neuroethics

From my long disappearance from the interwebs realm, I learned a lot about neurosurgery. I learned that the frontal lobotomy still taints the name of neurosurgery to this day, which is kind of why the term "psychosurgery" isn't used anymore (surgery to alter behavior rather than surgery to alter a dysfunctional brain). A brain scan of a Freeman-Watts frontal lobotomy (note the degeneration of frontal tissue) and a well-known case of a 12-year old receiving the rather crude "ice pick" transorbital frontal lobotomy:




The frontal lobotomy has the rather disgusting history of being blown out of proportion as one of those cure-alls for psychiatric patients. Moniz invented the procedure and squeezed a Nobel out of it, but never intended this technique to be used like Freeman & Watts adopted it for, which was essentially to slice and dice the white matter connections (actually in the end they just cut anything in the way) in the frontal lobes, strongly affecting many structures including the limbic system. Essentially, whether you were suffering from schizophrenia or your mom just found you intolerable (like that 12-year old), you'd be recommended for a frontal lobotomy that would change your personality and emotionally blunt you forever.

As a result, both the general public and clinicians are hesitant to give our neurosurgery, and it is generally saved as a last-resort measure with intensive screening that goes on prior to approval. It's funny though because in neurology, many clinicians are extremely hesitant about giving a psychiatric patient a neurosurgical intervention - for them they see a psychiatric illness as a disease state of the mind, and not of the brain. Psychiatrists, on the other hand, are glad to recommend for surgery, knowing full well that these disorders are biologically based. Perhaps this is why neurosurgery for somatic disorders such as Parkinson's Disease are rather ho-hum, while if you say to someone you can get surgery to cure your OCD, it might come as more of a surprise.

So then I ask, what is the personality? Is all neurosurgery psychosurgery? I read this paper by Walter Glannon (2006) who posed, "for the patients who experience significant memory loss or personality change aas a result of the procedure, the cure may come at the cost of their identities, their selves. In these metaphysical terms, the cure may seem worse than the disease." These procedures often come with frontal disinhibition, minor personality alterations - some are transient, some are persistent sequelae. Is any neurosurgery appropriate, when we are effectively changing who someone is? Or do the benefits of neurosurgery outweigh the risk, that even though a person may be different at least they get to live a semi-normal life free of psychiatric illness?

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Anyways, if you'd like to read my paper on 'Theoretical foundations underlying neurosurgical interventions for the treatment of intractable OCD', you can find it >here. Don't worry, I won't blame you if you don't read it.

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Glannon, W. (2006) Neuroethics. Bioethics, 20(1), p. 37-52.