PSYCHOSURGERY

MAIN COMPONENTS: Early

**Early procedures:**

* ==frontal lobes== of brain thought to be involved in __impulse control & mood regulation__ so EPs aimed to __relieve__ ppl. of distressing thoughts & beh. by __cutting connections between frontal lobes & rest of brain__
* ==prefrontal lobotomy:==
* surgical procedure involving __selective destruction of nerve fibres__ in FL.
* developed by ==Egas Moniz== (1930s)
* __drilling small hole either side of skull__ & inserting ==ice-pick== like instrument - __destroy nerve fibres__ underneath
* later refined - ==leucotomy: prefrontal leucotomy==
* ==wire loop== that could __cut into white matter__ & sever nerve fibres
* 1940s/50s: ==transorbital lobotomy==
* ==walter freeman==
* give patient local anaesthetic & inserting ice-pick like instrument at top of eye sockets - move it around to destroy connection in FL

MAIN COMPONENTS: Modern

**Modern procedures:**

* specialists developed more sophisticated psychosurgical procedures to __treat mental disorders__ e.g. OCD, depression - when __other treatments failed__
* brain scans (MRI) can be used to __pinpoint exact locations__ within brain to sever precise connections
* e.g. an area deep in brain aka ==cingulate== monitors & evaluates external stimuli & selects an appropriate emotional response
* scans shown ppl. w/ OCD have __increased activity__ in this area
* ==bilateral cingulotomy:==
* __reduces activity of cingulate__ in both hemispheres
* heating up fine ==wire electrode== & burning away tissue or __non-invasive tool__ ==__gamma knife__== - focus beams of radiation at target site
* ==capsulotomy:==
* __insert probes__ through top of skull & down to capsule - region near ==hypothalamus== part of brain’s reward system & involved in repetitive beh.
* tiny portions of tissue = burnt away w/ heated probes & OCD symptoms are __reduced__
* ==DBS:==
* electrodes are inserted & __remain in brain__ - powered by battery pack underneath collarbone
* targets ==area 25== - important component of moods, relatively overactive when depressed, continued stimulation makes ppl. feel better

Describe effectiveness of PS

* EP effective eliminating symptoms but cost of turning ppl into zombies
* MP more successful:
* cingulotomy effective 56%
* capsulotomy 67% of OCD patient
* strength - last resort for patients for whom all other treatments have failed
* only approx. 25 patients treated this way per yr in USA
* last resort - no suitable trials to compare effectiveness rates w/ other therapies
* difficult to draw valid concs. abt. effectiveness
* future directions look promising
* e.g. DBS used as research tool - provide R w/ info. other scanning methods cannot
* can give precise info regarding when & where certain activity is occurring in brain
* strength - other scanning methods cannot provide both pieces of info.

Describe side effects of PS

* EP had severe & disabling SEs
* e.g. lobotomies - fatality rate of 6% left many zombie like (lack emotional response) & often cause brain seizures
* problem - created worse problems than it solved
* decreases effectiveness

Does PS solve the cause or symptom?

* cause of disorder is addressed by PS rather than suppression of symptoms
* if cause = malfunction in specific region of brain - by altering the way area functions through PS, removing causes
* advantage - disorder should not return after treatment
* Increases effectiveness

How appropriate is PS?

* limited appropriateness = problem
* e.g. rarely used to treat phobias & not used to treat schizophrenia but there is pressure for research into this
* Szaz (1978) criticised PS generally bcs. he believed that a person’s psychological self is not something physical therefore physical treatments are inappropriate & illegal
* Decreases effectiveness

Describe the amount of patient involvement in PS

* Patients have no involvement in therapy
* they are passive at hands of experts who perform treatment on them e.g. PS
* Limitation - not being involved in their treatment
* no sense of control over their own welfare & cannot do anything themselves to prevent further relapse
* Decreases effectiveness

Describe the ethics of PS

Informed consent:

* early techniques were used in mental asylums & prisons on patients who had not always given VC to operation & debate around consent continues
* e.g. patients w/ severe depression are arguably not in the right state of mind to give IVC - contravenes w/ BPS code of ethics
* in response MHA incorporated more stringent provisions regarding consent to psychosurgical treatment so that those detained under MHA (not committed crime) have same rights to consent as ppl. not detained

Irreversible damage:

* major concern - effects of PS cannot be reversed
* EP resulted in significant changes to patient’s cognitive capabilities such as memory loss & severe blunting of emotions
* following early methods e.g. prefrontal leucotomy - many patients returned to community zombie like
* modern methods reduced risk of severe damage to brain bcs. of techniques that can target precise locations in brain
* however procedures e.g. DBS still carry risks of long-term side effects - still not risk free
* limitations - welfare of patients not being fully protected

What is the conclusion of PS?

* modern techniques - overcome many problems of early techniques
* offers last resort treatment to desperate patients for whom nothing else has worked
* highly invasive, uses still limited, q’s around consent & permanent nature = far from frisk free