Functional Neurosurgery for Psychiatric Disorders: A Historical Perspective

Functional neurosurgery for psychiatric disorders ('psychosurgery') has a colorful, and sometimes dubious, history. From the time of the first operations in 1935 to today, its usefulness has been overshadowed by doubts and ethical questions. Psychosurgery became popular in the 1940s and early 1950s, especially in the United States. Its main indications were for intractable mental illness, in particular, depression, anxiety, and obsessive-compulsive disorders. However, its side effects, especially the 'frontal lobe syndrome', led to the need for more refined surgical approaches; the most important of these was the use of stereotaxis. Cingulotomy, subcaudate tractotomy, limbic leucotomy, and anterior capsulotomy are generally the stereotactic treatments of choice today. Indications and postoperative sequelae vary slightly across treatments. The indications remain as affective, anxiety, and obsessive-compulsive disorders. Despite approval by the United States Department of Health, Education, and Welfare in 1978, psychosurgery is still not a common treatment. This low acceptance is perhaps due to continued concern over ethical problems and inadequate reporting of outcomes.