New surgery to control behavior

To break the maddening cycle of their own thoughts, some psychiatric patients have had wires surgically implanted inside their brains. Others have surgeons burn tiny holes in the middle of their brains, for the same purpose. The procedures are a last resort, an attempt to fix stubborn mental problems by operating directly on the neural circuitry itself. And now, a small cadre of doctors is starting to spread the word: Brain surgery, for some severe mood and anxiety disorders, is a viable treatment.

In the decades since frontal lobotomy -- a crude cut into the frontal lobe, behind the forehead -- was discredited as an ethically indefensible operation, neurosurgeons say they have developed far more precise techniques to operate on the brain, and a better understanding of how the organ functions. At several institutions around the world, including hospitals affiliated with Harvard and Brown universities' medical schools, surgeons have been operating on dozens of patients each year with severe psychiatric problems, including depression and, more commonly, obsessive-compulsive disorder, or OCD. The results have been encouraging enough that the federal government this year funded two brain-surgery research studies for OCD patients, and other major medical centers, including UCLA, are interested in establishing a program.

"There are some people who don't respond to other treatments at all," said Dr. Wayne Goodman, a psychiatrist at the University of Florida in Gainesville, who is directing one of the research studies for OCD. "And for the first time, they have some hope."

But with hope comes risk. Researchers still do not fully understand how the operations affect the brain, or why. There is not yet a consensus on which surgical procedures produce the best results. And doctors do not know for sure whether surgery by itself relieves symptoms or produces a strong placebo effect -- a self-fulfilling belief that the disease has been successfully treated.

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Caution and consent

Some experts who follow the emerging field are concerned that demand for these operations could tempt less-experienced surgeons to try them, without the safeguards or oversight of a research university. Given the history of this field, known as psychosurgery, there's little margin for error. At least one operation has gone badly already, causing permanent brain damage.