Medicine is an imperfect science, its history shot through with barbaric and dubious practices from grave robbing to bloodletting. Since even before the time of that father of modern medicine, it can seem that physicians have more often violated Hippocrates’ decree “above all, do no harm” than abided by it.
A photomicrograph of a Treponema pallidum bacterium, a spirochete that ranges from 5 to 15 micrometers in length, and is the causative agent of syphilis. Image: CDC/Susan Lindsley.
The psychiatric field gets the worst rap. Shock therapy, trepanation, and trans-orbital lobotomies do not command the same kind of grudging respect we can now muster for the similarly slow and painful advance of other healing disciplines. It is only now, with a critical retrospective eye, that we can see that some of these psychiatric therapies had the right idea despite their heavy-handed approach.
Shock therapy evolved and has emerged in the more sophisticated form of deep brain stimulation to treat patients with Parkinson’s and Huntington’s disease. Lobotomies no longer arbitrarily hulk-smash our precious frontal lobes, but a similar practice can target and carefully excise cortical regions to treat difficult cases of obsessive compulsive disorder and depression; the cingulotomy procedure that involves singeing small holes in the cingular lobe that sits atop our brainstem is one example (1). The craniotomy, in which a section of skull or “bone flap” is temporarily removed, can alleviate intracranial pressure and is essentially the modern version of trepanation. In this era of modern medicine, the goal is less excision, more precision. Fewer ice picks, too.
