Psychiatric Disorders

After the introduction of classic physiologic methods to the study of the forebrain, interest turned to how the results of these studies could be applied to the clinical realm. Because of the horrid conditions within psychiatric facilities at the time and the primitive nature of nonsurgical therapies (e.g., insulin and electric shock), the advent of psychosurgery held great promise. Stereotactic variants of psychosurgical procedures have included cingulot-omy [28], anterior capsulotomy [29], tractotomy [30], and others.

Evaluation of the psychosurgical literature is difficult, partly because of reporting methods, partly because diagnostic categories in psychiatry have changed greatly over the years. It appears, however, that certain categories of illness do respond to surgical intervention (e.g., obsessive compulsive disease, anxiety), whereas others do not (e.g., schizophrenia).

As with movement disorders, the introduction of effective drug therapy led to the demise of psychosurgery. Furthermore, political trends as well as the lack of a sound theoretic scientific basis for these procedures made continued widespread use of these methods untenable. Nevertheless, a few centers have continued these procedures on a limited basis. Advances in neuroscience research may, in the near future, provide a more firm basis for the re-exploration of surgical interventions for psychiatric disease.

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