Psychosurgery And The Problem Of Severe OCD
I know quite a few readers had a very strong, negative response to a New York Times article on Friday which examined psychosurgery–or brain surgery for psychiatric issues–because it showed up on the front page of the paper and to some seemed like promotion of latter-day lobotomies. I disagree. And let me state from the get-go that I am not a fan of the various psychosurgeries out there. They are fraught with tons of risk, the outcomes are unpredictable and sometimes people who undergo the techniques wind up with little relief or permanent brain damage.
I think Ben Carey’s article captured that pretty well and also captured the extreme desperation some people with OCD who are willing to try psychosurgery after anti-depressants and psychotherapy have failed and they are essentially non-functional from the disorder. He got into how psychosurgery is pretty tightly controlled by the medical profession and how it is voluntary for the patients. These aren’t the days of forced, involuntary lobotomies and I don’t think there was anything in the article to raise the specter of those days returning. Still, I do get where people would respond strongly to such an article. I think any journalist who’s thoughtful knows that simply writing about a controversial topic can seem as if you are promoting one side or another of the controversy, even if you’re writing a fairly neutral, dispassionate piece such as Carey did.
Besides, Carey has no control over where the article appears in the paper. That’s a decision made by editors a few rungs above him just as it always has been for me when I was at a paper. Besides, it’s good for Carey internally to have an A-1 story and I suspect people who know his work have enough respect for him to want him to do well and do other fine work in the neuroscience and psychological realms.
What does fascinate me is how many of these psychosurgery cases seem to be connected to people with OCD, very severe disabling OCD. I’ve seen some of these cases firsthand–there’s a man who lives in my part of Seattle who has literally dozens of restraining orders against him because his very severe OCD leads him to repetitively harass people very aggressively, especially women–and it’s so painful to watch that I cannot describe it. If someone like him has been through various rounds of psychotherapy and meds and is in a position to consent to voluntary neurosurgery (and knows the risks), then I wouldn’t want to stand in their way. And just to be clear, I am talking about adults, not children or teens.
I feel the same about the various depression treatment devices that have hit the world in recent years. While I think the jury is still very much out on the vagus nerve stimulation system, deep brain stimulation and transcranial magnetic stimulation, if someone wants to try it, then go for it. It’s their brain after all.
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