Comeback For Psychosurgery, Brain Stimulation

Psychosurgery. Electroshock. These terms may evoke the deranged visage of Jack Nicholson receiving electroshock therapy in One Flew Over the Cuckoo’s Nest. Or bring to mind the fragile, ghostly Catherine Holly of Tennessee Williams’ Suddenly Last Summer, a young woman who is institutionalized and threatened with lobotomy when she suffers an emotional breakdown.

Psychosurgery has a troubled and lurid past—procedures designed in the late 19th and early 20th century were imprecise, ethical abuses were rampant and many patients died or lapsed into vegetative state for the rest of their lives. But variations on those procedures have survived and have been quietly making a comeback. Today, some doctors attempt to treat severe mental illness, addiction, Parkinson’s disease and pain with deep brain stimulation, by which they implant electrodes into the brain, or cingulotomy, which essentially involves burning holes in the frontal lobe. Harvard Medical School’s Massachusetts General Hospital provides an overview of the history of psychosurgery and some current procedures here, and suggests that it is probably underutilized as a treatment option. Continue reading

Charting ties between drug companies, psychiatrists, lawmakers


Project Proposal: Some recent articles have covered the over-prescription of antipsychotics by both psychiatrists and general practitioners. Abilify and Seroquel, two antispychotics, are the fifth and sixth best selling prescription drugs in the U.S., writes Dr. Richard A. Friedman, professor of psychiatry at Weill Cornell Medical College in Manhattan, in a September article for the New York Times.

Second generation antipsychotics, so-called atypical antipsychotics, including the two mentioned above, came to market in 1993. While they have fewer neurological side effects than the first-generation of drugs, clinical trials have shown them to be no more effective or well-tolerated than the first generation of drugs. Plus they have serious long-term side effects of their own.

Here’s the worst part: they are increasingly being prescribed for illnesses for which they have not been approved by the FDA, including everyday anxiety disorders, insomnia and even mild emotional discomfort. And many of the people who are prescribed these medications are never told of their side effects. Nor have any real efforts been made to discourage this kind of off-label drug-pushing. In fact, the U.S. has been barred, under free-speech laws, from prosecuting drug-marketing reps for marketing their drugs for “lawful” but non-FDA approved off-label purposes. Continue reading

Stopping the Next Shooter: Guns and Mental Illness

The school shooting in Newton, Conn. over the weekend that left 27 dead sparked an intense debate about how we care for the mentally ill in the United States. All over the web, grief-stricken posters called upon our lawmakers and institutions to do something not just about gun control but about improving treatment for the mentally ill—and keeping guns out of their possession. Adam Lanza’s death spree in Connecticut recalls a number of similar shootings in recent years, all of them carried out by mentally ill individuals, including Jared Lee Loughner’s shooting spree in Arizona in 2011, the Aurora, Colorado shooting this summer by James Eagan Holmes and the Virginia Tech shooting by Seung-Hui Cho in 2007.

For an interactive story on this topic over at Storify, check out this link.

Covering Madness

One blog that is worth paying close attention to in this space is Mad in America: History Science and Psychiatry, a comprehensive look at mental illness treatment and pharmaceuticals written by Robert Whitaker, author of a number of books on the subject.

Whitaker’s eponymous Mad in America: Bad Medicine, Bad Science and the Continued Mistreatment of the Mentally Ill, published in 2010, was called, “One of the most disturbing, consequential works of investigative journalism I’ve read in a long time. Perhaps ever,” by John Horgan in Scientific AmericanWhitaker’s more recent Anatomy of an Epidemic, from 2011, examines whether psychiatric drugs are behind the meteoric rise in mental illness in the United States over the past fifty years. “In 1955, there were 355,000 adults in state and county mental hospitals with psychiatric diagnosis. During the next three decades (the era of the first generation psychiatric drugs), the number of disabled mentally ill rose to 1.25 million,” he writes in one post on the blog. The book attempts to answer that question—are doctor-prescribed pharmaceuticals inducing mental illness?—with a look at the science, and the blog is meant to provide readers with access to the studies that the book examines as well as to provide ongoing coverage of news on mental illness treatment, pharmaceutical company malfeasance and drug side effects in the U.S. Continue reading

In Treatment

Schizophrenia, a term coined in 1908 by Eugen Bleuler, is one of the most difficult mental illnesses to treat. Rates of recovery today are no better than they were 100 years ago. Antipsychotics, which target dopamine receptors in the brain, are the most common model of treatment, though the side effects can be crippling and permanent, and may even worsen the symptoms and prevent recovery. Part of the problem is that schizophrenia as biomedical concept has not been validated. Research has shown that people with schizophrenia and schizoaffective disorders tend to have abnormalities in the metabolism of tetrahydrobiopterin, dopamine, and glutamate, but how these abnormalities might cause the symptoms of schizophrenia is not understood. The illness has been shown to run in families, but specific genes have not yet been identified.

Some doctors are trying alternatives to drugs, like cognitive behavioral therapy, a kind of talk therapy that involves actively reorienting one’s thought patterns. It has been used to treat depression for over a decade, but some research suggests it may also be effective at treating schizophrenia.

Some believe schizophrenics are better off learning to cope with their voices, including journalist Robert Whitaker, who writes about it at his website Mad in America. In fact, studies have shown that schizophrenics in developing countries, where antipsychotics are less widely available, have better rates of long-term recovery than those in developed nations. Continue reading