Psychosurgery and other somatic means of altering behavior.

"The brain is no longer a sacred organ, excluded from surgical therapy because it supposedly houses the human soul." Dr. H. Thomas Ballentine, Jr., Massachusetts General Hospital.1 • • • • " Psychosurgery diH'ers from brain surgery. Brain surgery has been done as an accepted part of medical practice as a means of eliminating diseased tissue-primarily cancer and other tumors, but also abcesses and scar tissue that is a focus of epileptogenic activity. Psychosurg'ery is also brain surgery but is performed not to eradicate disease but to relieve pain, alter feelings and change behavior; scientific psychosurgery dates back to the development of the lobotomy procedure of Egas Moniz of Portugal who in 1936 published his Tentaives operatiores dans It~ Iraill'ml'lI! de certaines pS)lchoses2 which earned for him the Nobel prize because this pioneering work was seen as such a potential boon to mankind. A less scientific kind of psychosurgery had been performed in Ancient Egypt and pre-Columbian America; even earlier, trephines (small circular holes) were drilled into the skull by primitive man, as is evidenced by prehistoric skulls with trephination. Trephination is still practiced, "in primitive cultures as a form of magic medicine. ";1 Even prehistoric and primitive man ascribed the cause of disordered behavior to the brain. It followed naturally that if the skull could be pierced the evil that was within could be let out and dissipated. The early brain surgery procedures were performed to improve disordered behavior, but only in the nineteenth century did doctors begin to understand the localization of function within the brain, that, for example, a left-sided paralysis was caused by a lesion in the motor area of the right cerebral hemisphere, and only in this century have skilled neurologists been able to pinpoint through localizing symptoms the precise area of disease in the brain. J\lodern nomenclature reserves the term brain surgery or 1Ieurosurgery for the accepted procedures to cure disease or to alleviate symptoms caused by organic pathology; the newer term psychosurgay is used for procedures to relieve pain or alter behavior where organic pathology is absent or is minor. But the distinction between brain surgery to eradicate disease and psychosurgery to alter behavior is not dearcut. Patients with brain tumors show many evidences, often bizarre, of disordered behavior; a change of behavior or of personality in later life is one of the prime diagnostic criteria of a brain neoplasm. The surgery removes the diseased tissue and either restores the patient to his premorbid personality and behavior or, dependent upon the site of brain tissue removed and the extent of the surgery. leaves the patient with a permanent behavioral disorder (regressive behavior. poor ,judgment, impaired motor function) .