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....