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Sierra Rose
Colleen period 1-2
English
16 December 2016

Proposing A Solution
In 2016, approximately 18.2% of the American population suffers from mental illness.
Thats roughly 42.5 million American adults, and there are no signs of this problem solving itself
anytime soon, except for one. Psy-cho-sur-ger-y: noun; brain surgery, such as lobotomy, used to
treat mental disorder. Yes, the implications that surround words such as lobotomy often conjure
up images of inhumane scrambling of brains. However, with modern technology and safe
practices, psychosurgery can actually create a solution. In fact, it already has. Mental illness
cannot always be solved with medications and therapy. However, cases such as severe OCD and
other hard to treat illnesses can be cured with psychosurgery. With enough funding,
psychosurgery can provide a gateway into a clean, healthy population.
The word psychosurgery can be a bit intimidating, but it is actually a procedure that
involves removing about a teaspoon of brain matter using a probe inserted through the neurons
and fired at using a laser. Psychiatric neurosurgery involves the surgical ablation or
disconnection of brain tissue with the intent of altering abnormal affective and behavioral states
caused by mental illness, as stated by the Massachusetts General Hospital. The surgery is only
performed on patients who have been unresponsive to at least three different types of medication
as well as repeated therapy sessions with no response or impact at all. It is the hope for the
hopeless.
Before we move forward in solutions, perhaps a look back on the problem at hand will be
helpful as well. Mental illness has been documented in ancient Rome, Greece, India, and Egypt
but were not recognized as a disorder but instead as demonic possession. In the 5th century B.C.,

Hippocrates assisted in healing the mentally ill by adjusting their occupations and prescribing
medicinal herbs and substances. During the Middle Ages, mental illness was seen as a form of
religious punishment or, again, demonic possession which lead to confining the mentally ill
individuals in condescending and filthy conditions and the drilling of skulls. This lasted for
centuries until the first asylum for the mentally ill was built in Europe in the year 1406. In 1840,
a proposition to the American government went underway and, through a 40 year period, 32 state
psychiatric hospitals were built throughout the nation.
Although it may sound as though a solution was on the horizon, the patients who were
institutionalized in these psychiatric hospitals, or more commonly known as asylums, were living
in horrible conditions and cruelly abused. They did not act to help treat the mental illness these
patients were suffering from but, rather, removed them from society and from burdening their
families. A typical asylum from the 1500s to the 1800s and, in some places, even 1900s, would
hold their patients in shackles and chains so they would have to remain upright and straw over
the cold stone floors.
While asylums were most famous for their sadistic practices, there were some practices
that were tested on patients as an attempt to cure them too. Purging and bloodletting were the
most common of these acts, however there was also the treatments of dousing them in extreme
temperatures of hot or cold water, straightjackets, powerful drugs, and an invention labeled the
gyrating chair. The most malicious of these practices, however, was lobotomy. In the 1880s,
doctors began manipulating the brain in order to calm the patients by removing parts of the brain.
The first procedures involved cutting a hole in the skull and injecting ethanol into the frontal lobe
to destroy the brain tissues involved but, later, a surgical instrument called the leucotome (a large
rod that carves a circular hole out of the brain matter) was used in place of the injections.

Things took a dark turn when an even more gruesome surgery, called the transorbital
lobotomy, was introduced by an Italian psychiatrist which implemented the use of a modified
ice pick, called an orbitoclast, which would be thrust into the patient's eye using a hammer. It
would then be moved back and forth in the brain to separate the brain tissue, specifically the part
that receives and relays brain tissue. These lobotomies were associated with a high complication
rate including intellectual impairment, personality change, seizures, paralysis and death. The
majority of people who these surgeries were performed on were said to have increased negative
effects on their personalities, initiative, inhibitions, empathy, and their ability to function selfsustainably. The practice started to subside in the mid 1950s due to antipsychotic and
antidepressant medications that were much more effective.
While todays methods of dealing with mental illness are a lot more humane and
beneficial to the average patient, we are still not sure how things like depression truly come into
being. Antidepressants only focus on increasing the feel good chemical receptors in the brain
(serotonin, dopamine, etc.) but do not provide a cure for depression. Mental illness is usually
caused by three things: Inherited traits, environmental exposures before birth, and brain
chemistry. These can be caused by things such as physical or mental trauma, alcohol, recreational
drugs, or even simply stressful situations. Changes such as these can alter a persons brain
chemistry, thus the drugs prescribed are designed to give the patient balanced brain chemistry by
stimulating receptors and neurotransmitters.
Mental illness has no cure yet and these prescription drugs are great for making the side
effects much less severe, but these drugs with unknown consequences could become dire
situations. Although these drugs target neurotransmitters, they could also potentially affect a
persons genes. One example particularly highlights this point - The Hongerwinter. In September

1944, during World War II, German troops banned the export of food and coal to Germanys
northern parts. By winter, the population was aching with famine that continued until 1945.
People were forced to eat bark and grass while tens of thousands died of malnourishment. Later,
research performed on those who suffered through the famine showed that they had chronic
health issues such as depression, anxiety, heart disease, gum disease, osteoporosis, and diabetes
In the 1980s, however, a more intriguing pattern emerged: when the children born to women
who were pregnant during the famine grew up, they too had high rates of obesity and heart
disease In the 1990s, when the grandchildren of men and women exposed to the famine were
studied, they too had higher rates of obesity and heart disease. The acute period of starvation had
somehow altered genes not just in those directly exposed to the event; the message had been
transmitted to their grandchildren. As it is clearly stated by Siddhartha Mukherjee, we already
know that genes play an important role in passing down mental illness from generation to
generation. But what would happen if these drugs took a negative turn on the population? Gene
mutations are classified in two major ways: Hereditary mutations and acquired mutations.
Here an explanation is due - hereditary mutations are the driving factor of the reasons
why, if the subjects father was an alcoholic, chances are that the subject will be too. They are
mutations written in every fiber of a persons being and will be passed on to the subjects
children, whether or not the genes become dominant or recessive at that point. Acquired
mutations occur during a persons lifespan and do not exist in every cell of the subject. This can
happen due to exposure to large amounts of radiation or if a mistake is made as DNA copies
itself in cell division. These occur in over one percent of the population but are, however, largely
problematic.

This could be a problem for the human genome because genes do mutate, but not always
in a bad way. In a fashion that is similar to survival of the fittest, genes mutate to acquire better
traits to survive in the climate it exists within. So who is to say that these genes couldnt mutate
to reject antidepressants? Could the genes change so that, when antidepressants are admitted into
the subject's system, that it couldnt be translated into another message that does damage to the
neurotransmitters inside of the subjects mind? The physical side effects are so pronounced nausea, loss of sexual desire, erectile dysfunction, fatigue, insomnia, blurred vision, dizziness,
constipation, agitation, irritability, anxiety - whats to say there arent underlying side effects that
are unexplored as well? So then, in that instance, antidepressants would not be the answer.
Which completes the circle: Psychosurgery.
The argument could be made that the human race has come so far, why should these
malicious practices come into being when they hardly ever worked in the first place? To which
begs the response: This does work. Although the ethical objections about the use of psychiatric
neurosurgery have been addressed in all centers by insuring an informed consent from the patient
and family without coercion, along with unanimous agreement amongst the referring and treating
physicians. Given how lobotomies used to be performed, for people who dont respond to
medications and psychiatry, these surgeries have provided a relief they could find no place else.
These arent available just for anyone, however, only persons with chronic, severe and disabling
psychiatric illness that are completely refractory to all conventional therapy are considered for
surgery.
The surgery targets the anterior cingulate cortex, the main area that obsessive compulsive
disorder metastisizes within the cranium. The surgery requires drilling a small hole in the skill,
inserting a probe carefully past the neurons into the area affected, and a laser is fired, cutting

away that small area of grey matter. The anterior cingulate cortex is responsible for directing
brainpower to certain tasks. This targets the subjects urgency to complete tasks and a sense of
satisfaction once the task is complete. OCD occurs when the neurons associated in this region of
the brain malfunction or overreact. So far, severe OCD is the only mental illness that is granted
permission to have psychosurgery performed, however there are promising signs that depression
and the areas involved in the brain - the amygdala and prefrontal cortex - could soon be treated
with psychosurgery as well. To date only a few prospective long term follow-up trials have been
completed but these do appear to support the contention that even using the most stringent
outcome criteria, cingulotomy and anterior capsulotomy are helpful in 25 - 50% of patients with
intractable OCD. Using less stringent outcome criteria, improvement is seen in 50 - 70% of
patients which is similar to earlier studies, implying that there is grounds for improvement as
well as expansion in other forms of mental illness to be treated as well. The procedure is fairly
new, however it shows promising results.
In terms of finding a permanent solution to mental illness, psychosurgery is our best bet.
Although medications and therapy have been used to help ease the side effects of mental illness,
they do not provide a solution quite as sustainable and effective as this. With enough funds
granted into this field of research, many different types of previously thought untreatable
illnesses could suddenly be of hardly any concern. This is just further proof that we are on our
way to being a healthy human race.

Works cited

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