In favour of psychosurgery

In favour of psychosurgery

T I N S - January 1979 12 4. Hjorth-Simonsen, A. (1973) J. Comp. Neurol. 147, 145-162. 5. Jones, E. G. and Powell, T. P. S. (1970) Brain 93, 793-820...

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T I N S - January 1979

12 4. Hjorth-Simonsen, A. (1973) J. Comp. Neurol. 147, 145-162. 5. Jones, E. G. and Powell, T. P. S. (1970) Brain 93, 793-820. 6. Krettck, J. E. and Price, J. L. (1977) J. Cornp. NeuroL 172, 723-752. 7. Meibach, R. C. and Siegel, A. (1975) Brain Res. 88, 518--522. 8. Meibach, R. C. and Siegel, A. (1977) Brain Res. 124, 197-224. 9. Mellgren, S. I. and Srebro, B. (1973) Brain Res. 52, 19-36 I 0. Moore, R. Y. (1975) In: R. L. Isaacson and K. H. Pribram (eds), The Hippocampus, Vol. 1, Plenum, New York, pp. 215-237. 11. Rosene, D. L. and Van Hoesen, G. W. (1977) Science 198, 315-317. 12. Segal, M. and Landis, S. (1974) Brain Res. 78, 1-15. 13. Siegel, A. and Edingcr, H. (1976) In: J.F. DeFrance (ed.), The Septal Nuclei, Plenum, New York, pp. 70-114. 14. Swanson, L. W. and Cowan, W. M. (19761 In: J. F. DeFranee (ed.), The Septal Nuclei, Plenum, New York, pp. 37~64. 15. Swanson, L. W. and Cowan, W. M. (1977) J. Comp. Neurol. 172, 49-84. 16. Swanson, L. W. and Hartman, B. K. (1975) J. Comp. Neurol. 163, 467-503. i7. Swanson, L. W., Wyss, J. M. and Cowan, W. M. (1978) J. Comp. Neurol. (in press). L. W. Swanson is in the Department of Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO 63110, U.S.A.

F o l l o w i n g this m o n t h ' s a n a t o m i c a l insights into the c o n n e c t i o n s of the h i p p o c a m p u s , we plan to publish in o u r next issue, in an article entitled 'Synaptic plasticity in the h i p p o c a m p u s ' , T i m Bliss' account of physiological aspects relating to the hippocampus.

In favour of psychosurgery A. R o b i n ' s Point of V i e w a c o n c e r n i n g p s y c h o s u r g e r y brings to m i n d an observation s of one of his fellow c o u n t r y m e n that " T h e Devil can q u o t e Scripture for his p u r p o s e " . I refer specifically to R o b i n ' s s t a t e m e n t that: " T h e idea that p s y c h o s u r g e r y p r e v e n t s suicide is untenable. Such an effect is not only not k n o w n , but implicit anxiety has b e e n e x p r e s s e d that suicide m i g h t follow p s y c h o s u r g e r y ( ' t h e seven suicides in this series of 154 p a t i e n t s o p e r a t e d on are a m a t t e r of great concern' r e p o r t e d B a l l a n t i n e ) " . T h a t so-called "implicit a n x i e t y " was e l a b o r a t e d upon by B a l l a n t i n e I in an u n q u o t e d p a r a g r a p h i m m e d i a t e l y following the s e n t e n c e q u o t e d by Robin: " T h e s e d e a t h s attest to the seriousness of the illness b e i n g treated, to the n e e d for psychiatric care in the post-operative period and to the necessity for b e t t e r m e t h o d s of psychiatric diagnosis, evaluation a n d t r e a t m e n t , b o t h m e d i c a l and surgical." The suicide rate in the 154 p a t i e n t s m e n t i o n e d a b o v e was 4.5%. If the statistics of G u z e and R o b b i n s 2 are accurate, the suicide rate in p a t i e n t s with chronic t r e a t m e n t - r e s i s t a n t depression is 15%. The difference in the two suicide rates would a p p e a r to be statistically significant w h e t h e r or not one believes that " p s y c h o s u r g e r y prevents suicide".

The great s i x t e e n t h c e n t u r y psychiatrist previously q u o t e d also d e s c r i b e # the current mystery s u r r o u n d i n g depressive illness w h e n he had A n t o n i o s p e a k as follows "In sooth, I know not why 1 am so sad. It wearies me; you say it wearies you; But how I caught it, found it, or came by it, What stuff 'tis made of, whereof it is born 1 am to learn; And such a want-wit sadness makes of me That I have much ado to know myself." Finally, in reference to " r a n d o m i z a t i o n by waiting list" as a d v o c a t e d by R o b i n : physicians in the U n i t e d States express explicit anxiety w h e n p a t i e n t s kill themselves while waiting for hospital treatment. H. THOMAS BALLANTINE, JR. Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.

1. Ballantine, H. T., Jr., Levy, B. S., Dagi, T. and Giriunas, I.B. (1977) In: W.H. Sweet, S. Obrador and J. G. Martin-Rodriguez (eds), Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy, University Park Press. Baltimore, pp. 348-349. 2. Guze, S.B. and Robbins, E. (197(t) Br.J. Psychiat. 117, 437-438. 3. Robin, A. (19781 Trends NeuroSci. 1, 111-112. 4. Shakespeare, W. The Merchant of Venice, Act 1, Scene t. 5. Shakespeare, W. The Merchant of Venice, Act 1, Scene 3.