Against the Current: Wilder Penfield, the Frontal Lobes and Psychosurgery

Leblanc, Richard

doi:10.1017/cjn.2019.48

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…Women were more frequently subject to leucotomies 7 which might reflect epidemiological differences and possibly societal inequalities. 8,9 This trend included institutions in Canada [10][11][12][13][14] and some cases were related to homosexuality. [8][9][10] The decline of psychosurgery was associated with the emergence of effective treatments such as antipsychotics and was also due to the limited evidence for their use (based on small-scale longitudinal studies), the lack of randomized controlled trials, the absence of clear diagnostic indications for its use, risky procedures, adverse effects, and ethical violations involved in its implementation.…”

Section: Introductionmentioning

confidence: 99%

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Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

et al. 2023

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The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to ‘correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients’ selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

et al. 2023

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“…120 In Japan hadden extreem linkse studenten het ten slotte op Sano gemunt. 121 In Ernst Rodin (1925Rodin ( -2017, hoofd van de neurologische afdeling van de Lafayette Clinic, en psychiater Jacques Gottlieb (1907Gottlieb ( -1979, hoofd van de psychiatrische afdeling en directeur van de Lafayette Clinic, lazen in 1970 het boek Violence and the brain van Ervin en Mark. 123 Ze kwamen samen tot de conclusie dat het telemetrische en psychochirurgische werk van hun collega's therapeutisch interessant zou kunnen zijn voor hun seksueel agressieve patiënten.…”

Section: Een Belangrijke Confrontatie Vond Plaats Tijdens Het Neurolo...unclassified

“…Dat is des te opmerkelijker, omdat ECT de meest effectieve behandeling voor ernstige depressie is. 121…”

Section: Depressieunclassified

“…Wilder Penfield had de periode van blind opereren volgens de methode van Freeman en Watts met lede ogen toegezien. Het leverde volgens hem veel onnodige schade op 121. In samenwerking met psychiater Ewen Cameron behandelde hij in 1944 en 1945 een aantal psychiatrische patiënten met een zogenaamde 'bilateral frontal gyrectomy' in de hoop een techniek te ontwikkelen die even effectief zou zijn als een standaard lobotomie of leukotomie, maar meer functies van de frontaalkwab zou sparen 122.…”

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Elektrisch evenwicht

Linden¹

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This history of deep brain stimulation in psychiatric disorders describes how the idea, technology and scientific and clinical application of deep brain stimulation developed, from the first research with brain electrodes around 1860 to modern therapeutic deep brain stimulation. From 1860, brain researchers knew how to relate specific cortical brain areas to certain (sensory and motor) functions with increasing precision through ablation and electrical stimulation, and neurosurgeons explored the first diagnostic possibilities of cortical electrical stimulation. Between the 1920s and 1950s, backed by unprecedented philanthropic investment, particularly from the Rockefeller Foundation, a scientific psychiatric approach developed in which biological, psychological and social aspects were considered important. From this holistic perspective combined with psychoanalytic insights, doctors and researchers in the 1930s and 1940s tried to understand and improve two important new somatic treatments of the 1930s - electroconvulsive therapy and psychosurgery. From 1948, the first experiments with deep brain stimulation in psychiatric patients took place in the United States. Deep brain stimulation managed to develop into its own experimental field with the support of the American government, but the clinical experiments did not yield unambiguous results. The psychoanalytic interpretation of patients' experiences during stimulation also proved to be difficult. Despite these problems, all stakeholders and institutions believed that deep brain stimulation was a promising therapy. In the 1950s during the Cold War, deep brain stimulation in the United States contributed to the fear of (massive) mind control and behavioural manipulation of civilians. Doctors and researchers had found several brain regions in the midbrain in particular that they could use to influence behaviour of their laboratory animals through deep brain stimulation. In the 1970s, the anti-psychiatric movement strongly protested against electroconvulsive therapy and (plans for) experiments to influence unwanted and/or aggressive behaviour of psychiatric patients and prisoners through psychosurgery and deep brain stimulation. Doctors were, on the contrary, working hard at the time to optimise their psychosurgical procedures, both technologically through the stereotact and neuroanatomically through standardisation of some brain regions relevant to psychopathology. Discussions between proponents and opponents were conducted from strong utopian and dystopian perspectives with overly high expectations of the possibilities of deep brain stimulation. Investigations of the American government in the 1970s revealed a serious lack of national oversight of the above developments. This contributed to new medical-ethical guidelines on informed consent, among other things. However, controversy meant that by the end of the 1970s, psychosurgical procedures, including deep brain stimulation, hardly ever took place, despite new scientific understanding that they could be effective treatments for certain psychiatric patients and could not be used for mind control. During the reintroduction of deep brain stimulation for psychiatric disorders in the late 1990s expectations were again high. This was despite the fact that the treatment had remained virtually unchanged and it was not - and still is not - well understood how it works. The positive results of small-scale experiments were not replicated in better-controlled large-scale effect studies. Unlike in the 1970s, there was relatively little critical discussion.

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The birth of experimental neurosurgery: Wilder Penfield at Montreal’s Royal Victoria Hospital, 1928–1934

Leblanc

2022

Journal of Neurosurgery

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Wilder Penfield is well known as the founder of the Montreal Neurological Institute (MNI), the site of his most important contributions to the investigation and treatment of epilepsy and to our understanding of the structure-function relationship of the brain. The seeds of the MNI were sown 6 years before its opening in 1934, when Penfield accepted the position of head of the Subdepartment of Neurosurgery at McGill University’s Royal Victoria Hospital (RVH). Penfield took this position because of the facilities made available to him to pursue the neuropathological research that he had undertaken with Pío del Río Hortega in Madrid, and to continue his investigation into the nature and treatment of posttraumatic epilepsy that he began with Otfrid Foerster in Breslau. Penfield and his first neurosurgical research fellows Joseph Evans, Jerzy Choróbski, Nathan Norcross, Theodore Erickson, Isadore Tarlov, and Arne Torkildsen studied the substrate of focal epilepsy, the innervation of cortical arteries, the function of the diencephalon, the microscopic structure of spinal nerve roots, and the ventricular system in health and disease. In his 6 years at the RVH, Penfield and his fellows effected a paradigm shift that saw neurosurgery pass from empirical practice to scientific discipline.

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Against the Current: Wilder Penfield, the Frontal Lobes and Psychosurgery

Cited by 3 publications

References 16 publications

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

Elektrisch evenwicht

The birth of experimental neurosurgery: Wilder Penfield at Montreal’s Royal Victoria Hospital, 1928–1934

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