Psychosurgery

Psychosurgery, also called neurosurgery for mental disorder, is the neurosurgical treatment of mental illness, and has always been a controversial field of medicine. Its modern history began in the 1880s with the Swiss psychiatrist Gottlieb Burckhardt, and the Portuguese neurologist Egas Moniz developed the operation known as leucotomy in the mid-1930s, for which he was awarded the Nobel Prize in 1949. In the United States the neuropsychiatrist Walter Freeman and the neurosurgeon James Watts devised a standard prefrontal version of the operation that they named lobotomy. Use of psychosurgery declined through the 1950s, and by the 1970s the Freeman-Watts style operation had become rare, though other forms continued on a much smaller scale. Some countries have abandoned psychosurgery altogether; in others, including the United States and the United Kingdom, it is performed at only a few centers, on small numbers of people with depression or obsessive-compulsive disorder, and in some countries also schizophrenia and other disorders. The operation is carried out under general anesthesia using stereotactic methods, destroying or removing a small piece of brain tissue by radiation, heat, freezing, or cutting; the most common current forms are anterior capsulotomy, cingulotomy, subcaudate tractotomy, and limbic leucotomy. About a third of patients show significant improvement in their symptoms, and remaining risks include seizures, incontinence, decreased drive and initiative, weight gain, and cognitive and emotional problems. Interest in the neurosurgical treatment of mental illness has increasingly shifted from destroying brain tissue toward deep brain stimulation, in which implanted electrodes stimulate areas of the brain instead.