Untitled Page

RESIDENTS' CORNER: Neuroethics and the Haunted History of Psychosurgery

Nir Lipsman
Nir Lipsman

Nir Lipsman spent a summer working with Andres Lozano in 2005, the year that the first paper on Deep Brain Stimulation (DBS) for depression was published. He has been collaborating with Andres, neurologists, and psychiatrists ever since, focusing on the mind - body relationship and applying novel neurosurgical tools to psychiatric populations. Nir completed undergraduate training in Psychology at the University of Toronto and medical school at Queen's University in Kingston. He is currently a 4th year neurosurgery resident, in his first year of a neuroscience PhD in the Clinician Investigator Program.

His thesis will be focused on using deep brain stimulation, and single neuron recordings to probe emotional reward and decision making circuitry. Courses for his PhD program include the schizophrenia seminar, genetics, epidemiology, neuroanatomy and research ethics.

Surgeon - ethicist Mark Bernstein sparked Nir's interest in neuroethics, a subset of biomedical ethics that looks at ethical challenges in the neurosciences. Typical neuroethics topics include consent and patient selection for deep brain stimulation, balancing the risks and gains of stimulation and clinical trials of DBS. Neuroscience merges with philosophy when research examines the impact of deep brain stimulation on concepts of free will, choice and a wide range of psychological effects. This rapidly expanding field is generating knowledge, has developed journals (Neuroethics, American Journal of Bioethics: Neuroscience) and has developed a society (Neuroethics Society: www.neuroethicssociety.org)

Nir described 'the haunted history of psychosurgery' and the renaissance of interest in the field over the past several years. In the 1950s and 60s, over 40.000 lobotomies were

performed, leaving psychosurgery with a bad reputation. Currently, however, we are well past the lobotomy era with safe and effective procedures under investigation to treat the many patients with resistant mental illness. Up to 30% of psychiatric patients get no benefit from current treatment. Another neurosurgical operation, temporal lobectomy, works for many patients with epilepsy, but few are offered this treatment because of fear and lack of knowledge.Will deep brain stimulation for depression go the same way as temporal lobectomy? Nir hopes to prevent this misinterpretation and misuse of a valuable intervention through scholarly examination, research and practice.

One day Nir was in the operating room with a patient who was receiving deep brain stimulation for depression following failure of electro-convulsive therapy. The patient, who had been bed- bound for years, said that all the colours got brighter when the stimulator was on. She described it as "a lightening". The stimulator was nowhere near the optic nerves or the optic areas of the brain. The lightening or brightening was "like a change of glasses" and has been experienced by patients in other centres. Afterward, the patient said: "I'd like to go clean my house". She and others have also developed this "clean my garage...take care of myself or my home" - grooming behaviour. This opens up a new avenue of research on motivation and reward through DBS.

As Andres Lozano pioneers this field, there is a danger that others might want to move too fast, as Christian Bernard did - taking his specialty into cardiac transplantation prematurely. "The appropriate approach should be the development of registries instead of single case reports and single surgeon adventures. Currently psychosurgery is more focused, minimally invasive, hypothesis driven and generally reversible. It is based on genetics, imaging, and performance in the scientific setting. Public education is an important task given the haunted history of the specialty."

Nir was born in Israel; moved to Toronto at age 6. He is married to Sarit Marko, a professional artist.


Skip Navigation Links