Psychosurgery, broadly defined as techniques for changing behavior by surgically altering the contents of the skull, historically has had a bad reputation. The widespread use of frontal lobotomies in the mid-20th century and the resulting damage to the personalities of those treated is the basis for much of the distrust of psychosurgical techniques. Recently, however, psychosurgery is making a comeback in the form of a new technology: deep brain stimulation (DBS).
Deep brain stimulation involves surgically implanting electrodes into specific areas of the brain. After a suitable recovery time, the electrodes are turned on, delivering controlled and adjustable pulses of electricity to adjacent brain regions. Unlike earlier forms of psychosurgery, which involved substantial and irreversible loss of brain tissue or connectivity, DBS is largely reversible and has far fewer side effects. DBS is currently used primarily to treat severe Parkinson's disease, most often by targeting part of the dopamine pathway known as the subthalamic nuclei, although other brain regions can be stimulated as well . Such treatment can reduce the tremors and other symptoms associated with the disease. DBS also shows promise in treatment of chronic pain and depression .
These initial successes suggest that DBS may also have a future in treating other brain conditions which affect behavior. One of the most interesting psychiatric conditions from a neurolaw perspective is sociopathy, in which the affected person engages in manipulative and impulsive behavior with little empathy or concern for the welfare of others. Evidence from neuroimaging studies indicates that sociopaths may have abnormal functioning in at least their amygdala and orbitofrontal cortex . Could deep brain stimulation of these regions improve the behavior of sociopaths? Such a treatment might allow these very troublesome individuals to reintegrate safely into society rather than need to be jailed for extended periods for the safety of those around them.
There are several large obstacles to experiments aimed at developing such a treatment. Most critically, sociopathy is a disease that primarily negatively affects those around the sociopath. The "psychiatric patient" usually lacks the empathy or guilt needed to care about the damage that their behavior causes. Convincing such an individual to voluntarily undergo major brain surgery would be quite difficult. Involuntarily forcing sociopaths to be treated, of course, creates all sorts of moral and civil liberty issues, even for convicted murderers on death row. Perhaps some kind of incentive could be offered to criminal sociopaths, in the style of the movie Clockwork Orange. Before experiments with using DBS to treat sociopathy can proceed, the legal framework involving patient consent will have to be analyzed very carefully.