There is no subject at the interface of law, psychiatry and medical ethics which is more controversial than psychosurgery. The divergent views of the treatment begin with its definition. The World Health Organisation1 and others2 define psychosurgery as the selective surgical removal or destruction of nerve pathways or normal brain tissue with a view to influencing behaviour. However, proponents of psychosurgery demur on the basis that the `modern' treatment is concerned predominantly with emotional illness, without any specific (...) effect upon behaviour. The alternative definition offered is `the surgical treatment of certain psychiatric illnesses by means of localised lesions placed in specific cerebral sites.3It is difficult entirely to accept this definition because, as examined below, scientific psychiatry is not yet in a position to directly treat psychiatric illness solely through surgical intervention. There is no reliable theoretical relationship between particular cerebral sites (which are normal and healthy) and an identifiable psychiatric illness or symptomatology. Given this state of psychiatric understanding, it is misleading to suggest fine distinctions between generalised alteration of behaviour or mood and treatment of an illness. Highly divergent practices and theories (relating to the multiplicity of conditions treated, surgical methods adopted and areas of the brain operated upon) further undermine exaggerated claims that psychosurgery can scientifically `treat' specific illness through precise surgical intervention. Nonetheless, contemporary psychosurgery does not contain quite the same `broadbrush' approach of its ancestors and it can lay some legitimate claim as an effective empirical treatment in narrowly limited circumstances. Major ethical problems still, however, arise and these will be discussed in this article. (shrink)

Deep brain stimulation has recently been identified as the “new frontier” in the surgical treatment of major depressive disorder. Powerful memories of the lobotomy era, however, pose a rhetorical challenge to clinical researchers who wish to make a case for its therapeutic future. For DBS advocates, establishing the relationship between these two treatments is not just a matter of telling a history; it also requires crafting persuasive arguments for the lineage of DBS that relate the new psychosurgery in some (...) way to the old. Working from a rhetorical perspective, this article identifies and analyzes three strategies employed by DBS advocates to manage the memory of lobotomy, which it terms evolutionary, genealogical, and semantic. In conclusion, this article suggests that a rhetorical perspective might be brought to bear on the frequent calls for dialogue with regard to psychosurgery, which are meaningless without attention to the persuasive dynamics such dialogue entails. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older (...) forms of psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

Book reviewed in this article: Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Radical Treatments for Mental Illness. By Elliot S. Valenstein. Ethical Issues in Psychosurgery. By John Kleinig.

ArgumentIn the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more “scientific” understanding (...) and better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable. (shrink)

The paper involves an attempt to draw out the implications of a ‘moderate materialism’ for the understanding of mental illness. The argument of the paper is that once a moderate materialism which navigates carefully between the poles of (materialist) reductionism and dualism has been unpacked, the relations between the manifestations, bases, aetiologies and treatments of mental illnesses emerge as being considerably more complex than is often allowed for. Specifically, the conceptual tools required within a moderate materialist position about the mind (...) allow us to expose potential fallacies in thinking about the nature of mental illnesses, in inferences drawn from these ‘natures’ to ideal modes of treatment, and in inferences drawn from treatment response. It is concluded that moderate materialism undermines the oversimplifications which tend to cloud ‘biophysical versus psychosocial’ debates in the field of psychopathology, in part because psychological change is physiological change, and because physiological change and/or intervention need not ‘cure’ by removing a physiological cause. (shrink)

Between 1935 and 1970, tens of thousands of people worldwide underwent brain operations due to psychiatric indication that were intended to positively influence their mental state and behaviour. The majority of these psychosurgical procedures were prefrontal lobotomies. Developed in 1935, the procedure initially met with fierce opposition, but was introduced in numerous countries in the following decade, and was employed up until the late 1960s. This article investigates why psychosurgery was widely accepted after World War II. It examines the (...) effects it was hoped psychosurgical intervention would have, the undesired outcomes in which the method could potentially result, and the significance these outcomes were given. The analysis of scientific articles of the period as well as one case study show that the goal of the operation was, first and foremost, to help the mentally ill adapt to the social order inside and outside the mental institution. After initial criticism, changes in personality, severe physical side-effects and death were accepted in order to reach this goal. Thus, with psychosurgical intervention the social adjustment of patients, also in their own interest, was rated higher than physical and psychic integrity. This widely held view shows that after World War II a post-bourgeoise order of the subject dominated, according to which an individual was to adapt and to function in the interests of the collective. According to the assumption, the triumph of lobotomy was related to the development of a new conception of the self that made possible a broad implementation of the procedure and that was consolidated through psychosurgery. (shrink)

Neuroimaging, psychosurgery, deep-brain stimulation, and psychopharmacology hold considerable promise for more accurate prediction and diagnosis and more effective treatment of neurological and psychiatric disorders. Some forms of psychopharmacology may even be able to enhance normal cognitive and affective capacities. But the brain remains the most complex and least understood of all the organs in the human body. Mapping the neural correlates of the mind through brain scans, and altering these correlates through surgery, stimulation, or pharmacological interventions can affect us (...) in both positive and negative ways. We need to carefully weigh the potential benefit against the potential harm of such techniques. This paper examines some of these techniques and explores the emerging ethical issues in clinical neuroscience. (shrink)

In the 1940s and 1950s thousands of lobotomies were performed on people with mental disorders. These operations were known to be dangerous, but thought to offer great hope. Nowadays, the lobotomies of the 1940s and 1950s are widely condemned. The consensus is that the practitioners who employed them were, at best, misguided enthusiasts, or, at worst, evil. In this paper I employ standard decision theory to understand and assess shifts in the evaluation of lobotomy. Textbooks of medical decision making generally (...) recommend that decisions under risk are made so as to maximise expected utility (MEU) I show that using this procedure suggests that the 1940s and 1950s practice of psychosurgery was justifiable. In making sense of this finding we have a choice: Either we can accept that psychosurgery was justified, in which case condemnation of the lobotomists is misplaced. Or, we can conclude that the use of formal decision procedures, such as MEU, is problematic. (shrink)

Walter Freeman, the self styled neurosurgeon, became famous (or infamous) for psychosurgery. The operation of frontal leucotomy swept through the world (with Freeman himself performing something like 18,000 cases) but it has tainted the whole idea of psychosurgery down to the present era. Modes of psychosurgery such as Deep Brain Stimulation and other highly selective neurosurgical procedures for neurological and psychiatric conditions are in ever-increasing use in current practice. The new, more exciting techniques are based in a (...) widely held philosophical position on the relationship between the mind, brain and soul, which is the key to ethical debates in this area. Psychosurgery has always posed questions of responsibility, personality, character, identity, spirit, relationship, integrity, and human flourishing and they do not go away when we enter the brave new world of neuroethics and Deep Brain Stimulation. (shrink)

Deep brain stimulation (DBS) is frequently described as a ‘reversible’ medical treatment, and the reversibility of DBS is often cited as an important reason for preferring it to brain lesioning procedures as a last resort treatment modality for patients suffering from treatment-refractory conditions. Despite its widespread acceptance, the claim that DBS is reversible has recently come under attack. Critics have pointed out that data are beginning to suggest that there can be non-stimulation-dependent effects of DBS. Furthermore, we lack long-term data (...) about other potential irreversible effects of neuromodulation. This has considerable normative implications for comparisons of DBS and brain lesioning procedures. Indeed, Devan Stahl and colleagues have recently argued that psychiatric DBS should be subject to the same legal safeguards as other forms of psychosurgery, supporting their position by forcibly criticising the claim that DBS is reversible. In this paper, I respond to these criticisms by first clarifying the descriptive and evaluative elements of the reversibility claim that supporters of DBS might invoke, and the different senses of ‘reversibility’ that we might employ in discussing the effects of medical procedures. I go on to suggest that it is possible to defend a nuanced version of the reversibility claim. To do so, I explain how DBS has some effects that are stimulation dependent in the short term, and argue that these effects can have significant normative implications for patient well-being and autonomy. I conclude that we should not abandon a nuanced version of the reversibility claim in the DBS debate. (shrink)

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson’s disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with other types of psychosurgery. Clinical studies of epileptic patients who have undergone an anterior temporal lobectomy have identified a range of side effects and complications in a number of domains: (...) psychological, behavioural, affective and social. In many cases, patients express difficulty adjusting from being chronically ill to their new status as ‘treated’ or ‘seizure free’. This postoperative response adjustment has been described in the literature on epilepsy as the ‘Burden of Normality’ (BoN) syndrome. Most of the discussion about DBS postoperative changes to self is focused on abnormal side effects caused by the intervention (ie, hypersexuality, hypomania, etc). By contrast, relatively little attention is paid to the idea that successfully ‘treated’ individuals might experience difficulties in adjusting to becoming ‘normal’. The purpose of this paper is (1) to articulate the postoperative DBS psychosocial adjustment process in terms of the BoN syndrome, (2) to address whether the BoN syndrome illustrates that DBS treatment poses a threat to the patient’s identity, and (3) to examine whether the current framework for rehabilitation after DBS procedures should be updated and take into account the BoN syndrome as a postoperative self-change response. (shrink)

Neurosurgery for psychiatric disorders, also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and (...) to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law, what types of regulations are required, and how to approach international harmonization given the potential migration of researchers and patients. (shrink)

Deep brain stimulation (DBS) is optimistically portrayed in contemporary media. This already happened with psychosurgery during the first half of the twentieth century. The tendency of popular media to hype the benefits of DBS therapies, without equally highlighting risks, fosters public expectations also due to the lack of ethical analysis in the scientific literature. Media are not expected (and often not prepared) to raise the ethical issues which remain unaddressed by the scientific community. To obtain a more objective portrayal (...) of DBS in the media, a deeper collaboration between the science community and journalists, and particularly specialized ones, must be promoted. Access to databases and articles, directly or through science media centers, has also been proven effective in increasing the quality of reporting. This article has three main objectives. Firstly, to explore the past media coverage of leukotomy, and to examine its widespread acceptance and the neglect of ethical issues in its depiction. Secondly, to describe how current enthusiastic coverage of DBS causes excessive optimism and neglect of ethical issues in patients. Thirdly, to discuss communication models and strategies to enhance media and science responsibility. (shrink)

This book seeks a conception of God that will sastisfy inquiring twentieth-century minds. Carefully, it sorts out the evidence that has been given for the existence of a deity -- the word of Sacred Scriptures, the logical proofs of Anselm and others, and the witness of those who claim mystical experience -- and separates what can be believed from what cannot. It then explores what this deity could be like. Can we credit the all-powerful Calvinist and Islamic God who is (...) above and separate from his creation? The author seeks further -- on to the more subtly-conceived Gods of Spinoza, Kierkegaard, and such philosophers of our own time as A.N. Whitehead, E.S. Brightman, and Charles Hartshorne. Many topics of particular interest today -- "paranormal" phenomena; miraculous healing and exorcism; drugs, psychosurgery, and brain-washing; and ideas on karma -- are brought in as the author proceeds to his stimulating conclusions. [Back cover]. (shrink)

This article discusses ethical questions in neurosurgery as falling into two categories, namely those surrounding what neurosurgeons are currently doing, i.e. their current practices, and those surrounding what neurosurgeons will, theoretically, be capable of doing in the future, i.e. their future practices. It reveals the current and emerging applications of functional neurosurgery as well as the future controversies that will stem from them. It focuses on psychosurgery, enhancement and the brain–machine interface, in order to illustrate the pertinent ethical challenges (...) and the role of the neurosurgeon in helping to address them. These three applications represent natural extensions of each other, as an exploration of the underlying mechanisms of psychopathology will ultimately provide insight into normal brain function. Concerns about the future of implantable technology, and the neurosurgeon's role in installing it, need to be addressed. (shrink)

The emergence of implantable drug delivery systems will allow us to produce the effects of psychosurgery and surgical sterilization without their irreversible invasions of bodily integrity. However, this clinical advantage does not resolve the most important ethical problems these surgeries face, and may even obscure them when they arise in the practice of drug implantation.

The emerging transdisciplinary field of consciousness studies merges transpersonal psychology with recent brain studies. In this paper, I argue that this new discipline must come to terms with the rhetorics of control in the history of brain research. I establish parallels between the discourses of lobotomy and psychosurgery, Electrical Stimulation of the Brain (ESB), and cybernetics, using the work of Jose Delgado, Norbert Wiener, and Bernard Wolfe. The rhetoric of social control remains a shadow side of brain research, of (...) the popularization of brain science, and of attempts to apply such research. (shrink)

This book uses a neo-Aristotelian framework to examine human subjectivity as an embodied being. It examines the varieties of reductionism that affect philosophical writing about human origins and identity, and explores the nature of rational subjectivity as emergent from our neurobiological constitution. This allows a consideration of the effect of neurological interventions such as psychosurgery, neuroimplantation, and the promise of cyborgs on the image of the human. It then examines multiple personality disorder and its implications for narrative theories of (...) the self, and explores the idea of human spirituality as an essential aspect of embodied human subjectivity. (shrink)

Growing interest in psychiatric neurosurgery, and in deep brain stimulation (DBS) in particular, requires that the field be placed in the appropriate historical and scientific context. Current methods of neuromodulation for refractory psychiatric conditions are premised on assumptions similar to those proposed in earlier attempts, namely, the number of resistant patients and the absence of any other effective treatments. As a result, a discussion of the current and future prospects, as well as the limits, of neuromodulation is required to avoid (...) a replay of earlier transgressions, and to place its current chapter in the appropriate historical and ethical context. (shrink)

BackgroundPsychiatric neurosurgery is experiencing a revival. Beside deep brain stimulation, several ablative neurosurgical procedures are currently in use. Each approach has a different profile of advantages and disadvantages. However, many psychiatrists, ethicists, and laypeople are sceptical about psychiatric neurosurgery.MethodsWe identify the main concerns against psychiatric neurosurgery, and discuss the extent to which they are justified and how they might be overcome. We review the evidence for the effectiveness, efficacy and safety of each approach, and discuss how this could be improved. (...) We analyse whether and, if so, how randomised controlled trials can be used in the different approaches, and what alternatives are available if conducting RCTs is impossible for practical or ethical reasons. Specifically, we analyse the problem of failed RCTs after promising open-label studies.ResultsThe main concerns are: reservations based on historical psychosurgery, concerns about personality changes, concerns regarding localised interventions, and scepticism due to the lack of scientific evidence. Given the need for effective therapies for treatment-refractory psychiatric disorders and preliminary evidence for the effectiveness of psychiatric neurosurgery, further research is warranted and necessary. Since psychiatric neurosurgery has the potential to modify personality traits, it should be held to the highest ethical and scientific standards.ConclusionsPsychiatric neurosurgery procedures with preliminary evidence for efficacy and an acceptable risk–benefit profile include DBS and micro- or radiosurgical anterior capsulotomy for intractable obsessive–compulsive disorder. These methods may be considered for individual treatment attempts, but multi-centre RCTs are necessary to provide reliable evidence. (shrink)

Preferentism is the doctrine that "in deciding what is good and what is bad for a given individual, the ultimate criterion can only be his own wants and his own preferences." If preferentism is true then it would seem to follow that modifying a person's preferences so that they are satisfied by what is on offer should be as good as improving the circumstances of her life to satisfy her preferences. Our intuitive response to stories of life-adjustment through brainwashing, (...) class='Hi'>psychosurgery and the like suggests otherwise. I sketch a broadly preferentist account drawing upon Sen's (non-preferentist) capability approach that resists such putative counterexamples. (shrink)

Book Reviews in This Article:Robert Jay Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide.Eric Stovcr and Elena O. Nightingak, eds., The Breaking of Bodies and Minds: Torture, Psychiatric Abuse and the Health Professions.Elliot S. Valenstein, Great and Desperate Cures: The Rise and Decline of Psychosurgery and Other Related Treatments for Mental Illness.

Vesilind, P.A. There Is No Such Thing As Environmental Ethics.Science and Engineering Ethics 2:307–318.The author is a neuropsychologist with interests in history and polities of science, the social and ethical implications of psychosurgery, mental testing, sociobiology and other aspects of psychotechnology.

The article argues that Beckett's Trilogy stages the effects of a lobotomy operation on a potentially politically subversive writer, and that the consequences of the operation can be traced in both the retreat of the narrator of the Trilogy into the mind and into comatose mental states and in the detail of the operation itself, based on the 'icepick' lobotomies performed by neurologist Walter Freeman in the late 1940s and early 1950s. To write about extreme psychiatric situations in the post-war (...) period is necessarily to invoke the political uses of psychosurgery with which this article engages. The article goes on to consider the figure of the brain-damaged mind as a Cold War trope in the references to botulism and the motif of the penetrated skull in The Unnamable. (shrink)

Growing interest in psychiatric neurosurgery, and in deep brain stimulation (DBS) in particular, requires that the field be placed in the appropriate historical and scientific context. Current methods of neuromodulation for refractory psychiatric conditions are premised on assumptions similar to those proposed in earlier attempts, namely, the number of resistant patients and the absence of any other effective treatments. As a result, a discussion of the current and future prospects, as well as the limits, of neuromodulation is required to avoid (...) a replay of earlier transgressions, and to place its current chapter in the appropriate historical and ethical context. (shrink)

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents a (...) rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. (shrink)

SummaryIn this synthetic exposition, devoted to the relations which exist between psľchic functions and anatomic structures, Dr Pontes first insists on the difficulties of the subject and of its scientific analysis. Soma, Psyche, and social Milieu form a kind of continuum which is artificiallľ dissociated by our one‐sided approaches. Experimentation cannot be fullľ practised on man, nor can its results on animal be extended to man without serious risks of error. Similar limitations appear if, resorting to the pathological method, we (...) try to apply to the normal conclusions arrived at through the Study of the abnormal. Special reference is made here to psychosurgery, a topic quite familiar to Dr Fontes, who is Dr Egas Moniz’ countryman.The author then summarises our present knowledge concerning the structure, connections and functions of encephalic centers, especially; the thalamus, the hypothalamus and the frontal lobes.Finally, he subscribes, though not without serious reservations, to the hierarchical conception of the Nervous Sľstem as well as of the human mind, first suggested by Jouffroy, after him developed by Baillarger, Janet, Wallon in France, by Hughlings Jackson in Great Britain, and recentlľ revived in Europe by von Mona‐kow and Mourgue, Eľ, and Delaľ. This view enables one to consider nervous or psľchic illnesses as various dissolutions, resulting on the one hand from the suppression of higher centers or powers, on the other hand from the liberation of lower ones. It agrees rather well with the informations gathered by the anatomy and the physiology of the nervous sľstem, and with the conclusions suggested by psychosurgical opérations. To the thalamus and hypothalamus correspond the lower and older manifestations of mind: emotion and instinct, to the cortex the higher and more recent adaptive and intellectual processes. The hypothalamus plays a most important role in the nervous machinery as a regulator of vegetative and instinctive life, of wake and sleep, of consciousness, and of the basic biological rhythms. At the cortical level the frontal lobe appears as the structural basis for such psychical functions as Ego‐control, Will, Personality, and succèssfull action on the milieu. (shrink)

Background Deep brain stimulation is approved for treating refractory obsessive-compulsive disorder in adults under the US Food and Drug Administration Humanitarian Device Exemption, and studies have shown its efficacy in reducing symptom severity and improving quality of life. While similar deep brain stimulation treatment is available for pediatric patients with dystonia, it is not yet available for pediatric patients with obsessive-compulsive disorder, although soon could be. The prospect of growing indications for pediatric deep brain stimulation raises several ethical concerns relating (...) to bodily integrity, the ability to offer informed assent, and the role pediatric patients play in the decision-making process. Objective The aim of this study is to solicit and assess the views of stakeholders (children, parents, clinicians) on pediatric assent, autonomy, and bodily integrity in the context of potential pediatric deep brain stimulation for obsessive-compulsive disorder. Methods Semi-structured interviews were conducted with pediatric obsessive-compulsive disorder patients ( n = 21), caregivers of pediatric obsessive-compulsive disorder patients aged 14–18 ( n = 19), and clinicians with experience treating refractory obsessive-compulsive disorder ( n = 25). Interviews were transcribed and coded in MAXQDA 2018 and 2020 software and processed for thematic content analysis to isolate and compare specific themes. Results A majority of respondents (74%, 48/65) across all three stakeholder groups voiced that the decision-making process should be collaborative and involve everyone (clinicians: 84% or 21/25, caregivers 71% or 15/21, and patients 63% or 12/19). We identified a split between respondents’ views on who should have the final say in the event of disagreement (38% or 25/65 favored the patient versus 35% or 23/65 favoring caregivers). A split between respondents also emerged concerning the maturity relevant for deep brain stimulation decision-making, with 45% (29/65) favoring developmental maturity (age/physiological development) and 45% (29/65) favoring decisional maturity (capacity to understand and weigh information). A majority of clinicians indicated that they would not move forward with deep brain stimulation without securing patient assent (80% or 20/25), with some stating the only exception is if patient quality of life was very poor and/or they lacked insight. Both caregivers and patients expressed a significant respect for the patient's right to bodily integrity, with 67% of caregivers (14/21) and 68% of patients (13/19) justifying patient involvement in decision-making specifically with reference to infringements of bodily integrity. Conclusion Our findings demonstrate that despite broad agreement across stakeholders that the decision-making process for pediatric deep brain stimulation for obsessive-compulsive disorder should be collaborative and somehow involve pediatric patients, there is disagreement about what this process entails and what factors determine patient involvement in the process. However, there is agreement that children have a right to bodily and brain integrity, which should only be infringed upon in rare circumstances. (shrink)

This book begins well. Blank first gives, for the benefit of lay readers and those unfamiliar with the area of neuroscience, a brief but informative description of the structure and workings of the brain itself. He then goes on to offer an overview of the current state of brain intervention ranging from direct brain intervention (electroconvulsive therapy, electronic and magnetic stimulation, psychosurgery and neural implants), psychotropic drugs, the use of virtual reality, nootropics and neurogenetics. Blank offers a concise summary (...) and evaluation of each of these methods, outlining both potential benefits and risks. He makes the important point that most of these methods, however, do not present a cure, but rather are aimed at altering behaviour, raising the important question as the ethics of behavioural control for social convenience – particularly in relation to the vulnerable, such as the management of children with ADHD.Blank then offers a well-researched and balanced overview .. (shrink)

On the publication of Robert Lowell’s Life Studies in 1959, some critics were shocked by the poet’s use of seemingly frank autobiographical material, in particular the portrayal of his hospitalizations for bipolar disorder. During the late fifties and throughout the sixties, a rich vein, influenced by Lowell , developed in American poetry. Also during this time, the nascent science of psychopharmacology competed with and complemented the more established somatic treatments, such as psychosurgery, shock treatments, and psychoanalytical therapies. The development (...) of Thorazine was a remarkable breakthrough allowing patients previously thought incurable to leave hospital. In 1955, the release of Miltown, the first ‘minor’ tranquilizer, was heralded with a media fanfare promising a new dawn of psychological cure-all. These two events blurred the boundary between ‘normality’ and madness by making treatment in the community more widely possible and by medicalizing more commonplace distress. Lowell’s early depictions of madness situate it as emblematic of the cultural malaise of ‘the tranquilized fifties. ’ By his final collection, Day by Day (1977), mental illness had lost its symbolic power. These late poems explore the power of art as a way of representing and remedying suffering in a culture where psychopharmacology has normalized madness. (shrink)

Die Behandlung von einwilligungsunfähigen psychisch kranken Menschen mit neuen Therapiemethoden ist insbesondere im Kontext des „individuellen Heilversuchs“, der als Anwendung wenig erprobter Therapieansätze im Rahmen von „ultima ratio“-Entscheidungen charakterisiert ist, mit ethischen Abwägungsproblemen verbunden. Diese bestehen aufgrund von Einschränkungen in der Handlungs- und Entscheidungsautonomie der betroffenen Patienten und, aufgrund eigen- oder fremdgefährdender Symptome der psychischen Krankheit selbst, insbesondere in der praktischen Umsetzung ethisch akzeptierter Modelle stellvertretender Entscheidung sowie in der Wahl des Bezugspunkts der Nutzen-Risiko-Analyse des intendierten Therapieverfahrens. Der Artikel untersucht (...) den ethischen Konflikt zwischen gerechtfertigter Hilfeleistung und Instrumentalisierungsrisiko psychisch kranker Menschen zu Fremdzwecken am historischen Beispiel der „Rindenexcisionen“ des Psychiaters Gottlieb Burckhardt (1836–1907). Als Lösungsmöglichkeit dieses ethischen Konflikts wird das „Konzept des kontrollierten individuellen Heilversuchs“ diskutiert. (shrink)

This article suggests that investigational deep brain stimulation (DBS) for mental disorders raises few new bioethical issues. Although the scientific basis of the procedure may be both complex and largely unknown, addressing informed consent in such situations is a familiar problem. After reviewing the legal and moral background for investigating DBS and the scientific difficulties DBS faces as a potential treatment for mental disorders, the article focuses on informed consent and makes two primary suggestions. The study of DBS may proceed, (...) but “hyper-disclosure” of the complexities should be required for competent subjects or proper surrogates if the candidate is not competent, and the most rigorous standard for competence should be employed. Throughout, neuromodesty and caution are urged. (shrink)