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J Neurol Neurosurg Psychiatry 63:701-705 doi:10.1136/jnnp.63.6.701
  • Editorial

Neurosurgery for psychiatric disorders

  1. F OVSIEW
  1. Clinical Neuropsychiatry Service
  2. Department of Psychiatry
  3. University of Chicago, Chicago, USA
  4. Section of Neurosurgery
  5. Department of Surgery
  6. University of Chicago, Chicago, USA
  1. Dr Fred Ovsiew, Department of Psychiatry MC3077, University of Chicago Hospitals, 5841 S Maryland, Chicago, IL 60637, USA. Telephone 001 773 702 3770; fax 001 773 702 6454; email f-ovsiew{at}uchicago.edu
  1. D M FRIM
  1. Clinical Neuropsychiatry Service
  2. Department of Psychiatry
  3. University of Chicago, Chicago, USA
  4. Section of Neurosurgery
  5. Department of Surgery
  6. University of Chicago, Chicago, USA
  1. Dr Fred Ovsiew, Department of Psychiatry MC3077, University of Chicago Hospitals, 5841 S Maryland, Chicago, IL 60637, USA. Telephone 001 773 702 3770; fax 001 773 702 6454; email f-ovsiew{at}uchicago.edu

    Daring must be an inborn trait. Egas Moniz, the neurologist who extrapolated from the abolition of experimental neurosis in two chimpanzees to the invention of a procedure to ablate pathways of the frontal lobes in mentally ill human beings, had already developed angiography and spent time in jail for opposition to the Portugese monarchy1 . Such a man could write, in recording the results in the first 20 cases of frontal leucotomy, that the procedure was highly effective and “always safe”.2

    But Moniz’s may have been daring whose time had come. Burckhardt, a Swiss psychiatrist, had operated on six patients some 40 years earlier.3 He had reasoned that destruction of the sites responsible for mental symptoms, such as the auditory centres in the case of hallucinations, or the tracts conducting their abnormal influences on other structures, would ameliorate mental disorder. A brief vogue of surgical intervention for general paresis of the insane had occurred at about the same time.4 But Moniz reported frontal leucotomy in 1936, a year before Klüver and Bucy5described the emotional and behavioural changes due to temporal lobectomy and Papez6 published his “proposed mechanism of emotion”. Perhaps the time was ripe for a psychiatric treatment based on a theory of the cerebral mechanism of mental illness.

    Indeed, Moniz devoted the bulk of his 1936 essay to an explication of his theory of cerebral function in mental disorders.7 He thought that “there are no cellular areas in the brain that are assigned specifically to a determined psychic manifestation”. Rather, mental functions, “even the simplest ones, originate from the activity of celluloconnective groups of different parts of the central nervous system”. In other words, a network model of higher functions—more modern in conception than the localisationist/associationist model of Burckhardt’s work—underlay Moniz’s …