The life and legacy of William Beecher Scoville

Dr. William Beecher Scoville (1906-1984) is a giant figure in the history of neurosurgery, well known by the public for his operation on Patient H.M. He developed dozens of neurosurgical instruments and techniques, with many tools named after him that are still widely used today. He founded numerous neurosurgical societies around the world. He led the movement in psychosurgery, developing the technique of selective orbital undercutting and performing hundreds of lobotomies throughout his career. However, his many contributions to the advancement of neurosurgery have not been well described in the medical literature. To bridge the knowledge gap, this article seeks to detail the life and career of William Beecher Scoville and bring to attention the enduring impact of his work.

Psychosurgery (1974-2014). Withdrawals and revivals. New movements and old inspirations

At the Paris Colloquium held forty years ago, and which this paper celebrates, the issue of psychosurgery had not been tackled yet. At that time psychosurgery was tainted by the controversial history of lobotomy and leucotomy. Supporters of psychosurgery at the time of the Colloquium were preparing their fourth International Conference, which was held in Madrid the following year. This represented a key characteristic of the collective, institutional and symbolic action of psychosurgery practitioners. At the end of the seventies, their strategy changed as noted below. Furthermore, we focus on the special importance of the results presented and commented on by psychosurgery supporters, including its conception and classification throughout the rhetoric historically involved (its supposed ventriloquism, its persuasive strength). Based on this view, we suggest a critical reflection encompassing old and new psychosurgery, while questioning the value of new rhetorical devices for the assessment and presentation of psychosurgery results after the surge of Deep Brain Stimulation.

Deep brain stimulation for psychiatric disorders: where we are now

Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned.

Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry.

This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

A transnational perspective on psychosurgery: beyond Portugal and the United States

The history of psychosurgery is most often recounted as a narrative wherein Portuguese and American physicians play the leading role. It is a traditional narrative in which the United States and, at times, Portugal are central in the development and spread of psychosurgery. Here we largely abandon the archetypal narrative and provide one of the first transnational accounts of psychosurgery to demonstrate the existence of a global psychosurgical community in which more than 40 countries participated, bolstered, critiqued, modified and heralded the treatment. From its inception in 1935 until its decline in the mid-1960s, psychosurgery was performed on almost all continents. Rather than being a phenomenon isolated to the United States and Portugal, it became a truly transnational movement.