PHILOSOPHERS TELL US THAT THE HORIZON OF KNOWLEDGE IS always out of
reach. How far out of reach is the practical question and the source of
all dilemmas having to do with treating the sick. Do doctors wait until
they really know -- or know more -- before they try this treatment or that?
If they wait, will it mean more suffering for a patient? Is suffering
tolerable if there are means of relieving it? Are some risks ever worth
taking? Are some ever not?
The treatment dilemma posed by psychosurgery -- surgery to treat
psychiatric disorders -- is this: Experts know something about mental
illness and about operations that can help some patients; but they don't
know enough to completely assure patients, families, each other, or the
rest of us that surgery is the best, or proper, course. That it is ever
worth the risk.
Perhaps they can never know enough. Driving the demand for, and use
of, psychosurgery is the belief -- some call it the pretension -- that the
human brain can understand and repair its own mind. And more, that
scientists will come to understand the mind and brain better by studying
it the way they study it now -- anatomically, biochemically, and
empirically, by analyzing and observing its parts and the things it
does.
Publicly, the subject of psychiatric brain surgery hasn't been
discussed since 1978, when the National Commission for the Protection of
Human Subjects of Biomedical and Behavioral Research issued a report
saying that psychosurgery had a deservedly bad reputation for wretched
excess. But the report also documented successes, declared that
psychosurgery was not the unmitigated horror its critics had labeled it,
and decreed that -- with strict regulations and safeguards -- psychosurgery
was acceptable for certain cases and that more research and good
record -- keeping were needed.
As a result, perhaps, psychosurgery -- albeit under new names, more
refined and more selective than the lobotomies that psychiatrists and
neurosurgeons abandoned more than 30 years ago -- is still very much
around. Actually, it never completely went away.
Although the number of procedures have plunged since the heyday of
psychosurgery (50,000 estimated in the United States alone between 1939
and 1960), there are still at least 200 to 300 openly declared
psychosurgeries labeled as such each year being performed by a few dozen
surgeons here and abroad. Reports are trickling in of more operations
being done in South America and the developing world. And if we count the
operations that affect the "psyche" but disclaim changes in mood and
behavior as primary goals, the total is certainly in the thousands and
growing.
Psychosurgery has now greatly evolved. Surgeons no longer destroy
large amounts of brain tissue in futile efforts to "cure" schizophrenia
and neurosis. Instead, they take pinpoint aim at millimeter-long clusters
of cells to stop suicidal depression, disable obsessive-compulsive
disorders, cripple anxiety, and smother the uncontrollable rage and
aggression that keep sick people in locked wards. They go after
destructive behavior that accompanies organic diseases of the body and
brain.
The great promise of psychosurgery is not without critics. For
some, the abuses of the past remain open sores on the national
conscience. Some see it as Frankenstein-style science. Others dismiss the
whole idea as plain goofy -- based on oversimplified views of human
behavior and emotional chaos. And certain religious groups, such as the
Scientologists, brand psychosurgery and all physical treatment of mental
illness as assassination attempts on the mind.
Practically nothing has been written to update the general public
in the last 10 years about the new operations, their availability, and
any ongoing problems they pose. While psychosurgery's past excesses have
been forever characterized by Ken Kesey's Randle McMurphy in One Flew
over the Cuckoo's Nest, the conventional wisdom of that era is now
vulnerable to new knowledge and rising demands for help from the mentally
ill and their advocates. Moreover, today, as in the past, the need to
balance treatment with protection from abuse is especially important for
the ill who are homeless, poor, female, children, imprisoned, and
minorities: They were historically the guinea pigs of psychosurgery and
could become so again. On the other hand, they could become beneficiaries
of a therapy that still has promises to keep.
They could be Matthew.
I must tell you that I am very afraid of this man. Even under guard
he is unpredictable, very scary. He is like a feral animal, a cat. He
raises his arms and dives into people. He could kill.
-- Matthew's neurosurgeon, 1990
The story of Matthew frames much of the reasonable and unreasonable
debate over the need for psychosurgery and its potential abuse. Matthew
has a social history of violent behavior and a medical history that makes
modem psychosurgery a last -- and long delayed -- hope. The following
excerpts from a letter written on January 4, 1990, to Matthew's lawyer
from a neurologist describe the cold, clinical details:
Dear Mr. --
Tags:
bad reputation,
belief,
brain surgery,
dilemma,
horizon,
human brain,
human subjects,
lobotomy,
mental illness,
nam,
neurology,
philosophers,
pretension,
psychiatric disorders,
psychosurgery,
record keeping,
safeguards,
scientists,
strict regulations,
successes,
surgery,
worth the risk,
wretched excess
