Safe, sound and surgical

by Pete Fleischmann

Openmind 112, Nov/Dec 2001

The white paper, Reforming the Mental Health Act (2001), is a key part of the Government's reform of mental health law, which claims to be creating a modern service that is 'safe, sound and supportive'. It seems strange, then, that hidden in the white paper is clause 5.19, which will allow psychiatrists to expand the use of a treatment banned in most Western countries.

Egas Moniz, a Portuguese psychiatrist, first practised lobotomy - also known as psychosurgery - in 1935. The procedure involves surgically destroying small bits of brain believed to control emotions. In England and Wales by the end of 1954, 12,000 operations had been performed. Psychosurgery has been touted as the cure for everything from combat stress, gambling addiction and violence to sexual deviance and obesity. It remained a major psychiatric treatment until the early 1970s.

Sarah Harris' aunt, Lucy Harris (not their real names), had psychosurgery in the 1960s. Sarah Harris said 'After the operation she had no finer feelings, no sensitivity. It really is barbaric.' Derek Hutchinson had a hypothalamotomy in 1974, intended to control his aggressive behaviour. The operation involved probing the brain with thin rods, while he was still conscious, to locate the centres that control fear, which were then burned out. Derek claims that the operation ruined his life: 'I lost a full family. I've been in mental hospital, treated with psychiatric drugs, depression, anorexia. They had no right to do that to me. You know I've had six heart attacks, well this heart specialist believes that the heart attacks are coming because part of my hyperthalmous is missing.'

The UK is the only country in Western Europe in which psychosurgery - now rebranded as neuro-surgery for mental disorder (NSMD) - is still available. Cardiff University Hospital and Dundee Hospital perform the operations. Ian Reid, Professor of Psychiatry at the University of Dundee, leads a team that refers about ten people a year for psychosurgery.... He claims good results, saying that a third of the patients show improvement, although he admits that, given the nature of the operation, it is impossible to do double-blind tests....

Mental health expert Howard Davis is sceptical about the effectiveness of psychosurgery: 'The numbers of people involved are so small that there are no reliable research studies.'

Mind would like to see psychosurgery banned, and are calling for a review of its use: 'There are serious risks. It is extremely invasive, it is irreversible, there is little known about whether it works and the monitoring of psychosurgery is inadequate,' said a spokesperson.

Clause 5.19 will enable advocates of psychosurgery to operate on people without their consent. Currently, valid consent has to be given by the patient and verified by the watchdog body, the Mental Health Act Commission. Clause 5.19 will allow doctors to apply to the High Court to operate on people whom they deem incapable of giving consent. 'Personally I am surprised to see this extension of powers to compel treatment extended to cover irreversible treatments,' said Howard Davis. ...

Although the numbers of people who undergo psychosurgery are small, they are extremely vulnerable. How such people are treated is a measure of our civilisation. The question we must ask ourselves is whether extending this practice, however, marginally, fits with the progressive reform of our mental health system.