Brain Surgery for Sexual Disorders

[MonDie]

A neurological pathway has gone awry, so disrupt that pathway. It seemed simple enough, so I did a search.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1629706/

It was performed as early as the 60s, and this rather breif summary describes optimistic results. I'm tempted to call it a cure! What happened? Most articles on treating sex offenders only mention therapy and libido-reducing drugs, but both of these involve life-long regimes that subjects might undermine or quit.

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And today we have a reversable intervention called deep brain stimulation.

http://link.springer.com/chapter/10.1007/978-3-319-01144-8_4

https://en.wikipedia.org/wiki/Deep_brain_stimulation

[MonDie]

Although the hardware + procedure averages about $50,000.

[imatfaal]

Although the hardware + procedure averages about $50,000.

 

How many days in prison does that account to - not many at all. And it needs to be 100pct before we try it on real people BUT the only way we get it to be 100 pct is by trying it on real people. As an advocate I would claim that mind-alteration in anyway other than via voluntary rehabilitation is "cruel and unusual".

 

Will read your links if I have time - but we need to be very certain of our moral, legal, and cultural rights before we start mucking around with intervention like this. Just as a thought - Alan Turing one of the greatest minds of the 20th Century was placed on a severe drug regime to "cure" his homosexuality; not the sort of precedent we want to rush to follow

[MonDie]

The psychosurgery patients were sexually oriented toward children. A subset of such men do want to be cured. I don't know how much risk they pose, but without treatment, they might change their mind.

 

 

There may also be some hypersexuals who would volunteer.

 

A Treatment-Oriented Typology of Self-Identified Hypersexuality Referrals

Cantor, Klein, Lykins, Rullo, Thaler, & Walling, 2013

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958916/

Edited December 22, 2014 by MonDie

[StringJunky]

Sexual disorders are largely those behaviours that any given society considers to be immoral. I don't see how surgery can be a cure for immorality. Look in other societies and those "disorders" are not considered such at all; Imatfaal's Turing example is a case in point of the clearly evolving ground secular morality stands on: we can only look back with sadness on the great man's predicament at the hands of our old moral system. Imagine how we might look back now if the UK was performing that procedure MonDie posted in Turing's day.

[John Cuthber]

Brain surgery doesn't have a particularly good historical record when it comes to treating what are perceived to be psychological disorders.

http://en.wikipedia.org/wiki/Lobotomy

[imatfaal]

The psychosurgery patients were sexually oriented toward children. A subset of such men do want to be cured. I don't know how much risk they pose, but without treatment, they might change their mind.

 

You don't see the delicious irony of society labelling individuals as so far from the norm that they need to be permanently altered through surgery YET we are willing to defer to their judgment on whether this is a good idea and to credit them with the ability to give informed consent?

[StringJunky]

 

You don't see the delicious irony of society labelling individuals as so far from the norm that they need to be permanently altered through surgery YET we are willing to defer to their judgment on whether this is a good idea and to credit them with the ability to give informed consent?

In that light it does look rather at odds.

[John Cuthber]

It looks a lot like coercion to me.

"Mr Bloggs- we can lock you up for a long time in circumstances that are probably worse than most criminals or you can "volunteer" for some experimental surgery.

 

Obviously, it's possible that in future years, evidence may come to light that you were never actually guilty in the first place- but that's just the way the cookie crumbles."

[MonDie]

You don't see the delicious irony of society labelling individuals as so far from the norm that they need to be permanently altered through surgery YET we are willing to defer to their judgment on whether this is a good idea and to credit them with the ability to give informed consent?

They didn't choose their sexual orientation (or to be hypersexual), so it doesn't reflect the quality of their judgments.

There is a body of research regarding the effects of CSA: internalizing disorders most notably.

 

I'll concede that, in those particular instances, the relative ages remains unknown. Ted Haggard was reported by his congregation to have solicited a "young male" (of 20 years ).

 

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Obviously, it's possible that in future years, evidence may come to light that you were never actually guilty in the first place- but that's just the way the cookie crumbles."

Cleared of the crime, the electrodes will be removed.

Edited December 22, 2014 by MonDie

[John Cuthber]

 

Cleared of the crime, the electrodes will be removed.

And the other half of my point...

[MonDie]

It looks a lot like coercion to me.

"Mr Bloggs- we can lock you up for a long time in circumstances that are probably worse than most criminals or you can "volunteer" for some experimental surgery.

 

The premise is that his crime will be rewarded with free medical care. How bizarre!

Edited December 23, 2014 by MonDie

[John Cuthber]

 

The premise is that his crime will be rewarded with free medical care. How bizarre!

I understand that prisons have hospitals so, while you see it as bizarre, and I see it as humane and probably a sensible investment, it hasn't got anything to do with the point.

How is it not coercion?

[imatfaal]

They didn't choose their sexual orientation (or to be hypersexual), so it doesn't reflect the quality of their judgments.

There is a body of research regarding the effects of CSA: internalizing disorders most notably.

 

I'll concede that, in those particular instances, the relative ages remains unknown. Ted Haggard was reported by his congregation to have solicited a "young male" (of 20 years ).

 

Clearly you are positing that something in their behaviour, psyche, or makeup is placing them in a position which allows society to make decisions on their behalf and about their future. I would say that your argument must have the corollary that their ability to make decisions is somehow degraded.

The premise is that his crime will be rewarded with free medical care. How bizarre!

 

Lots of us live in societies in which everyone gets free medical care (or at least should) - this is a fact of which I am immensely proud.

 

And yes; someone who has demonstrated, in some of the most vilest ways imaginable, that he (almost always he) cannot prevent himself from perpetrating terrible injuries on the most vulnerable members of the community needs intensive, specialist, and immediate medical care. How can there be any doubt to this question?

 

Almost certainly this care will have to take place (initially at least) in parallel with sequestration from the community - but I would draw the line well before advocating gross surgery or intervention on the brain itself.

[MonDie]

Lots of us live in societies in which everyone gets free medical care (or at least should) - this is a fact of which I am immensely proud.

 

I would side with you, but I was pointing out the oddity of rewarding a criminal act.

 

Almost certainly this care will have to take place (initially at least) in parallel with sequestration from the community - but I would draw the line well before advocating gross surgery or intervention on the brain itself.

 

Generally, the younger the person is, the better their brain will cope. Those with this orientation may be identifiable through phallometric testing.

 

45 years ago

 

"Stereotaxic surgery enables small areas of nervous tissue to be accurately located and destroyed and the desired physiological changes to be produced with minimal unwanted disturbance."

"Apart from a transient rise in gonadotrophin in one patient no postoperative metabolic, endocrine, or autonomic disturbances were noted."

 

Anonymous (1969). Brain Surgery for Sexual Disorders. British Medical Journal.

 

Although I don't know whether deep brain stimulation would be the way to go, here is an article on DBS describing the risks of brain surgery today.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004693/

 

Possible risks of any brain surgery are:

Blood clot or bleeding in the brain

Brain swelling

Coma

Confusion, usually lasting only for days or weeks at most

Infection in the brain, in the wound, or in the skull

Problems with speech, memory, muscle weakness, balance, vision, coordination, and other functions, which may be short-term or permanent

Seizures

Stroke

Risks of general anesthesia are:

Reactions to medications

Problems breathing

 

 

 

 

You would prefer a lifetime of social isolation to trying the surgery?

Edited December 23, 2014 by MonDie

[Willie71]

It's not as simple as snipping some neurons in the brain. Sexuality is a combination of genetic predispositions, environmental cues, and learned behaviour. I worked with sex offenders, and I am unaware of any evidence that psychosurgery has consistent, positive results. I'll do a search next time I log into the library and see what is there. CBT, relapse prevention, social skills training are all shown to have positive results.

[imatfaal]

I would side with you, but I was pointing out the oddity of rewarding a criminal act.

 

No - medical care is not a privilege that can be given as a reward; it is a basic human right that we too often fail to provide. Right-wing authoritarian-tending societies prefer to spend fortunes on prisons, policing, and surveillance rather than investing in policies which remove wage-disparities, in providing a good minimum level of mental and physical healthcare, and in building up barriers and fear rather than trying to bring them down.

 

The seriously mentally ill can be seen as (actual or potential) serious offenders whose crimes merit the harshest of punishment - and this is role the press, the government, and justice system reserve for them; whereas I would see them as those who have critical and chronic illness, have most often sought help, and have yet been let down by the system. A society as advanced as ours should have as a high priority the care and treatment of those who cannot be wholly self-determining agents within society.

[John Cuthber]

 

I would side with you, but I was pointing out the oddity of rewarding a criminal act.

 

Since prisons have hospitals, we do that anyway. So it's irrelevant.

Rather than rehashing that, perhaps you would like to answer my question about coercion.

[MonDie]

I understand that prisons have hospitals so, while you see it as bizarre, and I see it as humane and probably a sensible investment, it hasn't got anything to do with the point.

How is it not coercion?

This assumes we're getting his consent. This is not punishment, John; this is treatment. If he cannot control himself, then he must undergo treatment regardless (if he's to rejoin society). If it was a willful act, then he must be punished regardless. If we want to permanently alter his brain despite the willfulness of his act, then maybe we ought to consider a life sentence.

However, the concept of self-determination may be slightly gray here. He's not psychotic, so he knows what he's doing. Although some subjects may lose control under some circumstances, they're presumably aware of this defect. Hence the crime at least shows a lack of motivation, if not total disregard.

This brings me back to Imatfaal's point that was left unaddressed.

 

 

Clearly you are positing that something in their behaviour, psyche, or makeup is placing them in a position which allows society to make decisions on their behalf and about their future. I would say that your argument must have the corollary that their ability to make decisions is somehow degraded.

If their judgment becomes temporarily impaired under certain circumstances, this may be their motivation for seeking the treatment that would otherwise be forced upon them after the fact. Yet there may be other sources of distress even for those who easily control themselves.

 

The seriously mentally ill can be seen as (actual or potential) serious offenders whose crimes merit the harshest of punishment - and this is role the press, the government, and justice system reserve for them; whereas I would see them as those who have critical and chronic illness, have most often sought help, and have yet been let down by the system. A society as advanced as ours should have as a high priority the care and treatment of those who cannot be wholly self-determining agents within society.

A lack of self-control may be a convenient explanation for why so many engage in this harmful behavior, but it still needs to be supported with evidence. It saddens me that they're disposed to do harm, which is why I want to fix them, but I don't think we should be lax in punishing a willful act.

Yet it remains true that we all influence eachother. Punishment can't be the only way to reduce crime.

Edited December 24, 2014 by MonDie

[davidivad]

such a subject should be considered too important to ignore.

throwing people in jail is a quick fix to the problem.

however i am unsure how surgery would treat an addiction.

[MonDie]

It's not as simple as snipping some neurons in the brain. Sexuality is a combination of genetic predispositions, environmental cues, and learned behaviour. I worked with sex offenders, and I am unaware of any evidence that psychosurgery has consistent, positive results. I'll do a search next time I log into the library and see what is there. CBT, relapse prevention, social skills training are all shown to have positive results.

I look forward to it, Willie.

[physica]

We also need to factor in physical complications of brain surgery. Infections are a serious issue. Plus the brain is delicate, the amount of mess ups I've seen in post op brain surgery patients is extensive. My friend is a neurosurgical trainee and he always says, if you can avoid brain surgery then you should. It's really a last resort like removing brain tumours or draining strokes. Even then the eligibility criteria is extremely narrow. If you look at new innovations like phototherapy for lung cancer and keyhole surgery etc they try and reduce the surgical emphasis as much as they can. Surgery is not done as a option if there are non surgical treatments. Brain surgery would have to advance a lot before we should consider it for treating personality disorders.

[Dekan]

I agree that " brain surgery" should be considered strictly as a last option.

 

This because no-one really understands how the human brain works. Least of all the surgeon who's doing the op on your brain.

 

Surgeons have been taught a basic idea. Which is this - you cut the bad bits out with a scalpel. That's an excellent general principle. It works well with most bodily parts, such as arms, legs, stomachs, and so on. These parts are well understood by medical science. So you can trust your surgeon to do a good job, when cutting such bits out.

 

However, when it comes to cutting into the Brain, I don't think the surgeons are quite sure what they're doing. That's not to disparage them at all. They do their best for us.

[Willie71]

OK, I'm doing a search. 1st Psychosurgery and Sex offenders.

 

1 result:

 

 

Abstract: Focuses on a project of Lafayette Clinic, a state psychiatric research in Detroit, Michigan, to perform brain surgery on criminal sexual psychopath to control aggression. Appropriation of fund by Michigan legislature for 28 inmates of mental hospitals to undergo this treatment; Argument pertaining to the preliminary hearing of the John Doe case; Release of Doe after 18 years of confinement, when the Michigan legislature repealed the Sexual Psychopath Act; Rejection of the viewpoint of the Lafayette Clinic and the psychosurgeons that an amygdalotomy was a treatment for brain disorder causing aggression.

Lowinger, P. (1974). Psychosurgery. New Republic, 170(15), 17-19.

 

Basically a critique of the misuse of the term aggression, ethical concerns regarding consent etc.

 

Search 2:

 

Psychosurgery Sexual Deviance.

 

Zero results.

 

Search 3:

 

Psychosurgery Sex

 

Zero results.

 

4. psychosurgery sex offending Zero results.

 

5. psychosurgery deviance

 

 

Source: American Journal of Law & Medicine. Winter79, Vol. 4 Issue 4, p449. 1/4p. Document Type: Book Review ISSN: 0098-8588 Accession Number: 6336941

 

Book release notice. No information.

 

6. Psychosurgery

 

 

Abstract: Although the utilization of psychosurgery has commenced in early 19th century, when compared with other neurosurgical fields, it faced many obstacles resulting in the delay of advancement of this type of surgical methodology. This was due to the insufficient knowledge of both neural networks of the brain and the pathophysiology of psychiatric diseases. The aggressive surgical treatment modalities with high mortality and morbidity rates, the controversial ethical concerns, and the introduction of antipsychotic drugs were also among those obstacles. With the recent advancements in the field of neuroscience more accurate knowledge was gained in this field offering new ideas for the management of these diseases. Also, the recent technological developments aided the surgeons to define more sophisticated and minimally invasive techniques during the surgical procedures. Maybe the most important factor in the rerising of psychosurgery is the assemblage of the experts, clinicians, and researchers in various fields of neurosciences implementing a multidisciplinary approach. In this article, the authors aim to review the latest concepts of the pathophysiology and the recent advancements of the surgical treatment of psychiatric diseases from a neurosurgical point of view. [ABSTRACT FROM AUTHOR]

Aydin, S., & Abuzayed, B. (2013). Psychosurgery: Review of Latest Concepts and Applications. Journal Of Neurological Surgery. Part A. Central European Neurosurgery, 74(1), 29-46. doi:10.1055/s-0032-1304805

 

This isn't available in my library. If someone has access, maybe a review?

 

 

Abstract: Background: Behavioral surgery (BS) is resurging because of unmet clinical need, advances in basic sciences, neuroimaging, neurostimulation, and stereotaxy. However, there is a danger that BS will fall unless acceptable strategies are adopted by BS providers. Methods: A critical review of conditions leading to rise of psychosurgery (PS) and concerns resulting in its fall was conducted to learn lessons and safeguard BS of the future. Results: PS rose and spread in 1960 like wildfire without adequate preclinical and clinical studies. Hundreds of patients had PS without adequate preoperative diagnosis or assessment, proper consent, and non-objective reporting of outcome. Furthermore, there was public opposition against PS because of its potential abuse to control violent behavior and dissidents. Advances in neurostimulation, neuroimaging, and stereotaxy, and emergence of treatment-resistant mental disorders led to increased interest in BS. Several recent studies have shown BS to be safe and effective. However, concerns related to strength of evidence, safety, efficacy, consent, and objectivity of studies have been raised. Unless clinical and regulatory governance structures are adopted in each jurisdiction, BS will face the same fate as that of PS in the past. Conclusion: The future of BS as a safe and effective therapy is dependent upon adopting clear moral ethical and governance standards on the following lines: Patients must have failed adequate therapies; must be assessed by psychiatrist-led multidisciplinary teams; patients' abilities to give consent and diagnosis must be verified by independent authorities designated for this purpose by the state; and the independent authority must also decide whether the teams were adequately trained to perform BS. [ABSTRACT FROM AUTHOR]

Eljame, S. (2012). Strategies for the return of behavioral surgery. Surgical Neurology International, 3(2), S34-S39. doi:10.4103/2152-7806.91608

 

 

Abstract: The amygdala was a popular target during the era of psychosurgery, specifically for the treatment of intractable aggression. This mesiotemporal structure was thought to primarily mediate fear and anger. However, recent evidence suggests that the amygdala is part of a complex network that mediates the formation of a larger repertoire of positive and negative emotions. Dysfunctions within the network or the amygdala itself can lead to various mental illnesses. In those cases, deep brain stimulation (DBS) applied focally may treat the symptoms. This review presents data supporting the potential therapeutic role of DBS of the amygdala in the treatment of anxiety disorders, addiction, and mood disorders. The success of DBS for psychiatric conditions will likely depend on our ability to precisely determine the optimal target for a specific case. [ABSTRACT FROM AUTHOR]

Bolded: mime. This is what the current thinking is. A couple months ago, there was a great article in Scientific American Mind on the current knowledge of brain function. The idea that discrete areas of the brain are responsible for specific tasks is waning. Neuro imaging shows how several structures work in dynamic concert for tasks.

 

Langevin, J. (2012). The amygdala as a target for behavior surgery. Surgical Neurology International, 3(2), S40-S46. doi:10.4103/2152-7806.91609

 

 

Abstract: The article focuses on the controversy regarding the social and medical history of pyschosurgery. It states that the controversial history of psychosurgery marked promising results and disappointing failures. It justifies the fact that brain surgery is being performed to treat mental illness and potentially produce positive outcomes for the benefit of the patients

 

Their position is that psychosurgery should be available, and reviewed on a case by case basis in consultation with a group of experts.

 

This is interesting as three of the authors are psychiatrists I worked with, Werneke at the Grey Nuns Hospital, and White and Brooks at Alberta Hospital. All brilliant, top of tghe field kind of guys. White traditional Behaviourist, Werneke into the fringes, transgender, sexual deviance, MPD in the early 90's. I learned a lot from both of them. Brooks was a pioneer in adolescent delinquency. He established the YOGI, young offender guided interview that hit on every major risk factor in adolescent delinquency a decade before the structured risk assessments were developed.

 

Carr, P. F., Brooks, S., Chaimowitz, G., Looper, K., Milev, R., O'Reilly, R., & ... White, P. J. (2009). Psychosurgery. Canadian Journal Of Psychiatry, 54(7), 1-2.

 

 

Abstract: Abstract: Psychosurgery, the neurosurgical treatment of psychiatric disease, has a history dating back to antiquity, and involves all of the clinical neurosciences. This review discusses the history of psychosurgery, its development in the 19th century, and the conditions of its use and abuse in the 20th century, with a particular focus on the frontal lobotomy. The transition to the modern era of psychosurgery is discussed, as well as the neurobiology underlying current psychosurgical procedures. The techniques of stereotactic cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leukotomy are described, as well their indications and side effects. Due to the past abuse of psychosurgery, procedures are currently under strict control, and the example of the Cingulotomy Committee at the Massachusetts General Hospital is discussed. Finally, future directions of psychosurgery and somatic therapies are explored, including transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation, gene therapy, and stem cell therapy. In summary, this review provides a concise yet comprehensive introduction to the history, current practice, and future trends of neurosurgery for psychiatric disorders. [Copyright &y& Elsevier]

 

Mashour, G. A., Walker, E. E., & Martuza, R. L. (2005). Psychosurgery: past, present, and future. Brain Research Reviews, 48(3), 409-419. doi:10.1016/j.brainresrev.2004.09.002

 

 

Abstract: Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. Several double-blind controlled and open trials have been conducted and the response rate is estimated around 54%. Open trials have shown encouraging results with DBS for therapy-refractory depression and case reports have shown potential effects of DBS on addiction. Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research. [Copyright &y& Elsevier]

Luigjes, J., de Kwaasteniet, B. P., de Koning, P. P., Oudijn, M. S., van den Munckhof, P., Schuurman, P. R., & Denys, D. (2013). Surgery for Psychiatric Disorders. World Neurosurgery, 80(3/4), S31.e17-S31.e28. doi:10.1016/j.wneu.2012.03.009

 

 

 

So it seems that psychosurgery is a really mixed bag of ethical concerns, partial successes, severe brain damage, and triumphs. Its risky. Deep brain stimulation holds promise. Most cited successes are in the field of OCS first, then depression second. Behavioural control is much less clear. As the understanding of th brain improves over the next decade, we will likely see a re-emergence of surgery. What has been learned in the last 10 years eclipses the last century, and if the trend continues, I would think surgery will become a viable option.

[MonDie]

Physica and Dekan, I share your concerns with complications, but this may not require a comprehensive neurocognitive theory since the aim is to disrupt, rather than rewire. The patient won't get aroused to adults, but loss of eroticism will still be a gain considering their prior predicament of experiencing arousal to human juveniles. Hopefully this effect could be achieved with negligible side effects, although, as Willie pointed out:

 

 

 

Bolded: mime. This is what the current thinking is. A couple months ago, there was a great article in Scientific American Mind on the current knowledge of brain function. The idea that discrete areas of the brain are responsible for specific tasks is waning. Neuro imaging shows how several structures work in dynamic concert for tasks.

 

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I like to search DuckDuckGo with the affix "site:nih.gov". I'll report back on this research paper.

 

Neurological control of human sexual behaviour: insights from lesion studies (Baird, Wilson, Bladin, Saling, & Reutens, 2007)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117556/