hospitals.<ref name="abnormal psyc">{{cite book | title=Essentials of Abnormal Psychology |edition=4th | first1=V. Mark |last1=Durand | first2=David H. |last2=Barlow | publisher=Thomson Wadsworth | year=2006 | url=http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24 | access-date=2007-02-13 | archive-date=2007-10-20 | archive-url=https://web.archive.org/web/20071020013459/http://www.wadsworth.com/cgi-wadsworth/course_products_wp.pl?fid=M20b&product_isbn_issn=0534605753&discipline_number=24 | url-status=dead }}</ref> Freeman's patients included 19 children, one of whom was 4 years old.<ref>{{cite journal | doi = 10.1176/appi.ajp.2008.08020174 | last1 = Stewart | first1 = D. G. | last2 = Davis | first2 = K. L. | year = 2008 | title = Images in psychiatry: the lobotomist | journal = American Journal of Psychiatry | volume = 165 | issue = 4| pages = 457–58 | pmid = 18381916 }}</ref>

The 1940s saw a rapid expansion of psychosurgery, in spite of the fact that it involved a significant risk of death<ref name="Tooth">{{cite report |first1=G. C. |last1=Tooth |first2=M. P. |last2=Newton |name-list-style=amp |year=1961 |title=Leucotomy in England and Wales, 1942–54 |location=London |publisher=[[His Majesty's Stationery Office]]}}</ref> and severe personality changes.<ref name="Swayze">{{cite journal | last1 = Swayze | first1 = II |name-list-style=vanc| year = 1995 | title = Frontal leucotomy and related psychosurgical procedures in the era before antipsychotics (1935–54): an historical overview | journal = American Journal of Psychiatry | volume = 152 | issue = 4| pages = 505–515 | pmid = 7900928 | doi=10.1176/ajp.152.4.505| citeseerx = 10.1.1.455.9708 }}</ref> By the end of the decade, up to 5000 psychosurgical operations were being carried out annually in the US.<ref name="Swayze"/> In 1949, Moniz was awarded the [[List of Nobel laureates in Physiology or Medicine|Nobel Prize for Physiology or Medicine]].

Beginning in the 1940s various new techniques were designed in the hope of reducing the adverse effects of the operation. These techniques included [[William Beecher Scoville]]'s [[History of psychosurgery in the United Kingdom#Subcaudate tractotomy|orbital undercutting]], Jean Talairach's [[History of psychosurgery in the United Kingdom#Capsulotomy|anterior capsulotomy]], and Hugh Cairn's [[bilateral cingulotomy]].<ref name="Heller"/> Stereotactic techniques made it possible to place [[lesion]]s more accurately, and experiments were done with alternatives to cutting instruments such as radiation.<ref name="Heller"/> Psychosurgery nevertheless went into rapid decline in the 1950s, due to the introduction of new drugs and a growing awareness of the long-term damage caused by the operations,<ref name="Heller"/> as well as doubts about its efficacy.<ref name="Mashour"/> By the 1970s, the standard or transorbital lobotomy had been replaced with other forms of psychosurgical operations.

===1960s to the present===
During the 1960s and 1970s, psychosurgery became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Particularly controversial in the United States was the work of Harvard neurosurgeon [[Vernon Mark]] and psychiatrist [[Frank Ervin]], who carried out amygdalotomies in the hope of reducing violence and "pathologic aggression" in patients with temporal lobe seizures and wrote a book entitled ''Violence and the Brain'' in 1970.<ref name="Mashour"/> The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures.<ref name="Mashour"/><ref>{{Cite journal | doi = 10.1017/S0269889714000349 | last1 = Casey | first1 = B. P. | title = The surgical elimination of violence? Conflicting attitudes towards technology and science during the psychosurgery controversy of the 1970s | journal = Science in Context | volume = 28 | issue = 1| pages = 99–129 | pmid = 25832572 | date=March 2015| s2cid = 25379245 }}</ref> Since then, a few facilities in some countries, such as the US, have continued to use psychosurgery on small numbers of patients. In the US and other Western countries, the number of operations has further declined over the past 30 years,{{clarify timeframe|date=February 2023}} a period during which there had been no major advances in ablative psychosurgery.<ref name="Sachdev"/>