A Brief History of Neurosurgery for Mental Disorder

This information is from David Christmas' thesis, the full version of which is available on the site.

Sections

3.1Preface
3.2A Prehistory of NMD
3.3The Story of Phineas Gage
3.4The Nineteenth Century: Gottleib Burckhardt
3.5The 20th Century
3.6Psychosurgery in Europe
3.7The decline of lobotomy
3.8A renaissance (of sorts)
3.9Definitions of Neurosurgery for Mental Disorder
3.10Psychosurgery under the spotlight
3.11Conclusions

The evil that that men do lives long after them;
The good is oft interred with their bones.

Antony, in Julius Caesar Act III Scene 2, by William Shakespeare

Preface

The convention regarding terminology has been one such that early (i.e. before stereotactic methods) references to psychiatric surgery adopt the contemporary title of the time, i.e. ‘psychosurgery’. Later procedures such as cingulotomy and capsulotomy are referred to as ‘NMD’ to reflect the change both in technique and thinking that accompanied these advances.

Traditionally, the history of Neurosurgery for Mental Disorder (NMD) begins with trepanation and at some point crosses paths with the story of Phineas Gage. Both are worthy of a mention in the preface. We should note that the history of NMD is not a smooth continuum of progress, but instead is simply one of recognisable steps.

Trepanation is not the starting point because it initiated a gradual evolution of surgical activity culminating in modern neurosurgery, but because we have clear archaeological evidence of such a human endeavour occurring early on in society and it give us an intriguing, and time-locatable point with which to begin the story. The two practices were guided by very different belief systems and medical contexts, and it would be foolish to link such early ‘surgical’ practices with those that emerged in the 19th and 20th Centuries.

The inclusion of Phineas Gage is more problematic. There is little to suggest that he influenced the development of psychosurgery to any degree yet his story refuses to go away. Reasons for this are discussed later in Section 3.3, but perhaps his oddly morbid tale simply appeals to us all.