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Sad psychosurgery

John Garfield FRCS
DOI: http://dx.doi.org/10.1093/brain/awt301 1262-1265 First published online: 20 November 2013

It is ironic that this book should appear at a time when, despite acceptable and randomized controlled studies, there remain a plethora of advances claimed for neurosurgical treatments that have no basis whatsoever in evidence. Indeed what is fashionable often risks outstripping that which is based on hard science, as the latter becomes ever more complex and increasingly expensive to deliver. The desperate cry for innovations and protection of their instigators from litigation has led to proposals that could deny patients the security of critical evaluation and audit using sufficient rigour and appropriate disciplines. The difficulty is to control but never completely suppress the maverick protagonist; and once financial gain complicates the picture, motivation becomes even more suspect. But, in a way we need the maverick, for today’s eccentric may be tomorrow’s Messiah.

The remarkable Lobotomy letters illustrate the importance of examining carefully the history of medicine, especially during those periods in which initial acceptance of an idea eventually ends in controversy. Sadly, the expectation that scientific evidence will always settle dispute is often not realized. Rivalries between practitioners, especially those who jealously guard their reputations, may mislead and impede progress. This is well illustrated by the accounts of neurosurgical practice in France during the 19th and early 20th centuries; and contrast with the more open attitude in the United States at that time. But let us not be too certain that even today rivalries and competition do not lead to stultifying and chauvinistic attitudes amongst neurosurgeons. During the 1960s, I worked in respected—indeed famous—institutions in which ‘Cabots spoke only to God’. That was the place of our ‘firm’ in the hierarchy, or so we believed; we the acolytes and willing slaves of Sir Wylie McKissock (1906–94) were sent to spy on the neurosurgical ‘Lowells’ to observe their surgical pace …

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