Summary

The creation of lesions in healthy brain tissue in order to treat psychiatric disorders is paradoxical in view of the frequent occurrence of psychiatric disorders after focal and diffuse brain lesions. Thus, the introduction of neurosurgery for psychiatric disorders, or psychosurgery, in the 1930s was seen as a bold, indeed desperate, attempt in the face of a therapeutic impasse. The rationale for psychosurgery was based on very modest evidence, and while the evidence base has grown in subsequent years, it remains a controversial treatment, limited in its scientific base and unable to shrug off the legacy of its early days of over-enthusiastic application. The recent introduction of neuromodulatory techniques, in particular deep brain stimulation, has altered the tone but not the nature of the debate, and better empirical evidence as well as theoretical rationale are necessary before the paradox underlying psychosurgery can be readily explained.

The history of paradoxical treatments in psychiatry

Psychiatric treatment is no stranger to paradoxes, and its history is littered with examples of counter-intuitive strategies, and bold attempts to heal the fractured mind. One ancient treatment that can be traced to prehistoric times is the practice of trepanation, or the creation of holes in the skull to treat diseases (Restak,2000). When performed for mental illnesses or epilepsy, the rationale was to permit malevolent spirits to escape the skull. The practice of seemingly antithetical treatments continued into the twentieth century, although the scientific grounding of some of these treatments had improved.