Date of Award

8-2-2010

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Robert Rohrbaugh

Abstract

Neurosurgery for the treatment of mental illness is attracting attention from researchers and the public alike. Although different from antiquated procedures like prefrontal lobotomy in several crucial ways, it is unclear how mental health professionals view these procedures. To answer this question, an original survey was sent to the Yale mental health and medical student communities, to assess practice patterns, attitudes towards various treatment modalities, and likelihood to refer for these surgeries in the future. Historical data and an ethical analysis are included to put these results into context. Overall, clinicians tended to rate the risks of Deep-Brain Stimulation for depression similarly to those of Electroconvulsive Therapy and pharmacotherapy, with 49%, 62% and 66%, respectively, rating each treatment as moderate risk. More clinicians considered DBS to be high or very high risk than Electroconvulsive Therapy and pharmacotherapy (40%, 13%, 7%, respectively), but leukotomy was rated high or very high risk by 83%. As for likelihood to refer patients, nearly 50% of responding clinicians would refer their own patients if 60% or more of experimental subjects showed significant improvement. No clinicians required that 100% of subjects show improvement. Over 80% of clinicians would refer patients if just 40% of patients experienced complete remission of symptoms. These results suggest that the negative history of lobotomy can be overcome, if clinical trials continue to show positive results for new surgical treatments of mental illness.

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