Review articleFrom psychosurgery to neuromodulation and palliation: history's lessons for the ethical conduct and regulation of neuropsychiatric research
Section snippets
Optimism tempered by history
As we contemplate the emerging era of neuromodulation and imagine the utility of deep brain stimulation for disease entities in neurology and psychiatry, our enthusiasm is immediately tempered by history. Just a generation ago, other confident investigators were heralding invasive somatic therapies like prefrontal lobotomy to treat psychiatric illness. That era of psychosurgery ended with widespread condemnation, congressional calls for a ban [3], and a vow that history should never repeat
When psychosurgery was therapy
It is one of those strange paradoxes in history that 2 years after the articulation of the Nuremberg Code and the development of the sterotactic technique, Egas Moniz won the Nobel Prize for the development of the prefrontal leukotomy [22], [23]. He began his work in 1935 [24], just 3 years after the initiation of the Tuskegee Syphilis Study [25]. Both the Tuskegee Syphilis Study and psychosurgery would be criticized decades later as an abrogation of patient rights invoking the same ethical
Psychosurgery and the body politic
Not even chlorpromazine was enough of an advance to remove psychosurgery entirely from therapeutic consideration in the 1960s and early 1970s. Some physicians, such as the Harvard neurosurgeon H. Thomas Ballantine, Jr, maintained that psychosurgical procedures like cingulotomy retained a role in conjunction with standard psychiatric care for refractory patients. He articulated guidelines to regulate the judicious use of the procedure for the relief of the patient's suffering and improvement of
Regulatory bioethics: the National Commission's report on psychosurgery
Elliot S. Valenstein, commenting on this period, observed that “The coalition of civil-rights, anti-psychiatry, and minority groups opposed to psychosurgery proved to be much more effective politically than the earlier opposition to psychosurgery from within the medical profession had been” [95]. Indeed, public sentiment, catalyzed in part by an organized and growing scholarly bioethics movement, led the National Commission for the Protection of Human Subjects of Biomedical and Behavioral
Summary: fairness, palliation, and psychosurgery
Moving forward, we need to create regulatory mechanisms that will balance human subject protections for individuals with intractable neurologic and psychiatric disorders against scientific progress and access to potentially beneficial interventions. This fiduciary obligation of practitioners, clinical investigators, and public policy makers can be facilitated by building on the yet uncompleted efforts of the 1977 National Commission Report on Psychosurgery. This report should serve as a
Acknowledgements
The author thanks Nicholas D. Schiff, Benjamin D. Greenberg, Franklin G. Miller, G. Rees Cosgrove, and Amy B. Ehrlich for their helpful insights, Diane Richardson of the Oskar Diethelm Library of the Payne Whitney Clinic and Chris McKee of the Hastings Center Library for their archival assistance, and Ali R. Rezai and Alim Benabid for the opportunity to present earlier versions of this paper to the neuromodulation meetings held in Aix-Les-Bain, France, in January and June 2002.
References (116)
- et al.
Medical and surgical treatment of obsessive-compulsive disorder
Neurol Clin
(1997) The Nobel chronicles. 1949: Walter Rudolf Hess (1881–1973) and Antonio Egas Moniz (1874–1955)
Lancet
(1999)- Moniz E. How I came to perform prefrontal leucotomy. In: Proceedings of the First International Congress of...
Teacher and student
Aequanimitas and other addresses
(1904)Congress weighs 2 measures
JAMA
(1973)- et al.
Deep brain stimulation in neuropsychiatric disorders
Curr Psychiatr Rep
(2001) - et al.
Does vestibular stimulation activate thalamocortical mechanisms that reintegrate impaired cortical regions?
Proc R Soc London B Biol Sci
(1999) - et al.
Developing prosthetics to treat cognitive disabilities resulting from acquired brain injuries
Neurol Res
(2002) A proposed ethical framework for interventional cognitive neuroscience: a consideration of deep brain stimulation in impaired consciousness
Neurol Res
(2000)- Carmichael M. Healthy shocks to the head. Newsweek June 24, 2002. p....
Great and desperate cures: the rise and decline of psychosurgery and other radical treatments for mental illness
Functional neurosurgery for psychiatric disorders: a historical perspective
Stereotact Funct Neurosurg
Neurosurgical treatment of psychiatric illness
Psychiatr Clin North Am
The continuing evolution of psychiatric neurosurgery
CNS Spectrums
Deep brain stimulation reduces symptoms of Parkinson disease
Cleve Clin J Med
Health-related quality of life in patients with advanced Parkinson's disease treated with deep brain stimulation of the subthalamic nuclei
Mov Disord
Truth telling and reciprocity in the doctor-patient relationship: a North American perspective
Egas Moniz, pioneer of angiography and leucotomy
Mt Sinai J Med
Prefrontal leucotomy in the treatment of mental disorders, 1937
Am J Psychiatry
Bad blood, the Tuskegee Syphilis experiment
The mystery of angiography and the “unawarded” Nobel Prize: Egas Moniz and Hans Christian Jacobaeus
Neurosurgery
A historical perspective: the rise and fall of prefrontal lobotomy
Adv Neurol
Egas Moniz and the origins of psychosurgery: a review commemorating the 50th anniversary of Moniz's Nobel Prize
J Hist Neurosci
Portrayal of lobotomy in the popular press: 1935–1960
J Hist Neurosci
An historical review of somatic therapy in psychiatry
Am J Psychiatry
Reminiscences: 1938 and since
Am J Psychiatry
Prefrontal leucotomy in the treatment of mental disorders. 1937
Am J Psychiatry
Lobotomy: a personal memoir
Pharos
Neurosurgical treatment of certain abnormal mental states
JAMA
American men of medicine
Last resort, psychosurgery and the limits of medicine
Frontal leukotomy and related psychosurgical procedures in the era before anti-psychotics (1935–1954): a historical overview
Am J Psychiatry
A rating scale analysis of the clinical effects of lobotomy
Am J Psychiatry
Treatment in psychiatry
Proceedings of the Second Research Conference on Psychosurgery. Public Health Service Publication No. 156
Clinical observations concerning schizophrenic patients treated by prefrontal leukotomy
N Engl J Med
Psychiatric surgery 1935–1973: evolution and current perspectives
Can Psychiatr Assoc J
Frontal lobotomy: clinical experience with 107 cases in a state hospital
Am J Psychiatry
Functional neurosurgery for psychiatric disorders: a historical perspective
Sterotact Funct Neurosurg
Symposium on lobotomy
Am J Psychiatry
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2022, Progress in Brain ResearchCitation Excerpt :It was recommended to establish for each hospital where psychosurgery is performed consent review boards (a) whose members are not members of the team treating the specific case and (b) whose members include legal and moral experts (Neville, 1975, p. 110). In 1974 the National Commission for the protection of human subjects of biomedical and behavioral research was created in USA by the National Research Act in the wake of revelations about the Tuskegee Syphilis Study and other research ethics abuses (Fins, 2003). It recommended strict oversight of psychosurgery by specially constituted institutional review boards (IRBs) with a subcommittee of Department of Health, Education, and Welfare (DHEW)-sanctioned experts or consultants in neurology, neurosurgery, psychology, and psychiatry.
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