Psychosurgery and Electroconvulsive Therapy (ECT)

Psychosurgery and Electroconvulsive Therapy (ECT)

Psychosurgery and Electroconvulsive Therapy (ECT)

Psychosurgery (any surgical alteration of the brain) is the most extreme medical treatment. The oldest and most radical psychosurgery is the lobotomy. In prefrontal lobotomy, the frontal lobes are surgically disconnected from other brain areas. This procedure was supposed to calm persons who didn’t respond to any other type of treatment.

In electroconvulsive therapy, electrodes are attached to the head and a brief electrical current is passed through the brain. ECT is used in the treatment of severe depression.

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

 

Electroconvulsive therapy (ECT)

A treatment for severe depression, consisting of an electric shock passed directly through the brain, which induces a convulsion.

Psychosurgery

Any surgical alteration of the brain designed to bring about desirable behavioral or emotional changes.

Mental hospitalization

Placing a person in a protected, therapeutic environment staffed by mental health professionals.

Partial hospitalization

An approach in which patients receive treatment at a hospital during the day, but return home at night.

Deinstitutionalization

Reduced use of full-time commitment to mental institutions to treat mental disorders.

Psychosurgery and Electroconvulsive Therapy (ECT)

When the lobotomy was first introduced in the 1940s, there were enthusiastic claims for its success. But later studies suggested that some patients were calmed, some showed no change, and some became mental “vegetables.” Lobotomies also produced a high rate of undesirable side effects, such as seizures, blunted emotions, major personality changes, and stupor. At about the same time that such problems became apparent, the first antipsychotic drugs became available. Soon after, the lobotomy was abandoned (Mashour, Walker, & Martuza, 2005).

To what extent is psychosurgery used now? Psychosurgery is still considered valid by many neurosurgeons. However, most now use deep lesioning, in which small target areas are destroyed in the brain’s interior. The appeal of deep lesioning is that it can have value as a remedy for some very specific disorders (Mashour, Walker, & Martuza, 2005). For instance, patients suffering from a severe type of obsessive-compulsive disorder may be helped by psychosurgery (Dougherty et al., 2002).

Deep lesioning is another method used to study the brain. See Chapter 2, pages 60–63.

It is worth remembering that psychosurgery cannot be reversed. Whereas a drug can be given or taken away and electrical stimulation can be turned off, you can’t take back psychosurgery. Critics argue that psychosurgery should be banned altogether; others continue to report success with brain surgery. Nevertheless, it may have value as a remedy for some very specific disorders (Mashour, Walker, & Martuza, 2005; Sachdev & Chen, 2009).

Hospitalization In 2008, about 3 million Americans received inpatient treatment for a mental health problem (National Institute of Mental Health, 2011a). Mental hospitalization involves placing a per- son in a protected setting where medical therapy is provided. Hospitalization, by itself, can be a form of treatment. Staying in a hospital takes patients out of situations that may be sustaining their problems. For example, people with drug addictions may find it nearly impossible to resist the temptations for drug abuse in their daily lives. Hospitalization can help them make a clean break from their self-destructive behavior patterns (André et al., 2003).

At their best, hospitals are sanctuaries that provide diagnosis, support, refuge, and therapy. This is frequently true of psychiatric units in general hospitals and private psychiatric hospitals. At worst, confinement to an institution can be a brutal experience that leaves people less prepared to face the world than when they arrived. This is more often the case in large state mental hospitals. In most instances, hospitals are best used as a last resort, after other forms of treatment within the community have been exhausted.

Another trend in treatment is partial hospitalization. In this approach, some patients spend their days in the hospital but go home at night. Others attend therapy sessions during the evening. A major advantage of partial hospitalization is that patients can go home and practice what they’ve been learning. Overall, partial hospitalization can be just as effective as full hospitaliza- tion (Drymalski & Washburn, 2011; Kiser, Heston, & Paavola, 2006).

Deinstitutionalization

In the last 50 years, the population in large mental hospitals has dropped by two thirds. This is largely a result of deinstitutionalization, or reduced use of full-time commitment to mental institutions. Long-term “institutionalization” can lead to dependency, isolation, and continued emotional disturbance (Novella, 2010). Deinstitutionalization was meant to remedy this problem

How successful has deinstitutionalization been? In truth, its success has been limited (Talbott, 2004). Many states reduced mental hospital populations primarily as a way to save money. The upset- ting result is that many chronic patients have been discharged to hostile communities without adequate care. Many former patients have joined the ranks of the homeless. Others are repeatedly jailed for minor crimes. Sadly, patients who trade hospitalization for unemployment, homelessness, and social isolation all too often end up rehospitalized or in jail (Markowitz, 2011).

Large mental hospitals may no longer be warehouses for society’s unwanted, but many former patients are no better off in bleak nursing homes, single-room hotels, board-and-care homes, shelters, or jails. For every mentally ill American in a hospital, three are trapped in the criminal justice system (National Institute of Mental Health, 2010a). These figures suggest that jails are replacing mental hospitals as our society’s “solution” for mental illness (Markowitz, 2011). Yet, ironically, high-quality care is available in almost every community. As much as anything, a simple lack of money prevents large numbers of people from get- ting the help they need (Torrey, 1996).

Depending on the quality of the institution, hospitalization may be a refuge or a brutalizing experience. Many state “asylums” or mental hospitals are antiquated and in need of drastic improvement.

 

9781285519517, Introduction to Psychology: Gateways to Mind and Behavior with Concept Maps and Reviews, Thirteenth Edition, Coon/Mitterer – © Cengage Learning. All rights reserved. No distribution allowed without express authorization.

 

Halfway houses may be a better way to ease a patient’s return to the community (Soyez & Broekaert, 2003). Halfway houses are short-term group living facilities for people making the transition from an institution (mental hospital, prison, and so forth) to independent living. Typically, they offer supervision and support, without being as restricted and medically oriented as hospitals. They also keep people near their families. Most important, half- way houses can reduce a person’s chances of being readmitted to a hospital (Coursey, Ward-Alexander, & Katz, 1990; Soyez & Broekaert, 2003).