H. Thomas Ballantine

Treatment of psychiatric illness by stereotactic cingulotomy

The treatment of 198 psychiatrically disabled patients with stereotactic cingulotomy was evaluated prospectively for a mean follow-up of 8.6 years. Patients with major affective disorders and anxiety disorders fared the best, with a return to normal functioning in the majority. Patients with obsessive-compulsive disorders, schizophrenia, and personality disorders improved less predictably, with an uneven improvement in functioning that required active ongoing psychiatric treatment. Low mortality and morbidity, a reduction of violent behavior, a possible reduction of suicidal risk, and a lessening of the intractable suffering of chronic psychiatric illness all indicate that cingulotomy can be an effective, safe treatment for patients with affective disorders that are unresponsive to all other forms of therapy.

A View from a Clinician’s Window

Most of the essays in this volume have been written by individuals who have made distinguished contributions to a further understanding of modern ethical and philosophical issues. Others are erudite in the fields of economics and public health. As one of the few clinicians who has been privileged to be invited to contribute, I will refer to certain of the opinions of my fellow authors, comment on current policy in the public and private sectors as it relates to the delivery of medical care in the United States and, finally, attempt to forecast future developments. In order for the reader to assess clearly the worth of my presentation since it may be biased by my past experiences, a brief biographical sketch follows.