Who Holds the er?

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http://www.motherjones.com/news/feature/2005/11/who_holds_clicker.html

 

 

 

 

Who Holds the Clicker?

 

News: Neuroscientists hope that brain implants can treat intractable

mental illness. But can the circuitry of despair be pinpointed? And

who would control those brave new minds?

 

By Lauren Slater

 

November/December 2005 Issue

 

 

 

MARIO DELLA GROTTA IS 36 years old, with a buzz cut and a tattoo of a

rose on his right bicep. He wears a gold chain around a neck that is

thick as a thigh. He's the kind of guy you might picture in a bar in a

working-class neighborhood, a cigarette wedged in the corner of his

lip and a shot glass full of something amber. He seems, on first

appearance, like the kind of guy who swaggers his way through the

world, but that is not true of Mario. There was a time when rituals to

ward off panic consumed 18 hours of his day. He couldn't stop counting

and checking. Fearful of dirt, he would shower again and again. He

searched for symmetries. His formal diagnosis was obsessive-compulsive

disorder, which is just a fancy way of saying scared. Had he

remembered to lock the car door? Did he count that up correctly? The

French call obsessive-compulsive disorder folie du doute, a much more

apt title than our clinical OCD; folie du doute, a phrase that gets to

the existential core of worry, a clenched, demonic doubting that

overrides evidence, empiricism, plain common sense. For Mario, his

entire life was crammed into a single serrated question mark.

 

Mario's anxiety was so profound, and so impervious to other

treatments, that six years ago his psychiatrists at Butler Hospital in

Providence, Rhode Island, suggested psychosurgery, or what—in an

effort to avoid the stigmatization associated with lobotomies and

cingulotomies—is now being labeled more neutrally: neurosurgery for

psychiatric disorders. Medtronic, a Minneapolis-based company, has

adapted implants it originally developed to treat movement disorders

in Parkinson's patients for use in the most intractable but common

psychiatric problems: anxiety and depression. These neural pacemakers,

composed of eight bilateral implanted electrodes, four per hemisphere,

emit an electrical current that, theoretically, jams pesky brain

circuits, the ones that say you suck you suck you suck or oh no oh no

oh no. This idea made sense to Mario. His experience of mental illness

was one of a terrible loop de loop. So he said yes to surgery. He said

yes in part because he knew that if he didn't like the neural

implants, he could simply have them switched off.

 

And so, Mario became one of the first American psychiatric patients to

undergo this highly experimental procedure. Worldwide there have so

far been only some 50 implantations for OCD and 15 for depression, but

the technology suggests a not-too-distant future when options other

than drugs may be available to sufferers of serious mental illness.

Industry analysts predict that the entire " neurostimulation

market " —already worth $550 million and growing 20 percent a year—could

top $5 billion and that the technology will be adapted to combat

everything from addiction to obesity.

 

Such fervor has critics nervous that rather than curing problems

antidepressants have been unable to address, the implant industry

could repeat the problems that have scandalized the pharmaceutical

world (see " War of the Wires, " page 66). And psycho-surgery, by its

very nature, brings with it a thicket of ethical twisters. Whose head

is it? By directly manipulating the brain might we turn ourselves into

Maytag technicians, programming speed cycles and rinses? Could it be

possible to actually control the content of another's thinking, as

opposed to merely their affective states? Even setting aside these

sci-fi concerns, should doctors wade into apparently healthy brain

tissue when they have yet to precisely locate mental pathology?