Elektrisch evenwicht

Abstract

This history of deep brain stimulation in psychiatric disorders describes how the idea, technology and scientific and clinical application of deep brain stimulation developed, from the first research with brain electrodes around 1860 to modern therapeutic deep brain stimulation. From 1860, brain researchers knew how to relate specific cortical brain areas to certain (sensory and motor) functions with increasing precision through ablation and electrical stimulation, and neurosurgeons explored the first diagnostic possibilities of cortical electrical stimulation. Between the 1920s and 1950s, backed by unprecedented philanthropic investment, particularly from the Rockefeller Foundation, a scientific psychiatric approach developed in which biological, psychological and social aspects were considered important. From this holistic perspective combined with psychoanalytic insights, doctors and researchers in the 1930s and 1940s tried to understand and improve two important new somatic treatments of the 1930s - electroconvulsive therapy and psychosurgery. From 1948, the first experiments with deep brain stimulation in psychiatric patients took place in the United States. Deep brain stimulation managed to develop into its own experimental field with the support of the American government, but the clinical experiments did not yield unambiguous results. The psychoanalytic interpretation of patients' experiences during stimulation also proved to be difficult. Despite these problems, all stakeholders and institutions believed that deep brain stimulation was a promising therapy. In the 1950s during the Cold War, deep brain stimulation in the United States contributed to the fear of (massive) mind control and behavioural manipulation of civilians. Doctors and researchers had found several brain regions in the midbrain in particular that they could use to influence behaviour of their laboratory animals through deep brain stimulation. In the 1970s, the anti-psychiatric movement strongly protested against electroconvulsive therapy and (plans for) experiments to influence unwanted and/or aggressive behaviour of psychiatric patients and prisoners through psychosurgery and deep brain stimulation. Doctors were, on the contrary, working hard at the time to optimise their psychosurgical procedures, both technologically through the stereotact and neuroanatomically through standardisation of some brain regions relevant to psychopathology. Discussions between proponents and opponents were conducted from strong utopian and dystopian perspectives with overly high expectations of the possibilities of deep brain stimulation. Investigations of the American government in the 1970s revealed a serious lack of national oversight of the above developments. This contributed to new medical-ethical guidelines on informed consent, among other things. However, controversy meant that by the end of the 1970s, psychosurgical procedures, including deep brain stimulation, hardly ever took place, despite new scientific understanding that they could be effective treatments for certain psychiatric patients and could not be used for mind control. During the reintroduction of deep brain stimulation for psychiatric disorders in the late 1990s expectations were again high. This was despite the fact that the treatment had remained virtually unchanged and it was not - and still is not - well understood how it works. The positive results of small-scale experiments were not replicated in better-controlled large-scale effect studies. Unlike in the 1970s, there was relatively little critical discussion.