Psychosurgery, also called neurosurgery for mental disorder (NMD), is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt. The first significant foray into psychosurgery in the 20th century was conducted by the Portuguese neurologist Egas Moniz who during the mid-1930s developed the operation known as leucotomy. The practice was enthusiastically taken up in the United States by the neuropsychiatrist Walter Freeman and the neurosurgeon James W. Watts who devised what became the standard prefrontal procedure and named their operative technique lobotomy, although the operation was called leucotomy in the United Kingdom. In spite of the award of the Nobel prize to Moniz in 1949, the use of psychosurgery declined during the 1950s. By the 1970s the standard Freeman-Watts type of operation was very rare, but other forms of psychosurgery, although used on a much smaller scale, survived. Some countries have abandoned psychosurgery altogether; in others, for example the US and the UK, it is only used in a few centres on small numbers of people with depression or obsessive-compulsive disorder (OCD). In some countries it is also used in the treatment of schizophrenia and other disorders.
Electroconvulsive therapy (ECT) is a psychiatric treatment where a generalized seizure is electrically induced to manage refractory mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head, resulting in approximately 800 milliamperes of direct current passing between the electrodes, for a duration of 100 milliseconds to 6 seconds, either from temple to temple or from front to back of one side of the head. However, only about 1% of the electrical current crosses the bony skull into the brain because skull impedance is about 100 times higher than skin impedance.
A lobotomy, or leucotomy, is a form of neurosurgical treatment for psychiatric disorder or neurological disorder that involves severing connections in the brain's prefrontal cortex. The surgery causes most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, to be severed.
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders.
Donald Ewen Cameron was a Scottish-born psychiatrist. He is largely known today for his central role in unethical medical experiments, and development of psychological and medical torture techniques for the CIA. He served as president of the American Psychiatric Association (1952–1953), Canadian Psychiatric Association (1958–1959), American Psychopathological Association (1963), Society of Biological Psychiatry (1965) and the World Psychiatric Association (1961–1966).
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite and thinking of harming yourself or others.
Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing. It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct boundary with individual or group psychotherapy on the other. Social psychiatry combines a medical training and perspective with fields such as social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to mental distress and disorder. Social psychiatry has been particularly associated with the development of therapeutic communities, and to highlighting the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, with the latter focused on genetics, brain neurochemistry and medication. Social psychiatry was the dominant form of psychiatry for periods of the 20th century but is currently less visible than biopsychiatry.
Hervey Milton Cleckley was an American psychiatrist and pioneer in the field of psychopathy. His book, The Mask of Sanity, originally published in 1941 and revised in new editions until the 1980s, provided the most influential clinical description of psychopathy in the twentieth century. The term "mask of sanity" derived from Cleckley's belief that a psychopath can appear normal and even engaging, but that the "mask" conceals a mental disorder. By the time of his death, Cleckley was better remembered for a vivid case study of a female patient, published as a book in 1956 and turned into a movie, The Three Faces of Eve, in 1957. His report of the case (re)popularized in America the controversial diagnosis of multiple personality disorder. The concept of psychopathy continues to be influential through forming parts of the diagnosis of antisocial personality disorder, the Psychopathy Checklist, and public perception.
Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. It was introduced in 1927 by Austrian-American psychiatrist Manfred Sakel and used extensively in the 1940s and 1950s, mainly for schizophrenia, before falling out of favour and being replaced by neuroleptic drugs in the 1960s.
Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between general medicine/pediatrics and psychiatry, usually taking place in a hospital or medical setting. The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.
Eliot Trevor Oakeshott Slater MD was a British psychiatrist who was a pioneer in the field of the genetics of mental disorders. He held senior posts at the National Hospital for Nervous Diseases, Queen Square, London, and the Institute of Psychiatry at the Maudsley Hospital. He was the author of some 150 scientific papers and the co-author of several books on psychiatric topics, notably on disputed 'physical methods'. From the mid-50s to his death, he co-edited Clinical Psychiatry, the leading textbook for psychiatric trainees.
James Winston Watts was an American neurosurgeon, born in Lynchburg, Virginia. He was a graduate of the Virginia Military Institute as well as the University of Virginia School of Medicine. Watts is noteworthy for his professional partnership with the neurologist and psychiatrist Walter Freeman. The two became advocates and prolific practitioners of psychosurgery, specifically the lobotomy. Watts and Freeman wrote two books on lobotomies: Psychosurgery, Intelligence, Emotion and Social Behavior Following Prefrontal Lobotomy for Medical Disorders in 1942, and Psychosurgery in the Treatment of Mental Disorders and Intractable Pain in 1950.
Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.
Psychosurgery is a surgical operation that destroys brain tissue in order to alleviate the symptoms of mental disorder. The lesions are usually, but not always, made in the frontal lobes. Tissue may be destroyed by cutting, burning, freezing, electric current or radiation. The first systematic attempt at psychosurgery is commonly attributed to the Swiss psychiatrist Gottlieb Burckhardt who operated on six patients in 1888. In 1889 Thomas Claye Shaw reported mental improvement in a case of General Paralysis of the Insane after a neurosurgical intervention. This led to a lively debate in the British Medical Journal on the usefulness of neurosurgery for the treatment of insanity. In the 1930s the Portuguese neurologist Egas Moniz developed a surgical technique for the treatment of mental illness and called it "leucotomy" or "psychosurgery". Moniz' technique was adapted and promoted by American neurologist Walter Freeman and his neurosurgeon colleague James W. Watts. They called their operation, where burr holes are drilled in the side of the skull and the white matter is sliced through in order to sever the connections between the frontal lobes and deeper structures in the brain, lobotomy. In the United Kingdom it became known as the standard Freeman-Watts prefrontal leucotomy. British psychiatrist William Sargant met Freeman on a visit to the United States and on his return to England encouraged doctors at the Burden Neurological Institute in Bristol to instigate a programme of psychosurgery.
Judith S. Beck is an American psychologist who is best known for her work in cognitive therapy and cognitive behavioral therapy. Her father is Aaron Beck, the founder of cognitive therapy, with whom she has worked on many occasions.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental conditions. These include various issues related to mood, behaviour, cognition, and perceptions.
The lunatic asylum was an early precursor of the modern psychiatric hospital.
The following outline is provided as an overview of and topical guide to psychiatry:
Psychosurgery, also called neurosurgery for mental disorder or functional neurosurgery, is surgery in which brain tissue is destroyed with the aim of alleviating the symptoms of mental disorder. It was first used in modern times by Gottlieb Burckhardt in 1891, but only in a few isolated instances, not becoming more widely used until the 1930s following the work of Portuguese neurologist António Egas Moniz. The 1940s was the decade when psychosurgery was most popular, largely due to the efforts of American neurologist Walter Freeman; its use has been declining since then. Freeman's particular form of psychosurgery, the lobotomy, was last used in the 1970s, but other forms of psychosurgery, such as the cingulotomy and capsulotomy have survived.
Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.
