Miguel A. Faria

Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1 – From trephination to lobotomy

Psychosurgery was developed early in human prehistory (trephination) as a need perhaps to alter aberrant behavior and treat mental illness. The “American Crowbar Case” provided an impetus to study the brain and human behavior. The frontal lobe syndrome was avidly studied. Frontal lobotomy was developed in the 1930s for the treatment of mental illness and to solve the pressing problem of overcrowding in mental institutions in an era when no other forms of effective treatment were available. Lobotomy popularized by Dr. Walter Freeman reached a zenith in the 1940s, only to come into disrepute in the late 1950s. Other forms of therapy were needed and psychosurgery evolved into stereotactic functional neurosurgery. A history of these developments up to the 21st century will be related in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International (SNI).

Violence, mental illness, and the brain – A brief history of psychosurgery: Part 2 – From the limbic system and cingulotomy to deep brain stimulation

Knowledge of neuroscience flourished during and in the wake of the era of frontal lobotomy, as a byproduct of psychosurgery in the late 1930s and 1940s, revealing fascinating neural pathways and neurophysiologic mechanisms of the limbic system for the formulation of emotions, memory, and human behavior. The creation of the Klüver-Bucy syndrome in monkeys opened new horizons in the pursuit of knowledge in human behavior and neuropathology. In the 1950s specialized functional neurosurgery was developed in association with stereotactic neurosurgery; deep brain electrodes were implanted for more precise recording of brain electrical activity in the evaluation and treatment of intractable mental disorders, including schizophrenia, “pathologic aggression,” and psychomotor seizures in temporal lobe epilepsy. Psychosurgical procedures involved deep brain stimulation of the limbic system, as well as ablative procedures, such as cingulotomy and thalamotomy. The history of these developments up to the 21st century will continue in this three-part essay-editorial, exclusively researched and written for the readers of Surgical Neurology International.

Shooting rampages, mental health, and the sensationalization of violence

Gun violence and, most recently, senseless shooting rampages continue to be sensitive and emotional points of debate in the American media and the political establishment. The United Nations is already set to commence discussing and approving its Small Arms Treaty in March 2013. And following the Newtown, Connecticut tragedy in the United States this past December, American legislators are working frantically to pass more stringent gun control laws in the U.S. Congress. The American media and proponents of gun control assert that the problem lies in the “easy availability of guns” and “too many guns” in the hand of the public. Second Amendment and gun rights advocates, on the other hand, believe the problem lies elsewhere, including a permissive criminal justice system that panders to criminals; the failure of public education; the fostering of a culture of dependence, violence, and alienation engendered by the welfare state; and the increased secularization of society with children and adolescents growing up devoid of moral guidance. I cannot disagree with the latter view, but I believe there are additional, contributing, and more proximate causes — e.g., failures of the mental health system and the role of the media and popular culture in the sensationalization of violence — that also need to be specifically pointed out and discussed in the medical literature, as I have set out to do in this review article.

Violence, mental illness, and the brain - A brief history of psychosurgery: Part 3 - From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans.

In the final installment to this three-part, essay-editorial on psychosurgery, we relate the history of deep brain stimulation (DBS) in humans and glimpse the phenomenal body of work conducted by Dr. Jose Delgado at Yale University from the 1950s to the 1970s. The inception of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978) is briefly discussed as it pertains to the “determination of the Secretary of Health, Education and Welfare regarding the recommendations and guidelines on psychosurgery.” The controversial work - namely recording of brain activity, DBS, and amygdalotomy for intractable psychomotor seizures in patients with uncontrolled violence – conducted by Drs. Vernon H. Mark and Frank Ervin is recounted. This final chapter recapitulates advances in neuroscience and neuroradiology in the evaluation of violent individuals and ends with a brief discussion of the problem of uncontrolled rage and “pathologic aggression” in today’s modern society – as violence persists, and in response, we move toward authoritarianism, with less freedom and even less dignity.

Longevity and compression of morbidity from a neuroscience perspective: Do we have a duty to die by a certain age?

The search for longevity, if not for immortality itself, has been as old as recorded history. The great strides made in the standard of living and the advances in scientific medicine, have resulted in unprecedented increases in longevity, concomitant with improved quality of life. Thanks to medical progress senior citizens, particularly octogenarians, have become the fastest growing segment of the population and the number of centenarians is increasing, even though in the last two decades, spurred by the bioethics movement, the priority assigned to the prolongation of lifespan has taken a back seat to the containment of health care costs. This article describes what individuals can do to lead healthy lifestyles and increase longevity, concomitant with preservation of quality of life until the very end of life—as postulated by Dr. James F. Fries’ hypothesis of the compression of morbidity. This review article investigates the contention of bioethicist Dr. Ezekiel Emanuel that Fries’ theory is a “fantasy” and not a realistic possibility. In this context recent advances in neurobiology, epigenetics, and aging are described, and the hypothesis of the compression of morbidity re-examined. We find that people are not only living longer but are remaining healthier. Recent studies suggest that brain plasticity develops and potential neurogenesis occurs in those individuals who continue to be mentally and physically active allowing them to thrive well into old age. Controlled studies as well as Medicare spending data strongly corroborate Fries’ predictions and support my conclusion that compression of morbidity should be upgraded from a hypothesis to a theory. Lastly, leisure in association with or without retirement is discussed and suggestions are made as to how to use this time to remain intellectually sharp and physically vigorous until the very end of life.

Neolithic trepanation decoded- A unifying hypothesis: Has the mystery as to why primitive surgeons performed cranial surgery been solved?

The perplexing mystery of why so many trephined skulls from the Neolithic period have been uncovered all over the world representing attempts at primitive cranial surgery is discussed. More than 1500 trephined skulls have been uncovered throughout the world, from Europe and Scandinavia to North America, from Russia and China to South America (particularly in Peru). Most reported series show that from 5-10% of all skulls found from the Neolithic period have been trephined with single or multiple skull openings of various sizes. The unifying hypothesis proposed by the late medical historian Dr. Plinio Prioreschi (1930-2014) regarding the reason for these trepanations (trephinations) is analyzed. It is concluded that Dr. Prioreschis cohesive explanation to explain the phenomenon is valid and that his intriguing hypothesis is almost certainly correct. In the opinion of this author, the mystery within an enigma has been solved.

Bioethics and why I hope to live beyond age 75 attaining wisdom!: A rebuttal to Dr. Ezekiel Emanuel's 75 age limit.

American bioethicists have been providing persuasive arguments for rationing medical care via the theory of the necessary “rational allocation of finite health care resources.” Anticipating the need for the drastic rationing of medical care in the U.S. with the implementation of ObamaCare and assisted by various sectors of organized medicine in league with the State, bioethicists have deduced that more ingenious approaches are necessary to convince Americans who have been accustomed to receiving the best medical care that third-party payers are willing to pay for. It is in this context that the individual-based, patient-oriented ethics of Hippocrates, including his fundamental dictum, “First Do No Harm,” have to be supplanted by the utilitarian approach promoted by the bioethicists. And todays foremost proponent of the bioethics movement is Dr. Ezekiel Emanuel. This editorial proposes a rational rebuttal to Dr. Emanuels proposal to limit life expectancy to age 75 as a rational paradigm to a better life.

The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics?

In 2013, U.S. President Barack Obama decreed the creation of the Presidential Commission for the Study of Bioethical Issues, as part of his

ObamaCare: Another step toward corporate socialized medicine in the US.

100 million Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative. In the wake of the work of this Commission, the purpose, goals, possible shortcomings, and even dangers are discussed, and the possible impact it may have upon neuroscience ethics (Neuroethics) both in clinical practice as well as scientific research. Concerns were expressed that government involvement in bioethics may have unforeseen and possibly dangerous repercussions to neuroscience in particular and to medicine in general. The author emphasizes that the lessons of history chronicle that wherever governments have sought to alter medical ethics and control medical care, the results have frequently been perverse and disastrous, as in the examples of the communist Soviet Union and National Socialist (Nazi) Germany. The Soviet psychiatrists’ and the Nazi doctors’ dark descent into ghastly experimentation and brutality was a product of convoluted ethics and physicians willingly cooperating with authoritarianism citing utilitarianism in the pursuit of the ‘collective’ or ‘greater good.’ Thus in the 20th century, as governments infringed on the medical profession, even the Liberal Democracies have not been immune to the corruption of ethics in science and medicine.

Glyphosate, neurological diseases – and the scientific method

The Patient Protection and Affordable Care Act (2010), more commonly referred to as ObamaCare, has become one of the most controversial pieces of legislation passed by the Democrat-controlled, 111th U.S. Congress during President Obamas administration. Despite significant political opposition and poll-after-poll evincing the American peoples strong dissatisfaction with a health care plan that was correctly seen as further socializing American medicine, ObamaCare [Figure 1] was passed by the two houses of the U.S. Congress and signed into law by the president on March 23, 2010. Figure 1 U.S. President Barack Obama at the White House, flanked by activist physicians, expounding on ObamaCare (expansion of corporate socialized medicine in the U.S.) One stated goal of the plan is ostensibly to “expand access to insurance for nearly 30 million Americans.” And to accomplish this “reform,” the Obama administration has introduced the elements of compulsion — and more ominously, unconstitutional powers. To increase access to insurance for 30 million uninsured Americans, ObamaCare forces insurance companies and managed care plans to extend coverage to people with pre-existing conditions; in effect, converting conventional rules of indemnity coverage (i.e., coverage for unforeseen medical illnesses and injuries) into prepayment for chronic medical care. But perhaps the most egregious section of ObamaCare is to force uninsured Americans to purchase medical insurance. Noncompliance with this “reform” will trigger heavy fines imposed by the federal government as a penalty. This is referred to as the health insurance mandate, and it is quite different from National Health Insurance as in Canada,[2,3,11] National Health Service as in Great Britain,[6] or socialized medicine in France, Germany, and Japan.[12,16] Thus, I make a relative distinction between the Obama administrations plan for health care as corporate socialized medicine (i.e., public-private, corporativist partnerships) and the fully socialized medicine as in most European countries.[7–10] The price of socialized medicine in every country in which it has been implemented is the usurpation of liberty, the erosion of individual autonomy, the gradual loss of the freedom to choose – working in parallel with the rationing of medical services and technology because the raison d’etre of socialism is to control the population by depriving the people of freedom and keeping them subservient and dependent on the State. The free enterprise system in the United States has traditionally relied on free choice in a free market place, whether we are talking about buying a home, an automobile, computers – or medical care. Government compulsion and social engineering are not well received by free marketeers and individualists in our society. Small steps, incremental “reforms,” have taken place in American medicine via increased rules and regulations regarding utilization and rationing of services, coverage, payments to physicians, etc. But further large-scale attempts to socialize American medicine have been repeatedly defeated since 1965, when Medicare (i.e., health care for the elderly) and Medicaid (i.e., health care for the indigent) were instituted.[4,5,9] A good example of this rejection of socialized medicine was the failed attempt by President Bill Clinton to revamp the U.S. health care system in 1993–1994. The Health Security Act of 1993 was a grandiose effort to further socialized American medicine in a corporativist direction,[8–10] and was dubbed “HillaryCare” because the effort was led by former First Lady Hillary Clinton [Figure 2], who serves today as President Barack Obamas Secretary of State. Figure 2 Hillary Rodham Clinton during the health care debate of 1993