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A prehistoric relic of trepanation history.

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The oldest known psychosurgical procedure, trepanation, has been used for thousands of years to treat various ailments, including mental illness and neurological disorders. The act of drilling or cutting a hole into the skull was believed to release evil spirits or alleviate conditions like epilepsy and migraines.

In ancient Egypt, trepanation was performed with stone tools, and surprisingly, many patients survived the procedure. Over time, the technique was adapted for psychosurgery, with early practitioners believing that altering brain pressure could improve psychiatric symptoms.

With this being one of the very few psychological interventional techniques available in ancient times, trepanation was eventually pushed aside as less crude methods emerged, particularly with the development of modern neurosurgery and psychiatric treatments in the 20th century.

Sources:

(1)

http://www.neurosurgicalhistory.org/2024/10/trepanation-dawn-of-neurosurgery-in.html

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Trepanation: The Dawn of Neurosurgery in Ancient Civilizations

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Neurosurgery, one of the most intricate and sophisticated branches of modern medicine, has roots that trace back thousands of years. Long be…

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The topectomy, a psychosurgical procedure in which Gottlieb Burckhardt excised portions of the frontal, parietal, and temporal cortex in six psychiatric patients. (Read below)

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Psychosurgery traces its origins to Gottlieb Burckhardt, a Swiss psychiatrist who, in 1888, performed the first documented procedures in this field. Burckhardt believed that altering brain structures could help alleviate psychiatric symptoms, leading him to surgically remove portions of the cerebral cortex in six patients. His work was met with skepticism, as the medical community questioned both the ethics and effectiveness of such drastic interventions. Despite the controversy, his pioneering approach set the stage for future explorations into surgical treatments for mental illness.

Another key figure in neurosurgery was Harvey Cushing, an American surgeon whose contributions in the early 20th century shaped modern brain surgery. Cushing refined techniques for treating brain tumors and developed methods to control intracranial pressure, innovations that were critical in enabling surgeons to focus on specific brain regions to improve patient outcomes. His meticulous work helped establish neurosurgery as a distinct and respected medical discipline.

The legacies of early neurosurgeons, including Burckhardt and Cushing, laid the foundation for psychosurgery as a medical practice. As surgical techniques advanced, interventions targeting the brain became more common in the treatment of mental disorders, influencing the development of procedures that sought to modify neurological function to alleviate psychiatric conditions.

Sources:

(1) https://thejns.org/focus/view/journals/neurosurg-focus/25/1/article-pE9.xml

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Puusepp was the world's first professor of neurosurgery and played a pioneering role in the early development of the field during the early 20th century. He performed operations for epilepsy, hydrocephalus, brain tumors, and spinal cord injuries at a time when neurosurgery was still in its infancy, helping to establish foundational techniques that shaped modern brain surgery.

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In the early 20th century, psychosurgery emerged as a radical approach to treating severe psychiatric disorders. Before the development of effective pharmacological treatments, institutionalization and experimental procedures were among the few options available for managing mental illness, many of which were inhumane. The idea that altering brain structures could alleviate psychiatric symptoms gained traction, leading to early surgical interventions.

One notable contributor was Ludvig Puusepp, an Estonian neurosurgeon who conducted brain surgeries on psychiatric patients in St. Petersburg during the early 20th century. Puusepp’s work focused on exploring the relationship between brain structures and psychiatric symptoms, helping to lay the foundation for future psychosurgical techniques. Alongside Vladimir Bekhterev, a Russian neurologist, Puusepp experimented with frontal leucotomy, a procedure aimed at reducing psychomotor agitation in patients with manic-depressive psychosis. However, dissatisfied with the results, they eventually abandoned the endeavor.

Sources:

(1)

https://thejns.org/focus/view/journals/neurosurg-focus/25/1/article-pE9.xml

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A well-known image of a cerebral angiography, illustrating how vascular abnormalities become clearly visible to physicians, enabling precise diagnosis and treatment planning.

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In 1927, Egas Moniz revolutionized neurology by developing cerebral angiography, a technique that allowed doctors to see blood vessels in the brain using contrast dyes and X-ray imaging. His breakthrough allowed for more accurate diagnostics of many neurological abnormalities including aneurysms tumors and irregular vessel formations.

Moniz’s work was inspired by earlier imaging techniques, such as ventriculography, developed in 1918, which involved injecting air into the brain’s ventricles to detect abnormalities. However, with the understanding that this method had a high rate of risk, Moniz aimed to create a safer and precise alternative by injecting contrasting dyes directly into the internal carotid artery, allowing for detailed visualization.

With the help of his assistant Almeida Lima, Moniz experimented with various contrast mediums, ultimately refining a technique that provided clear images of the brain’s vascular system. His contribution remains a foundational advancement in neuroscience, shaping modern diagnostic techniques and improving patient outcomes.

Sources:

(1) https://journals.sagepub.com/doi/pdf/10.1177/159101999700300201

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Egas Moniz's invention, the leucotome, featured a narrow shaft and a retractable wire loop or blade, allowing surgeons to precisely cut brain tissue.

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In 1936, Portuguese neurologist Egas Moniz performed the first leucotomy, an invasive surgical procedure designed to treat severe psychiatric disorders by severing connections in the frontal lobes. Moniz theorized that disrupting neural pathways could relieve symptoms of schizophrenia, severe depression, and other serious mental illnesses.

The procedure was initially met with enthusiasm, as early reports suggested improvements in patients' emotional stability and behavior. However, the results were inconsistent, and many patients experienced severe cognitive issues. His leucotomy technique later evolved into the more widely known lobotomy, which became a controversial treatment in psychiatric hospitals worldwide.

Sources:

(1)

https://www.samhs.org.au/Virtual%20Museum/Surgery/Leucotomy/Leucotomy.html

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Walter Freeman, the man credited with popularizing lobotomies, reportedly performed two lobotomies simultaneously in the 1940s. This act not only demonstrated the perceived ease of the procedure but also highlighted Freeman's infamous showmanship.

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As psychosurgery gained momentum as a treatment for severe psychiatric disorders, beginning with the development of the leucotomy, the lobotomy was introduced in the United States by Walter Freeman and James Watts, who performed the first American lobotomy in 1936. Initially, they employed the prefrontal lobotomy technique, which involved drilling holes into the skull to access and sever frontal lobe connections.

Freeman later developed the transorbital lobotomy, a less invasive method that used an ice-pick-like instrument inserted through the eye socket to manipulate brain tissue. This innovation made the procedure more accessible, as it could be performed outside of traditional operating rooms, particularly in psychiatric hospitals where patients were many and resources few.

By the 1950s, the rise of antipsychotic medications provided a less invasive alternative, leading to a decline in the popularity of lobotomies. Freeman himself was eventually banned from performing the procedure.

Sources:

(1)

https://www.theparisreview.org/blog/2017/04/18/the-art-of-the-lobotomy-and-other-news/

(2)

https://www.asylumprojects.org/index.php/Walter_Freeman

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A depiction of hysteria, historically characterized by excessive emotional reactions and unexplained physical symptoms. The word originates from the Greek hystera, meaning "uterus," reflecting the ancient belief that the condition stemmed from the female reproductive system.

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A major concern was that many psychosurgery procedures, especially lobotomies, were performed on women, minorities, and institutionalized individuals, often without proper consent, particularly in the 1940s and 1950s in the UK and US.

Doctors often justified lobotomies as a way to control "unruly behavior" in women, framing it as a cure-all for conditions like hysteria. Similarly, underfunded patients, such as institutionalized individuals and marginalized groups, were subjected to these surgeries with little regard for their autonomy. It was only much later that these practices sparked broader discussions on medical ethics and the importance of patient rights in the 1970s.

Sources:

(1)

https://psychcentral.com/blog/the-surprising-history-of-the-lobotomy

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Rosemary was subjected to a difficult life of incapacitation after her procedure. Despite al of this she was found moments of joy in music and inspired her sister to found the special Olympics later on.

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The most infamous case was that of Rosemary Kennedy, the sister of John F. Kennedy, who underwent a lobotomy in 1941 at the age of 23. Her father arranged the procedure in an attempt to manage her behavioral difficulties, but the operation permanently robbed her of her autonomy, leaving her unable to speak intelligibly. Her condition was kept secret for decades, and she was institutionalized as a result.

The introduction of antipsychotic medications in the 1950s, such as chlorpromazine, provided less invasive and more effective alternatives for treating psychiatric disorders. By the 1970s, lobotomies were largely discredited in favor of more certain and humane treatment methods.

Tragic outcomes like Kennedy's lobotomy serve as a reminder that procedures and therapies need to prioritize safety and efficacy above all else, which is more easily found in less invasive surgerical methods.

Sources:

(1)

https://allthatsinteresting.com/rosemary-kennedy

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Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that uses magnetic fields to modulate neural activity. First introduced in 1985, TMS has since progressed into a therapeutic treatment for conditions such as depression, anxiety, and neurological disorders.

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Psychosurgery, as it evolved, began transitioning from invasive procedures to non-ablative neuromodulation techniques. Early psychosurgical methods like trepanation and lobotomy were based on the idea that altering neural pathways was the most effective way to alleviate psychiatric symptoms, despite their numerous issues and ethical concerns.

In the late 20th century, advancements in functional neuroimaging and electrophysiology allowed researchers to explore specific brain regions for a more refined approach. Techniques like deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS) emerged as alternatives, offering reversible and adjustable interventions.

The shift toward neuromodulation reflects a broader trend in neuroscience—moving away from destructive procedures toward precision medicine, where treatments are tailored to the unique neurological profiles of individual patients.

Sources:

(1)

https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2019.00108/full

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the method of DBS by implanting electrodes in the brain and the pulse generators underneath the collarbone.

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Deep brain stimulation (DBS), introduced in the 1980s, revolutionized the treatment of movement and psychiatric disorders. The technique involves implanting electrodes into specific brain regions to deliver electrical signals to modulate neural activity without causing permanent changes, unlike prior methods.

DBS' origin can be traced back to early electrical stimulation experiments in the 20th century, where researchers studied how brain activity could be affected by electrical currents, similar to the stereotactic methods of the 1950s.

Deep brain stimulation was initially developed to treat Parkinson's disease and tremors, but its applications have expanded to conditions like OCD and epilepsy. The adjustability and reversible nature of DBS provides a great alternative to the crude psychosurgery techniques of the past.

Sources:

(1)

https://my.clevelandclinic.org/health/treatments/21088-deep-brain-stimulation

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By using excitation or inhibition of light sensitive proteins specific changes are visible, especially in live, active animals.

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Optogenetics, developed within the last fifteen years, has revolutionized neuroscience by allowing researchers to alter brain activity using light-sensitive proteins. Karl Deisseroth and his team have demonstrated this technique's ability to effectively silence or activate specific brain regions with remarkable precision. Optogenetics has become a critical tool not only in treating disorders but also in understanding depression, epilepsy, and Parkinson’s disease.

The significance of optogenetics lies in its ability to bridge the gap between fundamental neuroscience research and clinical applications. This highly specific, non-invasive approach has revolutionized the way scientists study neurological function, representing a major leap in treatment methodologies. By allowing precise control over brain activity, optogenetics has paved the way for innovative therapies targeting psychiatric and neurological disorders.

Sources:

(1)

https://www.media.mit.edu/publications/a-history-of-optogenetics-the-development-of-tools-for-controlling-brain-circuits-with-light/

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An illustration of Egas Moniz in the doctoral regalia in 1932.

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The Life of Egas Moniz (Individual Entry)

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The Life of Egas Moniz (Individual Entry)

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António Egas Moniz (1874–1955) was a Portuguese neurologist known for developing angiography and lobotomy, the highly controversial procedure.

Moniz studied medicine at the University of Coimbra, later becoming a professor of neurology at the University of Lisbon. He also actively participated in Portuguese politics, serving as an ambassador to Spain and later as a Minister for Foreign Affairs.

Born in Avianca, Portugal, his most influential work was in the 1930s and 1940s, earning the Nobel Prize in Physiology or Medicine in 1949 for his contributions to psychosurgery by developing leucotomy.

Sources:

(1)

https://www.nobelprize.org/prizes/medicine/1949/moniz/biographical/