2

Psychosurgery has a controversial history and despite modifications still raises serious questions about benefit, risks, and the adequacy with which consent is obtained. Its continued use is defended by references to the "therapeutic imperative" to do something in the case of psychiatric patients who have not responded to other forms of treatment, and the evidence that some patients see improvement in their symptoms following surgery.1

It seems that for very severe cases of epilepsy this procedure is still considered and possibly used, according to this neurosurgery study of 2004 Temporal lobotomy in the surgical management of epilepsy, but I'm not sure if that's really the same procedure as the transorbital lobotomy used in psychosurgery.

While I believe that medical professionals try within their best abilities to diagnose and treat patients at best. Apparently in some cases, as a matter of further damage control measures need to be taken. Yet, the measure of likely doing permanent damage to a brain with such procedure seems barbaric. Is this procedure therefore medically considered ethical and what checks and balances are in place before moving forward with such a procedure?

Lastly, I can imagine that in some cases (such as epilepsy) modern Deep Brain Stimulation techniques might be the preferable (less permanent) way to go. Can DBS possibly completely eradicate the need for lobotomies in that case or even in all cases where lobotomies would be considered?


1 https://en.wikipedia.org/wiki/Psychosurgery#Ethics

  • Good question Bob. You say lobotomies are barbaric; I’m just curious why removal of a lobe of cerebral cortex might be considered more barbaric than other neurosurgery if other treatments have failed. I will have a look at the evidence - I have certainly heard of occasional temporal lobotomies for refractory epilepsy. I agree that “psychosurgery” is more dodgy ethical territory - especially if a patient is not capable of valid informed consent. – Chris Dec 2 '19 at 11:53
  • @Chris Thanks. I understand the proof-based approach but as I have a technical, not medical background it is hard to imagine that anno 2019 we would not have sufficient measurement devices for diagnosing (a technical issue with a brain), computing power to analyse the massive amounts of data from such scans and any form of (spinal cord) stimulation systems to basically surpress, reverse or "retrain" the brain into "normal", healthy patterns. Additionally, it sounds a bit like a death sentence, once the damage is done, there is no way back. I doubt enough is tried before considering this. – Bob Ortiz Dec 2 '19 at 12:25
  • Yes, I’m very uncomfortable with the idea of brain surgery for mental illness. As far as I know, there is now very specific surgery in cases of refractory epilepsy, where they map the brain to find the focus of the epilepsy and then excise it in a much more minimal and conservative way. You’re right that with a lobotomy there would be some irreversible loss of function and it would be a rare case indeed where someone might find the procedure worth those risks. – Chris Dec 2 '19 at 12:42
  • @BobOrtiz I think you completely misinterpret the current technology of brain stimulation. We do do an awful lot of data analysis prior to epilepsy surgeries, to find exactly which part of the brain to remove. Epilepsy does a lot of damage to the brain, and seizure foci may not even be all that functional. Surgery is highly preferable to allowing continued seizures which can lead to further brain damage and death. I'll be happy to write up a full answer when I get a chance, but in the meantime it might be worth rewriting your answer to be a bit less charged. – Bryan Krause Dec 2 '19 at 21:15
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    Let us continue this discussion in chat. – Bob Ortiz Dec 2 '19 at 21:44

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