Prefrontal
leucotomy is the worst idea on the mind, according to the audience vote at a
debate hosted by the Royal Institution. The idea that mental illness can be
successfully treated by cutting nerve fibres in the front of the brain, beat
off stiff competition from three rivals: Freud’s notion of hysteria; the
practice of post-trauma counselling or ‘debriefing’; and the ‘chemical
imbalance’ model of mental illness.
Hysteria
Richard
Webster, author of ‘Why Freud Was Wrong: Sin, Science and Psychoanalysis’,
kicked off the debate with a story from the 1960s about a girl who suffered
from painful muscular convulsions. Doctors couldn’t find a physical explanation
for the girl’s illness, and following an account from her parents that the
symptoms only began shortly after a boy pulled down her pants, psychiatrists
diagnosed the girl with conversion hysteria. In other words, they believed her
physical symptoms had a psychological cause. They even locked her in isolation and
made her crawl to reach her food in the belief this would help cure her. It was
only some time later that neurologists realised the girl had the rare physical
condition dystonia musculorum deformans.
Although made (in)famous by Freud, it was in fact his
teacher, the nineteenth century French neurologist Jean-Martin Charcot, who
proposed that it was a patient’s ‘idea’ of his or her trauma that could
manifest as physical symptoms. In Charcot’s day, closed head injury without
outward signs of injury, and frontal lobe epilepsy, were both routinely
misdiagnosed as conversion hysteria - ‘probably the most profound medical
misunderstanding of the last 150 years’, according to Webster.
Post-trauma counselling
Sixteen randomly controlled trials have now shown that
psychological debriefing after a trauma definitely does not work, and in fact
probably increases the risk of post-traumatic stress disorder, argued Professor
Simon Wessely from the Institute of Psychiatry.
Talking to a counsellor soon after being traumatised can
interrupt natural recovery processes, can cause re-traumatisation, and by
describing to people some of the symptoms they could suffer, counsellors may
actually induce those symptoms by power of suggestion. And yet, whenever a
major incident occurs, an exasperated Wessely observed, we still hear that
trained counsellors are on hand (for example, a witness to the killing of Jean
Charles de Menezes, was apparently immediately offered counselling by police). ‘And why’,
Wessely asked, ‘is it always ‘trained’ counsellors? We’d find it odd if
airplane pilots introduced themselves as "trained pilots"’, he said.
It’s
not that there’s anything wrong with talking after a trauma, Wessely clarified
- it’s the idea that you need to speak to a professional. Indeed, he pointed to an article he co-authored in BMJ last year that surveyed a sample of
Londoners in the weeks after the July terrorist bombings. Seventy-six per cent
had attempted to speak to friends or family immediately after the bombings, but
just one per cent said they wanted counselling.
‘Post-traumatic
counselling is a bad idea and a bad intervention’, Wessely argued, ‘it assumes
normal people are too incompetent to deal with adversity and it takes attention
and resources away from those people who really do need help from interventions
that work, like CBT’.
The chemical imbalance model of mental distress
Dr Joanna Moncrieff at UCL argued the worst notion on the
mind is the theory that mental distress is caused by some kind of chemical
imbalance - an idea propagated doggedly by drugs companies. ‘Most people think
the link between depression and the neurotransmitter serotonin is established’,
she said, ‘and yet there’s no evidence for it at all’. Moncrieff explained that
it’s not even possible to measure serotonin directly in the brain. Instead,
most studies rely on measuring serotonin receptors, especially the 5-HT1
receptor. Some of these studies have found the receptor is lowered in
depression, Moncrieff said, but others have found it the same or raised.
‘Don’t just take my word for it’ Moncrieff added, pointing
to a quote from David Burns, the Stanford psychiatrist who won an award from
the Society for Biological Psychiatry for his research on serotonin metabolism:
‘I
spent the first several years of my career doing full-time research on brain
serotonin metabolism, but I never saw any convincing evidence that any
psychiatric disorder, including depression, results from a deficiency of brain
serotonin’. (Source: PLOS Medicine).
With
11 per cent of women in the USA now taking antidepressants, Moncrieff said the
chemical imbalance idea has moral and political implications. It promotes
dissatisfaction in people and implies there’s some kind of ideal balance that
we should all be striving for. And it is used to justify harmful interventions.
Most recently, drug-company funded research has identified intermittent
explosive disorder and compulsive shopping as new conditions treatable with
antidepressants…
Leucotomy
But
the historian Professor Edgar Jones at the Institute of psychiatry successfully
persuaded the audience that neither hysteria, trauma counselling, nor the
chemical imbalance idea, are as bad as leucotomy (also known as frontal
lobotomy).
‘I
won’t show you any pictures of the operation because that would give me an
unfair advantage over my colleagues’, Jones began. The Portuguese neurologist
Egas Moniz, who somewhat ironically won the Nobel Prize for Medicine in 1949,
was the driving force behind the first lobotomy conducted in 1935, Jones
said. But it was actually the American
neurologist Walter Freeman, in partnership with his neurosurgeon colleague
James Watts, who really championed and developed the procedure, claiming it was
a cheap, effective treatment for young sufferers of psychosis that would save
state hospitals countless dollars.
However,
Freeman and Watt’s only outcome measure was whether a patient had returned to
some kind of employment, and their irreversible procedure, which lacked any
evidence base or ethical approval, left patients brain damaged and with
profoundly altered personalities. Despite this, Jones said that by the early
1950s, the procedure had been performed on over 50,000 patients, including
traumatised soldiers from WWII.
Leucotomy received 61 votes; the chemical imbalance
model 48 votes; trauma counselling 43 votes; and hysteria 16 votes. The prequel
to this debate - who is the greatest mind to have changed our minds? - took
place in April; see June news.
--
Dr. Christian Jarrett, staff journalist.
|
The Psychologist
