A Controversial Past

Abstract

Psychosurgery was born from the need to manage patients suffering from untreatable mental pathologies. In 1935, the Portuguese neurologist Moniz, a pioneer in the field, devised the prefrontal leucotomy, for which he received the Nobel Prize a decade and a half later. Psychosurgery reached its apex in the first half of the 1950s with over 60,000 interventions performed throughout the world. Thereafter, the evolution of frontal lobe surgery was shaped by two trends: simplification and greater selectivity of lesions. The first, simplification, was initiated by the American Walter Freeman who popularized the transorbital lobotomy as a procedure performed outside the operating room thus making it more broadly available. The second, greater selectivity of lesions, stemmed from a desire to reduce the serious negative effects, cognitive alterations, and personality changes associated with previous techniques. Some of these more targeted procedures, such as the capsulotomy and the cingulectomy, are still relevant today. After 1955, following the advent and successes of psychopharmacology, the number of interventions dropped significantly. By the end of the 1960s though, a lack of effective medication for certain patients along with improved surgical methods, notably stereotaxy, led to renewed interest in psychosurgery. This revival was short-lived: abuses, an already wary public, and fears of ``psycho-enforced'' authoritarianism led to strict regulations and even bans in several countries. Since 1999, the success of deep brain stimulation, a new reversible and adaptable therapy devised for the treatment of Parkinson's disease, has offered the hope of new forms of treatment for patients with severe psychiatric disorders like OCD. Today, these new neuromodulation-based treatments are reshaping the field of psychosurgery.